Sealants in Molars Affected by Molar-Incisor Hypomineralization
Survival of Sealants in Molars Affected by Molar-Incisor Hypomineralization
Aim: To evaluate the clinical survival of fluoride sealants applied in first permanent
molars affected by Molar-Incisor Hypomineralization (MIH).
Material and Methods: For this case control study, it was selected 41 first permanent molars
of the 21 children aged 6-8 years. MIH was classified by one calibrated examiner (kappa
0.80) according severity of the MIH lesion (EAPD, 2003). Inclusion criteria were FPM with
MIH or sound (without MIH), fully erupted, and with sealant treatment indication.
The FPMs were assigned into two groups: G1 - Control group and G2 - MIH group. Both group
teeth were treated with sealant application (Fluroshield, NY, USA). Clinical follow-up was
performed at baseline, 1, 6, 12 and 18 months for anatomic form, marginal adaptation,
retention and presence of caries, according to the United States Public Health Service
USPHS-Modified by a blinded examiner (kappa 0.80). The Acturial Method was used to evaluate
the survival of sealants. Statistical analysis compared the ratings of each criterion
between materials using the Fisher's exact test at a level of significance of 5% (p<0.05).
This study was conducted according to the Helsink Declaration. The approval was obtained
from the Ethics and Research Committee at Araraquara Dental School, São Paulo, Brazil
(protocol #11/09). All parents/guardians of the children signed the informed consent.
This case control study included four clinical exams performed in 6 to 8 years-old children
that received preventive treated with sealants, divided into 2 groups: G1 - teeth not affect
by MIH and G2 - teeth affect by MIH.
The 21 children included in the study had been previously diagnosed with MIH, according to
the EAPD criteria. A total of 41 first permanent molars teeth (FPM) were included, being 16
without MIH and 25 with MIH.
Calibration of the examiner for the evaluations:
The examiner was calibrated according to MIH based on criteria proposed by the European
Academy of Pediatric Dentistry and for USPHS-Modified. The examiner assessed 32 clinical
photographs of patients from the Clinic of Pediatric Dentistry of the Araraquara Dental
School in São Paulo, Brazil, followed by a discussion with the MIH research team of all the
indices and codes. After an agreement, 30 patients with enamel alterations (17 of them with
MIH) were evaluated. After 2 weeks, the patients were reevaluated and the Kappa coefficient
was used to verify the agreement between the evaluations. The intra-examiner values for MIH
and USPHS-modified were 0.80.
The 41 FMP were clinically examined and classified according the presence of MIH according
the European Association of Paediatric Dentistry and were distributed into groups. The
preventive procedures were performed at the Pedodontics Clinics of São Paulo State
University, for another operator. All teeth receive pre-treat with care 4 weekly
applications of fluoride varnish (Duraphat, NY, USA).
Both group teeth were treated with sealants.
The four clinical exams (1, 6, 12 and 18 months) were performed in a clinical environment
according exams preconized by the World Health Organization under artificial lights and
The sealants were clinically evaluated by a calibrated examiner (Kappa 0.80). The groups
were evaluated according to the criteria for quality of the restoration proposed by the
United States Public Health Service USPHS-Modified and classified as satisfactory or
unsatisfactory. When the tooth was considered unsatisfactory, it was considered failure and
the treatment was replaced but it had not considered for the research evaluations.
Molar Incisor Hypomineralization
Universidade Federal do Paraná
Universidade Federal do Paraná