Treatment options for hypomineralized first permanent molars and incisors

Abstract

The aim of this study was to discuss therapy possibilities in the management of molar incisor hypomineralization. Molar incisor hypomineralization (MIH) is defined as hypomineralization of one or more first permanent molars frequently affecting incisors. Etiology of MIH is not fully clarified and numerous etiological factors have been cited. Hypomineralized molars are more prone to caries, cause severe restorative problems and are frequently extracted due to serious damage and caries complications. Incisors can present demarcated enamel opacities, while enamel breakdown is uncommon. Clinically, affected molars can be sensitive to thermal and chemical irritations even when there is no enamel breakdown. Molars can be sensitive to mechanical irritations making even regular tooth brushing painful. Specific problems related to the treatment of these teeth are sensitivity and occlusion in molars and aesthetics in incisors. Considering the fact that permanent first molars with severe defects and incisors demand complex and multidisciplinary treatment they present serious problem for the patient as well as for the dentist.Cilj rada je bio da se analiziraju mogucnosti terapije hipomineralizovanih prvih stalnih molara i inciziva. Hipomineralizacija prvih stalnih molara i inciziva (Molar Incisor Hypomineralization - MIH) se definise kao hipomineralizacija jednog ili vise prvih stalnih molara, a cesto je udruzena sa promenama i na sekuticima. Etiologija ove pojave, jos uvek nije dovoljno razjasnjena pa se navode se brojni, moguci, etioloski faktori. Hipomineralizovani molari, su podlozniji nastanku karijesa, teski su za sanaciju i cesto su zbog komplikacija prerano izvadjeni. Promene na sekuticima nisu tako obimne i retko osim promene boje, dolazi do dezintegracije gledj. Klinicki zahvaceni molari su veoma osetljivi na termicke i hemijske nadrazaje, cak i u slucajevima kada ne postoji prekid kontinuiteta gledji. Posebno su osetljivi na mehanicke nadrazaje, tako da i uobicajeno pranje zuba moze biti bolno. Poseban problem u tretmanu i sanaciji ovih zuba je preosetljivost i okluzija molara, odnosno estetika kada su zahvaceni sekutici. Tretman ovako promenjenih molara je tezak, komplikovan i zahteva multidisciplinarni tretman.