Etiology and therapy of molarly incisional hypomineralization

Molarno incizivna hipomineralizacija (MIH) relativno je čest razvojni poremećaj koji ponajprije zahvaća prve trajne kutnjake i sjekutiće. Zdrava caklina visoko je mineralizirano tvrdo zubno tkivo s 96%-tnim teţinskim postotkom anorganskog dijela, 1%-tnim teţinskim postotkom organskih tvari i 3%-tnim teţinskim postotkom vode, dok caklina zahvaćena MIH-om sadrţava visok udio proteina, a sniţen udio mineralnog djela. Takva je caklina porozna, sklonu lomu i rapidnoj progresiji karijesa. Pretpostavlja se da je posljedica kombiniranog djelovanja sistemskih i okolišnih etioloških čimbenika u ranim razdobljima ţivota. Potrebna su dodatna istraţivanja kako bi se sa sigurnošću moglo ustanoviti što je uzrok poremećaju hipomineralizacije. Terapija je kompleksna i specifična jer je riječ o djeci s iznimno osjetljivim zubima, sklonima lomu, koje je ponekad teško anestezirati. Zato je liječenje potencijalno neugodno te se stvara temeljno tlo za razvoj dentalne anksioznosti. Promijenjena struktura cakline oteţava adheziju, što vodi neuspjesima restaurativne terapije te deset puta većom potrebom za stomatološkom intervencijom u usporedbi s pacijentima bez MIH-a.Molar incisor hypomineralization (MIH) is a relatively common developmental disorder affecting first permanent molars and incisors. Healthy enamel is made up of 96% mineral content, a 1% organic part and 3% water. On the other hand, MIH enamel has a high share of protein and a lower amount of mineral component. This enamel is porous, prone to post-eruption breakdown and rapid caries development. Assumptions have been made that this is a consequence of the simultaneous effect of both systemic and environmental factors in the child's early life. More research is needed to determine the causal factor for this hypomineralization condition. Treatment of MIH is complex and specific because children experience dental hypersensitivity, their teeth are susceptible to breakdown and there is difficulty in achieving a good level of anesthesia. That leads to discomfort in a dental office and serves as a basis for creating dental anxiety. Bonding to the altered enamel structure is compromised which is why children with MIH are ten times more likely to need treatment than patients with healthy enamel