Clinical trial NCT03870958: Glass Ionomer Cement Sealant in the Prevention of Post-eruptive Fractures in Molars Affected by MIH
Official title: Cost-effectiveness of the Application of Glass Ionomer Cement Sealant (GC Fuji TRIAGE®) in the Prevention of Post-eruptive Fractures in Molars Affected by Molar-Incisor Hipomineralisation: Controlled and Randomized Clinical Trial
Study type: INTERVENTIONAL
Overall status: UNKNOWN
Phase: NA
Conditions: Molar Incisor Hypomineralization
Lead sponsor: University of Sao Paulo
Sponsor class: OTHER
Collaborators: name: University of Guadalajara
name: University of Dublin, Trinity College
name: Academic Centre for Dentistry in Amsterdam
First posted: 2019-03-12
Enrollment: 195
Sex: ALL
Minimum age (years): 6
Maximum age (years): 9
Standard ages: CHILD
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: This two-arm, parallel group, patient-randomized controlled, superiority trial will have treatment provided in schools. Schoolchildren (age 6-9), presenting at least one MIH molar (n molars = 195,) will have random allocation to treatment with or without the application of a GIC sealant (GC Fuji TRIAGE®, GC Europe, Leuven, Belgium).
Primary purpose: PREVENTION

Brief summary: This trial will compare the application of Glass Ionomer Cement (GIC) sealant with no-intervention for the most clinically- and cost-effective strategy for managing MIH molars without post-eruptive breakdown, in a school setting, using low-technology and child-friendly dental techniques. Methods/Design: This two-arm, parallel group, patient-randomized controlled, superiority trial will have treatment provided in schools. Schoolchildren (age 6-9), presenting at least one MIH molar (n molars = 195,) will have random allocation to treatment with or without the application of a GIC sealant (GC Fuji TRIAGE®, GC Europe, Leuven, Belgium). Baseline measures and outcome data will be assessed through participant report and clinical examination. The primary outcome is the presence of post-eruptive fracture and development of caries lesions. Secondary outcomes are: (1) self-reported dental hypersensitivity; (2) oral health-related-quality of life, reported by children; (3) plaque index, (4) gingival health, (5) caries status (according to ICCMS scores) in primary and permanent teeth; (6) the incremental cost-effectiveness. A trained and calibrated examiner will evaluate the treated teeth every six months post treatment for a period of 36 months. Kaplan-Meier and Cox regression tests will be used to investigate the primary outcome. The Logistic Regression and Poisson Regression Analysis will be used to analyze the secondary outcomes (α=5%).

Detailed description: Background: Molar-Incisor Hypomineralisation (MIH) is defined as a qualitative defect that occurs during the mineralization phase of enamel of at least one first permanent molar. The opacities vary in size and color and are demarcated by healthy enamel. MIH molars present lower mechanical properties when compared to non-affected molars, due to the enamel's decreased mineralization. Allied to that, patients often report dental hypersensitivity, which impairs the mechanical removal of dental plaque; therefore, those molars are more prone to post-eruptive fractures and present higher risk of developing dental caries. This trial will compare the application of Glass Ionomer Cement (GIC) sealant with no-intervention for the most clinically- and cost-effective strategy for managing MIH molars without post-eruptive breakdown, in a school setting, using low-technology and child-friendly dental techniques. Methods/Design: This two-arm, parallel group, patient-randomized controlled, superiority trial will have treatment provided in schools. Schoolchildren (age 6-9), presenting at least one MIH molar (n molars = 195,) will have random allocation to treatment with or without the application of a GIC sealant (GC Fuji TRIAGE®, GC Europe, Leuven, Belgium). Baseline measures and outcome data will be assessed through participant report and clinical examination. The primary outcome is the presence of post-eruptive fracture and development of caries lesions. Secondary outcomes are: (1) self-reported dental hypersensitivity; (2) oral health-related-quality of life, reported by children; (3) plaque index, (4) gingival health, (5) caries status (according to ICCMS scores) in primary and permanent teeth; (6) the incremental cost-effectiveness. A trained and calibrated examiner will evaluate the treated teeth every six months post treatment for a period of 36 months. Kaplan-Meier and Cox regression tests will be used to investigate the primary outcome. The Logistic Regression and Poisson Regression Analysis will be used to analyze the secondary outcomes (α=5%).

Eligibility criteria: Inclusion criteria:

* children whose parents or legal guardians accept and sign the informed consent form; -children who assent to participate into the research;
* aged between 6 and 9 years;
* exhibiting good general health conditions and cooperative behavior;
* presenting at least one MIH molar.

Exclusion criteria:

* children presenting health conditions that impair the dental treatment, or children undergoing orthodontic treatment;
* MIH molars that present opacities not located on the occlusal surface, with post-eruptive breakdown, with the occlusal surface totally or partial covered by a gingival operculum, with caries dentine lesion (ICCMS score C), restorations or sealants.

Primary outcomes:
measure: Post-eruptive breakdown
timeFrame: After 12 months
Secondary outcomes:
measure: Caries lesions assessment
timeFrame: Every 6 months up to 36 months
measure: Sealant retention
timeFrame: Every 12 months up to 36 months
measure: Oral health-related quality of life (OHRQoL)
timeFrame: Baseline and every 12 months up to 36 months
measure: Cost-efficacy of treatments
timeFrame: Baseline, after treatment and every 12 months up to 36 months
measure: Hypersensitivity
timeFrame: hypersensitivity will be evaluated at 6-month intervals so that evaluations will be completed in 6, 12, 18, 24, 30 and 36 months by the same examiner.
Other outcomes:
Locations:
city: Guadalajara
country: Mexico
facility: Isaac Murisi Pedroza
state: Jalisco
Study officials:
affiliation: Academic Centre for Dentistry in Amsterdam
name: Daniela Hesse, Professor
role: STUDY_CHAIR
affiliation: University of Guadalajara
name: Isaac M Pedroza Uribe, MSc
role: PRINCIPAL_INVESTIGATOR
References:
citation: Ghanim A, Marino R, Manton DJ. Validity and reproducibility testing of the Molar Incisor Hypomineralisation (MIH) Index. Int J Paediatr Dent. 2019 Jan;29(1):6-13. doi: 10.1111/ipd.12433. Epub 2018 Oct 22.
citation: Folayan MO, Chukwumah NM, Popoola BO, Temilola DO, Onyejaka NK, Oyedele TA, Lawal FB. Developmental defects of the enamel and its impact on the oral health quality of life of children resident in Southwest Nigeria. BMC Oral Health. 2018 Sep 27;18(1):160. doi: 10.1186/s12903-018-0622-3.
citation: Ebel M, Bekes K, Klode C, Hirsch C. The severity and degree of hypomineralisation in teeth and its influence on oral hygiene and caries prevalence in children. Int J Paediatr Dent. 2018 Nov;28(6):648-657. doi: 10.1111/ipd.12425. Epub 2018 Sep 23.
citation: Velandia LM, Alvarez LV, Mejia LP, Rodriguez MJ. Oral health-related quality of life in Colombian children with Molar-Incisor Hypomineralization. Acta Odontol Latinoam. 2018 Jun;31(1):38-44.
citation: Fragelli CMB, Souza JF, Bussaneli DG, Jeremias F, Santos-Pinto LD, Cordeiro RCL. Survival of sealants in molars affected by molar-incisor hypomineralization: 18-month follow-up. Braz Oral Res. 2017 Apr 27;31:e30. doi: 10.1590/1807-3107BOR-2017.vol31.0030.
citation: Schraverus MS, Olegario IC, Bonifacio CC, Gonzalez APR, Pedroza M, Hesse D. Glass Ionomer Sealants Can Prevent Dental Caries but Cannot Prevent Posteruptive Breakdown on Molars Affected by Molar Incisor Hypomineralization: One-Year Results of a Randomized Clinical Trial. Caries Res. 2021;55(4):301-309. doi: 10.1159/000516266. Epub 2021 Jun 9.