A Minimally Invasive Esthetic Approach for Teeth with Molar Incisor Hypomineralization: a Clinical Case Report


  • Letícia Aparecida Margotto Schneider DDS Student, Department of Dentistry University Center of Espírito Santo (UNESC), Colatina, Espirito Santo, Brazil https://orcid.org/0009-0006-2949-5432
  • Sandro Basso Bitencourt Professor; Department of Rehabilitative & Reconstructive Dentistry, School of Dentistry, University of Louisville, Louisville, KY https://orcid.org/0000-0001-9140-7516
  • Natália Almeida Bastos-Bitencourt Professor, Department of Dentistry, Federal University of Juiz de Fora (UFJF), Governador Valadares, Minas Gerais, Brazil https://orcid.org/0000-0002-8365-0978




Demineralization, Composite Resins, Adhesives, Esthetics


Molar incisor hypomineralization (MIH) is a qualitative defect of enamel, clinically characterized by white or yellow/brownish demarcated opacities that affect permanent molars, often associated with permanent incisors. The etiology is multifactorial, including systemic and genetic/epigenetic factors. Defects of anterior teeth can negatively impact children since they might present lower self-esteem and socialization problems. Purpose: To describe a minimally invasive treatment for anterior teeth affected by molar incisor hypomineralization, performed with direct composite resin restoration and a universal adhesive system. Case Report: An 8-year-old patient sought dental care with complaints about her dental appearance, reporting suffering from school bullying. She presented a white-yellowish opacity on the maxillary right central incisor. After a clinical examination, she was diagnosed with molar incisor hypomineralization. To improve dental esthetics, a direct composite resin restoration was proposed. The enamel surface was prepared and etched with 35% phosphoric acid etchant solution for 15 seconds before applying the universal adhesive system. Two different shades of the composite were used for layering the material to disguise the defect without extensive removal of the dental structure. The result was satisfactory as it was possible to mask the opacity, reestablish enamel thickness, and improve the patient's quality of life. Conclusion: Conservative restorations comprising a universal adhesive system seem to bring desirable esthetic results for anterior teeth with molar incisor hypomineralization.


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Bussaneli DG, Vieira AR, Santos-Pinto L, Restrepo M. Molar-incisor hypomineralisation: an updated view for aetiology 20 years later. Eur Arch Paediatr Dent. 2022 Feb;23(1):193-198. doi: 10.1007/s40368-021-00659-6.

Lygidakis NA, Wong F, Jälevik B, Vierrou AM, Alaluusua S, Espelid I. Best Clinical Practice Guidance for clinicians dealing with children presenting with Molar-Incisor-Hypomineralisation (MIH): An EAPD Policy Document. Eur Arch Paediatr Dent. 2010 Apr;11(2):75-81. doi: 10.1007/BF03262716.

Garot E, Rouas P, Somani C, Taylor GD, Wong F, Lygidakis NA. An update of the aetiological factors involved in molar incisor hypomineralisation (MIH): a systematic review and meta-analysis. Eur Arch Paediatr Dent. 2022 Feb;23(1):23-38. doi: 10.1007/s40368-021-00646-x.

Lygidakis NA, Garot E, Somani C, Taylor GD, Rouas P, Wong FSL. Best clinical practice guidance for clinicians dealing with children presenting with molar-incisor-hypomineralisation (MIH): an updated European Academy of Paediatric Dentistry policy document. Eur Arch Paediatr Dent. 2022 Feb;23(1):3-21. doi: 10.1007/s40368-021-00668-5.

Schwendicke F, Elhennawy K, Reda S, Bekes K, Manton DJ, Krois J. Global burden of molar incisor hypomineralization. J Dent. 2018 Jan;68:10-18. doi: 10.1016/j.jdent.2017.12.002. Epub 2017 Dec 6. Erratum in: J Dent. 2019 Jan;80:89-92.

Weerheijm KL, Jälevik B, Alaluusua S. Molar-incisor hypomineralisation. Caries Res. 2001 Sep-Oct;35(5):390-1. doi: 10.1159/000047479.

Americano GC, Jacobsen PE, Soviero VM, Haubek D. A systematic review on the association between molar incisor hypomineralization and dental caries. Int J Paediatr Dent. 2017 Jan;27(1):11-21. doi: 10.1111/ipd.12233.

Fagrell TG, Dietz W, Jälevik B, Norén JG. Chemical, mechanical and morphological properties of hypomineralized enamel of permanent first molars. Acta Odontol Scand. 2010 Jul;68(4):215-22. doi: 10.3109/00016351003752395.

European Academy of Paediatric Dentistry. Guidelines on the use of fluoride in children: an EAPD policy document. Eur Arch Paediatr Dent. 2009 Sep;10(3):129-35. doi: 10.1007/BF03262673.

Pasini M, Giuca MR, Scatena M, Gatto R, Caruso S. Molar incisor hypomineralization treatment with casein phosphopeptide and amorphous calcium phosphate in children. Minerva Stomatol. 2018 Feb;67(1):20-25. doi: 10.23736/S0026-4970.17.04086-9.

Muniz RSC, Carvalho CN, Aranha ACC, Dias FMCS, Ferreira MC. Efficacy of low-level laser therapy associated with fluoride therapy for the desensitisation of molar-incisor hypomineralisation: Randomised clinical trial. Int J Paediatr Dent. 2020 May;30(3):323-333. doi: 10.1111/ipd.12602.

Fragelli CMB, Souza JF, Bussaneli DG, Jeremias F, Santos-Pinto LD, Cordeiro RCL. Survival of sealants in molars affected by molar-incisor hypomineralization: 18-month follow-up. Braz Oral Res. 2017 Apr 27;31:e30. doi: 10.1590/1807-3107BOR-2017.vol31.0030.

Lygidakis NA, Chaliasou A, Siounas G. Evaluation of composite restorations in hypomineralised permanent molars: a four year clinical study. Eur J Paediatr Dent. 2003 Sep;4(3):143-8. PMID: 14529336.

Grossi JA, Cabral RN, Ribeiro APD, Leal SC. Glass hybrid restorations as an alternative for restoring hypomineralized molars in the ART model. BMC Oral Health. 2018 Apr 18;18(1):65. doi: 10.1186/s12903-018-0528-0.

Oh N, Nam S, Lee J, Kim H. Retrospective study on the survival rate of preformed metal crowns in permanent first molars. J Korean Acad Pediatr Dent. 2020;47(2):140–7. doi: 10.5933/JKAPD.2020.47.2.140.

Crombie F, Manton D, Palamara J, Reynolds E. Resin infiltration of developmentally hypomineralised enamel. Int J Paediatr Dent. 2014 Jan;24(1):51-5. doi: 10.1111/ipd.12025.

Bhandari R, Thakur S, Singhal P, Chauhan D, Jayam C, Jain T. In vivo Comparative Evaluation of Esthetics after Microabrasion and Microabrasion followed by Casein Phosphopeptide-Amorphous Calcium Fluoride Phosphate on Molar Incisor Hypomineralization-Affected Incisors. Contemp Clin Dent. 2019 Jan-Mar;10(1):9-15. doi: 10.4103/ccd.ccd_852_17.

Weerheijm KL. Molar incisor hypomineralization (MIH): clinical presentation, aetiology and management. Dent Update. 2004 Jan-Feb;31(1):9-12. doi: 10.12968/denu.2004.31.1.9.

Prud'homme T, Hyon I, Dajean Trutaud S, Lopez Cazaux S. Different applicabilities of the etch-bleach-seal technique for treating opacities on permanent incisor damage by molar incisor hypomineralisation in three young patients. BMJ Case Rep. 2017 Dec 29;2017:bcr2017221442. doi: 10.1136/bcr-2017-221442.

Rodd HD, Abdul-Karim A, Yesudian G, O'Mahony J, Marshman Z. Seeking children's perspectives in the management of visible enamel defects. Int J Paediatr Dent. 2011 Mar;21(2):89-95. doi: 10.1111/j.1365-263X.2010.01096.x.

Ghanim A, Silva MJ, Elfrink MEC, Lygidakis NA, Mariño RJ, Weerheijm KL, Manton DJ. Molar incisor hypomineralisation (MIH) training manual for clinical field surveys and practice. Eur Arch Paediatr Dent. 2017 Aug;18(4):225-242. doi: 10.1007/s40368-017-0293-9.

Cutress TW, Suckling GW. Differential diagnosis of dental fluorosis. J Dent Res. 1990 Feb;69 Spec No:714-20; discussion 721. doi: 10.1177/00220345900690S138.

Suckling GW. Developmental defects of enamel--historical and present-day perspectives of their pathogenesis. Adv Dent Res. 1989 Sep;3(2):87-94. doi: 10.1177/08959374890030022901.

Seow WK. Clinical diagnosis of enamel defects: pitfalls and practical guidelines. Int Dent J. 1997 Jun;47(3):173-82. doi: 10.1002/j.1875-595x.1997.tb00783.x.

Leal SC, Oliveira TRM, Ribeiro APD. Do parents and children perceive molar-incisor hypomineralization as an oral health problem? Int J Paediatr Dent. 2017 Sep;27(5):372-379. doi: 10.1111/ipd.12271.

Hasmun N, Lawson J, Vettore MV, Elcock C, Zaitoun H, Rodd H. Change in Oral Health-Related Quality of Life Following Minimally Invasive Aesthetic Treatment for Children with Molar Incisor Hypomineralisation: A Prospective Study. Dent J (Basel). 2018 Nov 1;6(4):61. doi: 10.3390/dj6040061.

Pini NI, Sundfeld-Neto D, Aguiar FH, Sundfeld RH, Martins LR, Lovadino JR, Lima DA. Enamel microabrasion: An overview of clinical and scientific considerations. World J Clin Cases. 2015 Jan 16;3(1):34-41. doi: 10.12998/wjcc.v3.i1.34.

Wong FS, Winter GB. Effectiveness of microabrasion technique for improvement of dental aesthetics. Br Dent J. 2002 Aug 10;193(3):155-8. doi: 10.1038/sj.bdj.4801511.

ElBaz G, Mahfouz S. Efficacy of two different treatment modalities on masking white spot lesions in children with molar incisor hypo-mineralization. Egypt Dent J. 2017;63(3):2147–54. doi: 10.21608/edj.2017.75657.

Bhandari R, Thakur S, Singhal P, Chauhan D, Jayam C, Jain T. Concealment effect of resin infiltration on incisor of Grade I molar incisor hypomineralization patients: An in vivo study. J Conserv Dent. 2018 Jul-Aug;21(4):450-454. doi: 10.4103/JCD.JCD_61_18.

Crombie F, Manton D, Palamara J, Reynolds E. Resin infiltration of developmentally hypomineralised enamel. Int J Paediatr Dent. 2014 Jan;24(1):51-5. doi: 10.1111/ipd.12025.

Kumar H, Palamara JEA, Burrow MF, Manton DJ. An investigation into the effect of a resin infiltrant on the micromechanical properties of hypomineralised enamel. Int J Paediatr Dent. 2017 Sep;27(5):399-411. doi: 10.1111/ipd.12272.

Villarroel M, Fahl N, De Sousa AM, De Oliveira OB Jr. Direct esthetic restorations based on translucency and opacity of composite resins. J Esthet Restor Dent. 2011 Apr;23(2):73-87. doi: 10.1111/j.1708-8240.2010.00392.x.

Wray A, Welbury R; Faculty of Dental Surgery, Royal College of Surgeons. UK National Clinical Guidelines in Paediatric Dentistry: Treatment of intrinsic discoloration in permanent anterior teeth in children and adolescents. Int J Paediatr Dent. 2001 Jul;11(4):309-15. doi: 10.1046/j.1365-263x.2001.00300.x.

Elhennawy K, Manton DJ, Crombie F, Zaslansky P, Radlanski RJ, Jost-Brinkmann PG, Schwendicke F. Structural, mechanical and chemical evaluation of molar-incisor hypomineralization-affected enamel: A systematic review. Arch Oral Biol. 2017 Nov;83:272-281. doi: 10.1016/j.archoralbio.2017.08.008.

Bozal CB, Kaplan A, Ortolani A, Cortese SG, Biondi AM. Ultrastructure of the surface of dental enamel with molar incisor hypomineralization (MIH) with and without acid etching. Acta Odontol Latinoam. 2015;28(2):192-8. doi: 10.1590/S1852-48342015000200016.

de Souza JF, Fragelli CB, Jeremias F, Paschoal MAB, Santos-Pinto L, de Cássia Loiola Cordeiro R. Eighteen-month clinical performance of composite resin restorations with two different adhesive systems for molars affected by molar incisor hypomineralization. Clin Oral Investig. 2017 Jun;21(5):1725-1733. doi: 10.1007/s00784-016-1968-z.

William V, Messer LB, Burrow MF. Molar incisor hypomineralization: review and recommendations for clinical management. Pediatr Dent. 2006 May-Jun;28(3):224-32.

Rolim TZC, da Costa TRF, Wambier LM, Chibinski AC, Wambier DS, da Silva Assunção LR, de Menezes JVBN, Feltrin-Souza J. Adhesive restoration of molars affected by molar incisor hypomineralization: a randomized clinical trial. Clin Oral Investig. 2021 Mar;25(3):1513-1524. doi: 10.1007/s00784-020-03459-2.

Ekambaram M, Yiu CKY. Bonding to hypomineralized enamel – a systematic review. Int J Adhes Adhes. 2016;69:27–32. doi: 10.1016/j.ijadhadh.2016.03.016.

Lagarde M, Vennat E, Attal JP, Dursun E. Strategies to optimize bonding of adhesive materials to molar-incisor hypomineralization-affected enamel: A systematic review. Int J Paediatr Dent. 2020 Jul;30(4):405-420. doi: 10.1111/ipd.12621.

Somani C, Taylor GD, Garot E, Rouas P, Lygidakis NA, Wong FSL. An update of treatment modalities in children and adolescents with teeth affected by molar incisor hypomineralisation (MIH): a systematic review. Eur Arch Paediatr Dent. 2022 Feb;23(1):39-64. doi: 10.1007/s40368-021-00635-0.

Alex G. Universal adhesives: the next evolution in adhesive dentistry? Compend Contin Educ Dent. 2015 Jan;36(1):15-26; quiz 28, 40. PMID: 25822403.

Cuevas-Suárez CE, da Rosa WLO, Lund RG, da Silva AF, Piva E. Bonding Performance of Universal Adhesives: An Updated Systematic Review and Meta-Analysis. J Adhes Dent. 2019;21(1):7-26. doi: 10.3290/j.jad.a41975.

Bedran-Russo A, Leme-Kraus AA, Vidal CMP, Teixeira EC. An Overview of Dental Adhesive Systems and the Dynamic Tooth-Adhesive Interface. Dent Clin North Am. 2017 Oct;61(4):713-731. doi: 10.1016/j.cden.2017.06.001.

Fayle SA. Molar incisor hypomineralisation: restorative management. Eur J Paediatr Dent. 2003 Sep;4(3):121-6. PMID: 14529331.

Kamishima N, Ikeda T, Sano H. Color and translucency of resin composites for layering techniques. Dent Mater J. 2005 Sep;24(3):428-32. doi: 10.4012/dmj.24.428.



Como Citar

Schneider, L. A. M., Bitencourt, S. B., & Bastos-Bitencourt, N. A. (2024). A Minimally Invasive Esthetic Approach for Teeth with Molar Incisor Hypomineralization: a Clinical Case Report. ARCHIVES OF HEALTH INVESTIGATION, 13(1), 1–7. https://doi.org/10.21270/archi.v13i1.6111



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