Treatment options for hypomineralized first permanent molars and incisors

Abstract

The aim of this study was to discuss therapy possibilities in the management of molar incisor hypomineralization. Molar incisor hypomineralization (MIH) is defined as hypomineralization of one or more first permanent molars frequently affecting incisors. Etiology of MIH is not fully clarified and numerous etiological factors have been cited. Hypomineralized molars are more prone to caries, cause severe restorative problems and are frequently extracted due to serious damage and caries complications. Incisors can present demarcated enamel opacities, while enamel breakdown is uncommon. Clinically, affected molars can be sensitive to thermal and chemical irritations even when there is no enamel breakdown. Molars can be sensitive to mechanical irritations making even regular tooth brushing painful. Specific problems related to the treatment of these teeth are sensitivity and occlusion in molars and aesthetics in incisors. Considering the fact that permanent first molars with severe defects and incisors demand complex and multidisciplinary treatment they present serious problem for the patient as well as for the dentist

Molar-incisor hypomineralization: Therapeutic challenge to paediatric dentistry practice

“…Podaci o prevalenciji ovih defekata na ostalim stalnim zubima su oskudni, s obzirom da se epidemološka istraživanja najčešće rade u uzrastu kada ovi zubi još nisu nikli u ustima deteta 6 . Zvaničnih podataka o rasprostranjenosti MIH za našu zemlju nema, mada se procenjuje da iznosi oko 19,5% 7,8 . Osnovni patogenetski mehanizam MIH je poremećaj resorptivnog potencijala ameloblasta i inhibicija proteolitičkih enzima usled čega dolazi do zadržavanja gleđnih proteina, ometanja rasta kristala i maturacije gleđi [9][10][11][12][13][14] .…”

“…According to the severity of clinical picture, MIH has been classified into mild, moderate and severe form 21 . Asymmetry is a significant characteristic of MIH and indicates that the enamel of the first permanent molar/incisor is more affected or is affected by more severe changes compared to the enamel of contralateral first permanent molar/incisor 7,22 . Changes on first permanent molars vary from whitish blur to heavy hypomineralized changes accompanied by cracking enamel, often during teething, so dentine remains unprotected and the carious lesion is easily developed.…”

“…Data on the prevalence of these defects on other permanent teeth are scarce, given that epidemiological research is most often conducted at the age when these teeth have not yet sprung out in the mouth of the child 6 . There are no official data on the prevalence of MIH for our country, but it is estimated to be approximately 19.5% 7,8 . The main pathogenic mechanism of MIH is the disorder of adsorbent potential of ameloblasts and inhibition of proteolytic enzymes, causing retention of enamel proteins, interfering with crystal growth and maturation of enamel [9][10][11][12][13][14] .…”

“…Prema težini kliničke slike, MIH je klasifikovana na blagu, umerenu i tešku formu 21 . Asimetrija je značajna karakteristika MIH i označava pojavu da je gleđ jednog prvog stalnog molara /inciziva zahvaćena više ili težom vrstom promena u odnosu na gleđ kontralateralnog prvog stalnog molara/inciziva 7,22 . Promene na prvim stalnim molarima variraju od beličastih zamućenosti do teških hipomineralizovanih promena praćenih pucanjem gleđi, često već u toku nicanja zuba, te dentin ostaje nezaštićen, pa se karijesna lezija lako razvija.…”

Hipomineralización Incisivo Molar, una condición clínica aún no descrita en la niñez costarricense

“…No siempre la alteración se manifiesta en los incisivos, pero pueden llegar a afectarse en más del 30% de los casos, sobre todo los centrales superiores (10), en los que por lo general no se presenta pérdida estructural (19) aún cuando la lesión se puede extender ampliamente en la superficie vestibular (24). Ello representa un importante problema estético, debido a la visibilidad de las opacidades (25).…”