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Outcome and comparator choice in molar incisor hypomineralisation (MIH) intervention studies: a systematic review and social network analysis
  1. Karim Elhennawy1,
  2. Joachim Krois2,
  3. Paul-Georg Jost-Brinkmann1,
  4. Falk Schwendicke2
  1. 1 Department of Orthodontics, Dentofacial Orthopedics and Pedodontics, Charité – Universitätsmedizin Berlin, Berlin, Germany
  2. 2 Department of Operative and Preventive Dentistry, Charité – Universitätsmedizin Berlin, Berlin, Germany
  1. Correspondence to Dr Karim Elhennawy; karim.elhennawy{at}


Objectives Outcome and comparator choice strongly determine the validity and implementation of clinical trial results. We aimed to assess outcome and comparator choice in intervention studies on molar incisor hypomineralisation (MIH) using systematic review and social network analysis (SNA).

Design and data sources Medline, Embase, Cochrane Central, Google Scholar, as well as and were searched for MIH intervention studies. The search covered the period from 1980 to 2019.

Eligibility criteria Clinical single-arm/multiarm, controlled/uncontrolled studies reporting on the management of MIH were included. Reported outcomes and comparators were extracted and categorised. SNA was used to evaluate comparator choice and the resulting trial networks.

Data extraction Of the 7979 identified records, 100 were evaluated in full text and 35 studies (17 randomised controlled trials, 14 prospective and 4 retrospective cohort studies) were included.

Results In total, 2124 patients with a mean age of 11 years (min/max 6/70 years) were included. Outcomes fell in one of 11 different outcome categories: restoration success, aesthetic improvement, pain/hypersensitivity/discomfort, mineral gain, space management, anaesthesia effectiveness, preventive success, efficiency, quality of life, gingival and periodontal health and patient satisfaction. Comparators were mainly restorative interventions (17 studies), remineralisation (3), treatment of hypersensitivity (10), aesthetic interventions (5) and orthodontic interventions (3). Two highly clustered comparator networks emerged; many interventions were not robustly linked to these networks.

Conclusions MIH intervention studies recorded both clinically centred and patient-centred outcomes. Core outcome set development should consider these and supplement them with outcomes on, for example, applicability. The high number of compared interventions tested in only few studies and our SNA results implicate that the current evidence may not be robust.

  • systematic review
  • molar incisor hypomineralisation
  • core outcome set
  • outcomes
  • MIH
  • prevention
  • management
  • intervention

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  • Contributors The study was conceived by KE and FS. KE, FS and JK analysed, interpreted the data.KE, P-GJ-B and FS wrote the manuscript. All authors read and approved the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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