Nano Silver Fluoride and Photobiomodulation Therapy for Hypersensitivity and Pain in MIH-Affected Molars

Overview

Molar-incisor hypomineralization (MIH) is a developmental condition affecting primarily the first permanent molars and may be associated with post-eruptive enamel breakdown, hypersensitivity, and difficulties in achieving adequate pain control during dental treatment. This randomized controlled trial will evaluate the effectiveness of nano silver fluoride (NSF) and photobiomodulation therapy (PBMT) as desensitizing interventions applied before cavity preparation in children aged 7-12 years with MIH-affected first permanent molars with post-eruptive enamel breakdown. The study will compare the effects of NSF and PBMT with a control group receiving pre-appointment analgesics. Hypersensitivity will be assessed using the Cumulative Hypersensitivity Index (CHI), while pain during cavity preparation and restoration will be evaluated using the Wong-Baker FACES Pain Rating Scale and pulse rate monitoring. All treated molars will receive glass ionomer cement restorations, which will subsequently be evaluated using the Modified United States Public Health Service (USPHS) criteria at 3, 6, and 12 months.

Molar-incisor hypomineralization (MIH) is a developmental condition primarily affecting the enamel of the first permanent molars. Affected teeth may exhibit demarcated opacities, post-eruptive structural loss of enamel, hypersensitivity, and difficulties during restorative treatment. This study will evaluate the effect of using nano silver fluoride (NSF) and photobiomodulation therapy (PBMT) as desensitizing agents prior to cavity preparation in permanent molars affected by MIH with post-eruptive enamel breakdown. A total of 45 children aged 7-12 years will be included and randomly assigned to three groups, with 15 participants in each group: Group A: Nano silver fluoride (NSF). The affected molar will receive a single application of NSF 15 days before cavity preparation and restoration. Group B: Photobiomodulation therapy (PBMT). The affected molar will receive PBMT 15 days before cavity preparation and restoration using a low-level diode laser with a wavelength of 980 nm and a power output of 100 mW. Group C: Control group. Participants will receive oral hygiene instructions and pre-appointment analgesics before cavity preparation and restoration. For the NSF group, hypersensitivity will be assessed at baseline and 15 minutes after application, and again after 15 days. For the PBMT group, hypersensitivity will similarly be assessed at baseline, 15 minutes after treatment, and after 15 days. The control group will undergo baseline assessment and receive the planned pre-appointment analgesic regimen. At the second visit, hypersensitivity will be reassessed, followed by conventional cavity preparation and restoration. Pain during the procedure will be assessed using the Wong-Baker FACES Pain Rating Scale and pulse rate monitoring. All molars will be restored using glass ionomer cement (GC Equia Forte HT). The restorations will be clinically evaluated at 3, 6, and 12 months using the Modified United States Public Health Service (USPHS) criteria. The study will be conducted at the outpatient clinic of the Department of Pediatric Dentistry and Dental Public Health and the Laser Unit, Faculty of Dentistry, Ain Shams University.