Minimally invasive management of molar-incisor hypomineralization using semidirect restorations: a case series

Molar-incisor hypomineralization (MIH) poses clinical management challenges due to enamel fragility and hypersensitivity, and treatment is often more complicated in pediatric patients, who may show less cooperation. This case series describes a minimally invasive restorative approach with a semidirect occlusal replica technique that uses high-viscosity glass ionomer cement (GIC) to manage MIH-affected molars. Three children, aged 8 to 12 years, who had severe MIH affecting permanent first molars were treated using the semidirect replica technique. The procedures were focused on preserving tissue, minimizing discomfort, and restoring function. Diagnostic impressions were used to fabricate wax-ups, which were then used to produce silicone matrices that would replicate occlusal anatomy. Under conditions of relative isolation, high-viscosity GIC was applied to the molars via the matrices. All patients tolerated the procedures well, and local anesthesia was required in only 1 patient. The restorations showed anatomical accuracy and functional stability. The patients reported immediate relief of hypersensitivity, and no restorative failures or complications were observed at the 6-month follow-up examinations. The semidirect occlusal replica technique with high-viscosity GIC is a clinically feasible and effective method for restoring MIH-affected molars in the mixed dentition period, reducing chair time, delivering functional recovery, and ensuring patient comfort.