Efficacy of cryotherapy with local anesthesia in pain control during restoration of teeth with Molar Incisal Hypomineralisation - A Randomized Control Trial

INTRODUCTION: Molar Incisor hypomineralisation (MIH) is a prevalent dental condition that affects up to 25% of children worldwide. In general, enamel hypomineralization is caused by  disturbances in the function of ameloblast cells during any of the amelogenesis stages. MIH is believed to be due to multifactorial systemic factors that contribute to enamel hypomineralization. Its exact etiology remains uncertain.  Clinical management of young patients with MIH affected teeth becomes more challenging due to difficulty in achieving local anesthesia as there is  chronic sub clinical inflammation caused by ingress of bacteria in the exposed dentin, this causes an altered nerve potential. Inadequate anaesthsia leads to  limited cooperation for treatment  by the young children, thus affecting the quality of the restorations

RATIONALE OF THE STUDY: Studies have shown that cryotherapy application boosts the efficacy of pulpal anesthesia of the mandibular first permanent molars with Symptomatic Irreversible pulpitis . Therefore the efficacy of cryotherapy after Local administration is tested for pain control in patients with MIH

PROCEDURE  Group 1 (control): A standard IANB will be administered using 2.5 mL of 2% lidocaine with 1:200000 adrenaline . The block will be administered with a 24-Gauge, 25-mm needle (Dispovan) inserted and IANB will be given. Group 2 (IANB+ Endo frost spray cryotherapy): A standard IANB will be administered in the same way as in the control group, then endo-frost will be applied on the buccal, lingual (3 seconds/surface), and occlusal surfaces (4 seconds) for a total of 10seconds.

The restorative procedure in both the groups will begin 10minutes after the IANB when the patient has lip numbness. Standardization of the protocol will be done by choosing the same operator, material, technique, and clinical settings. The tooth will be isolated using a rubber dam

EVALUATION During the restorative procedure, a subjective and an observational scale is used to record the pain . Wong-Baker FPR scale  : the patients will be instructed to report their pain again on a scale. A set of six cartoon faces were shown to the child with varying facial expressions ranging from a very smiling face to a very sad face.

FLACC scale (Face, Legs, Activity, Cry, Consolability)  is recorded by an blinded observer.. The scale has five criteria, which are each assigned a score of 0, 1 or 2 Total scores are added from each criterion   EXPECTED OUTCOME: Null hypothesis: There will be no difference in pain between local anesthesia (traditional inferior alveolar nerve block) with cryotherapy and local anesthesia (traditional inferior alveolar nerve block) during restoration of MIH affected first Permanent mandibular Molar in children.