In later post-eruptive stages GIC may be valuable as sub-layer beneath composite restorations. Indirect restorations
Preformed metal crowns
Pre-formed metal crowns (PMC), also known as stainless steel crowns, can be used to reduce the risk of marginal breakdown, coronal leakage and has a good longevity. The use of preformed metal crowns on MIH-affected molars can prevent further tooth loss, control hypersensitivity and aim to establish correct interproximal and occlusal contact. They are relatively inexpensive and require little preparation.To prevent further tooth preparation and tissue loss, use of the Hall Technique should also be considered. There advantage is use during any stage of post-eruptive breakdown, but evidence of their efficacy is limited. Although the PMC has evidence to show that it is well accepted, a few of the children and their carers expressed their concerns about the metallic appearances of the restoration. Cast restorations
Cast restorations may include full coverage crowns for MIH-affected permanent teeth. Generally cast restorations requiring tooth preparation are not recommended in young children due to large pulp size, short crown height and potential difficulties in obtaining a good impression for subgingival crown margins. Extractions
A list of considerations can affect the final decision on whether extraction of the affected teeth should be carried out or should it be retained such as: severity of MIH; patient’s aesthetic expectations; whether the patient is suitable to undergo orthodontic treatment; orthodontic concerns (e.g. crowding, facial profile, missing or supernumerary teeth, presence of third molars).Timely extractions are often the preferred treatment plan for first permanent molars that are severely affected and symptomatic.
Microabrasion
The aesthetics of a child’s anterior teeth is a concern for both children and their parents alike. Yellow or brownish-yellow defects are of full thickness, and therefore may respond to bleaching with carbamide peroxide. However, careful consideration should be made of the risks including hypersensitivity, mucosal irritation and enamel surface alterations.Creamy-yellow or whitish-creamy defects are less porous and variable in depth, and may respond to microabrasion with 18% hydrochloric acid or 37.5% phosphoric acid and abrasive paste. Again, this should be undertaken cautiously as microabrasion may result in loss of enamel. Veneers
Direct or indirect composite veneers can be effective in improving aesthetics with minimal tooth tissue removal. Ceramic veneers as a treatment option should be delayed due to the risks of resulting in a short clinical crown height, immature tooth pulp irritation and also the instability of the gingival margins during the eruption of teeth. Posterior teeth
Fissure sealants
The placement of fissure sealants on permanent molars without post-eruptive breakdown should be undertaken. Use of a 5th generation bonding adhesive prior to fissure sealant application may improve retention rates of fissure sealants.For partially erupted molars with inadequate moisture control, glass ionomer cements (GIC) can be considered as an interim treatment option. As the retention rate of GIC is often poor, replacement with a resin-based fissure sealant is recommended following tooth eruption.Resin-based fissure sealants can be beneficial to patients affected with mild MIH where the first permanent molars have fully erupted, although the degree of hypomineralization affects the bond strength of said sealants.