Comparative evaluation of silver diamine fluoride and universal bonding agent in reducing dental caries in cariously affected molar incisor hypomineralized permanent molar teeth: Field randomized controlled trial

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INTRODUCTION: Molar-incisor hypomineralization/MIH's high prevalence, early-onset, rapid progression, multiple teeth involvement is concerning. Providing individualized care for all affected children globally is often unfeasible, costly, and requires a significant workforce and time. This necessitates scalable solutions suitable for population level rather than traditional clinical models. Hence, practical, simplified, and effective interventions at the point of care (communities) are urgently needed. Silver diamine fluoride (SDF) and universal bonding agent (UBA) are potential field-based interventions for MIH, but comparative evidence is limited. AIM: To evaluate the efficacies of SDF and UBA in arresting caries in MIH-affected teeth in a community-based setting using ICDAS scores. MATERIALS AND METHODS: A double-blind (participants, assessors, and statisticians), randomized controlled trial was conducted in four schools in India. Of over 5000 children screened, 186 had MIH pathology; 103 consented, 89 received treatment, and 79 were followed up. A total of 212 teeth (SDF: 111, UBA: 101) were assessed after 1 year. The primary outcome was caries arrest, measured by changes in ICDAS scores. Subgroup analysis and faceted plots were used to explore clinical trends. RESULTS: McNemar-Bowker test showed no statistically significant change in ICDAS scores from baseline to 1 year in either group (SDF: P =0.133; UBA: P =0.125). Subgroup trends showed more stable and improved outcomes in the UBA group, particularly in ICDAS-1 and -2. SDF was limited by discoloration concerns. CONCLUSION: While both materials were clinically effective, UBA demonstrated a more favorable clinical trend. The study's large sample size, real-world setting, and balanced design strengthen its applicability for population-level MIH management strategies.