Risk factors associated with occlusal caries in first permanent molars in a school program: longitudinal study

Aim: Evaluate the longitudinal status of dental caries in the occlusal surface of first permanent molars (FPM) and to identify risk factors for the progression to cavitated caries lesions in a school oral health program. Methods: Children who were enrolled in the program between September 2017 and October 2019, 5 to 10 years-old, presenting the four FPM were included. Four calibrated examiners assessed dental caries according to Nyvad criteria. Descriptive analysis included frequency, mean, and standard deviation calculations. Chi-square test was used in the bivariate analysis and, logistic regression adjusted for cluster effect was used to identify significant risk factors for cavity among the following independent variables: gender, age in the baseline, deft, upper/lower molar, initial caries score, Molar Incisor Hypomineralization (MIH), fluorosis, occlusal sealing. Odds ratio (OR) and respective confidence intervals (CI) are presented. Results: From 174 children enrolled in the program between 2017/2019, 120 were reevaluated in 2022. Eleven (2.6%) FPM in 11 children (9.2%) presented cavitated caries in the follow up examination. Significant risk factors for cavity were caries experience in the primary teeth (OR = 5.59; CI: 1.4 ­ 22.3) and the presence of MIH (OR = 5.33; CI: 1.6 ­ 18.1). Most of the active lesions in the follow up were considered active in the baseline examination. Conclusions: The progression to cavity was relatively low, significantly influenced by past caries experience and MIH

Typical esthetic outcomes using 5 different modalities to treat MIH affected teeth: a case series

Therapeutic options for incisors affected by Molar Incisor Hypomineralization range from very conservative procedures to those considered to be more invasive. Clinicians must select the appropriate approach, considering the outcomes of the procedures. This case series presents clinical outcomes of five female patients with aesthetic complaints associated with the Molar Incisor Hipomineralization. Macroabrasion, microabrasion and dental vital bleaching were used as combination techniques in three cases. Resin infiltration was indicated for a specific case, considering the oncoming orthodontic treatment. Composite restoration was performed in one patient with posteruptive enamel breakdown. Clinicians must select the appropriate approach according to an individualized evaluation of each case, considering factors such as the patient's expectations, dental age, psychosocial period, the severity of the condition, presence of sensitivity and the presumed aesthetic result of the selected treatment. The advantages and disadvantages of the techniques are presented.

Las opciones terapéuticas para los incisivos afectados por hipomineralización incisivo molar van desde procedimientos muy conservadores hasta los considerados más invasivos. Los clínicos deben seleccionar el enfoque adecuado, teniendo en cuenta los resultados de los procedimientos. Esta serie de casos presenta los resultados clínicos de cinco pacientes femeninas con quejas estéticas asociadas a la Hipomineralización Incisivo Molar. En tres casos se utilizaron la macroabrasión, la microabrasión y el blanqueamiento dental vital como técnicas combinadas. La infiltración de resina fue indicada para un caso específico, considerando el tratamiento de ortodoncia próximo. Se realizó una restauración con composite en un paciente con rotura posteruptiva del esmalte. Los clínicos deben seleccionar el abordaje adecuado de acuerdo con una evaluación individualizada de cada caso, considerando factores como las expectativas del paciente, la edad dental, el período psicosocial, la gravedad de la afección, la presencia de sensibilidad y el resultado estético presumible del tratamiento seleccionado. Se presentan las ventajas e inconvenientes de las técnicas.

Hipomineralización Incisivo Molar en paciente pediátrico con acidosis tubular renal distal. Reporte de caso. Control y seguimiento por 14 años

Introducción: la hipomineralización incisivo molar es un defecto sistémico del desarrollo que afecta a uno o más primeros molares permanentes, se asocia con frecuencia a los incisivos permanentes, de etiología multifactorial y con diversas opciones de tratamiento. Objetivo: se presenta el caso de un paciente que presenta hipomineralización incisivo molar en sus primeros molares permanentes con antecedentes de haber padecido de acidosis tubular renal distal, dicha entidad puede ocasionar defectos en el esmalte. Reporte del caso: masculino de 7 años de edad diagnosticado con acidosis tubular distal a los 4 meses de edad, al momento de la consulta ya superado. En sus primeros molares permanentes se observan lesiones sugestivas de hipomineralización incisivo molar. Se evalúa clínica y radiográficamente. Se le realizan restauraciones con vidrio ionomérico revisadas en controles semestrales y a los 10 años se decide colocar resinas compuestas en los molares afectados. Se indican controles periódicos a los cuales asiste regularmente por 14 años. Conclusión: la identificación temprana de la Hipomineralización incisivo molar permitirá la aplicación de medidas preventivas para asegurar la permanencia de los dientes afectados en boca. Es Importante afianzar las prácticas higiénicas especialmente en las superficies afectadas, concomitantemente con la aplicación de materiales restauradores.

Introdução: a hipomineralização molar incisivo é um defeito sistémico do desenvolvimento que afeta um ou mais primeiros molares permanentes, está frequentemente associada a incisivos permanentes, de etiologia multifatorial e com várias opções de tratamento. Objetivo: é apresentado o caso de um paciente que apresenta hipomineralização molar incisivo em seus primeiros molares permanentes com histórico de ter sofrido acidose tubular renal distal, esta entidade pode causar defeitos de esmalte. Relato de caso: menino de 7 anos de idade diagnosticado com acidose tubular distal aos 4 meses de idade, à época da consulta já ultrapassado. Em seus primeiros molares permanentes, foram observadas lesões sugestivas de hipomineralização molar incisivo. É avaliado clínica e radiograficamente. Restaurações de ionômero de vidro foram realizadas, revisadas em controles semestrais, e aos 10 anos foi decidido colocar resinas compostas nos molares afetados. São indicados controles periódicos, que frequenta regularmente há 14 anos. Conclusão: a identificação precoce da hipomineralização molar incisivo permitirá a aplicação de medidas preventivas para garantir a permanência dos dentes acometidos na boca. É importante reforçar as práticas de higiene, principalmente nas superfícies afetadas, então com a aplicação de materiais restauradores.

Summary Introduction: molar incisor hypomineralization is a systemic developmental defect that affects one or more permanent first molars, is frequently associated with permanent incisors, of multifactorial etiology and with various treatment options. Objective: the case of a patient who presents molar incisor hypomineralization in his first permanent molars with a history of having suffered from distal renal tubular acidosis is presented, this entity can cause enamel defects Case report: 7-year-old male diagnosed with distal tubular acidosis at 4 months of age, at the time of the consultation he had already passed. In his first permanent molars, lesions suggestive of molar incisor hypomineralization were observed. It is evaluated clinically and radiographically. Glass ionomer restorations were performed, reviewed at six-monthly controls, and at 10 years it was decided to place composite resins on the affected molars. Periodic controls are indicated, which he regularly attends for 14 years. Conclusion: early identification of molar incisor hypomineralization will allow the application of preventive measures to ensure the permanence of affected teeth in the mouth. It is important to strengthen hygienic practices, especially on affected surfaces, concomitantly with the application of restorative materials.

Prevalence of Dental Fear and its Association with Painful Oral Conditions in Adolescents

ABSTRACT Objective: To estimate the prevalence of dental fear and evaluate its association with dental caries and with Molar Incisor Hypomineralization (MIH) in schoolchildren aged 11-14 years. Material and Methods: A cross-sectional study was conducted with 375 adolescents in Campina Grande, Brazil. Socioeconomic and oral health information was collected, while dental fear was measured using the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS). The diagnosis of dental caries and MIH was performed by three trained examiners (κ ≥ 0.61) using the International Caries Detection & Assessment System - ICDAS II and a previously validated index, respectively. Data were descriptively analyzed using the Chi-Square, Fisher's Exact, and Poisson regression tests with robust variance (p<0.05). Results: The prevalence of dental fear was 18.4%, and the mean CFSS-DS total score was 28.96 ± 8.92. After adjusting for covariates family structure, schooling of parents/guardians, type of dental health service and dental pain in the last six months, the prevalence of dental fear was associated with dental pain in the last six months (PR=2.03; 95%CI=1.31-3.16; p=0.002). Conclusion: Although no association was found between dental fear, dental caries and MIH in adolescents, those who experienced dental pain in the last six months had a higher prevalence of dental fear.

Rehabilitation Treatment in Pediatric Patients with Molar Incisor Hypomineralization: A Scoping Review

ABSTRACT Objective: To identify the available evidence on the different treatment types for the rehabilitation of MIH-affected teeth in children. Material and Methods: A search was carried out in Pubmed, Cochrane Library, Epistemonikos, Lilacs and Google Scholar. Observational studies published until June 2022 were included. Two reviewers independently screened studies and extracted data. Results: 1593 studies were screened and a total of 38 articles were included, which were mainly case reports published in Brazil. Most included studies concluded that the evaluated treatment was "beneficial" or "probably beneficial". Reported treatments included: glass ionomer cements (GIC), composite resin restorations, preformed metal crowns, laboratory fabricated crowns, microabrasion management of incisors and resin infiltration. Conclusion: Successful treatment options have been identified, such as GIC as a provisional restoration for severe cases and for uncooperative children; restorations with composite, indirect restorations, or preformed metal crowns also seem suitable treatment options for young patients diagnosed with MIH. There is still little evidence to support an approach for anterior teeth affected by MIH.

Follow-up of first permanent molar restorative treatment with and without Molar Hypomineralization / Seguimiento del tratamiento restaurador de primeros molares permanentes con y sin Hipomineralización Molar

ABSTRACT Hypomineralization (MH) are controversial. The aim of this study was to compare need for treatment and status of restorations performed on first permanent molars in patients with and without MH. Retrospective design based on the clinical records of 153 patients who had received comprehensive care in 2014 at the Clinic of the Children's Comprehensive Dentistry Department (FOUBA) by 3 pediatric dentists (Kappa MH 0.94), and who attended periodical follow-up visits for at least 24 months. Need for treatment in first molars, and type and longevity of treatment were recorded (modified Ryge criteria /USPHS, Kappa 0.78). Results were compared between patients with MH and without MH. The Kruskal Wallis test was used to compare follow-up time, the asymptotic test was performed to compare proportions, and relative risk (RR) was calculated to compare need for treatment. Mean follow-up times for the 595 teeth analyzed were 61.7±20.1 months for Group without MH, and 57.5±23.9 months for Group with MH (p=0.0504). The percentages of teeth requiring at least one treatment were 7.2% in Group without MH and 27.5% in Group with MH (RR = 3.80, p <0.001). Of the teeth treated in Group with MH 23.1% required retreatment, while none of the teeth in Group without MH did. The need for treatment was approximately 4 times higher in molars affected with MH, with greater probability of retreatment.

RESUMEN La selección y estabilidad a largo plazo de los materiales de restauración en piezas afectadas por Hipomineralización Molar (HM) es en la actualidad un tema de controversia. El objetivo de este estudio fue comparar las necesidades de tratamiento y el estado de las restauraciones realizadas en primeros molares permanentes en pacientes con y sin HM. Diseño retrospectivo sobre las historias clínicas de 153 pacientes que habían recibido atención integral en 2014, en la Clínica de la Cátedra de Odontología Integral Niños (Facultad de Odontología de la Universidad de Buenos Aires) por 3 odontopediatras (Kappa HM 0,94) y que asistieron a las recitaciones periódicas durante un mínimo de 24 meses. Se registraron las necesidades de tratamiento, tipo y longevidad de los mismos en primeros molares (criterios Ryge modificados /USPHS, Kappa 0,78). Se compararon los resultados entre los pacientes con y sin HM. Se utilizó test de Kruskal Wallis para comparar tiempos de seguimiento, test asintótico de comparación de proporciones y se calculó riesgo relativo (RR) para comparar la necesidad de tratamiento. Los tiempos medios de seguimiento de las 595 piezas analizadas resultaron de 61.7±20.1 y 57.5±23.9 meses en los grupos sin HM y con HM respectivamente (p=0.0504). Los porcentajes de piezas que requirieron al menos un tratamiento fueron 7.2% en el grupo sin HM y 27.5% en el grupo con HM. (RR = 3.80, p <0.001) De las piezas con HM tratadas, el 23.1% requirieron retratamiento, mientras que en el grupo sin HM ninguna pieza lo necesitó. La necesidad de tratamiento fue aproximadamente 4 veces mayor en los molares afectados con HM con más probabilidad de retratamiento.

Association between hypomineralization of deciduous and molar incisor hypomineralization and dental caries

Abstract This study aimed to evaluate the association between the severity of hypomineralized second primary molars (HSPM), molar-incisor hypomineralization (MIH) and dental caries in children. 450 children between the ages of 6 and 7 years were included in this cross-sectional study. A calibrated examiner classified the enamel hypomineralizations and dental caries lesions using the MIH and HSPM and the Nyvad criteria, respectively. The primary outcome was the severity of MIH according to the severity of HSPM. Statistical analysis was performed using the generalized linear model and ordinal logistic regression. The prevalence of concomitant MIH and HSPM was 26% sex and age adjusted. Mild enamel defects were more frequent than severe enamel defects. An association was found between the severity of MIH and HSPM, both for mild defects (OR=87.54; 95%CI: 55.87, 137.17) and severe defects (OR=82.15; 95%CI: 45.72, 147.61). The severity of hypomineralization in permanent molars was associated with the activity of dental caries lesions (OR=29.85; 95%CI: 12.95, 68.83). To conclude, there is a strong association between the severity of HSPM and MIH, which is more significant in the presence of active dental caries lesions.

Resumo O objetivo desse estudo foi avaliar a associação entre a severidade da Hipomineralização de Segundos Molares decíduos (HSMD), da Hipomineralização de Molares e Incisivos (HMI) e cárie dentária em crianças. Neste estudo transversal foram incluídas 450 crianças entre 6 e 7 anos de idade. Um examinador calibrado classificou as hipomineralizações e lesões de cárie dentária utilizando o índice da HMI/HMD e o critério Nyvad, respectivamente. O desfecho primário foi a severidade da HMI de acordo com a severidade da HSMD. As análises estatísticas foram realizas usando o modelo linear generalizado e regressão logística ordinal. A prevalencia concomitante da HMI e HMSD foi de 26 % ajustada por sexo e idade. Defeitos leves foram mais frequentes que os defeitos severos. Foi encontrada a associação entre a severidade da HMI e da HSMD para defeitos leves (OR=87.54; IC95%: 55.87, 137.17) e severos (OR=82.15; IC95%: 45.72, 147.61). A severidade da hipomineralização em molares permamentes foi associada a atividade da lesão de cárie dentária (OR=29.85; IC95%: 12.95, 68.83). Conclui-se que existe uma forte associação entre a severidade da HSMD e da HMI, a qual foi mais significante na presença lesões ativas de cárie.

Preemptive analgesia with ibuprofen increases anesthetic efficacy in children with severe molar hypomineralization: a triple-blind randomized clinical trial

Abstract Molar incisor hypomineralization (MIH) is often accompanied by dental hypersensitivity and difficulty in achieving effective analgesia. Objective: This study evaluated the effectiveness of preemptive analgesia in children with severe MIH, post-eruptive enamel breakdown, and hypersensitivity. Methodology: Ibuprofen (10 mg/kg child weight) or placebo was administered, followed by infiltrative anesthesia and restoration with resin composite. Hypersensitivity was evaluated in five moments. The data were analyzed using the chi-square test, Fisher's exact test, and t-test. Results: Preemptive analgesia provided benefits for the treatment of severe cases of MIH, with an increase in the effectiveness of infiltrative anesthesia and improved patient comfort during the restorative procedure. Conclusion: Preemptive analgesia has shown efficacy in reducing hypersensitivity during restorative dental procedures, evidencing the significance of this study for patients with MIH and hypersensitivity.

Consideraciones diagnósticas para la exodoncia de primeros molares permanentes severamente afectados por la Hipomineralización de Molares e Incisivos / Considerações diagnósticas para a exodontia de primeiros molares permanentes severamente afetados pela Hipomineralização de Molares e Incisivos / Diagnostic considerations for extraction of first permanent molars severely affected by Molar-Incisor Hypomineralization

Resumen La Hipomineralización de Molares e Incisivos (HMI) es un defecto de desarrollo del esmalte de origen multifactorial que afecta de uno a cuatro primeros molares permanentes y frecuentemente está asociada con incisivos permanentes. Clínicamente se caracteriza por presentar opacidades demarcadas de color blanco-crema y/o amarillo-café. En casos severos puede haber dolor, fracturas posteruptivas, lesiones de caries dental y/o restauraciones atípicas. Entre las opciones de tratamiento se encuentran restauraciones temporales con cemento de ionómero de vidrio, restauraciones en resina compuesta, coronas, restauraciones indirectas y exodoncia. El objetivo de este caso es analizar las consideraciones diagnósticas de la exodoncia de primeros molares permanentes severamente afectados por la HMI. Paciente de sexo femenino, 9 años de edad, patrón esquelético Clase I, maloclusión Clase I bilateral e HMI severa. Para el tratamiento se optó por realizar la exodoncia de los cuatro primeros molares permanentes bajo anestesia general. Luego de 10 meses, se observa que los segundos molares permanentes están clínicamente sanos y presentan inclinaciones y posiciones favorables para el cierre espontáneo del espacio. Se concluye que la exodoncia de primeros molares permanentes severamente afectados por la HMI es una estrategia que mejora el pronóstico del paciente y para realizarla, se requiere trabajar en conjunto con el ortodoncista para diagnosticar y planear individualmente cada caso.

Resumo A Hipomineralização de Molares e Incisivos (HMI) é um defeito de desenvolvimento do esmalte, de origem multifatorial que afecta de um a quatro primeiros molares permanentes e frequentemente está associada aos incisivos permanentes. Clinicamente se caracteriza como opacidades demarcadas de coloração branco-creme e/ou amarelo-café. Em casos severos pode haver dor, fraturas pós-irruptivas, lesões de cárie dentária e restaurações atípicas. Dentre as opções de tratamento estão as restaurações temporárias com cimento de ionômero de vidro, restaurações em resina composta, coroas, restaurações indiretas e a exodontia. Esta última opção permite que o segundo molar permanente se reposicione espontaneamente desde que realizada a tempo, portanto, é considerada uma alternativa viável e custo-efetiva. O objetivo deste caso foi analisar as considerações diagnósticas de exodontia de primeiros molares permanentes severamente afetados pela HMI. Paciente do sexo feminino, 9 anos de idade, padrão esquelético Classe I, maloclusão Classe I bilateral e HMI severa. Para o tratamento, optou-se por realizar a exodontia dos quatro primeiros molares permanentes sob anestesia geral. Após 10 meses, se observa que os segundos molares permanentes estão clinicamente saudáveis e apresentam inclinações e posicionamentos favoráveis para o fechamento espontâneo do espaço. Conclui-se que a exodontia de primeiros molares permanentes melhora o prognóstico do paciente e para realizá-la requer um trabalho em conjunto com o ortodontista para diagnosticas e planejar individualmente cada caso.

Abstract Molar and Incisor Hypomineralization (MIH) is an enamel development defect of multifactorial origin that affects one-to-four permanent first molars and is frequently associated with permanent incisors. Clinically it is characterized by demarcated white-cream and/ or yellow-brown opacities. In severe cases, there may be tooth pain, posteruptive fractures, dental caries lesions, and/ or atypical restorations. Treatment options include temporary restorations with glass ionomer cement, restorations with composite resin, crowns, indirect restorations, and tooth extraction. When extractions are performed at the right time, it allows the spontaneous replacement of the second permanent molar, therefore, it is considered a viable and cost/effective treatment. The objective of this case report is to analyze the diagnostic considerations for the extraction of first permanent molars severely affected by MIH. Female patient, 9 years old, Class I skeletal pattern, Class I malocclusion, and severe MIH. For the treatment, it was decided to perform the extraction of the first four permanent molars under general anesthesia. After 10 months, it is observed that the second permanent molars are clinically healthy and have favorable inclinations and positions for spontaneous closure of the space. It is concluded that the extraction of first permanent molars severely affected by MIH is a strategy that improves the patient's prognosis and to carry out, it is necessary to work together with the orthodontist to diagnose and plan each case individually.

Molar-incisor hypomineralization and dental caries: A hierarchical approach in a populational-based study

Abstract The last couple of decades has seen an increasing interest in molar-incisor hypomineralization (MIH) studies. Hypomineralized defects can have several consequences such as hypersensitivity, increased dental plaque accumulation, and consequently higher caries risk. This cross-sectional study aimed to investigate the prevalence of MIH and its association with dental caries in schoolchildren from a city in southern Brazil. A random cluster sample of schoolchildren was selected. Clinical examinations were carried out to collect information on MIH (following the European Academy of Pediatric Dentistry criteria), dental caries (using the DMF-T index) and gingivitis. Socioeconomic, demographic and behavior variables were collected using a standardized questionnaire answered by the children's parents/caregivers. Prevalence ratios (PR) were estimated using Poisson regression analysis with robust variance through a hierarchical approach (p<0.05). A total of 513 schoolchildren were included in the study. MIH and caries prevalence was 19.7% and 31.6%, respectively. The mean age was 11.6 (+1.9) years. Dental caries was more prevalent in children with MIH (PR 1.39; 95% CI 1.05 - 1.85). Older children and children whose families were enrolled in conditional cash transference programs (PR 1.97 95% CI 1.47 - 2.64), and children who did not have their mother or father as the head of the family (PR 1.56 95% CI 1.06 - 2.30) presented a higher prevalence of dental caries. Our findings suggest that children with MIH are more likely to have dental caries.

Resumo Nas últimas duas décadas, observou-se um interesse crescente nos estudos de hipomineralização molar-incisivo (HMI). Os defeitos hipomineralizados podem ter várias consequências, como hipersensibilidade, aumento do acúmulo de placa dentária e, consequentemente, maior risco de cárie. Este estudo transversal teve como objetivo investigar a prevalência de HMI e sua associação com cárie dentária em escolares de um município do sul do Brasil. Uma amostra aleatória de alunos por conglomerado foi selecionada. Os exames clínicos foram realizados para coletar informações sobre HMI (seguindo os critérios da European Academy of Pediatric Dentistry), cárie dentária (usando o índice DMF-T) e gengivite. Variáveis socioeconômicas, demográficas e comportamentais foram coletadas por meio de um questionário padronizado respondido pelos pais / responsáveis pelas crianças. Razões de prevalência (RP) foram estimadas por meio de análise de regressão de Poisson com variância robusta por meio de abordagem hierárquica (p <0,05). Um total de 513 escolares foram incluídos no estudo. A prevalência de MIH e cárie foi de 19,7% e 31,6%, respectivamente. A média de idade foi de 11,6 (± 1,9) anos. A cárie dentária foi mais prevalente em crianças com HMI (RP 1,39; IC 95% 1,05 - 1,85). Crianças mais velhas e crianças cujas famílias estavam matriculadas em programas de transferência condicional de renda (RP 1,97 IC95% 1,47 - 2,64), e crianças que não tinham a mãe ou o pai como chefe da família (RP 1,56 IC95% 1,06 - 2,30) apresentaram maior prevalência de cárie dentária. Nossos resultados sugerem que crianças com HMI são mais propensas a ter cárie dentária.

Tratamiento estético de defecto de esmalte utilizando tratamiento combinado con resina infiltrante: Reporte de caso / Aesthetic treatment of enamel defect using combined therapy with resin infiltration: Case report

RESUMEN: La presencia de defectos en el esmalte puede afectar negativamente la autoestima de pacientes jóvenes, haciendo muchas veces necesario realizar un tratamiento estético. El tratamiento con resinas infiltrantes, permite obtener resultados estéticos sin realizar remoción del tejido dentario. Sin embargo, en casos de defectos de esmalte con fracturas post-eruptivas, la resina infiltrante por sí sola, no permite obtener un resultado óptimo. El presente reporte utiliza la combinación de resina infiltrante con resina compuesta directa para obtener resultados estéticos. De esta manera, al infiltrar primero, se mejora el aspecto estético de la lesión y también las características adhesivas del esmalte defectuoso, para posteriormente restaurar el contorno perdido aplicando una delgada capa de resina compuesta de translucidez media.

ABSTRACT: The presence of enamel defects can affect negatively the self-esteem of young patients, making it necessary to carry out an aesthetic treatment. Resin infiltration treatment provides aesthetic results without the necessity of removing the defective dental tissue. However, in cases of enamel defects with post-eruptive fractures, the treatment with resin infiltration by itself does not achieve optimal results. This report uses the combination of resin infiltration with direct resin composite to obtain an aesthetic result. This way, by first infiltrating, the aesthetic appearance of the lesion is improved, as well as the adhesive characteristics of the enamel, and subsequently the contour is restored by applying a thin layer of medium translucency resin composite.

Modified Hall technique for severely hypomineralized molars. Report of cases / Técnica de Hall modificada para molares severamente hipomineralizados. Reporte de casos / Técnica de Hall modificada para molares severamente hipomineralizados. Relato de caso

Abstract This article reviews the indications, objectives and step by step process of the Modified Hall Technique in the management of primary and permanent molars affected by severe enamel hypomineralization. Scientific based biological principles are discussed in order to provide relevant clinical information for Pediatric and General dentists in order to provide support for the safe use the technique in clinical practice.

Resumen En este artículo se revisan las indicaciones, objetivos y proceso paso a paso de la Técnica de Hall Modificada en el manejo de molares primarios y permanentes afectados por hipomineralización severa del esmalte. Los principios biológicos basados en la evidencia se discuten con el fin de proporcionar información clínica relevante para los odontólogos pediátricos y generales con el fin de proporcionar apoyo para el uso seguro de la técnica en la práctica clínica.

Resumo Neste artigo foram revisadas as indicações, objetivos e o passo a passo da Técnica de Hall Modificada para o manejo de molares decíduos e permanentes afetados pela hipomineralização severa do esmalte. Os princípios biológicos baseados na evidência são discutidos com o objetivo de proporcionar informações clínicas relevantes para odontopediatras e clínicos gerais, a fim de lhes fornecer apoio para o uso seguro da técnica na prática clínica.

Esthetic evaluation of resin infiltration for the treatment of molar-incisor hypomineralization / 口腔疾病防治

Objective @#To evaluate the clinical effects of resin infiltration in treating molar-incisor hypomineralization. @*Methods @#Twelve patients (36 teeth) with mild molar-incisor mineralization imperfecta who met the inclusion criteria were selected and treated with penetrating resin. Before treatment (T0), at the one-week follow-up (T1) and at the six-month follow-up (T2), a Crystaleye spectrophotometer was used to take photos, and the color differences (ΔE) between the lesion area and the surrounding normal enamel area at different times were calculated and analyzed. The area of the lesion and the total area of the labial surface of affected teeth were calculated using Adobe Photoshop CS3 software. The corresponding area ratio (R) and treatment efficiency (SR) were obtained. The R value was used to judge the effectiveness of resin penetration in the treatment of molar and incisor mineralization imperfecta and to evaluate its aesthetic effect. The results were analyzed by repeated measures one-way ANOVA. @*Results@#The color difference of the lesion area vs sound adjacent enamel (ΔE) decreased significantly, and that of the lesion area decreased significantly after resin infiltration (P < 0.001). The success rate was approximately 86.02%, which means that the esthetic effect of resin infiltration in treating molar-incisor hypomineralization was remarkable. No important adverse events or side effects were observed. @*Conclusion@# The aesthetic effect of resin infiltration in the treatment of mild molar and incisor hypomineralization is good. This method is recommended for clinical use.

Is there an association between dental caries, fluorosis, and molar-incisor hypomineralization?

Abstract Objective: This cross-sectional study aimed to determine the prevalence of dental caries, dental fluorosis, and molar-incisor hypomineralization, and their associations in a group of Brazilian schoolchildren. Methodology: Adolescents (n=411) were evaluated by two calibrated examiners for dental caries (DC), dental fluorosis (DF), and molar-incisor hypomineralization (MIH) using the CAST (Caries Assessment Spectrum and Treatment) instrument, Thylstrup and Fejerskov (TF) index, and MIH Severity Scoring System (MIH-SSS), respectively. Descriptive statistics, chi-square tests, and logistic regression were used for statistical analysis. Results: The sample comprised 42.75% boys and 57.25% girls. The prevalence of DC in permanent dentition was 94.75%, of which 29% were represented by dentin lesions. For DF, a prevalence of 40.75% was observed, with 69.32% mild, 12.88% moderate, and 17.79% severe. A positive association between the source of water and fluorosis was detected (p=0.01). The prevalence of MIH was 18%. Thirty adolescents (41.7%) presented with severe MIH. No association was found between DF or MIH and dentin DC or between MIH and DF at the individual level. However, a significant negative relationship was detected between DF and dentin carious lesions ( p <0.005) and DF and MIH ( p <0.00001) at the tooth level, whereas a positive association was observed between MIH and dentin carious lesions ( p <0.00001). A positive association was also observed between the severity of both conditions ( p <0.00001). Mild DF was the most prevalent problem observed. Cases of teeth with mild MIH were the most predominant in MIH-affected teeth. Conclusions: No association was observed among the dentin carious lesions, MIH, and DF at the participant level. However, a positive association between MIH and dentin carious lesions was found at the tooth level, whereas MIH, DF, and DF and dentin carious lesions showed a negative relationship.

Severidad de hipomineralización incisivo molar (HIM) y su relación con caries dental en niños / Severity of incisor molar hypomineralization (IMH) and its relationship with dental caries in children

Artículo original Original articleRevista Metro CienciaSeveridad de hipomineralización incisivo molar (HIM) y su relación con caries dental en niñosSeverity of incisor molar hypomineralization (IMH) and its relationship with dental caries in childrenSylvia Gabriela Pineda Bonilla1, Alejandra Cabrera Arias2Odontóloga de la Universidad Católica del Ecuador, Quito, Ecuador1Docente de la Universidad Católica del Ecuador, Quito, Ecuador2Recibido: 28/09/2020 Aceptado:05/10/2020 Públicado:29/10/2020Editorial: Hospital Metropolitano ISSN (impreso) 1390-2989 - ISSN (electrónico) 2737-6303Edición: Vol. 28 Nº 4 (2020) octubre - diciembreDOI: https://doi.org/10.47464/MetroCiencia/vol28/4/2020/42-51URL: https://revistametrociencia.com.ec/index.php/revista/article/view/95Pág: 42-51RESUMENLa Hipomineralización Incisivo Molar (HIM) es una alteración cualitativa en la formación de la estructura del diente que puede producir la pérdida de grandes áreas de la estructura dental. La prevalencia de Hipomineralización Incisivo Molar varía ampliamente en el mundo y han sido pocos los estudios epidemio-lógicos realizados en Latinoamérica y específicamente en Ecuador. Objetivo: Determinar la prevalencia y severidad de (HIM) y su asociación con caries dental en niños y niñas de 8 a 10 años de escuelas primarias públicas del Barrio Las Casas. Materiales y métodos: Corresponde a un estudio, transversal en el cual se evaluó a 366 escolares de 8 a 10 años de edad que asistían a las escuelas públicas del barrio Las Casas, que tuvieran todos los primeros molares e incisivos permanentes completamente erupcionados. Las variables fueron edad, género, escolaridad del representante, ocupación del representante, fre-cuencia de cepillado; las variables clínicas que se evaluaron fueron HIM mediante los criterios descritos por Mathu-Muju y Wright; y caries dental, utilizando el índice International Caries Detection and Assessment System (ICDAS II). Resultados: La prevalencia de hipomineralización incisivo molar en la muestra total fue de 21.3%, al asociarla con la caries dental se detectó que el 2.2% (n=8) de escolares que no presentaba caries presentó HIM, a diferencia del 9.3% (n=34) de escolares que presentaron caries con cavidades detectables y el 9.8% (n=36) de niños con lesiones incipientes tuvieron HIM. Conclusión: La presencia de HIM fue alta y si estuvo asociada a caries dental, los escolares con HIM presentaron más riesgo de desarrollar caries.

ABSTRACT Molar Incisor Hypomineralization (MIH) is a qualitative alteration in the formation of tooth structure that can cause the loss of large areas of tooth structure. The prevalence of Molar Incisor Hypomineralization varies widely in the world and there have been few epidemiological studies conducted in Latin America and specifically in Ecuador. Objective: To determine the prevalence and severity of (MIH) and its association with dental caries in children from 8 to 10 years old of public primary schools in Las Casas neighborhood. Material and methods: Corresponds to a cross-sectional study in which 366 schoolchildren between 8 and 10 years old were evaluated who attended to the public schools in Las Casas neighborhood, which had all the first molars and permanent incisors completely erupted. The variables were age, gender, education of the representative, occupation of the representative, frequency of brushing; the clinical variables that were evaluated were HIM using the criteria described by Mathu-Muju & Wright; and dental caries, using the International Caries Detection and Assessment System index (ICDAS II). Results: The prevalence of molar incisor hypomineralization in the total sample was 21.3% when it was associating with dental caries it was detected that 2.2% (n = 8) of schoolchildren without caries presented MIH, a difference of 9.3% (n = 34) of schoolchildren who presented caries with detectable cavities and 9.8% (n = 36) of children with incipient lesions had MIH. Conclusion: The presence of MIH was high and was associated with dental caries. Schoolchildren with MIH presented a higher risk of developing caries.

Analysis of prevalence and diagnostic criteria of molar-incisor hipomineralization / Análisis de prevalencia y criterios diagnósticos de hipomineralización molar-incisiva

To identify the prevalence and diagnostic criteria of Molar-Incisor Hipomineralization (MIH) in the scientific literature. Materials and Methods: This is a bibliographical research conducted through the analysis of indexed articles until October 2017 in the PubMed, Web of Science and Scopus databases. The Medical Subject Headings (MESH) used were "Dental Enamel Hypoplasia" and "Molar Incisor Hypomineralization". The analysis of articles was carried out by two reviewers, who collected information independently. The following information was collected: author, year of publication, place of work (continent and country), sample calculation, sample number, age of participants, type of study, prevalence of molar-incisor hypomineralization and criteria used for diagnosis. Data were tabulated using Microsoft Excel for Windows and presented using descriptive statistics. Results: A total of 484 articles were found and 57 were included in the study. Most of the studies were conducted in Europe (35%), and 31.6% of the studies mentioned using a probability sampling. The number of study participants ranged from 99 for a study in Brazil to 3,591 in Kenya. The most frequent age was 8 years, while the predominant type of study was cross-sectional (91.2%). The prevalence varied from 0.4% to 37.3% and most studies (73.6%) employed the European Academy of Pediatric Dentistry criteria for the diagnosis of MIH. Conclusion: There is great variability in prevalence in different countries, probably due to the use of different diagnostic criteria being used, and due to different age groups and geographical variation.

Objetivo: Identificar la prevalencia y los criterios diagnósticos de la hipomineralización de incisivos molares (HIM) en la literatura científica. Materiales y métodos: Investigación bibliográfica realizada a través del análisis de artículos indexados hasta octubre de 2017 en las bases de datos PubMed, Web of Science y Scopus. Los Medical Subject Headings (MESH) utilizados fueron "Dental Enamel Hypoplasia" y "Molar Incisor Hypomineralization". El análisis de los artículos fue llevado a cabo por dos revisores, quienes recolectaron información de manera independiente. Se recopiló la siguiente información: autor, año de publicación, lugar de trabajo (continente y país), cálculo y número de muestra, edad de los participantes, tipo de estudio, prevalencia de hipomineralización molar-incisiva y criterios utilizados para el diagnóstico. Los datos se tabularon con Microsoft Excel para Windows y se presentaron con estadísticas descriptivas. Resultados: Se encontraron un total de 484 artículos y 57 se incluyeron en el estudio. La mayoría de los estudios se llevaron a cabo en Europa (35%), y el 31,6% de los estudios mencionados utilizaron una muestra probabilística. El número de participantes en el estudio varió de 99 en un estudio en Brasil a 3.591 en un estudio desde Kenia. La edad más frecuente fue de 8 años, mientras que el tipo de estudio predominante fue transversal (91,2%). La prevalencia varió de 0,4% a 37,3% y la mayoría de los estudios (73,6%) emplearon los criterios de la Academia Europea de Odontología Pediátrica para el diagnóstico de HIM. Conclusión: Existe una gran variabilidad en la prevalencia de HIM en diferentes Países, probablemente debido al uso de diferentes criterios de diagnóstico, al utilizar diferentes grupos de etarios y a la variación geográfica.

Diversity of clinical, radiographic and genealogical findings in 41 families with amelogenesis imperfecta

Abstract Amelogenesis imperfecta (AI) is a group of enamel development disorders that alter the structure and chemical composition of the tissue. There is great variability in the clinical presentation; according to Witkop, AI can be categorized into 14 subtypes, which makes its diagnosis extremely complex. Objective: This study aimed to describe and determine the frequency of clinical and radiographic features and inheritance patterns found in 41 Chilean families diagnosed with diverse types of AI. Material and Methods: We analyzed the clinical records, photographs, pedigrees and radiographs of 121 individuals recruited between 2003 and 2016. All of the information was included in a database that was analyzed using the application Stata 14. Results: The 72 affected individuals had average age of 16 years, and no sex association with the presence of AI was found. The most frequent clinical subtypes were as follows: 43% hypomature, 25% hypoplastic, 21% hypomature/hypoplastic, 7% hypocalcified and 4% hypocalcified/hypoplastic. The number of severely affected teeth was 22, which occurred in the patients with hypocalcified and hypocalcified/hypoplasic AI who presented the highest number of damaged teeth. Caries and periodontal disease were found in 47 and 32% of the patients, respectively. Malocclusions were observed in 43% of the individuals with AI, with open bite being the most frequent. Radiographically, the thickness of the enamel decreased in 51% of the patients, and 80% showed decreased radiopacity of the enamel compared to that of dentin. Autosomal dominant inheritance pattern was found in 37% of the families with hypoplastic AI, and autosomal recessive pattern was present in 56% of the other clinical subtypes, but more frequently in those affected with hypomature and hypocalcified AI. Conclusion: Of the five clinical subtypes, autosomal recessive hypomature, autosomal dominant hypoplastic and autosomal recessive hypomature/hypoplastic AI were the most prevalent subtypes in this group.

Estado bucal en pacientes con fibrosis quística (FQ) / Oral status in patients with cystic fibrosis

En un estudio (Grasan, Sebelli, Anchava, Ferrari, y Biondi, 2016) se observó que niños con Fibrosis Quística (FQ) atendidos en un hospital revelaron menor patología dental comparados con pacientes sanos que concurrían a la Cátedra (FOUBA), siendo necesarios estudios comparativos con niños sin demanda de atención. Objetivo: determinar el estado bucal de pacientes pediátricos que concurren al Hospital Garrahan con diagnóstico de FQ y compararlos con niños sanos sin demanda de atención de la misma edad y sexo que concurren a una escuela pública del partido de Merlo, Buenos Aires. Método: Se empleó un diseño observacional, casos-control, en niños entre 3 y 16 años concurrentes Hospital (GFQ) y un grupo control de niños de la escuela (GS). A través de planillas se registraron datos personales, CPOD, CPOS, ceod, ceos, Indice de placa Silness y Loe, Hemorragia simplificado, Gingival Loe y Silness e Hipomineralización molar incisiva (HMI). Para la estimación de la prevalencia y otras variables cualitativas se calcularon las medias y desvíos estándar y Chi-cuadrado para las comparaciones. Resultados: cada grupo quedó conformado por 19 niños de 9+-6 años, 47% sexo femenino. Al comparar ambos grupos no se hallaron diferencias significativas en CPOD (p=0,236), CPOS (p=0,537), ceos (p=1,000), Indice de placa Silness y Loe (0,172) y Hemorragia simplificado (p=1,000) y HMI (p=0,001). Conclusiones: se concluye que los niños con FQ de la zona objeto del estudio, desde la muestra de 19 niños, no presentan diferencias en la salud bucal (AU)

Molar incisor hypomineralization: analysis of asymmetry of lesions

Clinically, MolarIncisor Hypomineralization (MIH) lesions are not distributed symmetrically, and their severity varies even within the same arcade. Aim: To estimate the frequency of asymmetries in hypomineralized lesions on permanent molars and incisors of children with MIH. Methods: Three pediatric dentists, calibrated following the diagnostic criteria of MathuMuju and Wright (2006) (Kappa 0.87) identified presence and severity of opacities on molars and incisors of patients with MIH. Six pairs of teeth (permanent maxillary and mandibular first molars, central and lateral incisors) were evaluated in each patient. Degree of lesion severity (0­none, 1­mild, 2­moderate, 3­severe) was recorded for each tooth. For each pair containing any affected teeth, asymmetry of presence (one tooth in the pair with lesion and the other intact), asymmetry of severity (both teeth with lesions but with different degrees of severity) or symmetry of severity (both affected teeth with the same degree of severity) were evaluated. The recorded values were entered into a database to calculate percentages, 95% confidence intervals and ChiSquare test for comparisons. Results: The sample consisted of 475 of the 1032 pairs of teeth evaluated in the 172 patients included in the study, mean age 11± 2.2 years, and 50% female. Asymmetry was found for 67.5% (63.1 71.7) of the pairs of the studied teeth. There was a significant relationship between asymmetries and symmetries (p=0.038). A total 50.1% of the pairs were asymmetrical for presence of opacities. Of these, 62.2% scored severity 1 (mild). Symmetry of severity was found for 32.5% of the lesions. Among the pairs of affected teeth, the most frequently observed degrees of lesion severity were mild and moderate, with the exception of lower molars, in which 49% had severe lesions. Conclusions: In this study, MIH lesions were asymmetrical both in presence and severity for all tooth types (AU)

Clínicamente las lesiones de Hipomineralización Molar Incisiva (HMI) no tienen una distribución simétrica variando su severidad inclusive en la misma arcada. Objetivo: Estimar la frecuencia de asimetrías en lesiones de hipomineralización en molares e incisivos permanentes de niños afectados con HMI. Métodos: Tres odontopediatras calibrados (Kappa 0,87) según los criterios de diagnóstico de MathuMuju y Wright (2006), registraron presencia y severidad de opacidades en molares e incisivos de pacientes con HMI. En cada paciente se evaluaron 6 pares de piezas dentarias permanentes: primeros molares, incisivos centrales y laterales de ambos maxilares. Para cada una de las piezas se registró el grado de severidad de la lesión (0­intacto, 1­leve, 2­moderado, 3­severo). Para cada par con alguna de sus piezas afectadas, se analizó si presentaba asimetría de presencia (una pieza del par con lesión y la otra intacta), asimetría de severidad (ambas piezas con lesión pero con distinto grado de severidad) o simetría (ambas piezas afectadas con el mismo grado de severidad en la lesión). Se calcularon porcentajes, I.C. del 95% y CHI2 para las comparaciones. Resultados: La muestra quedó conformada por los 475 pares de piezas dentarias que presentaron lesión entre un total de 1032 pares de piezas analizadas en los 172 pacientes incluidos en el estudio (edad media 11 ± 2,2 años, 50% género femenino). El 67,5% (63,171,7) de los pares de piezas dentarias estudiados presentaron relación de asimetría. La relación entre frecuencia de asimetrías y simetrías fue significativa (p= 0,038). Del 50,1% de los pares que presentó asimetrías en presencia, un 62,2% mostró grado de severidad 1(leve) en una de sus piezas. Entre los pares afectados, las lesiones leves y moderadas fueron las más observadas en todos los grupos dentarios, a excepción de los molares inferiores que revelaron un 49% de lesiones severas. Conclusiones: En este estudio las lesiones de HMI presentaron, en su mayoría, algún tipo de asimetría (de presencia o de severidad) en todos los grupos dentarios (AU)

Análisis de la relación entre la hipomineralización incisivo molar y los factores asociados a su etiología / Analysis of the relationship between molar incisor hypomineralization and the factors associated with its etiology

RESUMEN El objetivo de este artículo es analizar la relación entre la hipomineralización incisivo molar (HIM) y los factores asociados a su etiología publicados en la literatura. Material y métodos: El estudio se basó en una búsqueda de estudios epidemiológicos de casos y controles de HIM que describieron un factor etiológico asociado para obtener las odds ratio (OR) necesarias para analizar la prevalencia del factor afectado y su posible papel en la etiología de la condición. Resultados: Ocho artículos cumplieron los criterios para el análisis. La población total analizada consistió en una muestra de 7,901 sujetos, de los cuales 992 tenían HIM. En estos sujetos fueron reportados como factor asociado (FA) para HIM: asma (OR = 4.4954), uso de antibióticos (OR = 5.5348), fiebre (OR = 4.0545) y neumonía. Conclusión: Los resultados del presente estudio sugieren que un FA común a todos los casos de HIM estudiados es un proceso inflamatorio que conduce a una mayor concentración de agentes en el microambiente en el que se desarrollan las células formadoras del esmalte, lo que aumenta la presencia de proteínas en la matriz del esmalte o interfieren con su hidrólisis y eliminación y produce como resultado una deficiente mineralización.

ABSTRACT Hypomineralization enamel of the first permanent molars is the most common developmental abnormalities observed in the teeth. The aetiology of MIH remains unclear and may have a multifactor aetiology. The aim of this paper is to analyze the relationship between MIH and associated factors published in the literature. Material and methods: The study was based on a search for epidemiological case-control studies of MIH that described an associated etiological factor, in order to obtain the odds ratios needed to analyze the prevalence of the factor concerned and its possible role in the etiology of the condition. Results: The initial search produced 50 articles, eight of which met the criteria for the analysis. The total population analyzed consisted of a sample of 7,901 subjects, 992 of whom had MIH (i.e., a prevalence of 12.55%). Asthma was reported as an etiological factor in five papers, which included 474 subjects with MIH with an OR of 4.4954 (p < 0.0001). Antibiotic use was reported as an etiological factor in three papers, which reported on a population of 231 subjects with MIH and OR of 5.5348 (p < 0.0001). Fever was reported as an etiological factor in two papers, involving a population of 176 subjects with MIH and an OR of 4.0545 (p < 0.0001). Pneumonia was reported as an etiological factor in two papers, which dealt with a population of 454 cases of MIH and produced an OR of 2.285 (p < 0.0001). Conclusion: The results of the present study suggest that one etiological factor common to all of the MIH cases studied is an infl ammatory process, in which the presence of agents that cause alterations in ameloblasts can lead to higher concentrations of these agents in the microenvironment in which enamel forming cells develop, thus increasing the presence of proteins in the enamel matrix or interfering with their hydrolysis and removal, producing defects in enamel mineralization.