An Innovative Treatment Approach Using Digital Workflow and CAD-CAM Part 2: The Restoration of Molar Incisor Hypomineralization in Children

Abstract

Until recently, the treatment for molar incisor hypomineralization (MIH) mainly included interim restorations such as resin restorations and stainless-steel crowns. These require replacement after adolescence. The use of intraoral scanners (IOS) has opened a new venue for restoring MIH teeth, by reducing the challenge of dealing with uncooperative children’s behavior and enabling tooth structure preservation and long-lasting restoration. We present an innovative treatment approach for children with MIH, using a digital workflow with IOS and CAD-CAM (computer-aided design and computer-aided manufacturing) fabrication of the restoration. The overall protocol involves a thorough diagnostic phase throughout treatment planning, which takes into consideration the child’s behavior and the parent’s cooperation and compliance. Initial preparation consists of inhalation sedation if needed, an effective local anesthesia, and the use of a rubber dam. Removal of all areas of enamel and dentin porosity is essential, and the tooth/teeth must be appropriately prepared to accommodate inlays or onlays for molars and labial veneers for incisors. IOS impressions are taken, including scanning of the prepared tooth and its antagonist, scanning of the bite, and CAD-CAM preparation of the restoration. Next is restoration, cementation, and follow up. Digital workflow provides definitive restorations in young patients due to the high accuracy of the scanning.

Comprehensive CAD/CAM Prosthetic Rehabilitation Management in a Young Patient with Agenesis: A Case Report

“…An improvement in the patient’s aesthetic consideration can be noted directly after the placement of the prostheses. Similar results have also been shown in geriatric and pediatric dentistry but poorly described in the treatment of special needs patients: CAD/CAM procedure is rarely described in special care dentistry, although its use is promising from both an aesthetic and functional point of view [ 23 , 24 , 25 ].…”

Comparing the trueness of seven intraoral scanners and a physical impression on dentate human maxilla by a novel method

“…An increasing number of dentists are purchasing and implementing intraoral scanners (IOS) for making optical impressions of oral soft and hard tissues as an alternative to traditional impressions, which are generally poorly tolerated by patients [1][2][3]. The area of application previously consisted mostly of quadrant imaging [4][5][6][7][8]. However, as systems become faster, more accurate, and easier to use [9,10], more clinicians are scanning complete arches and wide-spanning dental restorations [11][12][13].…”

Biomimetic hydroxyapatite paste for molar–incisor hypomineralization: A randomized clinical trial

“…MIH treatments can be fluoride varnish applications or resin infiltration (Nogueira et al, 2021), arginine pastes (Da Cunha Coelho et al, 2019), glass ionomer cements restorations (Fragelli et al, 2015), casein phosphopeptide and amorphous calcium phosphate CPP-APC (Pasini et al, 2018), resin or silver diamine fluoride adhesive and sealant application (Ballikaya et al, 2022), composite restorations (Lygidakis et al, 2021), indirect restorations (Davidovich et al, 2020), stainless steel crowns (Wadia, 2021), and, finally, tooth extraction (Elhennawy & Schwendicke, 2016).…”