Sep 29, 2019
Molar-Incisor Hypomineralisation (MIH) is a very common and burdensome condition to treat. The prevalence varies greatly across countries, however, is estimated globally at 13.1%.(1)
In Australia, it is predicted that 3+ million people are affected by MIH. As such, you are likely to encounter these patients in your clinic.
We will not review MIH pathogenesis and diagnosis, or other treatment options, such as; extraction of compromised 6’s (which is very important to consider). This post will only focus on tips to restore MIH affected molars.
There are many difficulties in treating children with MIH including:
All of this may lead to increased dental anxiety
So, the primary issues you will have when restoring an MIH affected 6 are;
How To Anaesthetise A MIH Affected Molar
The pulp in MIH affected teeth can be hypersensitive and changes in pulpal tissues have been noted which may negate the effectiveness of your normal local anaesthetic techniques. As such it is likely you will need alternate/abstract techniques. If during the examination the patient complains of pain to cold air, or when drinking cold water etc… you are prewarned this tooth may be hard to anaesthetise. As such, possible variations you can try include: (2-4)
Once your tooth is anaesthetised, tips to increase restorative success include; (2, 4)
*GIC on its own has a very low success rate(4)
In some cases, the tooth may be moderately-to-severely affected, and one may consider extraction. However, there are some occasions when it is best to avoid/delay extraction. In cases like this, or when you have been unable to gain anaesthesia, placement of a stainless-steel crown (SSC) will result in the best treatment outcomes and has superior long-term outcomes compared to intra-coronal restorations. Placing separators prior and performing minimal reduction can leave the greatest amount of tooth structure for definitive restoration in the future. Other options include minimally invasive indirect inlays and onlays. However, until the dental and supporting structures have matured, less costly, time-consuming and invasive methods are recommended; such as a SSC.(2,4)
These teeth can be very difficult to treat and stressful for all involved. MIH is a massive topic in dentistry and this post only addresses one small part of management. Many of the severely affected teeth do benefit from an extraction (with orthodontic input). However, for those that are less affected and that you wish to keep, hopefully these tips help you to achieve this.
1. Schwendicke F, Elhennawy K, Reda S, Bekes K, Manton DJ, Krois J. Global burden of molar incisor hypomineralization. Journal of Dentistry 2018;68:10-18.
2. William V, Messer LB, Burrow MF. Molar incisor hypomineralization: review and recommendations for clinical management. Pediatr Dent 2006;28:224-232.
3. Jalevik B, Klingberg GA. Dental treatment, dental fear and behaviour management problems in children with severe enamel hypomineralization of their permanent first molars. Int J Paediatr Dent 2002;12:24-32.
4. Lygidakis NA. Treatment modalities in children with teeth affected by molar-incisor enamel hypomineralisation (MIH): A systematic review. Eur Arch Paediatr Dent 2010;11:65-74.
5. Horst JA, Ellenikiotis H, Milgrom PL. UCSF Protocol for Caries Arrest Using Silver Diamine Fluoride: Rationale, Indications and Consent. J Calif Dent Assoc 2016;44:16-28.
6. Chay PL, Manton DJ, Palamara JEA. The effect of resin infiltration and oxidative pre-treatment on microshear bond strength of resin composite to hypomineralised enamel. International Journal of Paediatric Dentistry 2014;24:252-267.
This article was originally published by Children's Dental Centre and reproduced with permission