Restorative Therapy of MIH-Affected Molars.

One fourth of teeth affected by molar incisor hypomineralisation (MIH) have required or will require treatment due to pain, sensitivity, or posteruptive breakdown. Restorative treatment becomes necessary in cases of severe MIH, characterized by posteruptive breakdown, which exhibits a wide range of clinical characteristics. Until approximately 20 years ago, all techniques, materials, and research were developed for treating caries lesions, not hypomineralisation. Research attempting to evaluate approaches to MIH treatment is recent and inconclusive. Therefore, there is still insufficient high-quality scientific evidence to establish a definitive clinical protocol for treating this condition. Recommendations based on best clinical practices can be provided rather than conclusions supported by a high level of evidence. To assist in clinical judgment regarding the best treatment strategy, eligible therapeutic options for restoring MIH-affected molars will be presented based on the strength and adhesive potential of the remaining hypomineralised enamel. The literature presents options for restorative materials ranging from direct alternatives such as glass ionomer cement and resin composite, through prefabricated devices, such as stainless-steel crowns and orthobands, to indirect restoration alternatives. However, it is essential to understand the indications of each restorative alternative and to know the restorative techniques, many of which are specifically developed to mitigate the difficulties encountered with the use of conventional techniques. Emphasis will be placed on the importance of adopting a personalized approach to restorative decision-making, considering the philosophy of minimal intervention dentistry and potential benefits for the patient's well-being and the family's needs.

What can impact on the presence of carious lesions in first permanent molars? Revisiting the association between MIH and caries.

OBJECTIVE: Assess whether the independent variables (IV) such as number of MIH-affected molars, MIH severity, past caries experience, visible plaque index (VPI), gingival bleeding index (GBI), age, and gender affect the presence of caries lesion (DMF_s) in first permanent molars, considering or not atypical restoration in MIH-affected molars as a previous caries lesion. METHODS: A sample of 476 schoolchildren, aged 6-10 years, were evaluated for MIH and caries diagnosis, using the Severity Scoring System (MIH-SSS) and the International Caries Detection and Assessment System (ICDAS), respectively. From the ICDAS, the DF-s/ D-s and df-s were calculated. The Zero-inflated Negative Binomial Regression was used to evaluate the impact of the IV on the dependent variable, considering or not the restorative component in MIH-affected molars. RESULTS: When the presence of caries was evaluated with the restorative component, age, MIH severity and past caries experience had a significant impact on the dependent variable (R2 = 0.176). Without the restorative component in MIH-affected molars, only age and past caries experience were statistically significant (R2 = 0.167). CONCLUSION: Since in the case of MIH teeth restoration may be attributed to post-eruptive breakdown rather than previous caries lesions, in the present study MIH did not influence the presence of caries lesions in the MIH-affected molars showing that restoration is not an adequate parameter for measuring the historical occurrence of caries. CLINICAL RELEVANCE: The first permanent molars may not necessarily be at an increased risk of caries due to MIH if the etiological factors for caries development are effectively managed.

Comparison between two molar incisor hypomineralization detection criteria in epidemiological surveys.

BACKGROUND: There is no consensus on which molar incisor hypomineralization (MIH) indices are more suitable for epidemiological surveys. AIM: To compare the operational aspects and diagnostic ability of the MIH index (simplified/MIH_s and extended/MIH_e) with the MIH-Severity Scoring System (MIH-SSS) in classifying and diagnosing MIH. DESIGN: This cross-sectional study assessed the indices in a homogeneous group of 680 6- to 10-year-old schoolchildren in Bauru, Brazil, who had at least one first permanent molar, ensuring consistent conditions. Followed by toothbrushing, the children seated on school chairs were examined by the two calibrated researchers under artificial lighting, using mouth mirror and WHO probe, and chronometer recording the duration of examinations. RESULTS: The prevalence of MIH was 24.7%. The most common characteristic of MIH was demarcated opacity, with a prevalence of 81.7% and 85.45% according to the MIH_s and the MIH-SSS, respectively. A positive association was observed among the MIH_s, the MIH_e, and the MIH-SSS (chi-squared test; p < .01). The MIH-SSS demonstrated a shorter average application time than both versions of the MIH index (ANOVA/Tukey; p < .05). Additionally, fluorosis was found to be the most prevalent among other developmental defects of enamel, with a prevalence of 38.38%. CONCLUSION: All systems effectively diagnosed MIH and its characteristics.

Influence of mandibular and palatal intraoral appliances on erosion in situ study outcome.

OBJECTIVE: The standardization of in situ protocols for dental erosion is important to enable comparison between studies.Thus, the objectives of this study were to evaluate the influence of the location of in situ intraoral appliance (mandibular X palatal) on the extent of enamel loss induced by erosive challenges and to evaluate the comfort of the appliances. MATERIAL AND METHODS: One hundred and sixty bovine enamel blocks were selected according to their initial surface hardness and randomly divided into two groups: GI - palatal appliance and GII - mandibular appliance. Twenty volunteers wore simultaneously one palatal appliance (containing 4 enamel blocks) and two mandibular appliances (each one containing 2 enamel blocks). Four times per day during 5 days, the volunteers immersed their appliances in 0.01 M hydrochloric acid for 2 minutes, washed and reinserted them into the oral cavity for 2 hours until the next erosive challenge. After the end of the in situ phase, the volunteers answered a questionnaire regarding the comfort of the appliances. The loss of tissue in the enamel blocks was determined profilometrically. Data were statistically analyzed by paired t-test, Chi-square and Fisher's Exact Test (p<0.05). RESULTS: The enamel blocks allocated in palatal appliances (GI) presented significantly higher erosive wear when compared to the blocks fixed in mandibular appliances (GII). The volunteers reported more comfort when using the palatal appliance. CONCLUSIONS: Therefore, the palatal appliance is more comfortable and resulted in higher enamel loss compared to the mandibular one.

Impact of a simplified in situ protocol on enamel loss after erosive challenge.

This study investigated the effect of the period of use and location of intraoral appliances on enamel surface loss. This randomized, single blind in situ study was conducted in 2 crossover phases based on the period of use, in which maxillary and mandibular appliances were simultaneously worn. Bovine enamel blocks (n = 120) were randomly divided among the studied groups by surface hardness. In each phase, fifteen volunteers used one maxillary appliance and two mandibular appliances for 5 days. Erosive challenge was performed 4X/day by immersion in 0.01 M HCL for 2 minutes. In the continuous phase, the intraoral appliances were worn for 20 hours. In the intermittent phase the appliances were worn for 8 hours and 30 minutes. Enamel loss was determined profilometrically. The discomfort of use of the appliances were evaluated in a questionnaire. Data were analyzed by two-way ANOVA/Tukey's test and chi-square test (p<0.05). The maxillary appliance promoted higher enamel loss compared to the mandibular one (p<0.001). Intermittent use of appliances resulted in similar enamel loss to the continuous one (p = 0.686). All volunteers preferred to use the maxillary appliance in an intermittent regimen. The intermittent use of maxillary appliance is a simplified reliable protocol appropriated for in situ erosion studies in enamel.

In situ effect of enamel salivary exposure time and type of intraoral appliance before an erosive challenge.

OBJECTIVES: This study tested the effect of enamel salivary exposure time prior to an acid challenge (30 min, 1, 2, or 12 h) and type of intraoral appliance (palatal or mandibular) on initial erosion. METHODS: After initial surface hardness evaluation, enamel blocks (n = 340) were randomly divided into groups and volunteers (n = 20). The control group was not exposed to saliva previously to the erosive challenge. The volunteers wore palatal and mandibular appliances simultaneously. After salivary exposure, the blocks were subjected to acid exposure by immersion in hydrochloric acid (0.01 M, pH 2.3) for 30 s. Then, the enamel surface hardness was evaluated. Data were analyzed using ANOVA, Kruskal-Wallis and Tukey's test (p < 0.05). RESULTS: No difference was observed on percent surface hardness change (% SHC) in the enamel blocks between the types of intraoral appliances. Exposure to saliva for 30 min and 1 h promoted similar enamel resistance to the erosive attack, which was similar to the control group for both appliances. Blocks exposed to saliva for 2 h showed less hardness loss when compared to 30 min. Keeping the blocks in saliva during 12-h overnight resulted in similar percentage of enamel hardness loss compared to 2 h. CONCLUSIONS: A 2-hour in situ exposure to saliva is adequate to promote partial protection against initial erosive lesions, independently of the type of intraoral appliance used. CLINICAL SIGNIFICANCE: This finding will help researchers in the development of erosion studies, which will provide information for dentists to offer a better treatment for erosion.

Effect of different salivary exposure times on the rehardening of acid-softened enamel.

This in situ study assessed the effect of different times of salivary exposure on the rehardening of acid-softened enamel. Bovine enamel blocks were subjected in vitro to a short-term acidic exposure by immersion in 0.05 M (pH 2.5) citric acid for 30 s, resulting in surface softening. Then, 40 selected eroded enamel blocks were randomly assigned to 10 volunteers. Intraoral palatal appliances containing 4 enamel blocks were constructed for each volunteer, who wore the appliance for 12 nonconsecutive hours: initial 30 min, followed by an additional 30, and then by an additional 1 hour. For the last additional 10 hours the appliances were used at night, during the volunteers' sleep. Surface hardness was analyzed in the same blocks at baseline, after erosion and after each period of salivary exposure, enabling percentage of surface hardness recovery calculation (%SHR). The data were tested using repeated measures ANOVA and Tukey's test (α = 0.05). Increasing periods of salivary action promoted a progressive increase in the surface hardness (p < 0.001). However a similar degree of enamel rehardening (p = 0.641) was observed between 2 hours (49.9%) and 12 hours (53.3%) of salivary exposure. Two hours of salivary exposure seems to be appropriate for partial rehardening of the softened enamel surface. The use of the intraoral appliance during sleep did not improve the enamel rehardening after erosion.

Strategies for control and treatment of carious lesions in deciduous molars: a review of the literature / Estratégias para o controle e tratamento das lesões de cárie em molares decíduos: Uma revisão de literatura

ABSTRACT In recent years, a reduction has been observed in the prevalence of dental caries in the global population. However, caries is still considered a public health problem. Currently, total removal of decayed tissue has been questioned and replaced by less invasive therapeutic approaches, which offer the possibility of incomplete removal of decayed tissue in one or two clinical sessions. Other techniques aim at sealing the carious lesion or use prefabricated metal crowns on the cavitated tooth without removal of the decayed tissue, preventing direct contact of the substrates with the carious lesion. Recently, ultra-conservative treatment has gained scientific prominence, and is able to control carious lesions through the disorganization of dental biofilm via supervised brushing. Each therapeutic approach has its advantages and limitations, and it is the responsibility of dental professionals to plan their patients' treatments according to their individual needs, allowing for better functional, aesthetic and psychological conditions for patients by preserving primary teeth until their physiological exfoliation.

RESUMO Nos últimos anos, foi perceptível a diminuição na prevalência da cárie dentária na população mundial. Entretanto, a doença cárie continua sendo considerada um problema de saúde pública. Atualmente, a remoção total do tecido cariado vem sendo questionada e substituída por abordagens terapêuticas menos invasivas, as quais oferecem a possibilidade de remoção incompleta do tecido cariado em uma ou duas sessões clínicas. Outras técnicas visam o selamento da lesão cariosa ou o emprego de coroas metálicas pré-fabricadas sobre o dente cavitado sem que haja remoção de tecido cariado, impedindo o contato direto dos substratos com a lesão cariosa. Recentemente, o tratamento ultraconservador tem ganhado destaque científico, o qual tem a capacidade de conduzir o controle da lesão de cárie através da desorganização do biofilme dentário pela escovação supervisionada. Cada abordagem terapêutica apresenta suas vantagens e limitações, sendo responsabilidade do profissional planejar o tratamento do seu paciente de acordo com as suas necessidades individuais, possibilitando melhores condições funcionais, estéticas e psicológicas para o paciente através da manutenção dos dentes decíduos até a sua esfoliação fisiológica.

Impact of Saliva and Intraoral Appliance on Erosion Lesions Rehardening Ability - A Pilot Study

Objective: To evaluate the ability of different periods of salivary exposure and two different removable appliances to rehardening initial erosive lesions. Material and Methods: This randomized, single blind in situ study was conducted with 2 crossover phases. The factors under study were: period of salivary exposure (15 minutes, 30 minutes, 1 hour and 2 hours) and type of oral appliance (maxillary or mandibular). Two hundred enamel blocks were selected by initial surface hardness (SHi). Enamel blocks were demineralized in vitro (0.05M citric acid; pH2.5 for 15 seconds), surface hardness (SHd) was remeasured and 160 blocks were selected and randomized among groups. Thus, there were 2 blocks per period of salivary exposure in each type of oral appliance for each one of the 10 volunteers. In each phase, one of the removable appliances was tested. The response variable was percentage of surface hardness recovery (%SHR=[(SHf-SHd)/SHi)]x100). Two-way ANOVA and Tukey's post hoc test were applied adopting 5% of significance. Results: No difference was found among oral appliances on enamel rehardening (p>0.01). Salivary exposure of 2 hours promoted similar enamel rehardening when compared to 1 hour (p>0.05), which showed similar rehardening to 30 min. All mentioned period of salivary exposure promoted superior rehardening than 15 min (p>0.01). Conclusion: The salivary time exposure between erosive attacks might be 2 hours to achieve a feasible maximum rehardening. In addition, both maxillary and the mandibular appliance have presented a similar rehardening ability.

Effect of different salivary exposure times on the rehardening of acid-softened enamel

Abstract This in situ study assessed the effect of different times of salivary exposure on the rehardening of acid-softened enamel. Bovine enamel blocks were subjected in vitro to a short-term acidic exposure by immersion in 0.05 M (pH 2.5) citric acid for 30 s, resulting in surface softening. Then, 40 selected eroded enamel blocks were randomly assigned to 10 volunteers. Intraoral palatal appliances containing 4 enamel blocks were constructed for each volunteer, who wore the appliance for 12 nonconsecutive hours: initial 30 min, followed by an additional 30, and then by an additional 1 hour. For the last additional 10 hours the appliances were used at night, during the volunteers' sleep. Surface hardness was analyzed in the same blocks at baseline, after erosion and after each period of salivary exposure, enabling percentage of surface hardness recovery calculation (%SHR). The data were tested using repeated measures ANOVA and Tukey's test (α = 0.05). Increasing periods of salivary action promoted a progressive increase in the surface hardness (p < 0.001). However a similar degree of enamel rehardening (p = 0.641) was observed between 2 hours (49.9%) and 12 hours (53.3%) of salivary exposure. Two hours of salivary exposure seems to be appropriate for partial rehardening of the softened enamel surface. The use of the intraoral appliance during sleep did not improve the enamel rehardening after erosion.

Remineralização e desmineralização erosiva do esmalte considerando diferentes tempos de ação salivar e dispositivos intrabucais: estudo in situ / Enamel erosive remineralization and demineralization considering different times of salivary action and intraoral appliances: in situ study

O potencial protetor da saliva tem sido descrito como um importante fator que influencia na patogênese da erosão dentária. O objetivo desse trabalho foi avaliar o efeito remineralizador in situ da saliva sobre lesões iniciais de erosão e a sua capacidade protetora em relação à desmineralização erosiva do esmalte, através da utilização de dispositivos intrabucais palatino e mandibular em diferentes tempos de avaliação (30 min, 1h, 2h e 12h). Este estudo foi dividido em dois subprojetos, cada um com número amostral de 20 voluntários. No subprojeto I, após a avaliação da dureza de superfície inicial, os blocos de esmalte foram desmineralizados in vitro (ácido clorídrico 0,01 M por 30 segundos), selecionados e divididos aleatoriamente entre os 2 dispositivos, sendo utilizado quatro blocos por dispositivo palatino e dois blocos por dispositivo mandibular (2 dispositivos por voluntário/direito e esquerdo). Durante a etapa in situ, os voluntários foram orientados a utilizar os dispositivos durante o período máximo de 12 horas, de modo que após cada período de tempo pré-determinado, os dispositivos foram removidos da cavidade bucal para retirada dos blocos de esmalte e avaliação imediata da dureza superficial pós remineralização. No Subprojeto II, blocos de esmalte foram selecionados pela dureza de superfície inicial e distribuídos aleatoriamente entre os voluntários de acordo com o fator tempo e tipo de dispositivo intrabucal. Além destes, foi utilizado um grupo controle com blocos não submetidos à ação salivar. Na etapa in situ, para cada tempo em avaliação, os voluntários utilizaram os dispositivos com dois blocos de esmalte em cada dispositivo palatino (1 dispositivo por voluntário) e um bloco em cada mandibular (2 dispositivos por voluntário/direito e esquerdo). Imediatamente após cada fase da etapa in situ, os blocos (grupos experimentais e controle) sofreram desmineralização erosiva através da imersão em ácido clorídrico durante 30 segundos e, em seguida...

The protective potential of saliva has been described as an important factor that influences the pathogenesis of dental erosion. The aim of this study was to evaluate in situ the remineralizing effect of saliva on initial erosion lesions and the protective effect of saliva in relation to erosive enamel desmineralization, using palatal and mandibular appliances in different times of salivary exposure (30 min, 1h, 2h e 12h). This study consisted of two subprojects, each one with a sample size of 20 volunteers. In subproject I, after initial surface hardness evaluation, enamel blocks were demineralized in vitro (hydrochloric acid 0.01 M for 30 seconds), selected and randomly assigned between two types of appliances. Four blocks were placed on the palatal device and two blocks for the mandibular appliance (2 aplliances per volunteer / right and left). In the in situ phase, the volunteers were instructed to use the palatal and mandibular appliances for 12 hours, so that after every predetermined period of time, the enamel blocks were removed from the appliances for immediate evaluation of surface hardness (remineralization surface hardness). In subproject II, enamel blocks were selected using initial surface hardness and randomized among the volunteers according to factors time (30 min, 1h, 2h, and 12h) and types of intrabucal aplliance (palatal and mandibular). A control group with enamel blocks not subjected to salivary effect was also used. In in situ phase, the volunteers used intrabucal appliances with two enamel blocks in the palatal appliance (1 appliance per volunteer) and one block in each mandibular appliance (2 aplliances per volunteer / right and left). Imeddiatelly after use in each phase, the enamel blocks were desmineralized and the surface hardness was assessed. The data were analyzed using two-way ANOVA and Tukey test subproject I; Kruskal-Wallis and Tukey test subproject II, considering p<0.05. In subproject I, was observed a significant...