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Preemptive analgesia is an important strategy used in pediatric dentistry to intercept pain signals in neural pathways early, thus mitigating the perception of pain and enhancing overall patient comfort. Pedodontists often encounter challenges in conducting the therapy and managing uncooperative patients, when addressing enamel defects of the Molar-incisor hypomineralization (MIH) type. The aim of this study is to demonstrate the impact of preemptive analgesia on optimizing behavioral management and restorative treatment strategies for immature permanent molars exhibiting severe MIH and Treatment need index 4 (TNI), through the effective control of pain. This study comprised 27 cases with MIH level 3 Posteruptive breakdown (PEB), indicating post-eruptive enamel breakdown, with initial hypersensitivity scores exceeding 4 on the Wong-Baker Scale, was conducted over 12 months, between January 2023-January 2024. Data on pediatric patients aged between 5 years and 4 months and 7 years and 1 month with varying degrees of sensitivity in their permanent first molars before the completion of the eruption process were collected. Pain intensity was systematically evaluated at six specific time points: before and after the administration of analgesic medication as well as during restorative treatment using the Wong-Baker scale and data from the Face, Legs, Activity, Cry, Consolability index (FLACC). Statistical analysis for Wong-Baker scores and FLACC index indicated statistical significance ( p < 0.05) for Mann-Whitney and Wilcoxon tests, respectively t -test. The comparison of mean scores recorded before and after preemptive analgesia during rotary instrumentation moments for the Wong-Baker index (4 > 0.29) and for the FLACC index (8.47 > 1.71) indicates the positive influence of administering ibuprofen. In conclusion, preemptive analgesia, alongside standardized anesthesia, significantly improved intraoperative pain management and behavioral outcomes., Competing Interests: The authors declare no conflict of interest., (©2024 The Author(s). Published by MRE Press.)

Background: Restoring first permanent molars affected with molar incisor hypomineralization (MIH) is challenging. Focusing on improving the quality of life for children affected by MIH, at least until the complete eruption of first permanent molars to receive full coverage, to decrease the hypersensitivity and to be able to perform proper oral hygiene measures, the purpose of this study was to compare silver modified atraumatic restorative technique (SMART) versus the conventional restoration and fluoride varnish application on moderate to severe hypomineralized molars. The comparison considered the restoration survival, hypersensitivity, and digital surface area changes after one year follow up., Methods: Twenty-eight children were selected (20 girls and 8 boys) with at least 2 MIH molars with the same defect severity. The study comprised 2 groups; MOD group (moderate hypomineralized molar severity) and SEV group (Severe hypomineralized molar severity) (n = 28 tooth). Each group was further subdivided into 2 subgroups according to the technique of restoration: SMART subgroup and CONV subgroup (high viscosity glass ionomer restoration and fluoride varnish application) (each = 14 tooth). Evaluation was done in terms of the restoration survival (6 months and 12 months), hypersensitivity at 1 weak, 6 months and 12 months and occlusal surface area changes at 12 months). Professional Fluoride varnish application and home prophylaxis using MI paste were the protocol for each child patient., Results: There was no significant difference between the 4 subgroups, regarding tooth restoration integrity at 6-months vs. 12-months. However, a statistically significant difference in tooth restoration integrity between the 4 subgroups at 12-months (P = .049). Also, the hypersensitivity score, there was a statistically significant difference between the 4-time intervals (P < .001) and a statistically significant difference in surface area changes between the 4 subgroups., Conclusions: Selective removal of carious tissue and SMART restoration, combined with dental home and professional preventive measures every 3 months maintained the integrity of restorations in severely and moderately affected permanent molars up to 1 year., Trial Registration: The study protocol was retrospectively registered on Clinical Trials (NCT05931822-05/ 07/2023)., (© 2024. The Author(s).)

Molar-incisor hypomineralization (MIH) presents a significant clinical challenge in orthodontics, with its complex etiology, variable presentation, and profound impact on enamel homeostasis. Utilizing Simon Sinek's "Golden Circle" method, this article systematically explores the implications of MIH within orthodontic practice. The "Why" emphasizes the critical need for orthodontists to understand MIH, given its prevalence and potential to disrupt treatment outcomes. MIH affects up to 40.2% of the global population, and its association with increased caries risk, hypersensitivity, and restorative failures necessitates an informed approach to management. The "What" section addresses the importance of recognizing the phenotypic variability of MIH and its influence on oral health-related quality of life. MIH impacts social and psychological well-being, particularly when anterior teeth are involved, and complicates orthodontic treatment due to challenges in bonding, banding, and restorative protocols. The "How" provides practical guidelines for orthodontic management, including diagnostic considerations, tooth restoration strategies, and the complexities of first permanent molar extractions. Strategic planning is essential to avoid complications such as mesial drift, overeruption, or space loss, with a multidisciplinary approach often required. This article highlights the importance of long-term monitoring and patient-centered care in managing MIH-affected teeth, underscoring the evolving nature of clinical protocols. By framing the discussion through the Golden Circle, this critical review offers a structured and impactful approach to understanding and addressing MIH within orthodontic contexts, aiming to enhance treatment outcomes and patient quality of life., (Copyright © 2024. Published by Elsevier Inc.)

Objectives: To evaluate the effectiveness of resin infiltration in improving the aesthetic appearance of anterior teeth affected by molar-incisor hypomineralisation (MIH)., Data Sources: PubMed, Scopus, EMBASE, Web of Science, ScienceDirect, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched from 2009 to 2024. The protocol was registered in the International Prospective Database of Systematic Reviews (PROSPERO CRD42023461909)., Study Selection: Interventional or comparative studies comparing resin infiltration and other treatments in MIH-affected anterior teeth were included. The risk of bias was evaluated using the Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I tool) and the Risk of Bias 2 (RoB 2.0) tool. Meta-analysis utilized a random-effects model., Data: Eighteen studies met the inclusion criteria, and twelve were included in the meta-analysis. Resin infiltration showed a higher color difference (ΔE) before and after treatment (mean difference 2.21, 95 % confidence interval [CI] 0.04-4.38, p < 0.001, I 2 = 98.61 %, p < 0.001) and better optical improvement (standardised mean difference [SMD] 2.68; 95 %CI 0.30-5.06; p = 0.027, I 2 = 97.8 %, p < 0.001) compared to controls. The estimated success rate based on dentist assessment was 92 % (95 %CI 88-95 %, I 2 = 17.92 %, p = 0.06). Non-randomised trials showed high (8/14) or moderate (6/14) risk of bias, mainly from confounding and selection issues. Randomised trials had high risk (1/3) or some concerns (2/3) due to missing data., Conclusions: The findings suggest that resin infiltration significantly improves aesthetic outcomes in MIH-affected anterior teeth, as evidenced by higher colour difference and optical improvement compared to controls., Clinical Significance: While our study shows promising results for resin infiltration, including high success rates and aesthetic improvements, larger-scale studies with longer follow-up periods are necessary to confirm these findings and assess its long-term efficacy., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Design: A prospective, randomized, split-mouth clinical study by the two previously trained and calibrated pediatric dentists without blinding operators and patients due to different protocols in both treatment groups. An SDF + potassium iodide (KI) and SDF + KI + glass ionmer cement (GIC) on International Caries Detection and Assessment System (ICDAS) 1/2 molar was received by each patient on either side of mouth. The local Ethics Committee approved this study., Data Source: Sample size calculation was not performed due to the lack of published studies on the longevity of SMART sealant on MIH-affected molars and the absence of research on the apparent difference between the effectiveness of SMART and SDF treatments in preventing further caries and sensitivity., Study Selection: These were children between the ages of 6 years to 13 years, who visited the Pediatric Dentistry Clinic at XX University School of Dentistry for routine exams and treatment between July 2019 to May 2020. They were in good health and had at least two fully erupted permanent first molars with MIH as per the European Academy of Pediatric Dentistry, ICDAS code 1/2. This study recorded 12 months of treatment outcomes on hypomineralised molars of 48 children with a follow-up of three years. Children were excluded with specific syndromes associated with enamel malformation, lack of cooperation, ongoing orthodontic treatment, and teeth with ICDAS 3/4/5/6 lesions, existing restorations, fluorosis, or pulpal symptoms., Data Analysis: Mann-Whitney U Test was used to assess differences between independent groups (SDF and SMART) and the Friedman Test between dependent groups at different time points. Kaplan-Meier analysis to evaluate the cumulative survival of SMART sealants and survival of caries-free hypomineralised molars in both groups. Chi-Square test was used to compare the success percentages of the SDF and SMART groups. To assess the changes in success percentages at three different time intervals for the caries preventive effect of SDF and SMART, and to evaluate the retention percentages for the SMART group. McNemar's test with a Bonferroni correction was used for significant differences. Cohen's kappa test indicated that the inter-examiner reliability determining the presence of MIH was 0.87. The intra-examiner reliability for US Public Health Service (USPHS)-Modified criteria was 0.90. The statistical significance level was set at p < 0.05 for all statistical analyses., Results: At 12, 24 and 36 months the caries preventive effect was 100%, 67.9%, and 65.4% for SDF + KI-treated teeth; and 100%, 97.6%, and 94.7% for SMART (SDF + KI + GIC) respectively. During the recall period, there was no substantial difference in hypersensitivity scores between the groups. There was no hypersensitivity in teeth at 18 months and beyond. Compared to the baseline Schiff Cold Air Sensitivity Scale (SCASS) score 26 molar with initial hypersensitivity to hypomineralisation had a massive reduction at evaluation periods. The mean survival probabilities for the caries-preventive effect were considerably lower in SDF + KI-treated teeth (31.01 months) than in SMART-treated teeth (35.61 months) (p < 0.001)., Conclusion: Considering the limitation of the study, both SMART (SDF + KI + GIC) sealants and 6-monthly application of SDF + KI, provided similar and substantial levels of desensitisation on the permanent MIH molars. When used as a sealing material on non-cavitated permanent MIH molars, the clinical retention rate for SMART was 88.7%, 73.1%, and 66.6% at 1, 2, and 3 years respectively. The caries preventive effect of SMART (SDF + KI + GIC) sealants was superior to SDF + KI application in hypomineralised teeth, however, a long-term monitoring and review is essential due to the gradual decrease in retention of SMART sealants., (© 2024. The Author(s), under exclusive licence to British Dental Association.)

Purpose: To evaluate perceptions, attitudes, and clinical experience of Brazilian dental practitioners regarding molar incisor hypomineralisation (MIH)., Methods: An online survey with 27 questions, covering professional profile data, perceptions, and knowledge on clinical management of MIH, was employed. Descriptive analyses, chi-square, Fisher's exact, and Cramer's V tests were used., Results: Sample comprised 100 participants, equally distributed between those working in private or public sectors. Most private sector practitioners had 21-30 years of clinical experience (28%) and master's degree (50%), while most public sector practitioners had 11-20 years of clinical experience (32%) and a PhD degree (32%). Most participants (86%) recognized MIH in their practice. Statistically significant differences were observed in frequency (p = 0.001), incidence (p = 0.039), and lesion type (p = 0.043) between practitioners from both sectors. Uncertainly in management was reported by 49%, mainly in public sector. For mild MIH in incisors, no treatment was chosen (43%), and the treatment longevity was the only significant factor reported (p = 0.012). In cases of mild MIH in first permanent molars (FPMs), 51% of respondents opted to keep the affected tissue and apply fissure sealant. Glass ionomer (GI) restoration was commonly indicated for FPMs with severe MIH with moderate loss of structure and sensitivity (38%). In cases with substantial structural loss and pulpal involvement, the most chosen treatment was endodontic intervention combined with preformed crowns., Conclusion: Brazilian dental practitioners face MIH in clinical practice. Although, public sector professionals are less confident in diagnosis and treatment, no significant differences in treatment preferences between public and private sector dental practitioners were identified., Competing Interests: Declarations Conflict of interest The authors declare that they have no conflict of interest. Ethical approval The present study was approved by local Research Ethics Committee (Hospital Universitário Clementino Fraga Filho – HUCFF/UFRJ) under the protocol number 4.886.892. Informed consent All participants were informed about the study prior to enrolment and gave voluntary consent., (© 2024. The Author(s), under exclusive licence to European Academy of Paediatric Dentistry.)

Objectives: Correct identification and management of Developmental Defects of Enamel (DDEs) are essential to provide the best possible treatment. The present survey aims to investigate Italian dentists' knowledge of DDEs, their ability to recognise the different clinical pictures, and to choose the most appropriate clinical approach., Methods: A cross-sectional survey was planned based on a questionnaire including 27 closed-ended questions, and that proposed 4 clinical pictures, molar incisor hypomineralisation (MIH), amelogenesis imperfecta (AI), dental fluorosis (DF), and an initial caries lesion (ICL). It was distributed by e-mail to all Italian dentists (N = 63,883) through the Italian Federation of Doctors and Dentists. Discrete variables were expressed as absolute and relative frequencies (%). A multivariate analysis assessed whether socio-demographic variables correlated with the answers' truthfulness., Results: About 5017 questionnaires were included and analysed. Although 90.19% of the sample stated that they had received information on DDEs, a significant percentage did not recognise MIH (36.36%), AI (48.34%), DF (71.50%), and ICL (46.62%). Only 57.07% correctly classified enamel hypomineralisation as a qualitative defect, and even fewer, 54.45%, classified enamel hypoplasia as a quantitative defect. According to the logistic regressions, female dentists, dentists who treat mainly children and received information about DDEs, were more likely to recognise the 4 clinical pictures (P < .01)., Conclusions: Italian dentists showed many knowledge gaps on DDEs that need to be filled; those who received formal training were more capable of correctly identifying the defects and were more likely to prescribe an appropriate management approach for the defects., Clinical Significance: Increasing university courses and continuing education on diagnosing and managing DDEs seems reasonable to fill the knowledge gap on DDEs., Competing Interests: Conflict of interest None disclosed., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Purpose: In addition to molar incisor hypomineralisation, the occurrence of enamel hypomineralisation in the primary dentition has become increasingly important in recent years. Hypomineralised second primary molar (HSPM) is defined as hypomineralisation of systemic origin affecting from one to all four second primary molars. Some years ago, the "Würzburg concept" was introduced, which proposed a grading of MIH findings (MIH treatment need index) in combination with an appropriate treatment plan depending on the severity of the affected tooth. Recently, this concept was updated and new treatment approaches have been added. However, currently, the concept solely addresses the treatment plan for permanent teeth. As there is a need to expand its scope to encompass primary teeth and, consequently, HSPM, this paper seeks to develop the second component of the Würzburg concept, the treatment plan, for the primary dentition in response to the increased focus on the disease in recent years. Although the evidence base for the different treatment options is still weak, there is a need for guidance for clinicians in their day-to-day practice., Methods: The authors conducted a comprehensive review of the literature, encompassing clinical and laboratory studies along with published guidelines., Results: The treatment plan of the HSPM Würzburg concept contains prophylactic and regenerative aspects, non-invasive interventions, temporary and permanent restorative techniques, and extraction., Conclusions: The intention is to provide practical guidance to practitioners, acknowledging the necessity for further validation through clinical trials., (© 2024. The Author(s).)

Objectives: To undertake a cost-effectiveness analysis of restorative treatments for a first permanent molar with severe molar incisor hypomineralization from the perspective of the Brazilian public system., Materials and Methods: Two models were constructed: a one-year decision tree and a ten-year Markov model, each based on a hypothetical cohort of one thousand individuals through Monte Carlo simulation. Eight restorative strategies were evaluated: high viscosity glass ionomer cement (HVGIC); encapsulated GIC; etch and rinse adhesive + composite; self-etch adhesive + composite; preformed stainless steel crown; HVGIC + etch and rinse adhesive + composite; HVGIC + self-etch adhesive + composite, and encapsulated GIC + etch and rinse adhesive + composite. Effectiveness data were sourced from the literature. Micro-costing was applied using 2022 USD market averages with a 5% variation. Incremental cost-effectiveness ratio (ICER), net monetary benefit (%NMB), and the budgetary impact were obtained., Results: Cost-effective treatments included HVGIC (%NMB = 0%/ 0%), encapsulated GIC (%NMB = 19.4%/ 19.7%), and encapsulated GIC + etch and rinse adhesive + composite (%NMB = 23.4%/ 24.5%) at 1 year and 10 years, respectively. The benefit gain of encapsulated GIC + etch and rinse adhesive + composite in relation to encapsulated GIC was small when compared to the cost increase at 1 year (gain of 3.28% and increase of USD 24.26) and 10 years (gain of 4% and increase of USD 15.54)., Conclusion: Within the horizon and perspective analyzed, the most cost-effective treatment was encapsulated GIC restoration., Clinical Relevance: This study can provide information for decision-making., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The aim of this study was to evaluate the 9-month clinical performance of different materials and treatment procedures in teeth with MIH in children, and to evaluate the effectiveness of Papacarie gel as a deproteinization agent. The study included 90 children (aged 8-15) who had 189 first permanent molars with MIH were restored randomly with 4 different materials/methods. Equia Forte HT (GC, Tokyo, Japan) was used in Group 1; In Group 2, G-eanial composite (GC, Tokyo, Japan) was used with a Fuji IX (GC, Tokyo, Japan) base; In Group 3 and Group 4, EverX Posterior (GC, Tokyo, Japan) base and G-eanial composite (GC, Tokyo, Japan) were used. In group 4, deproteinization was performed with Papacarie Duo gel (F&A, Sao Paulo, Brazil). The restorations were evaluated at 3-month intervals for 9 months using modified United States Public Health Service (USPHS) criteria. The overall recall rate was 94.1% for every 3-month clinical evaluation over 9 months. A total of 9 restorations were unsuccessful. Surface roughness of Group 1 was statistically different from all other groups in all control periods ( p < 0.05). Marginal adaptation of Group 2 was found to be significantly different from Groups 3 and 4 at the both of 6th and 9th month controls. There was no significant difference between the groups in terms of retention, color match, marginal discoloration and secondary caries in all control months. Restoration of MIH with Equia Forte HT is almost as successful as composites. The use of dentin replacement materials instead of glass ionomer cements as a base in composite restorations shows better results. Papacarie deproteinization showed similar success with other composite groups. This study was the first clinical study in which Papacarie was used for deproteinization in teeth with MIH and will thus contribute to the literature., Competing Interests: The authors declare no conflict of interest., (©2024 The Author(s). Published by MRE Press.)

Background: Molar incisor hypomineralisation (MIH) has a high prevalence in the Spanish pediatric population and is a precursor of carious lesions in teeth in which it is present. Although this pathology is included in the curricula of the Degree in Dentistry and the Training Cycle in Oral Hygiene in our country, the contents currently taught seem to be insufficient in relation to the level of knowledge that we have today about this condition., Methods: A digital questionnaire of 18 questions was sent to a sample of 448 students attending the 4th and 5th year of the Degree in Dentistry and 2nd year of the Training Cycle in Oral Hygiene from different universities and vocational training centers in the Valencian Community. Descriptive and multivariate statistical analysis of the data was subsequently performed., Results: Of the 290 questionnaires that were obtained, 53.8% were from students attending the 2nd year of a training course in oral hygiene and 46.2% were from students pursuing a degree in dentistry. Most of the respondents had heard about MIH (75.2%), mainly through master classes. However, most students had difficulties distinguishing MIH lesions from other lesions (58.3%). The degree of knowledge about MIH was greater among dental students in all the aspects evaluated: prevalence, diagnosis, prevention, and treatment. Of all the students, 83.8% were interested in increasing their training on MIH, especially in the areas of diagnosis and treatment., Conclusion: The results of the present study justify the need to expand the content on MIH, both theoretical and practical, in the educational curricula of the Degree in Dentistry and Integrated Vocational Training Centers in Spain., (© 2024. The Author(s).)

Molar incisor hypomineralization (MIH) is a systemic developmental qualitative defect of the enamel that affects 1-4 first permanent molars with or without incisor involvement. Enamel hypomineralization is identified visually as a demarcated opacity with a clear border with varying extensions and can be white, yellow, or brown. This opacity is characterized by a reduced quality of enamel that is of normal thickness but not fully mineralized. It is very common for the affected teeth to present with posteruptive breakdown, making them susceptible to caries, leading to their subsequent loss. Thus, MIH is a significant dental problem with clinical, economic, and psychosocial implications. The planned extraction of compromised teeth is a valid alternative to complex restorative treatment. Orthodontists' involvement is essential in developing effective treatment strategies for children affected by MIH, contributing to their oral health and well-being., (Copyright © 2023 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Purpose: To compare the aesthetic improvement of Molar-Incisor-Hypomineralisation (MIH) opacities treated by applying Icon-Etch for three cycles with the opacities treated by Icon-Etch for once, in the course of resin infiltration technique., Methods: Thirty incisors were sorted based on the colour of the opacities and then distributed according to the number of Icon-Etch cycles using a randomisation table into the groups: (1) White/Creamy one cycle, (2) White/Creamy three cycles, (3) Yellow/Brown one cycle, (4) Yellow/Brown three cycles. The primary outcomes of applying the resin infiltration to the opacities were compared amongst groups according to the parents' satisfaction, the amount of coverage, and the colour matching with the surrounding sound enamel. The stability of the results after 3 months was evaluated using a spectrophotometer., Results: The colour of the opacity pre-treatment affected the outcomes significantly (p < 0.05), compared according to the method of application (p > 0.05) in terms of parents' satisfaction. Whilst the multiple applications for Icon-Etch cycles showed more coverage amount in White/Creamy opacities than the application ones (p < 0.05); in colour matching, there was no statistically significant difference between the two methods (p > 0.05). For yellow/brown opacities, some negative results occurred with the single Icon-Etch cycle., Conclusion: In MIH opacities, it is possible to rely on the resin infiltration as a minimally invasive method to achieve acceptable results, especially with multiple Icon-Etch cycles applications in the white/creamy opacities. The colour stability has not been affected by either the colour of the opacity or the number of cycles., (© 2024. The Author(s), under exclusive licence to European Academy of Paediatric Dentistry.)

Purpose: The aim of this study was to investigate attitudes and preferred therapy choice for first permanent molars (FPM) with Molar-Incisor Hypomineralization (MIH)., Methods: An online questionnaire was sent out to general dentists (n = 559) working in the Public Dental Service in Region Västra Götaland, orthodontists (n = 293), and pediatric dentists (n = 156) (members from each interest association), in Sweden. The questionnaire contained three parts: general questions regarding the respondents, patient cases, and general questions regarding extraction of FPMs with MIH. Statistics were carried out using Chi-squared tests, with a significance level of 5%., Results: A response rate of 36% was obtained. Orthodontists and pediatric dentists were more prone to extract FPMs with both moderate and severe MIH, compared to general dentists. When restoring FPMs with moderate MIH, resin composite was preferred. Compared to the general dentists, the pediatric dentists were more prone to choose glass-ionomer cement in the FPMs with severe MIH. The most common treatment choice for FPMs with mild MIH was fluoride varnish. "When root furcation is under development of the second permanent molar on radiographs" was chosen as the optimal time for extracting FPMs with severe MIH, and the general dentists based their treatment decisions on recommendations from a pediatric dentist., Conclusion: Extraction of FPMs with moderate and severe MIH is considered a therapy of choice among general dentists and specialists, and the preferred time of extraction is before the eruption of the second permanent molar., (© 2024. The Author(s).)

Molar incisor hypomineralisation (MIH) is defined as hypomineralisation of systemic origin of one to four first permanent molars with or without the involvement of the permanent incisors. In addition to opacities and posteruptive breakdown, hypersensitivity may be a common problem, especially in the molars. Children then often report that hot and cold drinks and meals, toothbrushing, and even air flow cause pain. Therapy approaches to reduce and stop the hypersensitivity include the sealing of affected teeth. Fissure sealants can be placed in mildly affected molars that show no breakdowns in the occlusal surfaces. Thereby, resin-based sealants can be considered for fully erupted teeth, whereas glass ionomers are the treatment of choice in difficult clinical conditions as an interim treatment where isolation is inadequate and the molar has not fully erupted. The aim of this chapter is to describe the phenomenon of hypersensitivity in MIH-affected teeth, to discuss treatment approaches including the placement of sealants as well as the management of posteruptive breakdowns, and to present data on oral health-related quality of life in children suffering from hypersensitivity., (© 2024 S. Karger AG, Basel.)

Tooth hypersensitivity is a common symptom in molar incisor hypomineralisation (MIH) patients and can affect children's quality of life. During daily routine, children with MIH often report sensitivity to various thermal and mechanical stimuli, and difficulty in achieving effective analgesia is a common issue becoming a challenge for dentists. Research has focused on the possible pathophysiological mechanisms behind this phenomenon, which, in turn, have not been determined. Even with the apparently intact enamel of MIH-teeth, the porosity of the hypomineralised enamel acts as an open door for the invasion of oral microorganisms, which reach the dentinal tubules, and stimulate subclinical inflammatory reactions in the pulp. Tissue inflammation may, in turn, lead to morphological and cytochemical changes within sensory neurons, resulting in sensitization of these nerve fibers. This phenomenon is complex, and the treatment modalities focus on inflammation management followed by tubule obliteration by using different materials and technologies. In conclusion, this chapter reviews the concept and etiology of hypersensitivity in teeth with MIH and summarizes the clinical management according to the best evidence available., (© 2024 S. Karger AG, Basel.)

The awareness of molar incisor hypomineralisation (MIH) has led to its increased clinical detection, consequently drawing more attention to its associated complications. This text offers an overview of the esthetic management of anterior teeth affected by MIH, a condition characterized by enamel defects that present significant cosmetic challenges. The focus is on the clinical presentation of MIH characteristics, considering the depth of lesions and the clinical aspects, and the treatment protocols available, despite a lack of extensive scientific evidence. To the best of the current scientific knowledge, the text evaluates the potential of minimally invasive procedures, as well as the use of traditional composite resin techniques and their possible combinations, highlighting the critical role of esthetic considerations for the impacted anterior teeth. The chapter is augmented with five illustrative clinical cases that display the practical application of these treatment approaches. These examples articulate the clinical decision-making process and personalized restorative strategies, aiming to balance function with enhanced esthetic results. The described cases act as a roadmap for clinicians tackling the complexities of MIH treatment in the context of limited empirical evidence, providing insights into achieving both satisfactory and esthetically pleasing outcomes for patients suffering from this condition., (© 2024 S. Karger AG, Basel.)

One fourth of teeth affected by molar incisor hypomineralisation (MIH) have required or will require treatment due to pain, sensitivity, or posteruptive breakdown. Restorative treatment becomes necessary in cases of severe MIH, characterized by posteruptive breakdown, which exhibits a wide range of clinical characteristics. Until approximately 20 years ago, all techniques, materials, and research were developed for treating caries lesions, not hypomineralisation. Research attempting to evaluate approaches to MIH treatment is recent and inconclusive. Therefore, there is still insufficient high-quality scientific evidence to establish a definitive clinical protocol for treating this condition. Recommendations based on best clinical practices can be provided rather than conclusions supported by a high level of evidence. To assist in clinical judgment regarding the best treatment strategy, eligible therapeutic options for restoring MIH-affected molars will be presented based on the strength and adhesive potential of the remaining hypomineralised enamel. The literature presents options for restorative materials ranging from direct alternatives such as glass ionomer cement and resin composite, through prefabricated devices, such as stainless-steel crowns and orthobands, to indirect restoration alternatives. However, it is essential to understand the indications of each restorative alternative and to know the restorative techniques, many of which are specifically developed to mitigate the difficulties encountered with the use of conventional techniques. Emphasis will be placed on the importance of adopting a personalized approach to restorative decision-making, considering the philosophy of minimal intervention dentistry and potential benefits for the patient's well-being and the family's needs., (© 2024 S. Karger AG, Basel.)

Numerous therapeutic approaches are available for managing molar incisor hypomineralisation (MIH); however, the cost-effectiveness of these strategies is underexplored. Economic evaluations are crucial for determining the optimal treatment approach to individual patients' requirements. We systematically reviewed the literature on the topic to have a more comprehensive discussion about these issues. Systematic searches were carried out. After a two-stage selection, 11 studies were included for synthesis. These studies could be divided into three groups according to the type of information given on costs: assumptions or deductions based on the literature (n = 6), cost collection on the available sources (n = 3), and cost-effectiveness evaluations (n = 2). The economic evidence on MIH management is still scarce and incipient. However, some important findings were produced for this evidence synthesis. A database of costs valuable in different contexts for therapeutic approaches related to MIH and its consequences was created. Furthermore, compiling and digesting the evidence on the cost-effectiveness of different approaches for managing severe MIH cases points out possible directions to be considered in decision-making that should consider these economic outcomes in different contexts and their powers of generalizability and also other aspects of evidence-based practice (e.g., professional and patients' preferences). Finally, there is an imminent need for economic evaluations focused on investigating the potential efficiency of preventive approaches for managing minor-compromised MIH teeth to postpone/avoid the severe consequences, which are more critical, complex, and costly to treat., (© 2024 S. Karger AG, Basel.)

Background: Molar-incisor hypomineralisation (MIH) is the most common developmental abnormality observed in teeth. Being a relatively new condition, its treatment can present a challenge for the dentist. There is currently no study available that has evaluated the knowledge of Mexican dental personnel. This study aimed to evaluate the knowledge, experience, and perceptions of dental surgeons regarding the detection, assessment, and treatment of MIH in the metropolitan area of Mexico City., Methods: A cross-sectional study was designed. Dentists from Mexico City and its metropolitan area were invited through social networks to answer a questionnaire of 30 questions related to MIH. Participants were classified into general practice dentists, paediatric dentists, and other speciality dentists. Pearson's chi-square test was used for data analysis., Results: The questionnaire was answered by 391 dentists. A total of 86% (338 out of 391) of them identified MIH lesions, while 84% of them reported having observed MIH lesions in their practice. The most frequently observed lesions were yellow-brown opacities which accounted for 47% of the lesions, 46% were white opacities, while only 7% were observed as post-eruptive fractures in the enamel as part of the manifestations of MIH. The most frequently reported problem in the management of teeth with MIH was insufficient training for treating children with MIH. A total of 84% of dentists stated that they would like more information on the treatment of MIH lesions., Conclusions: Most of the surveyed dentists recognised MIH and reported having observed MIH lesions in their practice. Most of the dentists indicated that the main problem for the management of the MIH is the lack of training., (© 2023. The Author(s).)

Purpose: Molar incisor hypomineralization (MIH) is playing an increasingly important role in dental practice. MIH is defined as hypomineralization of systemic origin of one to four permanent first molars, often associated with affected incisors. Affected teeth are more susceptible to caries and post-eruptive enamel loss and should be diagnosed and treated as early as possible. In 2016, the Würzburg concept was developed for German-speaking countries including a classification index-the MIH Treatment Need Index (MIH-TNI)-and a treatment plan based on it for the use in daily practice. In the meantime, the concept has also gained international recognition. The aim of this paper is to update part 2 of the Würzburg concept, the treatment plan, as knowledge about MIH has increased and the disease has been studied more extensively in the last years. Other treatment approaches are now available and therefore need to be included in the concept. Although, the evidence of the different treatment options is still weak, practitioners need guidance in their daily practice., Methods: The authors reviewed the available literature, including clinical and laboratory studies and published guidelines., Results: The updated version of the Würzburg concept includes additional non-invasive strategies and temporary therapy options, as well as treatment approaches for incisors. It therefore covers currently available treatment modalities for MIH-affected teeth, ranging from prophylaxis, non-invasive treatment to restorative approaches and possibly even extraction., Conclusions: This is intended to help guide the practitioner and will need to be further validated by clinical trials., (© 2023. The Author(s).)

Dental trauma in primary teeth can cause irreversible changes in the development of permanent tooth germs, including enamel hypoplasia, crown dilaceration, and root dilaceration. This article discusses multidisciplinary treatment of enamel hypoplasia and root dilaceration in the maxillary left central incisor of an 11-year-old girl. A 10-year follow-up is reported to demonstrate the long-term clinical outcomes. At the initial presentation, the patient's mother reported that the child had an accident at the age of 2 years, resulting in intrusive luxation of the primary maxillary left central incisor. After the accident, the patient was monitored for eruption of the permanent successor tooth, and different approaches were proposed during each period of the patient's development on the basis of the clinical diagnosis of root dilaceration and enamel hypoplasia. The crown was restored with composite resin, and the root defect was restored with resin-modified glass ionomer cement. After 10 years, the clinical outcomes highlight that the multidisciplinary approach was successful in preserving the natural tooth with good periodontal health conditions., Competing Interests: No conflicts of interest reported.

This systematic review evaluated the available evidence on whether children with molar incisor hypomineralization (MIH) have more dental fear and anxiety (DFA) and dental behavior management problems (DBMPs) than those without MIH (Prospero CDR42020203851). Unrestricted searches were performed in PubMed, Scopus, Web of Science, Lilacs, BBO, Embase, Cochrane Library, APA PsycINFO, Open Grey, and Google Scholar. Observational studies evaluating DFA and/or DBMPs in patients with and without MIH were eligible. Reviews, case reports, interventional studies, and those based on questionnaires to dentists were excluded. The methodological quality assessment was based on the Newcastle-Ottawa Scale. Random-effects meta-analyses were conducted to synthesize data on DFA. The certainty of evidence was performed according to GRADE. Seven studies that evaluated a total of 3,805 patients were included. All of them presented methodological issues, mainly in the comparability domain. Most studies observed no significant difference in DFA between children with and without MIH. The meta-analysis did not show a significant effect of MIH on the standardized units for the DFA scores (SMD = 0.03; 95%CI: -0.06-0.12; p = 0.53; I2 = 0%). Synthesis including only the results for severe cases of MIH also did not show a significant effect of the condition on DFA scores (MD = 8.68; 95%CI: -8.64-26.00; p = 0.33; I2 = 93%). Two articles found DBMPs were significantly more frequent in patients with MIH. The overall certainty of evidence was very low for both outcomes assessed. The current evidence suggests no difference in DFA between children with and without MIH; DBMPs are more common in patients with MIH. This information should be viewed with caution because of the very low quality evidence obtained.

Background: Resin infiltration is a micro-invasive treatment for molar incisor hypomineralisation (MIH). In this study it was aimed to evaluate the masking effect of resin infiltration treatment (ICON) on hypomineralised enamel surface of permanent anterior teeth by using laser fluorescence, spectrophotometer, and cross-polarisation photography., Methods: A total of 116 permanent central incisors in 37 patients were included in the study. The resin infiltration treatment (Icon®) was applied to the teeth with MIH; the healthy teeth received no treatment (control). Hypomineralised enamel lesions were evaluated by ICDAS II criteria. DIAGNOdent Pen was used to assess the lesions and healthy enamel surface quantitatively. Colour changes in enamel lesions were evaluated by using a spectrophotometer (VITA EasyShare). Each enamel lesion was imaged using a cross-polarization technique before and after treatment. All photos were assessed using Image J to evaluate the changes in lesion size. Enamel lesions were evaluated before; immediately after; 1; 3; and 6 months after treatment. Statistical significance was set as p < 0.05., Results: After the resin infiltration, significant decreases were found in the mean DIAGNOdent values for the treatment group (p < 0.05). The colour differences before and after treatment significantly differed in all follow-ups (p < 0.05). In the treatment group, lesion areas decreased significantly after treatment (p < 0.05)., Conclusions: The resin infiltration treatment has a masking effect on MIH lesions without cavities, with stable outcomes after six months. The cross-polarization photography technique may be use to evaluate the lesion size instead of photography with flash., Trial Registration: NCT04685889 (registered 28 December 2020)., (© 2023. The Author(s).)

Introduction: Dentists' knowledge and expertise, especially in their early career, are primarily shaped during undergraduate studies. This cross-sectional study aimed to assess the knowledge and perception of Syrian under- and postgraduate students regarding diagnosing and managing molar-incisor hypomineralisation (MIH)-affected teeth., Materials and Methods: Final-year dental students (FY-students), postgraduates in paediatric dentistry (PD-postgraduates) and postgraduates in other lines of specialty (OS-postgraduates) in all Syrian dental schools were invited to participate in an established web-based survey covering the knowledge and attitudes regarding the prevalence, aetiology, diagnosis and management of MIH. Data were analysed with descriptive statistics and Fisher's exact/chi-squared tests at 5%., Results: In total, 1142 post- and undergraduate students from six public and five private dental schools in Syria participated in this study (867 FY-students, 74 PD-postgraduates and 201 OS-postgraduates). PD-postgraduates were found to present statistically significantly better knowledge regarding MIH compared with the two other groups. Only 19% of FY-students and 54% of OS-postgraduates reported themselves familiar with MIH (compared with 97% of PD-postgraduates). Similarly, 18% of FY-students and 27% of OS-postgraduates were capable of diagnosing MIH (compared with 81% of PD-postgraduates). Stainless-steel crowns and direct composite fillings were chosen as most suitable for treating MIH-affected molars from all responders., Conclusions: FY-students and even OS-postgraduates in Syria lack knowledge and confidence when confronted with MIH. The university curricula need to include more educational materials to equip the students with the necessary tools to manage MIH clinically., (© 2022 The Authors. European Journal of Dental Education published by John Wiley & Sons Ltd.)

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., (© Operative Dentistry, 2023.)

Background: Molar incisor hypomineralization (MIH) is a widespread oral health problem. Dentists encounter several challenges regarding MIH management worldwide. The aim of this study was to evaluate and compare the knowledge, perceptions, attitudes, and clinical experiences on MIH among general dental practitioners and pediatric dentists in Syria., Methods: All general dental practitioners and pediatric dentists belonging to the Syrian Dental Syndicate of Damascus were invited to complete a cross-sectional structured questionnaire (n = 1936). The questionnaire consisted of four sections and required responses regarding demographic data, knowledge, perceptions, attitudes, and experiences on MIH. Data were analyzed with Pearson's chi-square test and multivariate regression models using SPSS Ver. 23.0., Results: The overall response rate was 36.31% (703/1936). Pediatric dentists were significantly more familiar with MIH (p < 0.001) and more confident when diagnosing it (p < 0.001). Most participants (43.95%) perceived an increase in MIH prevalence in Syria. Stainless steel crowns were the most favorable restorative material for molars with post-eruptive breakdown (51.38%). As for molars and incisors with opacities, composite resin was preferred with (41.82%), and (67.51%) respectively. General dental practitioners requested further training regarding MIH treatment (p < 0.001)., Conclusions: Pediatric dentists were equipped with further knowledge regarding MIH, and were more confident when diagnosing it. There is a need for additional training and education for general dental practitioners. Most respondents perceived an increase in the prevalence of MIH. There is a dearth of data regarding MIH prevalence in Syria. The materials of choice for restoring teeth with MIH were stainless steel crowns and composite resin., (© 2022. The Author(s).)

Background: Molar Incisor Hypomineralisation (MIH) remains a challenge for clinicians underlining the gap in the literature regarding the condition. The study aimed to record knowledge and attitudes of Greek dentists regarding diagnosis and treatment of MIH and correlate findings with non-dental characteristics., Methods: It is a cross-sectional study based on a questionnaire consisting of 37 multiple-choice questions. Data regarding diagnosis, aetiopathogenesis, and clinical management of MIH were collected from active members of three Greek Dental Associations. Chi-square and student's t-test were used to correlate responses with practitioners' characteristics and odds ratios calculated to evaluate differences on treatment of MIH-affected teeth (p < 0.05)., Results: From the 360 participants (response rate = 94%), 185 were general dental practitioners (GDPs) and 175 dental specialists (59 paediatric dentists (PDs), 38 orthodontists and 78 of other specialties).MIH was commonly encountered as a clinical problem, with GDPs reporting genetics and fluoride intake as common aetiological factors at significantly higher percentages as compared to PDs (p < 0.05). Permanent molars and incisors (44%) were the teeth most commonly affected, with yellow/brown demarcated opacities (68%) the most common clinical feature with PDs reporting them in a significantly higher percentage (p < 0.05). Dentists with specialisation, dentists that treat > 10 children per week and children with MIH-affected teeth had a 2-5.5 times greater probability to report difficulty achieving sufficient anaesthesia and hypersensitivity problems (p < 0.001). Agreement between GDPs' and dental specialists' views was found on less invasive treatment of anterior lesions. Non-PDs reported bulk-fill restorations and onlays as the ideal treatment of severely-affected posterior teeth, as compared to PDs that preferred preformed metal crowns (p < 0.05). Multivariate logistic regression analysis revealed that the age of the clinician, years of experience and number of children treated per week were the factors significantly associated with the decision for the treatment of only severely-affected posterior MIH teeth., Conclusions: Most participants had encountered MIH-affected teeth in their clinical practice and were able to recognize main aetiological factors and clinical findings related to the condition. Nevertheless, their knowledge regarding treatment is limited., (© 2022. The Author(s).)

Objective: This overview analyzed the quality of the systematic reviews (SRs) available on treatments for molar-incisor hypomineralization (MIH)., Material and Methods: Six electronic databases were searched (PubMed/MEDLINE, Scopus, Web of Science, LILACS, Brazilian Bibliography of Dentistry and Cochrane Library) until March 2022. Two reviewers independently performed the selection, the quality assessment (Assessment of Multiple Systematic Reviews 2 - AMSTAR-2), and the risk of bias assessment of the SR (Risk of Bias in Systematic Reviews - ROBIS)., Results: Two hundred nine records were retrieved; after removing duplicates and applying the inclusion/exclusion criteria, 5 SRs remained. Three SRs were rated as showing critically low methodological quality and high risk of bias, and two were rated as moderate methodological quality and low risk of bias. The identified treatments that may be suitable for MIH were classified as (1) non-invasive - casein incorporated into toothpaste and sugar-free chewing gum, toothpaste containing arginine, 0.4% stannous fluoride gel; fluoride varnish; (2) micro-invasive - resin sealants for pits and fissures, microabrasion, dental whitening, resin infiltration; (3) invasive - ART restorations, indirect restorations (metal, composite, or ceramic); and (4) mixed intervention - stainless steel crowns., Conclusion: Despite the considerable number of published papers included in this set of systematic reviews, the evidence supporting the effectiveness of treatments for treating MIH is limited due to the methodological quality and risk of bias of the systematic reviews, as well as the quality of the primary studies (PROSPERO: CRD42020144831)., Clinical Relevance: Different treatments have been purposed for MIH treatment, but there is still not enough scientific evidence of good quality for the establishment of a definitive clinical protocol for the treatment of MIH., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Hypomineralization (MH) are controversial. The aim of this study was to compare need for treatment and status of restorations performed on first permanent molars in patients with and without MH. Retrospective design based on the clinical records of 153 patients who had received comprehensive care in 2014 at the Clinic of the Children's Comprehensive Dentistry Department (FOUBA) by 3 pediatric dentists (Kappa MH 0.94), and who attended periodical follow-up visits for at least 24 months. Need for treatment in first molars, and type and longevity of treatment were recorded (modified Ryge criteria /USPHS, Kappa 0.78). Results were compared between patients with MH and without MH. The Kruskal Wallis test was used to compare follow-up time, the asymptotic test was performed to compare proportions, and relative risk (RR) was calculated to compare need for treatment. Mean follow-up times for the 595 teeth analyzed were 61.7±20.1 months for Group without MH, and 57.5±23.9 months for Group with MH (p=0.0504). The percentages of teeth requiring at least one treatment were 7.2% in Group without MH and 27.5% in Group with MH (RR = 3.80, p <0.001). Of the teeth treated in Group with MH 23.1% required retreatment, while none of the teeth in Group without MH did. The need for treatment was approximately 4 times higher in molars affected with MH, with greater probability of retreatment., Competing Interests: The authors declare no potential conflicts of interest regarding the research, authorship, and/or publication of this article., (Sociedad Argentina de Investigación Odontológica.)

Background: There are diverse opinions among dentists about managing compromised first permanent molars (cFPMs) in children and a perceived lack of guidance to help them evaluate prognosis., Aim: To evaluate the current management of cFPM in children referred to a UK hospital centre and to report the severity of the affected teeth., Design: A service evaluation was undertaken, based on case records of medically fit children (6-11 years) referred to for the management of cFPMs. The presence of hypomineralisation, post-eruptive breakdown and the proposed care plans were recorded. Radiographic signs of severity were scored using the ICDAS index (intra/inter-rater kappa 0.96/0.82)., Results: From 349 records screened over a 4-month period, 249 met the selection criteria. Almost 81% were planned to have extraction of at least one cFPM, whereas 19.3% were managed without extraction. More than half of the extraction cases (n = 105) had radiographic radiolucencies not exceeding the middle third of dentine in the worst-affected FPM. At the time of extraction, the mean age of the patients was 9.8 years (±0.9). GA was used in 196 (97.5%) cases, and 40.8% had not received previous treatment in any of their cFPMs., Conclusion: Potentially restorable cFPMs in children is, most of the time, in a cohort of UK patients referred for tier 3 services, being managed by timed extractions under general anasethesia., (© 2021 The Authors. International Journal of Paediatric Dentistry published by BSPD, IAPD and John Wiley & Sons Ltd.)

The restoration of teeth affected by molar-incisor hypomineralization (MIH) is challenging. To this end, preformed stainless steel crowns (SSCs) are a good option; however, their conventional use involves the removal of tooth structure. In the Hall technique, the SSC is seated over the primary teeth without caries removal or tooth preparation, aiming to seal carious lesions. This case series reports the use of SSCs in a similar way to the Hall technique for 3 pediatric patients with MIH. The high-caries-risk patient in case 1 lost hypomineralized enamel and developed a carious lesion immediately after eruption of a permanent first molar. The patient in case 2 complained of hypersensitivity associated with MIH of a first molar that had previously been restored. The patient in case 3 experienced atypical restoration failures in MIH-affected first molars. In all 3 cases, the use of SSCs without tooth preparation was an effective restorative treatment. Although this conservative treatment is a temporary solution, it provides good longevity and preserves tooth structure until the patient reaches physical and emotional/behavioral maturity for a definitive restoration., Competing Interests: The authors report no conflicts of interest pertaining to any of the topics discussed in this article.

Background: Molar-Incisor Hypomineralization (MIH) is a common oral health condition that can lead to difficulties and complications for both dental professionals and patients. It also has a negative impact on the oral health-related quality of life. The present study aimed to assess the knowledge, clinical experience, and perceived need for training of a group of Egyptian dental students regarding MIH., Methods: Paper-based survey administration method was used to collect the responses of dental students regarding their knowledge, clinical experience, and perceived need for training about MIH. The survey consisted of two sections of questions regarding clinical features, etiological factors, prevalence, materials used in treating these teeth, factors affecting the choice of restorative materials, and their preferences regarding clinical training of MIH. Descriptive statistics was used for the data analysis by using SPSS® Statistics Version 26., Results: About two-thirds of the respondents were familiar with MIH (69.2%). The vast majority of students (87.8%) had difficulty distinguishing MIH as a developmental defect that differs from other tooth conditions (p < 0.001); most commonly enamel hypoplasia. The most common defects seen by the respondents were yellow/brown opacities (59.1%). Nearly half of the students (45.2%) choose composite resin as the material of choice for the treatment of MIH-affected teeth with aesthetics being the most common factor affecting the selection of restorative material. Almost all students expressed their needs for further clinical training on MIH, especially on treatment aspects., Conclusions: Most students are familiar with MIH theoretically. However, there is an urgent need to include clinical training on MIH diagnosis in the practical sessions of pediatric dentistry courses., (© 2022. The Author(s).)

Purpose: To evaluate clinical and radiographic outcomes of vital pulp therapy (VPT) in deeply carious young permanent first molars (PFM) affected with MIH over 24 months., Methods: In this prospective randomized clinical trial, n = 50 children with deeply carious young PFM affected with MIH, and diagnosed with reversible or irreversible pulpitis were randomized into 2 groups: indirect pulp treatment (IPT) and pulpotomy (partial or complete). Teeth were followed up clinically and radiographically for 24 months. Statistical analysis was done using Chi-square test; P ≤ 0.05 was considered significant., Results: A total of  n = 50 teeth/patients (n = 26 females (52%), n = 24 males (48%)) were included, and 14 upper and 36 lower PFM were treated. Mean age was 11 ± 3.2 years. Clinical and radiographic success rates were: 96% for IPT, 90% for PP and 82% for CP (and 86% for both types of pulpotomy combined) over 24 months. There were no significant differences in outcomes between treatment groups. Age, gender and tooth location/jaw were found to have no statistically significant difference in outcomes among treatment groups, nor did pulpal status or root maturity, regardless of type of VPT and follow up period., Conclusions: VPT is a valid treatment option in deeply carious young permanent first molars affected with MIH over 24 months. IPT had a higher clinical and radiographic success rate (96%) than partial or cervical pulpotomy (total 86%), but the difference was not statistically significant. Future randomized clinical trials on VPT for teeth affected with MIH are recommended with larger sample size and longer follow-up., (© 2022. The Author(s), under exclusive licence to European Academy of Paediatric Dentistry.)

Purpose: Dental bleaching in paediatric patients can be used to address discolouration of teeth due to trauma, endodontic treatment, or enamel and dentine defects. Despite being a minimally invasive and successful treatment, the use of bleaching products in children and young people remains controversial. This evaluation was designed to provide insight into the child's perspective on dental bleaching and the influence that this treatment has upon their life., Method: A dental bleaching patient reported outcome measure (PROM) was developed and piloted in 2019. Data were collected from 3 UK units (January-March 2020). Children attending these units for bleaching reviews were invited to complete the PROM., Results: Twenty seven PROM questionnaires were completed including 19 courses of external bleaching and 8 courses of internal/external bleaching. The average age was 14 years old (9-17 years). The common indications for bleaching were Amelogenesis Imperfecta, dental trauma and Molar Incisor Hypomineralisation. Patients reported improvements in their appearance (89%) and self-confidence (81%). Sensitivity was the most common side effect, reported in 63% of cases., Conclusion: This PROM supports the use of dental bleaching in children and young people when treating dental disease that causes discolouration. Bleaching not only improved the appearance of teeth, but also patients' self-confidence. Sensitivity is a common side effect and clinicians should discuss this common risk and its management with patients and their families., (© 2022. The Author(s), under exclusive licence to European Academy of Paediatric Dentistry.)

Objectives: The aim of this study was to evaluate the impact of treating demarcated opacities in anterior teeth on the esthetic perception of children and their parents. Additionally, the masking effect was evaluated quantitively and qualitatively., Methods: Thirty-nine patients, 8-18 years-old, presenting white-creamy opacity in permanent incisors were randomly allocated to test or control group. Test received resin infiltration and control received a placebo. The questionnaire Child's and Parent's Questionnaire about Teeth Appearance was used. The masking effect was quantitatively analyzed using the Lab System to calculate the color difference (ΔE) between the opacity and the surrounding enamel in Photoshop. Fisher's, Chi-square, Wilcoxon, Mann-Whitney tests and Spearman's correlation were applied to data analysis., Results: In the test group, a significant impact on physical and psychological domains in parents' and in social domain in parents' and children's perception was observed (p<0.05). Significant difference in ΔE between test and control groups was seen from 15 min of application onwards (p<0.05). After treatment, the mean ΔE was 4.07 (SD=3.07) in the test and 7.35 (SD=3.54) in the control group (p<0.01). One month later, the mean ΔE was 4.22 (SD=2.96) in the test and 6.06 (SD=2.52) in the control group (p<0.01). Total masking was seen only in the test group (p<0.01)., Conclusion: Aesthetic treatment of hypomineralization opacities in anterior teeth with resin infiltration impacted positively on parents and children. Resin infiltration reduced the color difference between opacities and sound enamel significantly after an application time of at least fifteen minutes., Clinical Significance: Opacities in anterior teeth impact the self-image of children and parents negatively. This study demonstrated that 15 min resin infiltration can mask opacities in permanent incisors and recover social wellbeing. This minimally invasive approach can be offered to MIH children who report dissatisfaction with their incisors., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: Children with molar-incisor hypomineralisation (MIH) frequently seek aesthetic treatment for incisor opacities. Surprisingly, few studies have evaluated the clinical success of such interventions., Aim: To quantify the effectiveness of minimally invasive treatments in reducing enamel opacity visibility in children with MIH., Design: This in vitro study used digital clinical images of 23 children aged 8-16 years with MIH who underwent microabrasion and/or resin infiltration for the management of incisor opacities. Standard images were taken pre-treatment and 6 months post-treatment. Image software (Image-Pro Plus ® V7) was employed to convert 24-bit RGB images to 16-bit greyscale and 145× magnification. Measurement repeatability was assessed using intra-class correlation coefficients (ICCs). Post-treatment changes in visible opacity area (mm 2 ) and brightness (greyscale value) were tested using the Wilcoxon signed-rank test for related samples., Results: The mean total opacity surface area significantly reduced from 14.3 mm 2 (SD = 7.5) to 9.4 mm 2 (SD = 9.0) post-treatment. The proportion of tooth surface affected by the opacity also significantly reduced from 22.5% (SD = 10.5) to 14.7% (SD = 12.7). The mean maximum opacity brightness significantly reduced from 53 066 greyscale value (SD = 4740) to 49 040 (SD = 3796). ICC was good/excellent (0.75-1.0)., Conclusion: Minimally invasive treatment is effective in reducing the size and brightness of discrete incisor opacities. Future research should compare objective findings with patient-reported outcomes., (© 2021 BSPD, IAPD and John Wiley & Sons Ltd.)

Aim: To develop, apply, and evaluate a virtual learning object (VLO) for teaching undergraduate dental students and paediatric dentists to diagnose and manage molar incisor hypomineralization (MIH)., Design: This controlled educational intervention included 170 undergraduate dental students and 50 paediatric dentists. The student intervention group (VLOG) was trained by the VLO, the control group of students (CG) received a synchronous virtual class, and the group of paediatric dentists (PDG) was trained by the VLO. Pre-test and post-test data were analyzed with a mixed one-way and Tukey's post hoc ANOVA test (α = 0.05). The answers to the questionnaire were analyzed with the one-way ANOVA test and Tukey's post hoc test (α = 0.05)., Results: The values obtained in the pre-test were significantly lower than those obtained in the post-test for all groups. The specialists showed a higher level of knowledge before and after the MIH training compared with the students (p < .001). Similarly, statistical differences were found in the level of knowledge, which increased after MIH training (p < .001). There were no differences between the CG and VLOG., Conclusions: The level of knowledge increased in all groups after training regardless of the method used. VLOG works similar to traditional teaching approaches., (© 2021 BSPD, IAPD and John Wiley & Sons Ltd.)

Aim: Molar incisor hypomineralization (MIH) is a prevalent oral health condition whose knowledge by dentists is key to the best clinical outcome. This study aimed to evaluate the knowledge, perceptions and clinical experiences of MIH among Portuguese dentists., Methods: A cross-sectional structured questionnaire was distributed nationally through a web-based survey platform. Data concerning demographic variables, years of experience, dental specialty, MIH prevalence, diagnosis, severity, training demands and clinical management of MIH were collected. We calculated a knowledge score (KS), and compared data between Pediatric Dentists (PDs), General Dental Practitioners (GDPs) and other dental specialties (ODS)., Results: Overall, 2.2% of Portuguese dentists (n = 257) answered the questionnaire. Most participants reported having identified MIH in their practice (82.5%), with PD reporting the prevalence appeared to have increased, and practically all (91.7%) considered it a public health problem. Resin composite was often the used material to restore MIH teeth (56.0%), however PDs indicated glass ionomer cements as the preferred and preformed crowns a better option. The average KS on MIH was 41.3 (± 5.7), with GDPs having a similar score than PDs. Most respondents (94.9%) reported a lack of information about MIH and were willing to receive appropriate clinical training., Conclusions: The average knowledge on MIH was considered low among Portuguese dentists. Respondents perceived an increased incidence of MIH, despite the lack of prevalence data in Portugal. The material of choice was Glass Ionomer and performed crowns, by PDs, while GDPs and ODS reported poor confidence to manage MIH. These results may serve future programs to increase knowledge, perceptions and clinical experiences towards MIH., (© 2022. The Author(s).)

Objective: Hypersensitivity is an important problem that is encountered during the treatment of hypomineralized teeth. The aim of this prospective study was to compare responses to electrical pulp tests (EPTs) and cold tests among carious teeth with and without molar incisor hypomineralization (MIH) before and after the administration of local anesthesia for caries removal Results: The EPT results of anesthetized carious teeth without MIH were significantly higher than those of carious teeth with MIH (p = 0.011). The cold test results were significantly higher for anesthetized carious teeth with MIH than for those without MIH (p = 0.0001). Intraoperative pain was significantly higher for carious teeth with MIH (p = 0.003)., Conclusions: The results of this study suggest that even after achieving sufficient anesthesia, hypersensitivity remains a clinical problem in MIH-affected carious molars. The results presented in this study indicate that this phenomenon is not related to achieving effective local anesthesia; therefore, behavior management in such cases is of the utmost importance compared to relying on adjacent anesthetic methods.

Molar incisor hypomineralization (MIH) is often accompanied by dental hypersensitivity and difficulty in achieving effective analgesia., Objective: This study evaluated the effectiveness of preemptive analgesia in children with severe MIH, post-eruptive enamel breakdown, and hypersensitivity., Methodology: Ibuprofen (10 mg/kg child weight) or placebo was administered, followed by infiltrative anesthesia and restoration with resin composite. Hypersensitivity was evaluated in five moments. The data were analyzed using the chi-square test, Fisher's exact test, and t-test., Results: Preemptive analgesia provided benefits for the treatment of severe cases of MIH, with an increase in the effectiveness of infiltrative anesthesia and improved patient comfort during the restorative procedure., Conclusion: Preemptive analgesia has shown efficacy in reducing hypersensitivity during restorative dental procedures, evidencing the significance of this study for patients with MIH and hypersensitivity.

Background: Treatment of oral diseases can have a long-lasting impact on a child's life well beyond its childhood years. The purpose of this study was to compare the impact of treatment on the oral-health-related quality of life (OHRQoL) of children with severe caries and severe molar incisor hypomineralization (MIH)., Methods: A total of 210 children (mean age 9 years; 49% female) with severe caries (inner third of dentin) and severe MIH (post-eruptive breakdown, crown destruction) were included in the study. Both groups were matched according to age, gender, and social status. The German version of the Child Perception Questionnaire for 8-10-year-olds (CPQ-G8-10) was used before and after treatment to analyze the impact on OHRQoL., Results: Patients with severe MIH showed a significantly higher total CPQ score (17.8 (±10.6)) before treatment compared to the caries group (13.8 (±14.3)). The mean CPQ score in all subdomains decreased significantly after therapy in the MIH group. Children with severe carious lesions had similar results except in the domain "functional limitations", as treatment led to only minor changes (2.9 (±3.6) to 2.2 (±2.6))., Conclusions: Despite a narrower treatment spectrum, patients with severe MIH experienced a greater overall improvement in OHRQoL compared to the caries group.

Objectives: To obtain the views and opinions of specialist members of the British Orthodontic Society (BOS) and British Society of Paediatric Dentistry (BSPD) in relation to (1) the multidisciplinary management of patients affected by molar incisor hypomineralisation (MIH) and (2) the diagnosis and management of MIH-affected first permanent molars (FPMs) in four clinical scenarios, and compare the responses to those of an expert panel consensus., Design: A prospective cross-sectional study., Setting: Part 1: Eastman Dental Institute and part 2: online questionnaire., Methods: Four clinical scenarios showing patients with differing severities of MIH affected FPMs were considered by a panel of orthodontists and paediatric dentists to agree on the severity of MIH and management. A 21-item online questionnaire sent to both specialist groups, after pilot study. The questionnaire covered demographics, access to multidisciplinary clinics, clinicians' opinions on various management aspects, and questions relating to the management of the same 4 clinical scenarios., Results: The overall response was 21.9% (20% of the orthodontists and 45% of the paediatric dentists). Approximately half of the respondents from both groups felt that these patients should be managed through a multidisciplinary treatment type clinic (49.0% of the orthodontists and 47.2% of the paediatric dentists). Only 40.3% of the orthodontists and 35.0% of the paediatric dentists agreed completely with the panel consensus on all management options. When assessing overall agreement on all four FPMs for all scenarios, agreement was predicted by severity of MIH (P<0.001) and complexity of malocclusion (P<0.001) where more complex malocclusions and more severe MIH resulted in poorer agreement, but specialty was not a significant predictor (P=0.21)., Conclusion: The majority of the respondents from both groups, felt that managing patients with MIH affected FPMs is challenging. Approximately half of the orthodontists and the paediatric dentists, felt that MIH affected patients should be managed through a multidisciplinary type clinic. Managing more severe cases on multidisciplinary clinics is indicated, to incorporate specialist input into decision making.

Background: Currently, there is no consensus on the superiority of any material for the restorative treatment of molars affected by molar-incisor hypomineralization (MIH)., Aim: To evaluate the survival of restorations with stainless-steel crown (SSC) or composite resin (CR) in first permanent molars affected by MIH for 24 months., Design: In this retrospective cohort study, 61 CR and 54 SSC restorations placed on molars affected by MIH of patients, aged between 7 and 10, that were treated and overseen at a university dental clinic in the period of 2017-2020 were evaluated. The primary outcome was the failure-free survival time. Parametric survival models were used for data censored by interval, and the comparison between SSC and CR was performed using the hazard ratio function with a 95% confidence interval., Results: The survival of SSC and CR restorations after 24 months was 94.4% and 49.2%, respectively. This difference was influenced by the presence of previous restoration (aHR = 3.4; 95% CI: 1.2-9.4) and cusp involvement (aHR = 4.0; 95% CI: 1.5-11.2)., Conclusion: In molars with MIH and the need for restorative treatment, SSC had a significantly higher survival rate than CR over 24 months., (© 2021 BSPD, IAPD and John Wiley & Sons Ltd.)

Aim: To identify the worldwide trends in scientific evidence and gaps in knowledge regarding molar incisor hypomineralisation (MIH) and deciduous molar hypomineralisation/hypomineralised second primary molars (DMH/HSPM), exploring the contribution of authors and countries, possible etiological factors and proposed treatments, in order to guide future research in the area., Methods: Searches were conducted in MEDLINE, Scopus, Web of Science, Cochrane Library, Lilacs/BBO, Embase and Google Scholar. Studies employing the terms MIH, DMH/HSPM and their linguistic variations were included. The following data were extracted: title, authors, year and journal of publication and first author's affiliation country. Studies were categorized according to topic, dentition, study design, etiological factors and types of treatments. Categories were analysed in relation to their distribution, co-occurrence, cross-correlation and/or autocorrelation., Results: Five hundred and three studies were included. The most published authors were Manton D (n = 47), de Souza JF (n = 22) and Ghanim A (n = 22) and four main collaboration clusters have been identified. Most of the studies were conducted on permanent dentition (MIH) (87.4%); with observational design (57.2%). The "European Archives of Paediatric Dentistry" was the most published journal (13.3%) and a significant increase in the number of publications was observed in the last decade. MIH was most studied in relation to prevalence/incidence, systemic factors involved in its aetiology and treatment with composite restorations, while a gap in knowledge was observed for extraction and sealants. Less studies were published on DMH/HSPM and most of them evaluated risk factors or prevalence/incidence. The gap of knowledge was observed in relation to treatments and patient's quality of life., Conclusions: This bibliometric review provided a comprehensive overview of research in MIH and DMH/HSPM over the past 19 years. Within the limitations of the present study, the following conclusions can be drawn: global trends point to an increasing peak of scientific publication, especially in the last decade, while there is a shortage of clinical studies on treatments, mainly evaluating tooth extractions. Finally the multifactorial nature should be further explored, considering environmental and systemic factors together., (© 2021. European Academy of Paediatric Dentistry.)

Background: Teeth affected with severe molar incisor hypomineralization (MIH) require extensive restorations, which do not last for a long time and often require treatment in the form of onlays or full coverage restorations., Aim: To evaluate and compare the clinical performance of zirconia, lithium disilicate, and cast metal crowns as full-coverage restorations on MIH-affected first permanent molars (FPMs)., Methods: 60 MIH affected FPMs requiring full-coverage crowns were identified in children aged 8-15 years and were randomly allocated to the three treatment groups according to the type of full coverage restoration received using block randomization technique. After an adequate removal of the MIH defect and restoration with composite resin, the tooth preparation was done followed by fabrication of crown and its cementation using resin cement. The intergroup comparison was done on the basis of USPHS criteria, gingival, plaque scores, patient and parents acceptance through a visual analog scale to decipher their clinical performance at 6, 12, 24 months., Results: After 24 months, the crowns showed similar clinical success in terms of the criterias used to compare their clinical performance. The retention, marginal adaptation, relief from hypersensitivity, proximal contact, gingival health with no statistically significant difference among the three groups., Conclusion: Based on the observations, Lithium disilicate, Zirconia and full cast metal crowns showed similar clinical success in rehabilitation of First permanent molars with severe MIH over 24 months of evaluation. The clinical success is not influenced by the material of the restoration. However, prospective studies with a longer follow-up are required to reach a more definitive conclusion., (© 2021. European Academy of Paediatric Dentistry.)