The facilitation of eruption of the second permanent molars to the space of the first permanent molar removes the burden of continuous restorative treatment.A favourable occlusion may be acquired following a well-planned treatment and this eliminates the need for fixed orthodontic appliances therapy. However, a comprehensive discussion of the possible need of orthodontic sequelae and treatment is important.Favorable eruption position of the second permanent molar may result if the first permanent molar is extracted when the child is at the age of between 8–10 years old. This is when the crown formation of the second permanent molar is complete and the mineralization of the bifurcation is commenced.Extraction of first permanent molars before 8 years old increases the chances of the unerupted second permanent premolar drifting distally. Extraction after the age of 10 years reduces the likelihood of the mesial movement of the second permanent molar in to the first permanent molar space and may result in tilting of the second permanent molar. Epidemiology
Since first recognised in the late 1970s, the condition has puzzled many people. It is thought to be a unique defect unlike other enamel disturbances e.g. fluorosis or amelogenesis imperfecta.Many prevalence studies have now been published from findings across the globe. However, there is a large amount of variation across the results of these studies. It is reported that the prevalence of MIH ranges from 3.6% to 40.2%  with an estimate of 14.2% of the global population suffering.
The index has been validated  and a training manual was developed to assist researchers in implementing the index in a standardised manner. Prevention
Prevention is of prior importance at an early developmental age as the defective tooth is more likely to have caries and post-eruptive breakdown due to its increased porosity. Appropriate dietary advice and toothpaste with a fluoride level of at least 1,000 ppm F should be recommended. For treating spontaneous hypersensitivity professional applications of fluoride varnish (e.g. Duraphat 22,600ppm F) or 0.4% stannous fluoride gel may be helpful.Casein Phosphopepetide-Amorphus Calcium Phosphate (CPP-ACP) provides a supersaturated environment of calcium and phosphate on the enamel surface to enhance remineralisation in the form of toothpaste or sugar free chewing gum. Its clinical effectiveness is still debatable but may benefit those patients who complain of mild pain to external stimuli. Treatment
The frequency of first permanent molar treatment for children with MIH is nearly 10 times greater compared to children without MIH. The available treatment modalities for MIH is extensive but the decision on which treatment should be used is complex and multi-factorial. Factors may include: condition severity, the patient’s dental age, the child/parent’s social background and expectations. There are treatment modalities available to manage children affected by MIH; however, the evidence supporting these modalities are still weak. Anterior teeth
Etch-bleach-seal technique
Involves repeated cycles of etching with 37% phosphoric acid followed by applying 5% sodium hypochlorite until improvement of discolouration is achieved. Clear resin composite or resin infiltrate can be used to seal the lesion after the technique.