Department of Pediatric Dentistry, Faculty of Dentistry, Hacettepe University, Sihhiye, 06100, Ankara, Turkey.
Clin Oral Investig. 2022 Feb;26(2):2197-2205. doi: 10.1007/s00784-021-04236-5. Epub 2021 Nov 6.
This study evaluated and compared the effect of silver diamine fluoride (SDF) and silver-modified atraumatic restorative treatment (SMART) sealants for the treatment of initial carious lesions of permanent molars affected by molar incisor hypomineralization (MIH).
One hundred and twelve hypomineralized permanent molars with ICDAS 1 or 2 lesions were selected in 48 children. The teeth were randomized into SDF and SMART sealant groups (n = 56 teeth/group) in a split-mouth fashion. Hypersensitivity, formation of caries, and enamel breakdown were evaluated in both groups. Hypersensitivity was assessed by Schiff Cold Air Sensitivity Scale (SCASS), and clinical assessments of SMART sealants were performed according to modified USPHS criteria at 1, 6, and 12 months. The data were analyzed statistically using Fisher's exact test, Kaplan-Meier analysis, Mann-Whitney U test, and Friedman test.
Twenty-six hypomineralized molars with marked baseline hypersensitivity showed significantly lower SCASS scores at all evaluation periods (p < 0.001). There was no significant difference in hypersensitivity scores between the groups at the repeated applications of SDF at 1, 6, and 12 months. The cumulative survival rates of SMART sealants on occlusal and palatal surfaces were 88.7% and 58.8%, respectively.
In hypomineralized molars, both SDF and SMART sealants showed favorable short-term prevention against dental caries while providing effective desensitization. Marginal discoloration was the most common side effect of the SMART sealants as a result of SDF application.
Both SDF and SMART sealants showed similar short-term effectiveness as non-aerosol procedures in arresting enamel caries and reducing hypersensitivity in hypomineralized molars.
Clinical Trials Registration Number: NCT03862014.
本研究评估和比较了银氟化物（SDF）和银改性非创伤性修复治疗（SMART）封闭剂治疗受低矿化磨牙（MIH）影响的恒磨牙初始龋损的效果。
在 48 名儿童中选择了 112 颗具有 ICDAS 1 或 2 病变的低矿化恒磨牙。这些牙齿以劈裂口的方式随机分为 SDF 和 SMART 密封剂组（每组 56 颗牙齿）。在两组中均评估了过敏、龋齿形成和釉质崩解。采用 Schiff 冷空气敏感量表（SCASS）评估过敏，根据改良 USPHS 标准在 1、6 和 12 个月时对 SMART 密封剂进行临床评估。使用 Fisher 确切检验、Kaplan-Meier 分析、Mann-Whitney U 检验和 Friedman 检验对数据进行统计学分析。
26 颗基线过敏明显的低矿化磨牙在所有评估期的 SCASS 评分均显著降低（p<0.001）。在 1、6 和 12 个月时重复应用 SDF 时，两组之间的过敏评分无显著差异。SMART 密封剂在咬合面和腭面的累积生存率分别为 88.7%和 58.8%。
在低矿化磨牙中，SDF 和 SMART 密封剂在提供有效脱敏的同时，均表现出对龋齿的短期良好预防作用。由于 SDF 的应用，SMART 密封剂最常见的副作用是边缘变色。
SDF 和 SMART 密封剂作为非气溶胶程序，在阻止釉质龋和降低低矿化磨牙的过敏方面表现出相似的短期有效性。
临床试验注册号：NCT03862014。
