Clinical efficacy of silver fluoride pretreatment on hypersensitivity relief and success of glass hybrid restorations in MIH-affected molars: A randomized controlled split-mouth clinical trial

OBJECTIVES: Managing hypersensitivity in molar incisor hypomineralization (MIH)-affected first permanent molars (FPMs) remains challenging. Silver fluoride (SF) combined with potassium iodide (KI) has been suggested to reduce sensitivity and improve clinical outcomes. This study aimed to evaluate whether the application of SF+KI prior to glass hybrid (GH) restorations provides additional benefit in reducing hypersensitivity and improving clinical performance in MIH-affected FPMs. METHODS: This randomized split-mouth clinical trial included 34 children (8-13 years) with MIH-affected FPMs. A total of 82 FPMs were allocated to SF+KI+GH or GH alone. Hypersensitivity was assessed using the "Schiff Cold Air Sensitivity Scale" at baseline and at 1, 3, 6, and 12 months. Clinical performance was evaluated using modified USPHS criteria. RESULTS: Hypersensitivity decreased markedly in both groups after treatment and remained minimal throughout follow-up, with no significant differences between groups (p>0.05). At 12 months, 90.6% (29/32) of the SF+KI+GH and 93.9% (31/33) of the GH restorations were clinically acceptable; three restorations in the SF+KI+GH group and two in the GH group were classified as unsatisfactory, with survival probabilities of 89.8% and 93.9%, respectively. CONCLUSION: Both protocols effectively reduced hypersensitivity and showed acceptable short-term clinical performance. SF+KI pretreatment did not provide additional benefit over GH alone within 12 months.