General Anesthesia
Therapeutic alternative in the treatment of Molar-Incisor Hypomineralization (MIH)
Castanho, J.*1; Ramos, R.1; Cardoso Martins, I.2; Coelho, A.3; Marques, P.F.4
1Pediatric Dentistry Postgraduate students, FMDUL; 2Pediatric Dentistry Assistant Lecturer, FMDUL;
3Pediatric DentistryAssistant Professor, FMDUL; 4Pediatric Dentistry Head and Professor, FMDUL
➤Female, 7-years-old, non relevant medical records.
➤The patient was referred to the Postgraduate Pedo clinic at FMDUL, where a diagnosis of mild hypomineralization on teeth 36 and 46 with carious lesions;
and severe hypomineralization on teeth 16 and 26 with extensive carious lesions and post-eruptive enamel breakdown was made. Extensive carious lesions were also detected on tooth 54, with pulp involvement on primary molars, teeth 55, 65, 75, 74, 84 and 85.
Molar-incisor hypomineralization (MIH) is characterized by demarcated qualitative defects of enamel, of systemic origin, that affect the first permanent molars, and may also involve the incisors.1The affected enamel looks porous and weakened, which can lead to post-eruptive enamel breakdown. The clinical approach of MIH presents several difficulties for the pediatric dentist due to the exacerbated sensitivity and difficulty of analgesia of these teeth, the rapid progression of carious lesions and the limited cooperation of the children. Choosing the right treatment is complex and depends on its severity. The treatment of hypomineralized molars with glass ionomer-based materials is not recommended in areas of high mechanical stress; and the adhesion of the composite resins is lower with a greater probability of failure at the interface with the porous enamel. According to current recommendations, the treatment of choice for teeth with severe MIH is the stainless steel crowns.2
In some cases, the treatment of this condition may be performed under general anesthesia (GA), which will allow to carry out the entire treatment plan at once, without the obstacles caused by the patient’s anxiety, fear and lack of cooperation.3This approach also presents some disadvantages such as the cost, the need to perform the treatments in a single session and limitations in the space maintenance management, since it does not allow the execution of the necessary apparatus. All these considerations should be taken into account when deciding which treatment plan to follow.
Conclusions
MIH adversely affects the overall health of children, quality of life, and socio-psychological status. Clinically it is a huge challenge hence its early identification will allow the monitoring of the first permanent molars so that remineralization and preventive measures can be applied once the affected surfaces are accessible, trying to minimize their consequences and to avoid the need for more invasive treatments. In specific cases the treatment of this condition can be performed under GA, which allows the therapeutic procedures to be performed quicker and comfortably.
References
1Silva MJ, Scurrah KJ, Craig JM, Manton DJ, Kilpatrick N. Etiology of molar incisor hypomineralization – A systematic review. Community Dent OralEpidemiol 2016; 44: 342–353.2William V, Messer LB, Burrow MF. Molar incisor hypomineralization: Review and recommendations for clinical management. Pediatric Dent 2006;28:224-32.;3Chen YP, Hsieh CY, Hsu WT, Wu FY, Shih WY. A 10-year trend of dental treatments under general anesthesia of children in Taipei Veterans General Hospital. J Chin Med Assoc. 2017 Apr;80(4):262-268.
Description
Figure 1: Preoperative intraoral photographs
Description
ion (MIH) is characterized by dem he incisors.1The affected enamel l eral difficulties for the pediatric d and the limited cooperation of Molar-incisor hypomineraliza
molars, and may also involve t approach of MIH presents sev progression of carious lesion
marcated qualitative defects of ooks porous and weakened, wh entist due to the exacerbated s the children. Choosing the rig
at affect the first permanent amel breakdown. The clinical esia of these teeth, the rapid depends on its severity. The Figure 5: Postoperative photographs (follow-up 1 week)
enamel, of systemic origin, tha ch can lead to post-eruptive en ensitivity and difficulty of analg
ht treatment is complex and d w
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Discussion
➤Due to the clinical signs and symptoms of pain, pulp involvement, need for immediate treatment of all lesions, sensitivity and difficulty in achieving adequate anesthesia of hypomineralized teeth and lack of cooperation of the child through the use of basic techniques of behaviour management, it was recommended to perform the treatment under general anesthesia.
➤Treatments performed: Extraction of teeth 55, 65 and 75; Restoration with stainless steel crowns of teeth 16, 26 and 54; Pulpotomy and restoration with stainless steel crowns on teeth 74, 84 and 85; Composite resin restoration on teeth 46 and 36; Fissure sealant application on tooth 64; Polishing of labial pigmented surface of tooth 53 withsof-lexdiscs.
Figure 2: Panoramic x-ray
d 46 with carious lesions Extensive carious lesion
Figure 3: Intraoperative photographsi h h Figure 4: Periapical radiographs
