Sealant vs laser for caries and post-eruptive breakdown prevention in MIH molars: 18-month randomized controlled...

Molar Incisor Hypomineralisation (MIH) is a qualitative enamel defect affecting one to four permanent first molars, with or without incisors, predisposing teeth to post-eruptive breakdown (PEB) and atypical caries.

To assess the effectiveness of Fuji TRIAGE glass ionomer sealant versus Er,Cr:YSGG laser therapy (LT) in the prevention of caries progression and post-eruptive breakdown (PEB) in MIH-affected molars.

In this two-arm, parallel, randomized clinical trial, 136 children aged 6-9 years with erupted first permanent molars affected by MIH, were enrolled. Affected molars were randomly assigned to Group 1: laser therapy (n = 68) or Group 2: Fuji TRIAGE glass ionomer sealant (n = 68). The primary outcomes dental caries and PEB, as well as the secondary outcome - sealant retention, were evaluated at 3, 6, 12, and 18 months. Associations were analyzed using Generalized Estimating Equations with adjustment for repeated measures and confounders (p < 0.05).

Over 18 months, caries progression increased slightly (22%) with no significant difference between laser and sealant groups (RR = 1.22, p = 0.210). At baseline, laser therapy showed lower PEB risk when compared to the sealant treatment (OR = 0.004, p < 0.001). However, over 18 months, there was 32% higher odds of PEB in laser therapy versus Fuji TRIAGE (OR = 1.319, p < 0.001). Sealant retention declined from 95.6% to 55.9%, and the sealant loss doubled PEB risk (OR = 2.15, p < 0.001). Both treatments reduced pain and anxiety, with sealants offering slightly greater immediate comfort (β = -1.5, p < 0.001).

Fuji TRIAGE offered more sustained protection against PEB compared to laser therapy, while both showed similar caries prevention in MIH-affected molars.

Fuji TRIAGE provides stronger long-term protection against PEB in MIH molars when compared to laser therapy with similar caries prevention effects; baseline risk factors and sealant retention remain crucial to overall preventive success.