Molar incisor hypomineralization: : aetiology, diagnosis and therapy

Molarno incizivna hipomineralizacija opisana je kao hipomineralizacija sistemskog uzroka na jednom do četiri prva trajna molara koja često zahvaća i trajne sjekutiće. Caklina može biti različito zahvaćena; u rasponu od blage do teške promjene, dok su promjene u dentinu blage. Ograničena zamućenja nalaze se na okluzanoj i bukalnoj strani zuba te mogu biti bijele, kremaste ili žuto do smeđe boje. Kod teže zahvaćenosti prisutna su poslijeeruptivna urušavanja cakline i atipične kavitacije. Takvi zubi skloni su nastanku karijesa, teško ih je anestezirati i potrebno je puno više posjeta stomatologu u odnosu na djecu bez MIH-a, što znatno povećava dentalni strah i otežava terapiju. Trenutačne informacije govore o prevalenciji od 2,4% do 40,2%. Brojnim istraživanjima nije potvrđen nijedan samostalan uzročnik MIH-a, no predloženi su mnogi okolišni čimbenici koji udruženi sa sistemnim stanjima tijekom prve tri godine djetetova života i intrauterino sudjeluju u nastanku bolesti. Terapija zahvaćenih molara može varirati od preventivnih pečatnih ispuna do kompozitnih restauracija ili potpuno metalne krunice. Vađenje teško zahvaćenih zubi prihvatljivo je u sklopu ortodontske terapije. Terapija zahvaćenih inciziva uglavnom je estetsko zbrinjavanje promijenjene boje zuba budući da rijetko dolazi do prekida u kontinuitetu cakline. Preventivni postupci od iznimne su važnosti kao i edukacija roditelja i djece o pravilnom provođenju oralne higijene te primjeni sredstva za remineralizaciju. Najpogodnija terapija trebala bi biti ostvarena posebno na svakom pojedinom slučaju.Molar incisor hypomineralization is defined as hypomineralization of systemic origin of one to four permanent first molars and is frequently associated with affected permanent incisors. The enamel can be affected differently; ranging from mild to severe changes, while changes in dentin are only mild. Demarcated opacities are located on occlusal and buccal surface of the teeth with change in color (white, cream or yellow to brown). In cases of severely affected enamel, post-eruptive breakdown and atypical cavitation are present. Such teeth are susceptible to caries, are difficult to anaesthetize and compared to children without MIH, many more dental visits are required by the patient, which significantly increases dental phobia and complicates treatment. The latest information indicate the prevalence of MIH in the range from 2.4% up to 40.2%. Several studies have not confirmed a single independent agent of MIH, but rather, many environmental factors coupled with systemic conditions intrauterine as well as during the first three years of a child's life were proposed to contribute to the development of this disease. Treatment of affected molars can vary from preventive sealant fillings to composite restoration or metal crown. Removing the severely affected teeth is acceptable as part of orthodontic treatment. Treatment of affected incisors is mainly aesthetic management of tooth discoloration because it rarely comes to a break in the continuity of the enamel. Preventive procedures, as well as educating parents and children about proper implementation of oral hygiene and the application of agents for remineralization, are extremely important. The most appropriate therapy should be provided individually for each case