Molar incisor hypomineralization (MIH): The “Why, What and How” of decision making for orthodontists

Molar-incisor hypomineralization (MIH) presents a significant clinical challenge in orthodontics, with its complex etiology, variable presentation, and profound impact on enamel homeostasis. Utilizing Simon Sinek's “Golden Circle” method, this article systematically explores the implications of MIH within orthodontic practice. The “Why” emphasizes the critical need for orthodontists to understand MIH, given its prevalence and potential to disrupt treatment outcomes. MIH affects up to 40.2% of the global population, and its association with increased caries risk, hypersensitivity, and restorative failures necessitates an informed approach to management. The “What” section addresses the importance of recognizing the phenotypic variability of MIH and its influence on oral health-related quality of life. MIH impacts social and psychological well-being, particularly when anterior teeth are involved, and complicates orthodontic treatment due to challenges in bonding, banding, and restorative protocols. The “How” provides practical guidelines for orthodontic management, including diagnostic considerations, tooth restoration strategies, and the complexities of first permanent molar extractions. Strategic planning is essential to avoid complications such as mesial drift, overeruption, or space loss, with a multidisciplinary approach often required. This article highlights the importance of long-term monitoring and patient-centered care in managing MIH-affected teeth, underscoring the evolving nature of clinical protocols. By framing the discussion through the Golden Circle, this critical review offers a structured and impactful approach to understanding and addressing MIH within orthodontic contexts, aiming to enhance treatment outcomes and patient quality of life.