Remineralization Strategies for Teeth with Molar Incisor Hypomineralization (MIH): A Literature Review.

Molar incisor hypomineralization (MIH) is a highly prevalent dental developmental disorder with a significant health burden for patients and high treatment needs, yet no comprehensive review article on all remineralization systems as a non-invasive treatment approach for MIH has been published. Typical characteristics of MIH-affected teeth are a lower mineral density and lower hardness compared to healthy teeth leading to sensitivity and loss of function. Thus, the use of formulations with calcium phosphates to remineralize MIH-affected teeth is reasonable. This review presents an up-to-date overview of remineralization studies focusing on active ingredients investigated for remineralization of MIH, i.e., casein phosphopeptide amorphous calcium phosphate (CPP-ACP), casein phosphopeptide amorphous calcium fluoride phosphate (CPP-ACFP), hydroxyapatite, calcium glycerophosphate, self-assembling peptide, and fluoride. Overall, 19 studies (in vitro, in situ, and in vivo) were found. Furthermore, an additional search for studies focusing on using toothpaste/dentifrices for MIH management resulted in six studies, where three studies were on remineralization and three on reduction of sensitivity. Overall, the studies analyzed in this review showed that MIH-affected teeth could be remineralized using calcium phosphate-based approaches. In conclusion, calcium phosphates like CPP-ACP, calcium glycerophosphate, and hydroxyapatite can be used to remineralize MIH-affected teeth. In addition to MIH-remineralization, CPP-ACP and hydroxyapatite also offer relief from MIH-associated tooth sensitivity.

Remineralization of molar incisor hypomineralization (MIH) with a hydroxyapatite toothpaste: an in-situ study.

AIM: This randomized, double-blind, crossover, in-situ study, compared the efficacy of toothpastes based on microcrystalline hydroxyapatite (HAP; fluoride-free) or fluoride, in remineralizing molar incisor hypomineralization (MIH). METHODS: Two lesion-bearing enamel blocks were produced from each of thirty extracted permanent molars diagnosed with MIH. Sixty produced blocks were randomly assigned to two groups (30/group): 20% HAP or 1450 ppm fluoride toothpaste. Each group was subdivided into, etched (n = 20), with lesion surface treated with 32% phosphoric acid-etchant for 5 s, and unetched (n = 10). Blocks were cemented into intra-oral appliances (2 blocks/appliance) worn full-time by 15 subjects. Subjects used the toothpastes in a two-phase crossover manner, lasting 14 days per phase, after one-week washout period. Baseline and post-treatment mineral density (MD) was quantified using microcomputed tomography. RESULTS: Overall, both groups showed statistically significant (paired t-test; p < 0.001) net-gain when MD was compared pre-treatment and post-treatment. HAP: pre-treatment (1.716 ± 0.315) and post-treatment (1.901 ± 0.354), Fluoride: pre-treatment (1.962 ± 0.363) and post-treatment (2.072 ± 0.353). Independent t-test demonstrated a practically significantly (≥10%) higher percentage remineralization with HAP toothpaste (26.02 ± 20.68) compared with fluoride toothpaste (14.64 ± 9.60). Higher percentage remineralization was observed in etched than unetched samples. CONCLUSION: The tested toothpaste based on hydroxyapatite can remineralize MIH lesions. Pre-treating the tooth surface with acid-etchant enhanced remineralization.

Zirconia crowns for children: A systematic review.

BACKGROUND: Preformed metal crowns (PMCs) have been the restoration of choice for paediatric dentistry; however, PMCs have a non-aesthetic appearance, which has become a point of concern. Recently, prefabricated zirconia crowns (PZCs) have been increasingly used as an aesthetic restorative material for primary teeth, as they have pleasing properties. AIM: This systematic review summarises the clinical results for PZCs in the primary dentition, including wear on the opposing dentition, retention, fracture resistance, parental satisfaction, gingival health, and cementation materials. MATERIALS AND METHODS: Electronic database searches were conducted using PubMed, Google Scholar, Web of Science, and the Cochrane Library. Clinical trials, observational studies, and case reports/series were included. The quality of the studies was analysed using the Cochrane tool and the domain-based evaluation for non-randomised studies of interventions. RESULTS: The search retrieved 166 references, of which 14 studies were included for qualitative analyses. The risk of bias varied from low to unclear. The included studies indicated that prefabricated zirconia crowns are retentive and are not associated with accelerated wear on the opposing dentition. They also exhibit a high fracture resistance, satisfy the parents and are compatible with gingival health. There is, however, inconclusive evidence with regard to cementation materials. CONCLUSION: Prefabricated Zirconia Crowns appear to be a good alternative to preformed metal crowns in term of esthetics, retention, resistance to fracture, parent satisfaction, and gingival health.

Dentin and enamel demineralization inhibition at restoration margins of Vitremer, Z 100 and Cention N.

PURPOSE: To examine the in vitro caries inhibition of a resin-modified glass-ionomer cement, and a fluoride and calcium releasing resin-based composite. METHODS: Standardized Class V preparations were placed in 30 molars, the gingival margin placed below the cemento-enamel junction. Randomly, 10 Vitremer, 10 Z 100 and 10 Cention N restorations were placed according to manufacturer's instructions, in 30 teeth. The Z 100 non fluoride-releasing resin-based composite group acted as the control. All teeth had an acid-resistant varnish placed to within 1 mm of restoration margins and they were placed into artificial saliva for 2 weeks, the saliva being replenished every 48 hours. All teeth were subjected to thermocycling each day and to an artificial caries challenge (pH 4.4) for one hour twice a day. Sections of 100 µm were obtained, photographed under polarized light microscopy and then demineralized areas adjacent to restorations were quantitated. RESULTS: The mean (± S.D.) area (µm 2) demineralization 100 µm from the enamel and dentin margins were: Vitremer 1,554 ± 1,153, 4,125 ± 301; Cention N 3580 ± 1,518, 6,246 ± 630; Z 100 13,257 ± 3,794, 8,842 ± 1,799. A Mann-Whitney Rank Sum Test indicated that Vitremer had significantly less enamel demineralization then Cention N (P< 0.003) and Z 100 (P< 0.001) and Cention N had significantly less enamel demineralization than Z 100 (P< 0.001) and Z 100 (P< 0.001). Vitremer also had significantly less dentin demineralization than Cention N (P< 0.001) and Cention N had significantly less dentin demineralization than Z 100 (P< 0.001). CLINICAL SIGNIFICANCE: Recurrent caries remains a concern and this in vitro research indicates that Cention N, as well as Vitremer may clinically inhibit caries at restoration margins.