Mascaramento de opacidades do esmalte dentário em pacientes com Hipomineralização Molar Incisivo: relato de caso e ensaio clínico controlado randomizado

Abstract

This thesis comprises two studies: a case report and randomized controlled trial. The protocols were approved by the Ethics Committee (UERJ) and participants/guardians signed an informed consent. A case report described a minimally invasive approach, infiltration technique with a low-viscosity resin, combined with composite restoration, to mask diffuse (fluorosis) and demarcated opacities (MIH), in permanent anterior teeth, in an eight-year-old child. The clinical report concluded that the treatment was effective in masking the opacities and after 24 months the color was stable and the patient satisfied. The randomized controlled trial that aimed to evaluate the impact of masking MIH demarcated opacities in permanent incisors. Thirty-nine patients, 8 to 18 years old, presenting at least one permanent incisor with white-creamy opacity were randomly allocated to test or control group. In the test group 28 teeth were treated and 29 in placebo group. The test received microabrasion + resin infiltration and the control received a placebo. Infiltrant and placebo were left on the teeth for 30 minutes. The evaluation of the treatment impact was carried out through the questionnaire: Child's and Parent's Questionnaire about Teeth Appearance. The masking effect was quantitatively analyzed by digital photography using the Lab System and ΔE between opacity area and sound area of the enamel (Photoshop). Two calibrated examiners did the qualitative analysis of clinical photographs. The impact of the test and placebo treatment on the perception about teeth appearance (mean score of the questionnaire) was analyzed by Wilcoxon test. The qualitative result (total, partial or no masking) was compared using Chi-square test. The examiners agreement was assessed using kappa coefficient. Mann-Whitney was used to test the difference in ΔE values in the different time points. Two summary measures were the main outcomes: the absolute and the percentage difference between initial ΔE and final/ follow-up ΔE. The level of significance was set at 0.05. In the test group, it was observed a significant reduction in the questionnaire scores in relation to physical (p = 0.01), psychological (p = 0.02), and social (p = 0.04) domains in parents' point of view after treatment. In the social domain a significant reduction was also seen in the children's opinion (p = 0.00). The parents (p=0.01) and children (p=0.04) from test group reported significantly less concern with tooth colour after treatment. Before treatment, the ΔE was 6.45 ± 3.53 in the test and 5.98 ± 2.57 in the control group (p=0.88). A significant difference between test and control groups was seen from 15 minutes of application onwards. After treatment, the ΔE was 4.07 ± 3.07 in the test and 7.35 ± 3.54 in the control group (p=0.000). In the follow up evaluation the mean ΔE was 4.22 ± 2.96 in the test and 6.06 ± 2.52 in the control group (p=0.002). A total masking was achieved in 16 (57.1%) and 13 (46.4%) teeth of the test group, according to the examiner 1 and 2, respectively. As a conclusion, observed a positive impact of resin infiltration on parents’ and children’s perception about tooth appearance. The infiltration decreased ΔE between the MIH opacities and sound enamel.