Adhesion to Enamel of Teeth Affected by Molar Incisor Hypomineralization: Literature Review

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Apostolina Theocharidou, Konstantinos Arapostathis

Department of Paediatric Dentistry, Aristotle University of Thessaloniki, Greece


Background/Aim: Molar incisor hypomineralization (MIH) is a qualitative defect of systemic origin, affecting permanent first molars and often permanent incisors. The treatment modalities can include, amongst others, fissure sealants for prevention of dental caries and composite restorations. Both require adhesion to tooth structure. The aim of this study was to review the literature on the adhesion to enamel affected by MIH.

Material and Methods: A search of PupMed/Medline, ResearchGate and Google Scholar was performed and limited between 2003, when the judgement criteria for MIH were set, and 2016. Thirty-three papers were considered relevant to the subject including five in vivo and six in vitro studies. Studies involving less than ten teeth were excluded.

Results: A four-year clinical trial showed that the application of a total-etch 2-step adhesive system prior to sealant placement is superior to the etch-seal technique. Despite the high success rate of composite restorations shown in three clinical longitudinal studies, there are conflicting results over self-etch being superior to total etch adhesive systems. Pretreating the enamel surface, prior to the adhesive system, with fluoride preventive solutions could reduce the mikroleakage under orthodontic brackets. Three in vitro studies provide inconsistent data about NaOCl pretreating potentials to improve adhesion of composite restorations. Resin infiltration, prior to resin restorations, could improve the microhardness of defected enamel, which may lead to increased bond strength, especially in combination with NaOCl pretreatment.

Conclusions: Adhesion to enamel affected by molar incisor hypomeralization is inferior compared to normal enamel. Sealants applied with the etch-bond-seal technique have greater retention than with the etch-seal technique. Further research is required to provide evidence of the effectiveness of the adhesive system and pretreatment to achieve optimal bonding to MIH.

1. Weerheijm KL. Molar incisor hypomineralization (MIH): clinical presentation, aetiology and management. Dent Update, 2004;31:9-12.Google Scholar

2. Mast P, Rodriguez Tapia MT, Daeniker L, Krejci I. Understanding MIH: Definition, epidemiology, differential diagnosis and new treatment guidelines. Eur J Paediatr Dent, 2013;14:204-208.Google Scholar

3. Weerheijm KL, Duggal M, Mejàre I, Papagiannoulis L, Koch G, Martens LC et al. Judgement criteria for molar incisor hypomineralisation (MIH) in epidemiologic studies: a summary of the European meeting on MIH held in Athens, 2003. Eur J Paediatr Dent, 2003;4:110-113.Google Scholar

4. 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;11:75-81.Google Scholar

5. Jälevik B. Prevalence and Diagnosis of Molar-Incisor-Hypomineralisation (MIH): A systematic review. Eur Arch Paediatr Dent, 2010;11:59-64.Google Scholar

6. Buonocore MG. A Simple Method of Increasing the Adhesion of Acrylic Filling Materials to Enamel Surfaces. J Dent Res, 1955;34:849-853.Google Scholar

7. 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. AOL, 2015;28:192-198.Google Scholar

8. Maria Da Costa-Silva C, Mialhe FL, Maria C, Silva C. Considerations for clinical management of molar-incisor hypomineralization: A literature review Considerações para o manejo clínico da hipomineralização molar-incisivo: Revisão de literatura. Rev Odonto Cienc, 2012;27:333-38.Google Scholar

9. Suga S. Enamel hypomineralization viewed from the pattern of progressive mineralization of human and monkey developing enamel. Adv Dent Res, 1989;3:188-198.Google Scholar

10. Weerheijm KL, Jälevik B, Alaluusua S. Molar–Incisor Hypomineralisation. Caries Res, 2001;35:390-391.Google Scholar

11. Elhennawy K, Schwendicke F. Managing molar-incisor hypomineralization: A systematic review. J Dent, 2016;55:16-24Google Scholar

12. Fearne J, Anderson P, Davis GR. 3D X-ray microscopic study of the extent of variations in enamel density in first permanent molars with idiopathic enamel hypomineralisation. Br Dent J, 2004;196:634-638.Google Scholar

13. Jälevik B, Odelius H, Dietz W, Norén J. Secondary ion mass spectrometry and X-ray microanalysis of hypomineralized enamel in human permanent first molars. Arch Oral Biol, 2001;46:239-247.Google Scholar

14. Farah RA, Monk BC, Swain MV, Drummond BK. Protein content of molar-incisor hypomineralisation enamel. J Dent, 2010;38:591-596.Google Scholar

15. Mahoney EK, Rohanizadeh R, Ismail FSM, Kilpatrick NM, Swain M V. Mechanical properties and microstructure of hypomineralised enamel of permanent teeth. Biomater, 2004;25:5091-5100.Google Scholar

16. Mahoney EK, Ismail FSM, Kilpatrick NM, Swain M V. Mechanical properties across hypomineralized/hypoplastic enamel of first permanent molar teeth. Eur J Oral Sci, 2004;112:497-502.Google Scholar

17. Da Costa-Silva CM, Jeremias F, De Souza JF, De Cássia Loiola Cordeoro R, Santos-Pinto L, Cilense Zuanon AC. Molar incisor hypomineralization: prevalence, severity and clinical consequences in Brazilian children. Int J Paediatr Dent, 2010;20:426-434.Google Scholar

18. Voronets J, Jaeggi T, Buergin W, Lussi A. Controlled toothbrush abrasion of softened human enamel. Caries Res, 2008;42:286-290.Google Scholar

19. Mathu-Muju K, Wright JT. Diagnosis and treatment of molar incisor hypomineralization. Compend Contin Educ Dent, 2006;27:604-610.Google Scholar

20. Lygidakis NA, Chaliasou A, Siounas G. Evaluation of composite restorations in hypomineralised permanent molars: a four year clinical study. Eur J Paediatr Dent, 2003;4:143-148.Google Scholar

21. Mejàre I, Bergman E, Grindefjord M. Hypomineralized molars and incisors of unknown origin: Treatment outcome at age 18 years. Int J Paediatr Dent, 2005;15:20-28.Google Scholar

22. Kotsanos N, Kaklamanos EG, Arapostathis K. Treatment management of first permanent molars in children with Molar-Incisor Hypomineralisation. Eur J Paediatr Dent, 2005;6:179-184.Google Scholar

23. Lygidakis NA, Dimou G, Stamataki E. Retention of fissure sealants using two different methods of application in teeth with hypomineralised molars (MIH): a 4 year clinical study. Eur Arch Paediatr Dent, 2009;10:223-226.Google Scholar

24. de Souza JF, Fragelli CB, Jeremias F, Paschoal MAB, Santos-Pinto L, de Cassia 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;21:1725-1733.Google Scholar

25. William V, Burrow MF, Palamara JEA, Messer LB. Microshear bond strength of resin composite to teeth affected by molar hypomineralization using 2 adhesive systems. Pediatr Dent, 2006;28:233.Google Scholar

26. Gandhi S, Crawford P, Shellis P. The use of a “bleach-etch-seal” deproteinization technique on MIH affected enamel. Int J Paediatr Dent, 2012;22:427-434.Google Scholar

27. Moosavi H, Ahrari F, Mohamadipour H. The effect of different surface treatments of demineralised enamel on microleakage under metal orthodontic brackets. Prog Orthod, 2013;14:2.Google Scholar

28. Crombie F, Manton D, Palamara J, Reynolds E. Resin infiltration of developmentally hypomineralised enamel. Int J Paediatr Dent, 2014;24:51-55.Google Scholar

29. Chay PL, Manton DJ, Palamara JEA. The effect of resin infiltration and oxidative pre-treatment on microshear bond strength of resin composite to hypomineralised enamel. Int J Paediatr Dent, 2014;24:252-267.Google Scholar

30. Shahabi M, Ahrari F, Mohamadipour H, Moosavi H. Microleakage and shear bond strength of orthodontc brackets bonded to hypomineralized enamel following different surface preparations. J Clin Exp Dent, 2014;6:e110-115.Google Scholar

31. Weatherhell J, Deutsch D, Robinson C, Hallsworth A. Fluoride concentrations in developing enamel. Nature, 1975;256:230-232.Google Scholar

32. Sapir S, Shapira J. Clinical solutions for developmental defects of enamel and dentin in children. Pediatr Dent, 2007;29:330-336.Google Scholar

33. Croll TP. Enamel microabrasion: observations after 10 years. J Am Dent Assoc, 1997;128:45S-50S.Google Scholar

34. Fayle SA. Molar incisor hypomineralisation: restorative management. Eur J Paediatr Dent, 2003;4:121-126.Google Scholar