A Qualitative Analysis of Treatment Patterns for Mild and Severe Molar Hypomineralization in Permanent Teeth: A Systematic Review.

Purpose: Using a systematic review to answer the following question: What are the treatment patterns for mild and severe molar hypomineralization in permanent teeth? Methods: Electronic searches were conducted to identify randomized clinical trials (RCT) that related treatment to molar hypomineralization- (MH) affected permanent molars in children from five to 16 years old. Data extraction and risk of bias evaluation, using the Cochrane risk of bias tool, were performed for all included studies. Studies were selected according to PICOS criteria. RCTs relating mild and severe MH to treatments on permanent molars were included. Studies analyzing clinical techniques, whether single or any association of tech- niques for restorative and desensitizing treatments, were included. Studies involving another disease or comparing different types of enamel defects related to trauma and hereditary were excluded. The certainty of the evidence was evaluated using the GRADE approach. Results: The electronic search was performed on MEDLINE via PubMed, Embase, Cochrane Library, and Grey literature up to May 9, 2022. Of the 5,201 studies initially identified, 88 were fully assessed and 14 RCTs were included. A total of 2,399 interventions were analyzed in 576 patients. Certainty of evidence was found to be of low quality for the outcomes remineralization, structural integrity maintenance, and decay prevention, and very low quality for hypersensitivity decrease and retention. Conclusions: Mild molar hypomineralization needs remineralization, desensitization, sealants, and close follow-up. Severe MH requires restoration both to treat hypersensitivity and reconstruct the affected teeth. Yellow-brown defects have a poor prognosis.

Degradation of polymeric restorative materials subjected to a high caries challenge.

OBJECTIVES: The aim of this study was to evaluate the degradation of different resin filling materials after a caries challenge, by high performance liquid chromatography (HPLC) and contact angle (θ) measurement. METHODS: Four different polymeric restorative materials (a resin composite, a polyacid-modified resin composite, an ormocer and a resin-modified glass ionomer cement) were tested. Five samples (30 mm × 6 mm × 2 mm) of each material were formed in a Teflon mold, following the manufacturer's instructions. After pH cycles, the solutions were injected in an HPLC. The θ was obtained, before and after pH cycle, by a goniometer at 60% air humidity and 25°C. A distilled water drop (0.006 ml) was put on the material surface, and after 6 min, 10 measures were obtained at 20s intervals. Each sample received 4 drops, one at a time, on different areas. RESULTS: HPLC results showed elution of byproducts in all materials. This was greater in the acid medium. Bis-GMA and TEGDMA were detected in TPH Spectrum and Definite residues. Analyses of the contact angle by ANOVA and Student-Neuman-Keuls's test showed that the surfaces of TPH Spectrum, Dyract AP and Definite were altered, except Vitremer (p<0.05). SIGNIFICANCE: All materials tested degraded on a caries simulated medium, suggesting that a great effort should be made to disseminate oral health information, since a high caries challenge environment (low pH) can lead to dental composite degradation, with potential toxic risks to patients.