Effect of two remineralization agents on mild and moderate Molar Incisor Hypomineralization defects in Mexican schoolchildren: a double-blind randomized controlled clinical trial

Background: Remineralization is the process of depositing calcium and phosphate ions into crystal voids in demineralized dental enamel preventing early enamel lesions progression. To evaluate, via laser fluorescence, the effect of the two remineralizing agents Fluor protector™ and Clinpro White Varnish™ on the permanent molars and incisors of 8–12-year-old Mexican schoolchildren with mild and moderate Molar Incisor Hypomineralization (MIH). Methods: The study was conducted on 78 children divided randomly into three groups: Group I—Oral-B kids™ toothpaste (sodium fluoride at 1100 ppm), which was used as the control group; Group II—Fluor protector™; and Group III—Clinpro White Varnish™. The remineralization effect was evaluated via Laser Fluorescence (LF) on commencement of the treatment, then one and three months later. The paired samples t-test was used to evaluate the changes observed in the LF average values during the monitoring period, an intragroup one-way repeated-measures analysis of variance (ANOVA) was carried out to evaluate the effectiveness of the remineralizing agents, and the Greenhouse-Geisser correction was applied to evaluate sphericity. Results: Both agents obtained higher levels of remineralization, than the control treatment, of the mild and moderate MIH defects after three months of monitoring (p < 0.001). The difference observed among the LF average values were similar for both treatment groups. Conclusions: The results obtained enable the conclusion that fluoride varnishes such as Fluor Protector™ and Clinpro White Varnish™ are effective in remineralizing mild and moderate MIH lesions evaluated via LF. Clinical Trial Registration: The protocol was also registered on the ClinicalTrials.gov Identifier, under the reference NCT06362681.

Molar Incisor Hypomineralization; Laser fluorescence; Remineralization; Fluoride varnish; Children

[1] Seow WK. Developmental defects of enamel and dentine: challenges for basic science research and clinical management. Australian Dental Journal. 2014; 59: 143–154.

[2] Zameer M, Birajdar SB. The ‘mysterious aetiology’ of molar incisor hypomineralisation. European Archives of Paediatric Dentistry. 2022; 23: 987–988.

[3] de Farias AL, Rojas-Gualdrón DF, Girotto Bussaneli D, Santos-Pinto L, Mejía JD, Restrepo M. Does molar-incisor hypomineralization (MIH) affect only permanent first molars and incisors? New observations on permanent second molars. International Journal of Paediatric Dentistry. 2022; 32: 1–10.

[4] Sluka B, Held U, Wegehaupt F, Neuhaus KW, Attin T, Sahrmann P. Is there a rise of prevalence for molar incisor hypomineralization? A meta-analysis of published data. BMC Oral Health. 2024; 24: 127.

[5] Neboda C, Anthonappa RP, King NM. Tooth mineral density of different types of hypomineralised molars: a micro-CT analysis. European Archives of Paediatric Dentistry. 2017; 18: 377–383.

[6] Fagrell TG, Dietz W, Jälevik B, Norén JG. Chemical, mechanical and morphological properties of hypomineralized enamel of permanent first molars. Acta Odontologica Scandinavica. 2010; 68: 215–222.

[7] Farah RA, Swain MV, Drummond BK, Cook R, Atieh M. Mineral density of hypomineralised enamel. Journal of Dentistry. 2010; 38: 50–58.

[8] Bozal CB, Kaplan A, Ortolani A, Cortese SG, Biondi AM. Ultrastructure of the surface of dental enamel with molar incisor hypomineralization (MIH) with and without acid etching. Acta Odontológica Latinoamericana. 2015; 28: 192–198.

[9] Bhandari R, Thakur S, Singhal P, Chauhan D, Jayam C, Jain T. In vivo comparative evaluation of esthetics after microabrasion and microabrasion followed by casein phosphopeptide-amorphous calcium fluoride phosphate on molar incisor hypomineralization-affected incisors. Contemporary Clinical Dentistry. 2019; 10: 9–15.

[10] Gatón-Hernandéz P, Serrano CR, da Silva LAB, de Castañeda ER, da Silva RAB, Pucinelli CM, et al. Minimally interventive restorative care of teeth with molar incisor hypomineralization and open apex—a 24-month longitudinal study. International Journal of Paediatric Dentistry. 2020; 30: 4–10.

[11] Rao A, Malhotra N. The role of remineralizing agents in dentistry: a review. Compendium of Continuing Education in Dentistry. 2011; 32: 26–33; quiz 34, 36.

[12] Restrepo M, Jeremias F, Santos-Pinto L, Cordeiro RC, Zuanon AC. Effect of fluoride varnish on enamel remineralization in anterior teeth with molar incisor hypomineralization. Journal of Clinical Pediatric Dentistry. 2016; 40: 207–210.

[13] Pollick H. The role of fluoride in the prevention of tooth decay. Pediatric clinics of North America. 20148; 65: 923–940.

[14] Baik A, Alamoudi N, El-Housseiny A, Altuwirqi A. Fluoride varnishes for preventing occlusal dental caries: a review. Dentistry Journal. 2021; 9: 64.

[15] Donly KJ. Fluoride varnishes. Journal of the California Dental Association. 2003; 31: 217–219.

[16] Mohd Said SN, Ekambaram M, Yiu CK. Effect of different fluoride varnishes on remineralization of artificial enamel carious lesions. International Journal of Paediatric Dentistry. 2017; 27: 163–173.

[17] Byeon SM, Lee MH, Bae TS. The effect of different fluoride application methods on the remineralization of initial carious lesions. Restorative Dentistry & Endodontics. 2016; 41: 121–129.

[18] Olgen IC, Sonmez H, Bezgin T. Effects of different remineralization agents on MIH defects: a randomized clinical study. Clinical Oral Investigations. 2022; 26: 3227–3238.

[19] Sezer B, Kargul B. Effect of remineralization agents on molar-incisor hypomineralization-affected incisors: a randomized controlled clinical trial. Journal of Clinical Pediatric Dentistry. 2022; 46: 192–198.

[20] Biondi AM, Cortese SG, Babino L, Fridman DE. Comparison of mineral density in molar incisor hypomineralization applying fluoride varnishes and casein phosphopeptide-amorphous calcium phosphate. Acta Odontológica Latinoamericana. 2017; 30: 118–123.

[21] Gutiérrez TV, Ortega CCB, Pérez NP, Pérez AG. Impact of molar incisor hypomineralization on oral health-related quality of life in Mexican schoolchildren. Journal of Clinical Pediatric Dentistry. 2019; 43: 324–330.

[22] Billings M, Lopez Mitnik G, Dye B. Sample size for clinical trials. Oral Diseases. 2017; 23: 1013–1018.

[23] Lygidakis NA, Dimou G, Marinou D. Molar-incisor-hypomineralisation (MIH). A retrospective clinical study in Greek children. II. Possible medical aetiological factors. European Archives of Paediatric Dentistry 2008; 9: 207–217.

[24] Inchingolo AM, Inchingolo AD, Viapiano F, Ciocia AM, Ferrara I, Netti A, et al. Treatment approaches to molar incisor hypomineralization: a systematic review. Journal of Clinical Medicine. 2023; 12: 7194.

[25] Bizhang M, Kaleta-Kragt S, Singh-Hüsgen P, Altenburger MJ, Zimmer S. Effect of 10% fluoride on the remineralization of dentin in situ. Journal of Applied Oral Science. 2015; 23: 562–570.

[26] Piesiak-Pańczyszyn D, Zakrzewski W, Piszko A, Piszko PJ, Dobrzyński M. Review on fluoride varnishes currently recommended in dental prophylaxis. Polymers in Medicine. 2023; 53: 141–151.

[27] Bijle MN, Ekambaram M, Lo EC, Yiu CKY. The enamel remineralization potential of fluoride varnishes containing arginine. Journal of Dentistry. 2020; 99: 103411.

[28] Koruyucu M, Özel S, Tuna EB. Prevalence and etiology of molar-incisor hypomineralization (MIH) in the city of Istanbul. Journal of Dental Sciences. 2018; 13: 318–328.

[29] West NX, Joiner A. Enamel mineral loss. Journal of Dentistry. 2014; 42: S2–S11.

[30] Sezer B, Tuğcu N, Calışkan C, Durmuş B, Kupets T, Bekiroğlu N, et al. Effect of casein phosphopeptide amorphous calcium fluoride phosphate and calcium glycerophosphate on incisors with molar-incisor hypomineralization: a cross-over, randomized clinical trial. Bio-Medical Materials and Engineering. 2022; 33: 325–335.

[31] Lygidakis NA, Garot E, Somani C, Taylor GD, Rouas P, Wong FSL. Best clinical practice guidance for clinicians dealing with children presenting with molar-incisor-hypomineralisation (MIH): an updated European Academy of Paediatric Dentistry policy document. European Archives of Paediatric Dentistry. 2022; 23: 3–21.

[32] Altan H, Yilmaz RE. Clinical evaluation of resin infiltration treatment masking effect on hypomineralised enamel surfaces. BMC Oral Health. 2023; 23: 444.

[33] Farah RA, Drummond BK, Swain MV, Williams S. Relationship between laser fluorescence and enamel hypomineralisation. Journal of Dentistry. 2008; 36: 915–921.

[34] Juárez-López MLA, Salazar-Treto LV, Hernández-Monjaraz B, Molina-Frechero N. Etiological factors of molar incisor hypomineralization: a systematic review and meta-analysis. Dentistry Journal. 2023; 11: 111.

[35] Garot E, Rouas P, Somani C, Taylor GD, Wong F, Lygidakis NA. An update of the aetiological factors involved in molar incisor hypomineralisation (MIH): a systematic review and meta-analysis. European Archives of Paediatric Dentistry. 2022; 23: 23–38.

[36] Crombie FA, Manton DJ, Palamara JE, Zalizniak I, Cochrane NJ, Reynolds EC. Characterisation of developmentally hypomineralised human enamel. Journal of Dentistry. 2013; 41: 611–618.

[37] Cardoso-Martins I, Pessanha S, Coelho A, Arantes-Oliveira S, Marques PF. Evaluation of the efficacy of CPP-ACP remineralizing mousse in molar-incisor hypomineralized teeth using Polarized Raman and Scanning Electron Microscopy—an in vitro study. Biomedicines. 2022; 10: 3086.