Effects of different remineralization agents on MIH defects: a randomized clinical study

Area of Science:

• Pediatric Dentistry
• Dental Biomaterials
• Cariology

Background:

• Molar incisor hypomineralization (MIH) affects permanent first molars, presenting as creamy-white or yellow-brown enamel defects.
• Early diagnosis and intervention are crucial for managing MIH to prevent further degradation and caries.
• Limited research exists on the long-term efficacy of various remineralization agents specifically for different MIH defect appearances.

Purpose of the Study:

• To comparatively evaluate the long-term effectiveness of fluoride varnish and pastes containing CPP-ACP (Casein Phosphopeptide-Amorphous Calcium Phosphate) and CPP-ACFP (CPP-ACP with Fluoride) for remineralizing MIH defects.
• To assess the efficacy of these agents on both creamy-white and yellow-brown MIH defects in permanent first molars.
• To provide insights into the management of MIH lesions based on their visual characteristics and treatment response.

Main Methods:

• A 24-month follow-up study involving 67 children (aged 6-9 years) with 120 newly diagnosed MIH teeth without caries or substance loss.
• Participants were randomly assigned to three groups: control (oral hygiene), fluoride varnish, or CPP-ACP/CPP-ACFP pastes.
• Evaluations used the International Caries Detection and Assessment System (ICDAS) criteria and laser fluorescence (DIAGNOdent) for remineralization assessment.

Main Results:

• The study concluded with 49 patients and 90 teeth.
• All tested remineralization agents significantly enhanced enamel remineralization in both creamy-white and yellow-brown MIH defects.
• No statistically significant differences in overall remineralization rates were observed between the agents after 24 months (p > 0.05); however, CPP-ACP and CPP-ACFP pastes demonstrated earlier observable effects compared to fluoride varnish.

Conclusions:

• Pastes containing calcium and phosphate (CPP-ACP/CPP-ACFP) are recommended for preserving teeth with yellow-brown MIH defects, particularly those prone to post-eruptive breakdown.
• The study highlights the importance of considering lesion appearance when selecting remineralization strategies for MIH.
• This research contributes valuable long-term data on MIH treatments, differentiating outcomes based on defect color and specific remineralization agents.