Effectiveness of Various Pain Control Methods in Managing MIH —A Systematic Review and Meta‐Analysis

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Abstract
Background: Pain management in children with molar–incisor hypomineralisation (MIH) presents a significant challenge, as affected teeth often respond poorly to local anaesthesia due to altered enamel and heightened pulp sensitivity. Overcoming these difficulties is crucial to achieving effective dental outcomes. Aim: To evaluate the effectiveness of pharmacological, desensitising and behavioural strategies for pain control in children and adolescents with MIH. Design: Systematic search of multiple electronic databases identified studies published between 2001 and 2024. Eligible designs included randomised controlled trials, randomised crossover studies and clinical trials. Risk of bias was assessed using Cochrane RoB 2 and ROBINS‐I V2 tools and certainty of evidence graded with GRADEpro. A random‐effects meta‐analysis was conducted to assess anaesthetic success with 4% articaine. Results: Thirteen studies were selected, with six included in the meta‐analysis. Pooled success rates for 4% articaine were 0.849 for inferior alveolar nerve block and 0.915 for intraosseous injection. Findings suggest improved anaesthetic success compared with 2% lidocaine. Pre‐emptive ibuprofen, laser desensitisation and virtual reality distraction also showed benefits for reducing pain and anxiety. Conclusion: Current evidence suggests that an individualised, multimodal approach may improve pain management in children with MIH. However, further high‐quality comparative studies are needed to guide clinical protocols. Trial Registration: PROSPERO Registration: CRD42024474840

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