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Restorative Techniques for Permanent First Molars Affected by Hypomineralization
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This systematic review analyzed 12 studies to determine the best approaches to restoring permanent first molars with molar hypomineralization (MH). Direct restorations (amalgam, glass ionomer cement, and resin-based composite) and indirect restorations (stainless steel, porcelain, ceromer, and gold crowns) were included with a follow-up of 6 to 216 months. The success of direct restorations and indirect restorations was 86.3% to 100% and 91.3% to 100%, respectively.
- Given the high success rates of both direct and indirect restorations with no clear best approach, the authors concluded that direct restorations with glass ionomer cement and resin-based composite, being minimally invasive, could be the first choices to restore permanent first molars with MH. They also acknowledged that caries extent, caries removal techniques, the severity of MH opacity, and hypomineralized enamel could all affect the restoration's success.
abstract
This abstract is available on the publisher's site.
Access this abstract nowPurpose
There are several restorative modalities for molar hypomineralization, but there is no consensus on the best approach. The purpose of this review was to describe restorative approaches applied to permanent first molars (PFM) with molar hypomineralization (MH).
Methods
This review was registered (PROSPERO database CRD42017078336). Searches were conducted in the PubMed, Scopus, Web of Science, LILACS, BBO, and Cochrane Library databases and grey literature. From a total of 1,751 studies, 12 that compared restorative treatments for PFM with MH were included. The risk of bias of the studies was assessed using the Cochrane Collaboration and the Newcastle-Ottawa Scale. The success rate was the primary outcome.
Results
The restorative treatment options were direct restorations with amalgam, glass ionomer cement, and resin-based composite as well as indirect restorations with stainless steel, porcelain, ceromer, and gold crowns. The restorative techniques, considering the type of isolation and the removal of caries and hypomineralization, vary between the study. There was also a lack of standard clinical criteria for restorative evaluation. The follow-up period ranged from six to 216 months. The success of direct restorations ranged from 86.3 to 100 percent. For indirect restorations, success ranged from 91.3 to 100 percent.
Conclusions
There were multiple clinical protocols for MH. The studies presented heterogeneity in the restoration technique, time, and clinical criteria for restorative follow-up. Direct restorations with glass ionomer cement and resin-based composite could be the first choices for restoration. Further randomized clinical trials on a restorative treatment for MH are needed.
Additional Info
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Restorative Techniques for Permanent First Molars Affected by Hypomineralization: A Systematic Review
Pediatr Dent 2022 Jan 15;44(1)17-24, A Lopes-Fatturi, L Wambier, TZC Rolim, A Reis, JF de SouzaFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
This systematic review included five randomized clinical trials and seven observational studies to compare the longevity of various restoration options for permanent first molars with molar hypomineralization (MH). These studies were performed in Brazil (4), Greece (2), Germany (2), Denmark (1), Switzerland (1), England (1), and Spain (1). The age of patients ranged between 6 to 18 years, and the follow-up time was 6 to 216 months. The PECO question and eligibility criteria seemed broad in that various direct and indirect restorative materials and adhesive techniques were included. An exhaustive search was performed followed by a systematic selection of relevant studies. The risk of bias was assessed using the Cochrane Collaboration tool and the Newcastle–Ottawa scale. The quality of evidence was determined as low due to the risk of bias from examiner blinding (9 of 12 studies), fewer randomized clinical trials, and inconsistencies among study protocols. Crowns/indirect restorations had a high success rate (>90%) at 42 to 216 months. Among the direct restorative materials, resin-based composites and glass ionomers performed better than amalgams.
With the advances in dental adhesives, defect-specific tooth preparation and restoration have become an important part of minimally invasive dentistry. The authors in this study advocate restoring MH with resin-based composites or glass ionomers since they preserve the tooth vitality and are more cost-effective than indirect restorations.
This study emphasizes the importance of long-term randomized clinical trials and standardized research protocols in the future to compare the longevity of various dental materials.