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

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.

Inclusion criteria

• Children aged 7-12 years diagnosed with molar-incisor hypomineralization (MIH) in first permanent molars according to the European Academy of Paediatric Dentistry (EAPD) criteria.
• MIH-affected teeth exhibiting demarcated opacity, post-eruptive structural loss of enamel, and hypersensitivity (Treatment Need Index = 4).
• Children who are able to cooperate during treatment and attend scheduled follow-up visits.
• Children whose parents or legal guardians provide informed consent for participation in the study.

Exclusion criteria

• Hypomineralized molars caused by other conditions, including syndromes, fluorosis, enamel hypoplasia, amelogenesis imperfecta, or dental caries.
• Teeth with defective restorations or pulpal symptoms.
• History of desensitizing treatment within the previous 6 months.
• Use of anti-inflammatory drugs or analgesics at the time of recruitment.
• Children who are physically or mentally disabled or who have a medical condition that may complicate treatment.
• Reported allergy to silver or any material included in the study.