Management strategies for posterior deciduous and permanent teeth with developmental defects of enamel presenting post-eruptive breakdown or atypical cavitated carious lesions: systematic review and meta-analysis

This study aimed to evaluate different management strategies for treating posterior deciduous and permanent teeth affected by developmental defects of enamel (DDE) presenting with post-eruptive breakdown or atypical cavitated carious lesions, with a focus on longevity and the acceptability/perception of the treatment by parents and children. A comprehensive search of electronic databases was conducted up to April 09, 2025, to identify clinical studies addressing treatment approaches for posterior deciduous or permanent teeth with DDE in children up to 14 years old. Ninety studies met the inclusion criteria: 15 focused on molar-incisor hypomineralisation (MIH), one on hypomineralised second primary molar, one on amelogenesis imperfecta, and two covering various types of DDE. The most used restorative treatments included aesthetic and metal crowns, composite resin (CR) and glass ionomer cement (GIC) restorations, and indirect restoration with composite resin (ICR) and ceramics (ICeramics), which have been well accepted by both parents and children. Meta-analyses were conducted exclusively on studies related to MIH. Over a 24-month follow-up period, the overall success rate was 84% (95% CI: 70–99%). Subgroup analyses did not indicate significant differences among restorative treatment options (p = 0.336). Aesthetic and metal crowns, ICR, ICeramics, CR, and GIC may be viable treatment options for the management of MIH and other types of DDE. However, the certainty of the evidence remains low, and most studies exhibited a high or critical risk of bias.