Molar Incisor Hypomineralization : A Clinical Guide to Diagnosis and Treatment

This book is a wide-ranging reference on current clinical and scientific knowledge regarding the various aspects of molar incisor hypomineralization (MIH). Background information is first presented on the structural properties of hypomineralized enamel, the prevalence of MIH, and potential etiological factors. Subsequent chapters focus on key considerations in clinical practice. Diagnostic criteria, classifications, and treatment strategies are discussed and detailed attention is devoted to potential associations between MIH and caries, the occurrence of hypomineralized primary teeth, and the knowledge and experience of dentists concerning MIH. In the last part of the book, the different treatment options are systematically presented and reviewed, covering pain control, prophylaxis and desensitization, fissure sealing, direct and indirect restorations, and extraction therapy. The cost-effectiveness of the available procedures is also considered. The book is written by acknowledged international experts in the field and will be an ideal source of up-to-date information and guidance for both dental professionals and postgraduate students. Preface 5 Contents 6 Contributors 8 Part I: Background 11 1: MIH: An Introduction 12 1.1 “The Beginning” 12 1.2 Pioneer Work 13 1.3 MIH and Fluoride Intake 17 1.4 The Future 18 References 18 2: Structural, Mechanical, and Chemical Evaluation of Molar Incisor Hypomineralization-Affected Enamel 20 2.1 Enamel Defects 20 2.2 Enamel Formation 21 2.3 MIH-Affected Enamel 23 2.3.1 Microstructural Changes 23 2.3.2 Mechanical Properties 24 2.3.3 Mineral Density 25 2.3.4 Chemical Properties 26 2.4 Heterogeneity in Current Research Findings 26 2.5 Clinical Considerations 27 2.6 Conclusions 27 References 28 3: Prevalence, Incidence, and Burden of Molar Incisor Hypomineralization 30 3.1 The Need for Epidemiologic Estimates on MIH 30 3.2 Estimating the Global Prevalence, Incidence, and Burden 31 3.3 The Global Prevalence, Incidence, and Burden of MIH 32 3.4 Interpretation 39 References 39 4: The Pathogenesis and Aetiology of MIH: More Questions Than Answers 41 4.1 Introduction 41 4.2 Amelogenesis 41 4.2.1 Secretion 42 4.2.2 Maturation 42 4.3 Aberrations During Amelogenesis 42 4.4 Genetic Influences 44 4.5 Potential Aetiological Factors 46 4.5.1 Environmental Contaminants 47 4.5.2 Birth “Complications” 47 4.5.3 Early Childhood 48 4.5.4 Medication 48 4.6 Overview of MIH Aetiology 49 References 49 Part II: Considerations in Clinical Practice 53 5: Diagnosis, Classifications and Treatment Strategies of MIH-Affected Teeth 54 5.1 Introduction 54 5.2 Clinical Presentation 55 5.3 Diagnostic Terms 55 5.4 Differential Diagnosis 57 5.4.1 Amelogenesis Imperfecta 59 5.4.2 Enamel Hypoplasia 59 5.4.3 Fluorosis 59 5.4.4 White Spot Lesions 60 5.5 Classifications 60 5.6 Treatment Approaches 61 5.7 Summary 64 References 64 6: Association Between Molar Incisor Hypomineralization and Dental Caries 66 6.1 Caries Experience in Children with MIH 66 6.2 Does DMF Index Represent Restorative Treatment Need or Dental Caries Experience in Children with MIH? 70 6.2.1 Children with MIH and Restorative Treatment Need 71 6.2.2 Children with MIH and Dental Caries Susceptibility 72 6.3 MIH as Caries Risk Factor 73 6.4 How to Deal with MIH Children in Relation to Dental Caries? 73 References 74 7: Hypomineralized Second Primary Molars 77 7.1 Introduction 77 7.2 Clinical Appearance 78 7.2.1 Early Clinical Sign 78 7.2.1.1 Demarcated Opacity 78 7.2.2 Late Clinical Signs 79 7.2.2.1 Posteruptive Enamel Breakdown 79 7.2.2.2 Atypical Restauration 79 7.2.2.3 Atypical Caries 80 7.2.2.4 Atypical Extraction 80 7.3 Mineral Content 83 7.4 Prevalence 83 7.5 Relation of HSPM–MIH 84 7.6 Relation HSPM—Caries 86 7.7 Aetiology 86 7.8 Treatment 87 7.9 Conclusion 89 References 89 8: Knowledge, Experience and Perception Regarding Molar Incisor Hypomineralization 92 8.1 Introduction 92 8.2 Dental Community Awareness 93 8.2.1 Knowledge Regarding Treatment 93 8.2.2 Knowledge Regarding Prevalence and Aetiologies 94 8.2.3 Training Aspects 96 8.3 Conclusions 97 References 97 Part III: Treatment Approaches 101 9: Treatment of Children with MIH: A Challenge in Pain Control and Behaviour Management 102 9.1 Introduction 102 9.2 Pain and Children 103 9.2.1 Definition of Pain and Fear 103 9.2.2 Peculiarities of the Child’s Perception of Pain 103 9.2.3 MIH-Induced Pain 104 9.3 Basics of Child Treatment 106 9.3.1 Behaviour Management Control and Treatment Protocols for Children with MIH 106 9.3.2 Key Moments for a Painless Clinical Examination and Treatment of Hypersensitive MIH Teeth 107 9.3.3 Everything Starts with a Painless Examination 107 9.3.4 Local Anaesthesia, Special Technics and Optimized Equipment 108 9.3.4.1 Local Anaesthesia in Children 108 9.3.4.2 Optimized Clinical Anaesthesia Technique 108 9.3.4.3 Optimized Technical Equipment 109 9.4 Premedication 110 9.5 Postoperative Pain Control, Medication After the Treatment 111 9.6 Sedation 112 9.7 General Anaesthesia 112 9.8 Conclusions 113 References 113 10: Prophylaxis and Desensitizing of MIH Teeth 115 10.1 Introduction 115 10.2 Conservative Management of MIH-Affected Teeth 116 10.3 Preventive Treatment Approaches 116 10.4 Existing Evidence from Clinical Studies 119 10.5 Concluding Remarks 124 References 125 11: The Use of Fissure Sealants in MIH-Affected Posterior Teeth 128 11.1 Introduction 128 11.2 Clinical Procedure 129 11.2.1 Isolation 129 11.2.2 Pretreatment 129 11.2.2.1 Mechanical Cleaning and Etching 129 11.2.2.2 Deproteinization 130 11.2.2.3 Adhesion/Bonding 130 11.2.3 Sealant Application 132 11.3 Success Rates 132 11.4 Conclusions 134 References 134 12: Direct Restorations of MIH-Affected Teeth 137 12.1 Introduction 137 12.2 Special Requirements 138 12.3 Micromorphological Features: Is Adhesion Actually Possible? 141 12.4 Different Enamel Microstructure 142 12.5 Bonding Strategies 144 12.6 Temporary Restoration 145 12.7 Adhesive Restoration 147 12.8 Repair 150 12.9 Chances and Limitations of Direct Restorations 150 References 151 13: Indirect Restoration Approaches for MIH-Affected Teeth 153 13.1 Introduction 153 13.2 Restorative Management of Hypomineralized First Permanent Molars 154 13.3 Preformed Metal Crowns 155 13.3.1 Indications 155 13.3.2 Placement Procedures 155 13.3.3 Clinical Outcomes 156 13.4 Indirect Restorations 156 13.4.1 Indications 156 13.4.2 Metal Alloys 157 13.4.3 Composites 157 13.4.3.1 Case 158 13.4.4 CAD/CAM 162 13.4.4.1 Case 162 13.5 Conclusions 164 References 165 14: Aesthetic Management of Molar Incisor Hypomineralization: Staged Strategies for Affected Incisors 167 14.1 Introduction 167 14.2 Biomechanical Considerations 168 14.3 Strategies for Optimizing Adhesive Strength 169 14.4 Restorative Considerations 169 14.5 Modalities of Treatment in Order of Staging 170 14.5.1 Remineralization Strategies 170 14.5.2 External Vital Bleaching 170 14.5.2.1 Case 1 171 14.5.3 Surface Microabrasion 171 14.5.3.1 Case 2 173 14.5.4 Resin Infiltration 174 14.5.4.1 Case 3 175 14.5.4.2 Case 4 175 14.5.5 Macroreduction and Aesthetic Layering 177 14.5.5.1 Case 5 181 14.5.5.2 Case 6 182 14.6 Conclusion and Remarks 184 References 185 15: Extraction of MIH-Affected Molars and Orthodontic Space Closure 187 15.1 Introduction 187 15.2 General Considerations for Extraction of Permanent Teeth in Orthodontics 187 15.2.1 Indications for the Extraction of MIH-Affected Molars 188 15.3 Extraction Timing of MIH-Affected Molars in Absence of Dental Crowding 190 15.4 Extraction Timing of MIH-Affected Molars in the Presence of Dental Crowding 191 15.5 Consequences of Late Extraction of MIH-Affected Molars 191 15.6 Consequences of Premature Extraction of MIH-Affected Molars 192 15.7 Importance of Choosing the Correct Timing of Orthodontic Extraction Therapy 192 15.8 Balancing and Compensatory Extraction Therapy 193 15.9 Prognosis for Orthodontic Space Closure After Extraction of MIH-Affected Molars 193 15.10 Advantages of Orthodontic Extraction Therapy of MIH-Affected Molars 194 15.11 Prognosis for Eruption of Third Molars After Extraction of MIH-Affected Molars 195 15.12 Summary 195 References 195 16: Health Economic Evaluation of Management Strategies for MIH 197 16.1 The Need for and Types of Health Economic Evaluations 197 16.2 Health Economic Analyses 199 16.3 Assessing the Cost-Effectiveness of Severe MIH 200 16.4 Cost-Effectiveness of Different Strategies for Managing Severe MIH 203 16.5 Interpretation and Critique 204 16.6 Conclusions 204 References 205 Part I Background Chapter 1 MIH - An Introduction -- Chapter 2 Structural, Mechanical and Chemical Evaluation of Molar Incisor Hypomineralisation-Affected Enamel -- Chapter 3 Prevalence, Incidence and Burden of Molar Incisor Hypomineralization -- Chapter 4 The Pathogenesis and Aetiology of MIH - More Questions than Answers -- Part II Considerations in Clinical Practice Chapter 5 Diagnosis, Classifications and Treatment Strategies of MIH Affected Teeth -- Chapter 6 Association Between Molar Incisor Hypomineralization and Dental Caries -- Chapter 7 Hypomineralized Second Primary Molars -- Chapter 8 Knowledge, Experience and Perceptions Regarding Molar Incisor Hypomineralization -- Part III Treatment Approaches Chapter 9 Treatment of Children with MIH: A Challenge in Pain Control and Behaviour Management -- Chapter 10 Prophylaxis and Desensitizing of MIH Teeth -- Chapter 11 The Use of Fissure Sealants in MIH Affected Posterior Teeth -- Chapter 12 Direct Restorations of MIH-affected Teeth -- Chapter 13 Indirect Restoration Approaches for MIH Affected Teeth -- Chapter 14 Aesthetic Management of Molar-Incisor Hypomineralisation: Staged Strategies for Affected Incisors -- Chapter 15 Extraction of MIH Affected Molars and Orthodontic Space Closure -- Chapter 16 Health Economic Evaluation of Management Strategies for MIH