Is It Possible to Remineralise Hypomineralised Enamel Lesions in Patients with Molar Incisor Hypomineralisation?

Abstract

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.