Esthetic Rehabilitation of Incisors with Severe MIH

Abstract

Introduction:  Molar-Incisor Hypomineralization (MIH) is a qualitative enamel defect of systemic origin that affects the first permanent molars and, in some cases, the incisors. This condition compromises function, aesthetics, and causes hypersensitivity, posing a clinical challenge due to progressive structural loss and variability in treatment response. The therapeutic guide proposed by Bekes in 2023 allows for clinical classification of affected teeth and standardized decision-making. Case Report:  We present the case of a 9-year-old female patient with severe MIH, classified as TNI 4 in the upper incisors 12, 21, and 22. She presented with intense hypersensitivity, post-eruptive enamel breakdown, and evident aesthetic compromise. During treatment, a new fracture was documented in tooth 11. The clinical approach included the application of fluoride varnish, the use of calcium phosphate remineralizing pastes, temporary restorations with glass ionomer cement, and reconstruction using a stratified composite resin technique. In teeth with opacities, microabrasion and ICON resin infiltration were performed prior to final direct restorations.  Conclusions:  A satisfactory functional and aesthetic rehabilitation was achieved, with complete resolution of hypersensitivity and improved self-confidence when smiling. This case highlights the importance of an individualized, sequential, and minimally invasive approach guided by the MIH-TNI index. The patient is currently undergoing treatment for rehabilitation of the affected permanent molars