Monographs in oral science最新文献

Amelogenesis, the intricate process governing enamel formation, is susceptible to a range of genetic, systemic, and environmental influences, resulting in distinct developmental defects of enamel (DDE), such as molar incisor hypomineralisation (MIH), enamel hypoplasia, dental fluorosis, and amelogenesis imperfecta (AI). This chapter aims to provide a comprehensive overview of amelogenesis and DDE, establishing correlations between histopathological findings and clinical manifestations. MIH, a qualitative enamel defect, occurs during the mineralisation and maturation phases, affecting first permanent molars and eventually incisors. Diagnostic challenges in MIH arise from the disorder's unique features, including variable tooth involvement and severity, influenced by a complex interplay of genetic, systemic, and environmental factors. Enamel hypoplasia, a quantitative defect, manifests in any tooth during enamel matrix secretion. Etiological factors include local, systemic, environmental, and genetic influences, with variable enamel matrix abnormalities depending on the stage of amelogenesis when aggression occurred. Dental fluorosis, a toxicological concern from chronic and excessive fluoride exposure, affects ameloblasts and compromises crystal growth of the homologous teeth during enamel development. Lastly, AI, an inherited condition, encompasses diverse phenotypes in enamel development. AI phenotypes, whether hypoplastic or hypomineralised, entail mutations in genes, such as AMELX, ENAM, MMP20, KLK4, WDR72, FAM83H, C4ORF26, amelotin, GPR68, and ACPT. Diagnosing AI involves considering family history and clinical observation. In conclusion, navigating the intricacies of amelogenesis, from MIH to AI, underscores the critical importance of accurate diagnosis for proper clinical management of DDE.

Molar incisor hypomineralisation (MIH) is characterized with reduced enamel mineral quantity, especially in the calcium and phosphate content, with increases in the carbonate and protein contents. Albumin is the main protein that accumulates pre-eruptively, leading to defective initiation of mineralisation. Other oral-fluid proteins are found in cases of posteruptive enamel surface breakdown. Most of the lesions extend through the full thickness of enamel. Due to the lower mineral quantity and increased carbon and protein content, MIH teeth are more prone to fractures once exposed to mastication. In addition, susceptibility to dental caries is increased and hypersensitivity is common in MIH patients. For these reasons, MIH-affected teeth might benefit from exposure to remineralising agents that will decrease caries susceptibility and reduce sensitivity. Several in vitro, in situ, and in vivo studies have shown that improving the mineralisation of MIH teeth after eruption is possible, especially at the surface. However, complete resolution is difficult due to the depth/thickness of these lesions. In fact, the process is similar to posteruptive maturation. Thus, this nomenclature should be used instead of remineralisation. The evidence available so far indicates that among the several available remineralising agents, casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) cream and fluoride (F) varnish show the best results and are equally effective in remineralising MIH-affected teeth. Fluoride varnish demands no patient adherence, while CPP-ACP cream can be applied at home. However, it is important to consider that fluoride varnish is generally more economical than CPP-ACP cream. Consequently, the choice between these agents can be tailored to the patient's specific requirements.

Based on the current state of the art regarding molar incisor hypomineralisation (MIH)-affected enamel, bonding systems are expected to play a relevant role on the restorative procedures when required. MIH-affected enamel is often subjected to posteruptive breakdown combined or not with carious lesions, predominantly on molars, and may also affect the aesthetics of anterior teeth. As unbalanced mineral and protein contents occur, understanding these alterations is essential before selecting the most appropriate adhesive systems, while bearing in mind their limitations. In particular, when dentin is involved due to enamel breakdown, the use of functional monomer-based bonding systems present in self-etching and universal systems produce a chemical interaction that enhance the bonding. So far, the overall recommendation relies on placing the margin of the restoration on clinically sound enamel, regardless of the category of the adhesive system.

Molar incisor hypomineralisation (MIH) is defined as hypomineralisation of systemic origin of one to four first permanent molars with or without the involvement of the permanent incisors. In addition to opacities and posteruptive breakdown, hypersensitivity may be a common problem, especially in the molars. Children then often report that hot and cold drinks and meals, toothbrushing, and even air flow cause pain. Therapy approaches to reduce and stop the hypersensitivity include the sealing of affected teeth. Fissure sealants can be placed in mildly affected molars that show no breakdowns in the occlusal surfaces. Thereby, resin-based sealants can be considered for fully erupted teeth, whereas glass ionomers are the treatment of choice in difficult clinical conditions as an interim treatment where isolation is inadequate and the molar has not fully erupted. The aim of this chapter is to describe the phenomenon of hypersensitivity in MIH-affected teeth, to discuss treatment approaches including the placement of sealants as well as the management of posteruptive breakdowns, and to present data on oral health-related quality of life in children suffering from hypersensitivity.

One fourth of teeth affected by molar incisor hypomineralisation (MIH) have required or will require treatment due to pain, sensitivity, or posteruptive breakdown. Restorative treatment becomes necessary in cases of severe MIH, characterized by posteruptive breakdown, which exhibits a wide range of clinical characteristics. Until approximately 20 years ago, all techniques, materials, and research were developed for treating caries lesions, not hypomineralisation. Research attempting to evaluate approaches to MIH treatment is recent and inconclusive. Therefore, there is still insufficient high-quality scientific evidence to establish a definitive clinical protocol for treating this condition. Recommendations based on best clinical practices can be provided rather than conclusions supported by a high level of evidence. To assist in clinical judgment regarding the best treatment strategy, eligible therapeutic options for restoring MIH-affected molars will be presented based on the strength and adhesive potential of the remaining hypomineralised enamel. The literature presents options for restorative materials ranging from direct alternatives such as glass ionomer cement and resin composite, through prefabricated devices, such as stainless-steel crowns and orthobands, to indirect restoration alternatives. However, it is essential to understand the indications of each restorative alternative and to know the restorative techniques, many of which are specifically developed to mitigate the difficulties encountered with the use of conventional techniques. Emphasis will be placed on the importance of adopting a personalized approach to restorative decision-making, considering the philosophy of minimal intervention dentistry and potential benefits for the patient's well-being and the family's needs.

Much effort has been spent in the identification of an environmental factor that explains the occurrence of molar incisor hypomineralisation (MIH). The best explanation, however, is accepting that MIH has a complex or multifactorial mode of inheritance. This chapter provides an analysis of how multifactorial inheritance operates in determining MIH, an explanation that accommodates the variation seen in the phenotype and the frequency of the problem around the world.

Numerous therapeutic approaches are available for managing molar incisor hypomineralisation (MIH); however, the cost-effectiveness of these strategies is underexplored. Economic evaluations are crucial for determining the optimal treatment approach to individual patients' requirements. We systematically reviewed the literature on the topic to have a more comprehensive discussion about these issues. Systematic searches were carried out. After a two-stage selection, 11 studies were included for synthesis. These studies could be divided into three groups according to the type of information given on costs: assumptions or deductions based on the literature (n = 6), cost collection on the available sources (n = 3), and cost-effectiveness evaluations (n = 2). The economic evidence on MIH management is still scarce and incipient. However, some important findings were produced for this evidence synthesis. A database of costs valuable in different contexts for therapeutic approaches related to MIH and its consequences was created. Furthermore, compiling and digesting the evidence on the cost-effectiveness of different approaches for managing severe MIH cases points out possible directions to be considered in decision-making that should consider these economic outcomes in different contexts and their powers of generalizability and also other aspects of evidence-based practice (e.g., professional and patients' preferences). Finally, there is an imminent need for economic evaluations focused on investigating the potential efficiency of preventive approaches for managing minor-compromised MIH teeth to postpone/avoid the severe consequences, which are more critical, complex, and costly to treat.

Oral health-related quality of life (OHRQoL) is a multifaceted concept that surpasses an exclusively clinical perception and includes functional, social, emotional, and environmental issues. The measure of OHRQoL represents a holistic approach for research and clinical practice. Negative impacts of oral conditions on OHRQoL in childhood can reflect on health development, especially in a life stage marked by social and cognitive maturation. Therefore, such problems can impact negatively on the daily lives of the individuals and their families. Individuals with molar incisor hypomineralisation (MIH) experience more frequent posteruptive breakdown, an elevated risk of tooth decay, filling failures, the need for recurrent dental treatment, and a higher prevalence of dental hypersensitivity. Children with severe MIH may struggle with everyday activities, such as brushing their teeth, speaking, smiling, chewing, and consuming hot or cold foods. MIH-affected incisors may exhibit opacities that can impact the aesthetics of their smiles. This condition may discourage children from smiling and can indirectly affect their parents as well. The management modalities are focused on solving functional, aesthetic, and hypersensitivity problems and to evaluate OHRQoL values before and after therapies. Therefore, this chapter aims to discuss how MIH affects the OHRQoL of children and the questionnaires that can be used to evaluate that impact.

Molar incisor hypomineralisation (MIH) and hypomineralised second primary molars (HSPMs) are commonly seen dental developmental problems with a mean prevalence of around 14% and 9%, respectively, but with a large variability in the reported prevalences. From the dental development, we know that the enamel mineralisation of the second primary molar is taking place between the 19th week of pregnancy until 1 year of age. For the first permanent molars (FPMs) and incisors, the enamel mineralisation is taking place between birth until the age of 3-5. When there is a disturbance during this period, HSPM and/or MIH can occur. There is an overlap in the development of the second primary molars and the FPMs and incisors; the period between birth and the first birthday of the child. A disturbance in this period could cause both HSPM and MIH. There is a relation found in the occurrence of HSPM and MIH. Diagnosing HSPM and MIH can be challenging. All teeth present in the mouth need to be examined. The use of the European Association of Paediatric Dentistry scoring criteria is a good help. In these criteria also, the most common differential diagnoses are included.

This chapter will discuss the orthodontic perspective of extractions of compromised first permanent molars (cFPMs) due to hypomineralisation. The context behind the diagnosis of a poor prognosis of cFPM that would support the planning of extractions will be presented. In addition, the ideal timing for interceptive extraction of cFPM as well as the favorable and unfavorable orthodontic scenarios for extractions in the permanent dentition will be discussed.