Nefzaoui Mariem, Chalbi Manel, Chemli Mohamed Ali
Pediatric Dentistry Department, Rabta Hospital, Tunis, Tunisia.
Faculty of Dental Medicine of Monastir, Monastir, Tunisia.
J Esthet Restor Dent. 2025 Sep;37(9):2072-2082. doi: 10.1111/jerd.13488. Epub 2025 May 30.
Molar-incisor hypomineralization (MIH) is a developmental enamel defect that often leads to aesthetic concerns, particularly when affecting incisors. Various treatment modalities, including microabrasion, bleaching, resin infiltration, and remineralizing agents, have been proposed, but their comparative effectiveness remains unclear. This systematic review aims to evaluate and compare the available aesthetic treatment options for hypomineralized incisors in children and adolescents.
A systematic search was conducted in MEDLINE via PubMed, Cochrane, Scopus, and ScienceDirect for studies published between 2013 and 2023. The review included randomized controlled trials (RCTs), non-randomized clinical studies, and in vitro studies published in English, focusing on aesthetic treatments for MIH-incisor opacities in pediatric patients (≤ 18 years old). Studies were screened and evaluated independently by two reviewers following PRISMA guidelines. Risk of bias was assessed using ROB 2 for RCTs, ROBINS-I for non-randomized studies, and the QUIN tool for quality evaluation of included studies.
From 1381 identified studies, 12 met the inclusion criteria (four RCTs, six non-RCTs, and two in vitro studies). Seven studies investigated resin infiltration, while five focused on microabrasion, either alone or combined with remineralizing agents. Evidence suggests that microabrasion is effective for superficial lesions, particularly when combined with casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) or fluoride-enriched remineralizing agents. Resin infiltration provides immediate and lasting aesthetic improvement, particularly for deeper opacities, with enhanced results when preceded by optimized etching protocols. Some studies suggest sodium hypochlorite pre-treatment enhances resin infiltration outcomes, though further validation is required.
Both microabrasion and resin infiltration show effectiveness depending on lesion characteristics. Current evidence supports the use of microabrasion, especially when combined with remineralizing agents, for mild or superficial lesions. Resin infiltration demonstrates promising results for deeper lesions; however, given that only two of the four RCTs included patients with mild MIH, the certainty of this evidence remains moderate. Treatment selection should therefore be guided by lesion depth, clinical presentation, and patient-specific factors. Further well-designed, long-term clinical trials are needed to establish standardized protocols and strengthen the evidence base for both interventions.
Treatment choice in managing MIH-affected incisors should be tailored to lesion depth, with microabrasion and remineralizing agents suitable for superficial defects and resin infiltration providing superior outcomes for deeper opacities.
磨牙-切牙矿化不全（MIH）是一种牙釉质发育缺陷，常引发美观问题，尤其是影响切牙时。已提出多种治疗方式，包括微磨除、漂白、树脂渗透和再矿化剂，但它们的相对有效性仍不明确。本系统评价旨在评估和比较儿童及青少年矿化不全切牙的现有美学治疗选择。
通过PubMed、Cochrane、Scopus和ScienceDirect在MEDLINE中对2013年至2023年发表的研究进行系统检索。该评价纳入以英文发表的随机对照试验（RCT）、非随机临床研究和体外研究，重点关注儿科患者（≤18岁）MIH切牙不透明的美学治疗。两名评价者按照PRISMA指南独立筛选和评估研究。使用ROB 2评估RCT的偏倚风险，使用ROBINS-I评估非随机研究的偏倚风险，并使用QUIN工具对纳入研究进行质量评估。
从1381项已识别研究中，12项符合纳入标准（4项RCT、6项非RCT和2项体外研究）。7项研究调查了树脂渗透，5项研究聚焦于微磨除，单独或与再矿化剂联合使用。证据表明，微磨除对表浅病变有效，尤其是与酪蛋白磷酸肽-无定形磷酸钙（CPP-ACP）或富含氟的再矿化剂联合使用时。树脂渗透能立即且持久地改善美观，尤其是对较深的不透明病变，优化蚀刻方案后效果更佳。一些研究表明次氯酸钠预处理可提高树脂渗透效果，不过还需进一步验证。
微磨除和树脂渗透均根据病变特征显示出有效性。目前证据支持对轻度或表浅病变使用微磨除，尤其是与再矿化剂联合使用时。树脂渗透对较深病变显示出有前景的结果；然而，鉴于4项RCT中只有2项纳入了轻度MIH患者，该证据的确定性仍为中等。因此，治疗选择应根据病变深度、临床表现和患者特定因素来指导。需要进一步设计良好且长期的临床试验来建立标准化方案并加强这两种干预措施的证据基础。
治疗受MIH影响的切牙时，治疗选择应根据病变深度进行调整，微磨除和再矿化剂适用于表浅缺陷，而树脂渗透对较深的不透明病变效果更佳。
