Department of Pediatric Dentistry, Faculty of Dentistry, Hacettepe University, Sihhiye 06230, Ankara, Turkey.
Department of Pediatric Dentistry, Faculty of Dentistry, Hacettepe University, Sihhiye 06230, Ankara, Turkey.
J Dent. 2024 Aug;147:105098. doi: 10.1016/j.jdent.2024.105098. Epub 2024 May 24.
This study aimed to assess the clinical outcomes of utilizing silver diamine fluoride + potassium iodide (SDF + KI) treatment and Silver-Modified Atraumatic Restorative Technique (SMART/SDF + KI + Glass Ionomer Cement) over a three-year period on hypomineralised permanent molars with initial carious lesions.
112 hypomineralised permanent molars with ICDAS 1 or 2 lesions were selected in 48 children. The teeth were randomized into SDF + KI and SMART (SDF + KI + GIC) groups (n = 56 teeth/group) in a split-mouth design. Hypersensitivity and caries development were evaluated in both groups. Schiff Cold Air Sensitivity Scale (SCASS) was used for evaluation of hypersensitivity, and the modified USPHS criteria were utilised for clinical assessments of SMART sealants at 1,6,12,18,24 and 36 months. Fisher's Exact test, Kaplan-Meier Survival Curves, Log-rank test, Mann Whitney U test, and Friedman test was performed for the statistical analysis.
The caries preventive effect was 100 %, 67.9 % and 65.4 % for SDF + KI-treated teeth; and 100 %, 97.6 % and 94.7 % for SMART(SDF + KI + GIC)-treated teeth at 12, 24 and 36 months, respectively. The mean survival probabilities for caries-preventive effect were significantly lower in SDF + KI-treated teeth (31.01 months) than SMART-treated teeth (35.61 months), (p < 0.001). Twenty-six molars with initial hypersensitivity due to hypomineralization demonstrated a significant reduction at all evaluation periods compared to baseline SCASS scores (p < 0.001). Additionally, there was no significant difference in hypersensitivity scores between the groups during the re-call periods, and none of the teeth exhibited hypersensitivity at the 18-month and beyond evaluations.
During the three-year assessment, both groups demonstrated effectiveness in reducing sensitivity in hypomineralised molars. However, SMART (SDF + KI + GIC) sealants offered better protection against tooth decay over time, despite experiencing gradual retention loss.
Both SMART (SDF + KI + GIC) sealants and SDF + KI proved effective in alleviating hypersensitivity in hypomineralised molars for up to three years. SMART (SDF + KI + GIC) sealants showed greater caries-preventive effect compared to SDF + KI. However, continuous long-term monitoring is crucial due to the gradual decline in retention of SMART (SDF + KI + GIC) sealants.
NCT03862014.
本研究旨在评估在三年期间，使用银胺氟化物+碘化钾（SDF+KI）治疗以及银改良无创伤性修复技术（SMART/SDF+KI+玻璃离子水门汀）治疗有初始龋损的低矿化恒磨牙的临床效果。
在 48 名儿童中选择了 112 颗有低矿化症的恒磨牙，ICDAS 1 或 2 级病变。这些牙齿采用随机分组的方式分为 SDF+KI 和 SMART（SDF+KI+GIC）组（每组 56 颗牙齿）。在两组中均评估了敏感性和龋齿发展情况。使用 Schiff 冷空气敏感量表（SCASS）评估敏感性，采用改良美国公共卫生协会（USPHS）标准在 1、6、12、18、24 和 36 个月时评估 SMART 密封剂的临床效果。采用 Fisher 确切概率检验、Kaplan-Meier 生存曲线、Log-rank 检验、Mann-Whitney U 检验和 Friedman 检验进行统计学分析。
SDF+KI 治疗组的龋齿预防效果在 12、24 和 36 个月时分别为 100%、67.9%和 65.4%；SMART（SDF+KI+GIC）治疗组的龋齿预防效果分别为 100%、97.6%和 94.7%。SDF+KI 治疗组的龋齿预防效果的平均生存概率（31.01 个月）显著低于 SMART 治疗组（35.61 个月）（p<0.001）。26 颗因低矿化引起的初始敏感磨牙在所有评估期与基线 SCASS 评分相比均显著降低（p<0.001）。此外，在随访期间两组之间的敏感性评分无显著差异，且在 18 个月及以后的评估中，没有牙齿出现敏感性。
在三年评估期间，两组均能有效降低低矿化磨牙的敏感性。然而，随着时间的推移，SMART（SDF+KI+GIC）密封剂在防止龋齿方面提供了更好的保护，尽管其保留率逐渐下降。
SMART（SDF+KI+GIC）密封剂和 SDF+KI 均可有效缓解低矿化磨牙敏感性，最长可达三年。与 SDF+KI 相比，SMART（SDF+KI+GIC）密封剂具有更好的防龋效果。然而，由于 SMART（SDF+KI+GIC）密封剂的保留率逐渐下降，因此需要持续进行长期监测。
NCT03862014。
