Title Sealants and re-sealings are recommended for Molar Incisor Hypo-mineralized (MIH) teeth especially when applied using 5th generation adhesive systems.
Clinical Question In patients with Molar-Incisor Hypomineralized (MIH) permanent molars, is sealing and re-sealing a better alternative to more invasive treatment?
Clinical Bottom Line Due to the high caries risk associated with MIH teeth, sealants and re-sealings are recommended as a preventative measure, especially when applied using a 5th generation adhesive system.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
28489117Fragelli/ 201741 permanent first molars were used for the study. Among them there were 25 MIH teeth and 16 control teethClinical Trial
Key resultsForty one permanent molars in 21 children were followed for a total of 18 months. 25 teeth with MIH comprised the first treatment group. 16 teeth-no evidence of MIH, were used as a control. Sealants were placed by calibrated clinicians utilizing rubber dam to ensure optimal isolation. The United states Public Health Service (USPHS)-Modified evaluation method was used for both groups. USPHS evaluates the following: anatomical form, marginal adaptation, surface texture, marginal discoloration, retention and presence of secondary carious lesions. Additionally, this method assigns letter scores A, B or C based on assessment data collected at each evaluation visit. C assignment deems the sealant "unsatisfactory" and "failed" for the purpose of study. If a "C" rating was applied to a study tooth, the sealant was replaced and no longer evaluated for study. Evaluation took place at 1, 6, 12 and 18 months. Overall, data indicated there was no difference in the retention rate of pit and fissure sealants in the control group having no MIH(72%) versus the treatment group with MIH (62%). All data conclude no significant difference in the frequency of failures as well as the scores between the two groups. It was noted, however that failures were more often associated with the following: retention, secondary caries, marginal adaptation and discoloration. Researchers concluded that these findings highlight the challenge of sealant adhesion on MIH affected teeth and that MIH opacity variations may indicate retention length in regard to occlusal sealants
19995506Lygidakis/2010N=47 set of molars in each group, 21 maxillary teeth and 26 mandibular teeth. Randomized Controlled Trial
Key resultsThis is a prospective, split mouth and double blind study.Criteria for MIH, included teeth in both groups: low enamel oppacities with no caries present, fully erupted, cross arch availability. After four years of evaluation, results show that pit and fissure sealants placed using a 5th generation bonding agent had a higher retention rate (70% were fully sealed, 29.7% partially sealed and none were unsealed) compared to conventional fissure sealants (25.5% fully sealed, 44.6% partially sealed and 29.7% unsealed)on study treated teeth. Data showed that there was a statistical difference between the retention rate of the two groups p<0.001. The teeth on which a one step adhesive was applied prior to sealant material had better retention then those without the adhesive layer. Further analysis revealed no difference in the caries rate and enamel breakdowns between either group: p>0.01. Conclusion and recommendation is that an adhesive layer used on MIH teeth allows for improved retention rates for dental sealants over time.
Evidence Search ("Dental Enamel Hypoplasia"[Mesh]) AND "Pit and Fissure Sealants"[Mesh] AND "last 5 years"[PDat]
Comments on
The Evidence
Fragelli’s study used Fischer’s exact test at a 5% level of significance (p>0.05) and SPSS16.0 software to analyze the results of the study. Both studies calibrated and blinded examiners to reduce bias and maintain protocol. The cited evidence provides overarching evidence to indicate there is decreased risk of caries and enamel loss in MIH that are sealed. Furthermore, adding an adhesive prior to sealant placement provides increased retention for standard pit and fissure sealants on MIH teeth. Additionally, due to varying degrees of MIH opacity throughout a population, further studies which include larger sample and control groups will better represent actuality as well as provide data that can better determine a standard retention rate for 5th generation bonding agent type sealants
Applicability Poor oral hygiene is extremely common in children with MIH due heightened pulp sensitivity . This can result in plaque stagnation and caries development.. MIH teeth can also exhibit post-eruptive fractures and low caries resistance due to hypo-hydroxyappatite formation. Therefore, timely intervention is highly recommended. MIH teeth with yellow/brown oppacities are more porous than white/yellow. Since sealants are retained mostly through chemical adhesion in MIH teeth, evidence supports that although there will be higher annual failure rates, early intervention with sealants and then providing re-sealings are effective in caries prevention and enamel fracture. Such treatment can possibly avoid more invasive treatment in the future for pediatric patients.
Specialty (General Dentistry) (Pediatric Dentistry) (Restorative Dentistry)
Keywords Molar Incisor Hypo mineralization, Sealants, GI fissure sealant, 5th generation adhesive system; adhesive use
ID# 3325
Date of submission 09/06/2018
E-mail pathiyil@livemail.uthscsa.edu
Author Nessa Pathiyil DDS
Co-author(s) e-mail
Faculty mentor Dr. Kevin Donly
Faculty mentor e-mail donly@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
Comments and Evidence-Based Updates on the CAT
None available