Treatment of Molar-incisor Hypomineralization: A Case Report of 11-year Clinical Follow-up
The purpose of this case report was to describe an 11-year follow-up of a patient presenting with molar-incisor hypomineralization (MIH) having yellowish and porous permanent incisors and molars. Clinical examination revealed demarcated brown opacities on one upper and one lower central incisor and three first permanent molars. Initially, treatment involved oral hygiene and periodic fluoride varnish application. Subsequently, the occlusal surfaces of the affected molars were restored or sealed with glass ionomer cement. At-home dental bleaching was also performed. Areas of unsatisfactory esthetics on the incisors were replaced by composite resins. This report discussed the patient’s needs and expectations, the difficulties of prolonged treatment for patients with MIH, and the restorative protocol involving at-home dental bleaching and composite resins.SUMMARY
Initial intraoral view of MIH-affected teeth #9 and #24. Yellow-brown spots are seen on the buccal surfaces of the permanent molars.
Maxillary permanent first molars, affected by MIH, with post-eruptive breakdown. Tooth #30 shows a slight light-yellow discoloration in the dental crown and tooth #19 shows sound clinical aspects.
A panoramic radiographic image demonstrates superficial lesions in the enamel of the maxillary permanent molars. There was no evidence of pulp exposure.
Intraoral views, 12 months postoperative. Tooth #19 with glass ionomer sealant occlusally. The other permanent molars with occlusal RMGIC.
(A and B) Clinical aspects of teeth #9 and #24 were restored with composite resin, 24 months postoperative. (C) After 4 years, the left maxillary and lower mandibular central incisors with unsatisfactory restorations.
(A and B): Intraoral views, eight years postoperative. Incisors affected by MIH had restorations replaced by composite resin. (C): Intraoral view after microabrasion with 6% hydrochloric acid.
Clinical and radiographic aspects, eight years postoperative. The permanent molars affected by MIH show marginal restorative breakdown, restorative material loss, marginal fractures, and recurrent dental caries. No pulp involvement is seen.
Before and after at-home dental bleaching, using 10% carbamide peroxide, for four weeks.
(A) Clinical aspect after at-home dental bleaching. (B and C) Removal of the unsatisfactory restoration using a conical trunk diamond bur (#4138, KG Sorensen) on the buccal surface of tooth #9. (D) Pumice and water prophylaxis. (E) Acid etching with 35% phosphoric acid. (F) Application of the universal adhesive system, and light-curing for 20 seconds. (H and I) Incremental placement of the opacifier on the buccal surface. (J) Incremental placement of the white enamel shade. (K, L, and M) Polishing using medium, fine, and extra-fine grain abrasive discs. (N and O) Polishing with fine and extra-fine silicone discs. (P) Final polishing with a silicone-carbide brush.
Extraoral and intraoral views after 11 years of clinical follow-up.
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