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Eighty-eight HPFMs with evidence of caries, with or without hypersensitivity were included. These molars scored (2a), (2b), (4a), or (4b) according to the MIH Treatment Need Index (MIH-TNI). Selective caries removal was performed using the ART protocol. The test group received ZrGI (Zirconomer\u00ae) restorations, and the control group received GhGI (Equia Forte\u00ae) restorations. Pain and sensitivity were assessed pre-operatively, using the Visual Analogue Scale (VAS), then re-assessed post-operatively after 1 week and after 3,6,9, and 12 months (M). Clinical success was evaluated, starting from the 3-month visit, using the ART evaluation criteria.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>After 12M, the median pain scores for the ZrGI gp., (Q1-Q3; 0.00 \u2013 0.00) and GhGI gp., (Q1-Q3; 0.00 \u2013 0.00) showed no statistically significant difference, (<jats:italic>p<\/jats:italic>\u2009=\u20090.329). Median sensitivity scores for the ZrGI gp., (Q1-Q3; 0.00 \u2013 5.00) and the GhGI gp., (Q1-Q3;0.00 \u2013 3.50), also showed no statistically significant difference, (<jats:italic>p<\/jats:italic>\u2009=\u20090.344). No significant difference was found between the 12M success rate of ZrGI (86.4%) and GhGI (84.1%), (<jats:italic>p<\/jats:italic>\u2009=\u20090.765).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>Regarding the reduction of pain and sensitivity, and clinical success, zirconia-reinforced GIC was as effective as glass hybrid GIC in restoring HPFM, using the ART approach.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Clinical significance<\/jats:title>\n            <jats:p>Zirconia-reinforced glass ionomer cement may be a promising restorative material due to its favorable physical properties and acceptable clinical results, as shown in this study. It may be used as an interim restoration in hypomineralized permanent first molars and holds potential for even wider applications in clinical pediatric dentistry.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Trial Registration<\/jats:title>\n            <jats:p>Please refer to this study by its ClinicalTrials.gov identifier: NCT05494749<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s00784-025-06352-y","type":"journal-article","created":{"date-parts":[[2025,5,8]],"date-time":"2025-05-08T01:12:00Z","timestamp":1746666720000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Zirconia-reinforced glass ionomer restorations in molar incisor hypomineralization: a randomized controlled clinical trial"],"prefix":"10.1007","volume":"29","author":[{"given":"Reham A.","family":"Mahfouz","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Azza G.","family":"Hanno","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amina M. 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