Department of Biological Sciences, Bauru School of Dentistry/University of São Paulo, Bauru, Brazil.
Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry/University of São Paulo, Bauru, Brazil.
Monogr Oral Sci. 2024;32:173-184. doi: 10.1159/000538887. Epub 2024 Jul 1.
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.
牙齿矿化不全（MIH）的特征是釉质矿化量减少，特别是钙和磷含量减少，而碳酸盐和蛋白质含量增加。白蛋白是在萌出前积累的主要蛋白质，导致矿化启动缺陷。其他口腔液蛋白在釉质表面萌出后破裂的情况下被发现。大多数病变延伸穿过釉质的全厚度。由于矿化量较低，碳酸盐和蛋白质含量增加，MIH 牙齿一旦暴露于咀嚼中更容易发生骨折。此外，MIH 患者的龋齿易感性增加，敏感性常见。由于这些原因，MIH 受影响的牙齿可能受益于暴露于再矿化剂，这将降低龋齿易感性并降低敏感性。几项体外、原位和体内研究表明，在萌出后改善 MIH 牙齿的矿化是可能的，尤其是在表面。然而，由于这些病变的深度/厚度，完全解决是困难的。事实上，这个过程类似于萌出后成熟。因此，应该使用这个命名法而不是再矿化。到目前为止，可用的证据表明，在几种可用的再矿化剂中，酪蛋白磷酸肽-无定形磷酸钙（CPP-ACP）乳膏和氟化物（F）涂料显示出最好的效果，并且在再矿化 MIH 受影响的牙齿方面同样有效。氟化物涂料不需要患者依从性，而 CPP-ACP 乳膏可以在家中使用。然而，重要的是要考虑到氟化物涂料通常比 CPP-ACP 乳膏更经济。因此，这些制剂之间的选择可以根据患者的具体要求进行定制。
