Selective Versus Non-selective Caries Excavation in MIH Affected Teeth.

The aim of this study is to compare the clinical and radiographic outcomes of selective versus nonselective caries removal in MIH affected teeth with deep carious lesions using enhanced clinical protocols.Cases will be collected from the undergraduate and postgraduate clinics over a 6 months' period according to predetermined inclusion criteria. Preoperative clinical and radiographic assessment will be conducted to MIH affected molars. MIH molars with deep caries (assymptomatic/ with symptoms of reversible pulpitis) will be randomly allocated for the choice of treatment with selective or non -selective caries excavation. Randomization of teeth between the 2 treatment groups will be performed using an online block randomization technique (block of 6) with the tooth as unit of randomization. Time taken for each procedure will be recorded by the research assistant each visit prospectively after achieving local anaesthesia till the end of procedure. Patients will be asked to rate their satisfaction with the received treatment on the end of treatment visit using a designed questionnaire. Clinical and radiographic success, and patient satisfaction will be evaluated at 6 and 12 months follow up.

Inclusion criteria

• The patient age <13 years old
• Non -contributory medical history
• Molar affected with MIH as per EAPD diagnostic criteria (White, creamy, or yellow to brownish opacities greater than one millimeter with/without postoperative enamel breakdown).
• Deep caries extending>= 2/3 of dentine but not exposing the pulp on the bitewing radiograph.
• The tooth should give positive response to cold sensibility testing.
• Clinical diagnosis of normal/ reversible pulpitis
• The tooth is restorable, probing pocket depth and mobility are within normal limits.
• No signs of pulpal necrosis including sinus tract or swelling
• No radiographic evidence of periapical changes indicative of apical periodontitis.

Exclusion criteria

• Medically compromised patient.
• Non-restorable tooth.
• Clinical diagnosis of irreversible pulpitis.
• Signs of pulpal necrosis including sinus tract or swelling.
• Teeth indicated for extraction for orthodontic reasons.
• Uncooperative children who could not be treated under local anesthesia.