Conservative approach for molar-incisor hypomineralization: a case report and 7-year follow-up

Molar-incisor hypomineralization (MIH) can result in minor injuries or major structural loss, especially in incisors and molars. Patients with MIH seek dental treatment early, usually in childhood. Choosing the best treatment option during this stage can be a challenge. Because these patients still present a mixed dentition, the use of prosthetic appliances is not usually the best option. This case report with a 7-year follow-up presents an overview of a conservative approach for the restoration of teeth affected by MIH. A 10-year-old girl presented with permanent molars and incisors that exhibited qualitative defects of enamel characteristic of MIH. During the restoration phase, direct resin-modified glass ionomer cement (RMGIC) restorations were placed in all 4 first molars with the aid of acetate crowns, which were used to facilitate reconstruction of the tooth morphology. The maxillary incisors were previously treated by another dentist, and the mandibular incisors were treated later, since they were not the main complaint of the patient at the time. During 7 years of follow-up, the RMGIC restorations proved to be a good option, presenting greater longevity in a molar with minor structural defects and requiring repair or replacement in molars with larger structural defects. Despite some failures and the necessity for new restorations, the patient conveyed satisfaction with the treatment and reported no tooth sensitivity, and there was no recurrence of caries. During this follow-up period, the defective mandibular incisors were treated first with enamel microabrasion, which proved esthetically unsatisfactory, and then with direct composite resin veneers. The results in this patient suggest that use of RMGIC may be a feasible conservative option for tooth restoration in young patients with a mixed dentition when permanent molars exhibit extensive structural loss associated with MIH.