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22 Dental Tribune Middle East & Africa Edition | January-February 2016 paediatric Tribune > Page 23 For more information about the association and its members please visit the ASDI welcome desk on Booth 8E12+8E15 www.swissdentalindustry.ch The Swiss Pavilion is organized by the Swiss Dental Industry Association (ASDI) with the support of Switzerland Global Enterprise (S-GE). Welcome to the Swiss Pavilion AEEDC 2016 Dubai 2-4 February Dubai International Convention & Exhibition Center Booth N° 8D13 www.intensiv.ch Booth N° 8E10 www.fkg.ch Booth N° 8D10 www.pdsa.ch Booth N° 8F13 www.deppeler.ch Booth N° 8F14 www.saremco.ch Booth N° 8E14 www.esro.ch Booth N° 8F17 www.tri-implants.com Booth N° 8D14 www.usfhealthcare.com Booth N° 8F12 www.ibi-sa.com Booth N° 8D12 www.smileline.ch Booth N° 8F15 www.edenta.com Booth N° 8E17 www.bienair.com Booth N° 8F10 www.bpr-swiss.com Booth N° 8E13 www.jota.ch Clinical Management Approach of Molar Incisor Hypomineralisation. A case report. ByDr.ShaikhaAlraeesi,UAE& Dr. Manal Al Halabi, UAE A bstract Molar incisor hypomin- eralisation (MIH) is a relatively common dental de- fect that appears in first per- manent molars and incisors and varies in clinical severity. The specific etiological factors remain unclear. Inappropriate diagnosis can result in mis- management of the condition and results in early loss of first permanent molars (FPM) in particular. Therefore, the early identification of such condi- tion will allow early interven- tion including monitoring and preventive interventions that might help in remineralisation of the hypomineralised tooth structure. These preventive measures can be instituted as soon as affected surfaces are accessible. Clinical relevance statement Failure of early diagnosis and dental management in cases of Molar Incisor Hypominer- alisation (MIH) leads to rapid development of dental caries, increased pulpal inflammation and continuous enamel as well as restoration breakdown. Objective statement The reader should understand the Molar Incisor Hypomin- eralisation (MIH) condition and the availability of differ- ent management options of this condition. Introduction Molar Incisor hypomineralisa- tion (MIH) is a developmen- tally derived dental defect that involves hypomineralisation of 1 to 4 first permanent molars (FPM), frequently associated with similarly affected per- manent incisors. The pattern of enamel defects consists of asymmetric, well-demarcated defects affecting the enamel of the FPMs and is associated with similar defects in permanent incisors and canines tips. (1) ~ Prevalence Available modern clinical prev- alence data for MIH, mostly from Northern Europe, ranges from 3.6% to 25% and seems to differ between countries and birth cohorts. (2) ~ An etiology An etiology of this condition is poorly understood, with many associated factors (including environmental changes, breast feeding, respiratory diseases, oxygen shortage of ameloblasts and high fever diseases) but few proven causative agents. (3) ~ Clinical Features Fairly large demarcated opaci- ties, whitish-yellow or yellow- ish-brown in colour that may or may not be associated with post eruptive enamel breakdown. Hypomineralised enamel can be soft, porous and look like discoloured chalk or Old Dutch cheese. Subsurface porosity leads to breakdown after erup- tion, especially under occlusal forces, resulting in exposed dentine and sensitivity. (4) ~ Management Permanent molars affected by hypomineralisation are prone to rapid development of dental caries and repeated breakdown of restorations. Therefore, careful planning is required, taking into ac- count patient’s age (behaviour management issues), degree of crowding and co-operation. Sensitivity of affected teeth plays a major role in difficulty of achieving anaesthesia and thus behavioural issues. - Preventive • Diet advice • Higher fluoride toothpaste (at least 1450ppm F) • Topical fluoride varnish • Casein phopshpeptide- amorphous calcium phosphate (CPP-ACP) - Restorative: • A small lesion can be treat- ed with localized composite, where the enamel is soft, or fis- sure sealants, where the hard- ness of the enamel appears no different from the unaffected enamel. • GIC is recommended as dentine replacement or as an interim restoration due the ease of placement, fluoride re- lease and chemical bonding. • For extensive lesions with post-eruptive breakdown espe- cially if the cusps are involved, preformed stainless steel crowns (SSCs) are preferred as an effective medium-term res- toration. SSCs can preserve the FPM until cast restorations are feasible. (5)(6) - To save the tooth or not? • The first decision in the management of the MIH FPM is whether the tooth should be saved or not. The decision to extract or restore will depend upon a number of different fac- tors, some of these being the degree/extent of hypominer- alisation, post-eruptive break- down, sensitivity, age and co- operation of the patient, any Fig. 1 (a, b, c, d & e). Showing a dislodged filling of 36. 16 yellowish brown hypomineralised lesions. 36 and46 large composite fillings. Fig. 2 (a, b & c). OPT radiograph showing: normal alveolar bone levels, a normally developing dentition, except lower left third molar, E’s are near physiological exfoliation, more than 2/3 of the roots of 7’s are calcified, 46 RCT’ed, 36 com- posite restoration, 16.26 deep caries. PA radiograph showing: no signs of perapical radiolucency in lower and upper left first molars.