Charité Center for Dental Medicine, Department of Orthodontics, Dentofacial Orthopedics and Pedodontics, Charité-Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197 Berlin, Germany.
Charité Centre for Dental Medicine, Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197 Berlin, Germany.
J Dent. 2016 Dec;55:16-24. doi: 10.1016/j.jdent.2016.09.012. Epub 2016 Sep 28.
We systematically reviewed treatment modalities for MIH-affected molars and incisors.
Trials on humans with ≥1 MIH molar/incisor reporting on various treatments were included. Two authors independently searched and extracted records. Sample-size-weighted annual failure rates were estimated where appropriate. The risk of bias was assessed using the Newcastle-Ottawa scale.
Electronic databases (PubMed, Embase, Cochrane CENTRAL, Google Scholar) were screened, and hand searches and cross-referencing performed.
Fourteen (mainly observational) studies were included. Ten trials (381 participants) investigated MIH-molars, four (139) MIH-incisors. For molars, remineralization, restorative or extraction therapies had been assessed. For restorative approaches, mean (SD) annual failure rates were highest for fissure sealants (12[6]%) and glass-ionomer restorations (12[2]%), and lowest for indirect restorations (1[3]%), preformed metal crowns (1.3 [2.1]%) and composite restorations (4[3]%). Ony study assessed extraction of molars in young patients (median age 8.2 years), the majority of them without malocclusions, but third molars in development. Spontaneous alignment of second molars was more frequent in the maxilla (55%) than the mandible (47%). For incisors, desensitizing agents successfully managed hypersensitivity. Micro-abrasion and composite veneers improved aesthetics.
Few, mainly moderate to high-risk-studies investigated treatment of MIH. Remineralization or sealants seem suitable for MIH-molars with limited severity and/or hypersensitivity. For severe cases, restorations with composites or indirect restorations or preformed metal crowns seem suitable. Prior to tooth extraction as last resort factors like the presence of a general malocclusion, patients' age and the status of neighboring teeth should be considered. No recommendations can be given for MIH-incisors.
Dentists need to consider the specific condition of each tooth and the needs and expectations of patients when deciding how to manage MIH. Strong recommendations are not possible based on the current evidence.
我们系统地回顾了 MIH 受累磨牙和切牙的治疗方法。
纳入了报告各种治疗方法的≥1 颗 MIH 磨牙/切牙的人类临床试验。两位作者独立检索和提取记录。在适当的情况下，估计了样本量加权的年失败率。使用纽卡斯尔-渥太华量表评估偏倚风险。
电子数据库（PubMed、Embase、Cochrane 中心、Google Scholar）进行了筛选，并进行了手工检索和交叉引用。
纳入了 14 项（主要为观察性）研究。10 项试验（381 名参与者）研究了 MIH 磨牙，4 项（139 名参与者）研究了 MIH 切牙。对于磨牙，评估了再矿化、修复或拔牙治疗。对于修复方法，窝沟封闭剂（12[6]%）和玻璃离子水门汀修复体（12[2]%）的平均（SD）年失败率最高，间接修复体（1[3]%）、预成金属冠（1.3 [2.1]%）和复合修复体（4[3]%）的年失败率最低。只有一项研究评估了年轻患者（中位年龄 8.2 岁）磨牙的拔牙，其中大多数患者没有错颌畸形，但第三磨牙正在发育。上颌第二磨牙的自发性排列更为常见（55%），而下颌（47%）则不然。对于切牙，脱敏剂成功治疗了过敏。微研磨和复合贴面改善了美观。
少数研究（主要为中高度偏倚风险）调查了 MIH 的治疗方法。对于严重程度有限和/或有过敏症状的 MIH 磨牙，再矿化或窝沟封闭剂可能是合适的。对于严重病例，复合或间接修复体或预成金属冠的修复可能是合适的。在作为最后手段拔牙之前，应考虑一般错颌、患者年龄和邻牙状态等因素。对于 MIH 切牙，无法给出建议。
牙医在决定如何处理 MIH 时，需要考虑每颗牙齿的具体情况以及患者的需求和期望。基于现有证据，无法给出强烈的建议。
