Indirect adhesive restorations with preformed crowns in teeth with MIH

Abstract

Introduction: Molar-Incisor Hypomineralization (MIH) is a qualitative enamel defect that primarily affects the first permanent molars and incisors. It is characterized by well-defined opacities of varying shades and by enamel that is less mineralized, with higher protein content and increased porosity. This condition, of multifactorial origin, is associated with genetic and environmental factors, including illnesses or medications during the prenatal, perinatal, or postnatal stages. Adhesive indirect restorations, especially with composite resin, represent a conservative and effective option in moderate to severe MIH cases. Case Report: Eight-year-old twin girls were seen at the Pediatric Dentistry Specialty Clinic of the University of Guadalajara. Twin 1 presented with severe MIH (TNI4c) in partially erupted molars and moderate involvement (TNI2a) in the maxillary incisors. Pulpotomies were performed, followed by placement of Biodentine and provisional glass ionomer, and later rehabilitation with bulk-fill resin and thermoplastic preformed crowns on molars 36 and 46. In molar 16, silver diamine fluoride was applied and an aesthetic ceromer crown was placed. Twin 2 presented with severe MIH in the lower molars and moderate in the upper molars. Pulpotomy was performed on molar 46 (TNI4c), and preformed crowns were placed on molars 36 (TNI4a) and 46 as a long-term provisional solution. Quarterly fluoride application was carried out on molars 16 and 26 (TNI2a). Conclusion: This case highlights the importance of individualized treatment according to the severity and eruption stage of the teeth, and supports the use of preformed crowns as an effective and functional option for teeth affected by MIH.