Decisão de tratamento e prevenção para dentes afetados pela hipomineralização molar incisivo: revisão integrativa

Abstract

Molar incisor hypomineralization (MIH) is one of the Developmental Enamel Defects (DED) that can occur in the deciduous dentition. It presents a challenge to pediatric dentistry, since the condition affects the quality of life related to oral health and contributes to increased anxiety during dental care. Objective: To describe what the literature has proposed for the prevention and for the prevention and treatment of patients with SMI. Methodology: a literature review was conducted using database-specific search strategies, without restriction as to year of publication or language, by July 2022 in the MEDLINE/PubMed and Scopus electronic databases. Inclusion criteria were: longitudinal experimental or retrospective observational studies that answered the following research question: In teeth affected by molar-incisor hypomineralization, what are the best preventive and treatment options for post-eruptive fractures (PEF), caries lesions, hypersensitivity or staining, compared to no treatment or other treatments resulting in preservation of tooth structural integrity, longer restoration survival, reduced pain or improved esthetics? Duplicates, other types of studies, or studies that did not answer the research question were excluded. Of the 398 studies found, 29 were selected for this review. Results: Dentifrices containing casein phosphopeptide and amorphous calcium phosphate (CPP-ACP), Calcium Glycerol phosphate (CaGP) or sodium fluoride varnish (NaF) with remineralizing effect in mild to moderate defects were found as preventive methods. Pit and fissure sealants can be a complementary strategy for preventing dental caries, with a desensitizing effect. The resinous infiltrants has been presented as a micro-invasive tool for masking opaque white spots, reducing dental hypersensitivity and increasing structural integrity. And the riva star (SDI) obtained desensitizing action with the disadvantage of tooth darkening. For restorative treatment, high viscosity glass ionomer cement and indirect restorations with full coverage crowns may be indicated, but the use of composite resin is still controversial. Thus, the treatment decision depends mainly on the impairment of the affected tooth. Conclusion: Early establishment of an appropriate treatment plan is necessary, and for this, the professional needs to have knowledge about the condition of the affected tooth. Furthermore, more longitudinal clinical trials are needed.