Clinical management of severe molar–incisor hypomineralisation using CAD/CAM fabricated PMMA crowns: a case report
DOI:
https://doi.org/10.2340/biid.v13.45566Keywords:
MIH, PMMA crowns, CAD/CAM, paediatric crownAbstract
Background: Molar-incisor hypomineralisation (MIH) is a well-documented developmental enamel disorder, typically involving first permanent molars (FPMs) and incisors. However, atypical presentations with extensive involvement of other permanent teeth remain uncommon and poorly understood leading to management challenges.
Materials and methods: This case report describes a severe presentation of MIH in a 10-year-old male, with a significant medical history of high-grade fever and febrile seizures during infancy. The patient reported normal timing of permanent tooth eruption, followed by progressive post-eruptive breakdown, affecting all permanent teeth except the premolars and second permanent molars. Clinical and radiographic evaluations confirmed severe MIH with substantial loss of enamel structure, especially in FPMs and incisors, which led to severe aesthetic and functional concerns. A comprehensive treatment plan was devised. CAD/CAM technology was employed to fabricate and deliver polymethyl methacrylate (PMMA)-based crowns for the affected teeth to restore aesthetics and function.
Discussion: The patient was monitored over 24 months, demonstrating satisfactory outcomes of PMMA crowns in terms of durability, mastication, appearance and psychological benefit, indicating a successful restorative outcome. This case highlights the severe presentation of MIH, possibly linked to early childhood systemic illnesses, and individualised management of MIH, particularly in young paediatric patients.
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Robles MJ, Ruiz M, Bravo-Perez M, González E, Peñalver MA. Prevalence of enamel defects in primary and permanent teeth in a group of schoolchildren from Granada (Spain). Med Oral Patol Oral Cir Bucal. 2013;18(2):e187–93.
https://doi.org/10.4317/medoral.18580 DOI: https://doi.org/10.4317/medoral.18580
Costa FS, Silveira ER, Pinto GS, Nascimento GG, Thomson WM, Demarco FF. Developmental defects of enamel and dental caries in the primary dentition: a systematic review and meta-analysis. J Dent. 2017;60:1–7.
https://doi.org/10.1016/j.jdent.2017.03.006 DOI: https://doi.org/10.1016/j.jdent.2017.03.006
Weerheijm KL. Molar incisor hypomineralization (MIH): clinical presentation, aetiology and management. Dent Update. 2004;31(1):9–12.
https://doi.org/10.12968/denu.2004.31.1.9 DOI: https://doi.org/10.12968/denu.2004.31.1.9
Silva MJ, Scurrah KJ, Craig JM, Manton DJ, Kilpatrick N. Etiology of molar incisor hypomineralization – a systematic review. Community Dent Oral Epidemiol. 2016;44(4):342–53.
https://doi.org/10.1111/cdoe.12229 DOI: https://doi.org/10.1111/cdoe.12229
Zhao D, Dong B, Yu D, Ren Q, Sun Y. The prevalence of molar incisor hypomineralization: evidence from 70 studies. Int J Paediatr Dent. 2018;28(2):170–9.
https://doi.org/10.1111/ipd.12323 DOI: https://doi.org/10.1111/ipd.12323
Ammar N, Fresen KF, Schwendicke F, Kühnisch J. Epidemiological trends in enamel hypomineralisation and molar-incisor hypomineralisation: a systematic review and meta-analysis. Clin Oral Investig. 2025;29(6):327.
https://doi.org/10.1007/s00784-025-06411-4 DOI: https://doi.org/10.1007/s00784-025-06411-4
Alfarraj JH, Alsaeed AA. Clinical management of molar incisor hypomineralization affected molars in a pediatric patient including endodontic treatment, case report and review of the literature. Clin Cosmet Investig Dent. 2022;14:183–9.
https://doi.org/10.2147/CCIDE.S371122 DOI: https://doi.org/10.2147/CCIDE.S371122
William V, Messer LB, Burrow MF. Molar incisor hypomineralization: review and recommendations for clinical management. Pediatr Dent. 2006;28(3):224–32.
Weerheijm KL, Jälevik B, Alaluusua S. Molar-incisor hypomineralisation. Caries Res. 2001;35(5):390–1.
https://doi.org/10.1159/000047479 DOI: https://doi.org/10.1159/000047479
Schmalfuss A, Stenhagen KR, Tveit AB, Crossner CG, Espelid I. Canines are affected in 16-year-olds with molar-incisor hypomineralisation (MIH): an epidemiological study based on the Tromsø study: ‘Fit Futures’. Eur Arch Paediatr Dent. 2016;17(2):107–13.
https://doi.org/10.1007/s40368-015-0216-6 DOI: https://doi.org/10.1007/s40368-015-0216-6
Inchingolo AM, Inchingolo AD, Viapiano F, Ciocia AM, Ferrara I, Netti A, et al. Treatment approaches to molar incisor hypomineralization: a systematic review. J Clin Med. 2023;12(22):7194.
https://doi.org/10.3390/jcm12227194 DOI: https://doi.org/10.3390/jcm12227194
van der Tas JT, Elfrink MEC, Heijboer AC, Rivadeneira F, Jaddoe VWV, Tiemeier H, et al. Foetal, neonatal and child vitamin D status and enamel hypomineralization. Community Dent Oral Epidemiol. 2018;46(4):343-351.
https://doi:10.1111/cdoe.12372 DOI: https://doi.org/10.1111/cdoe.12372
Da Costa-Silva CM, Ambrosano GM, Jeremias F, De Souza JF, Mialhe FL. Increase in severity of molar-incisor hypomineralization and its relationship with the colour of enamel opacity: a prospective cohort study. Int J Paediatr Dent. 2011;21(5):333–41.
https://doi.org/10.1111/j.1365-263X.2011.01128.x DOI: https://doi.org/10.1111/j.1365-263X.2011.01128.x
de Souza JF, Fragelli CB, Jeremias F, Paschoal MAB, Santos-Pinto L, de Cássia Loiola Cordeiro R. Eighteen-month clinical performance of composite resin restorations with two different adhesive systems for molars affected by molar incisor hypomineralization. Clin Oral Investig. 2017;21(5):1725–33.
https://doi.org/10.1007/s00784-016-1968-z DOI: https://doi.org/10.1007/s00784-016-1968-z
Lygidakis NA, Garot E, Somani C, Taylor GD, Rouas P, Wong FSL. Best clinical practice guidance for clinicians dealing with children presenting with molar-incisor-hypomineralisation (MIH): an updated European Academy of Paediatric Dentistry policy document. Eur Arch Paediatr Dent. 2022;23(1):3–21.
https://doi.org/10.1007/s40368-021-00668-5 DOI: https://doi.org/10.1007/s40368-021-00668-5
Mazur M, Corridore D, Ndokaj A, Ardan R, Vozza I, Babajko S, et al. MIH and Dental Caries in Children: A Systematic Review and Meta-Analysis. Healthcare (Basel). 2023;11(12):1795. Published 2023 Jun 18.
https://doi:10.3390/healthcare11121795 DOI: https://doi.org/10.3390/healthcare11121795
Jung M, Boutin S, Simon MM, Frese C. Comparative analysis of oral microbiome in molar-incisor hypomineralization vs healthy age-matched controls. Microbiol Spectr. 2025;13(5):e0289724.
https://doi:10.1128/spectrum.02897-24 DOI: https://doi.org/10.1128/spectrum.02897-24
Fütterer J, Ebel M, Bekes K, Klode C, Hirsch C. Influence of customized therapy for molar incisor hypomineralization on children’s oral hygiene and quality of life. Clin Exp Dent Res. 2020;6(1):33–43.
https://doi.org/10.1002/cre2.245 DOI: https://doi.org/10.1002/cre2.245
Mathu-Muju K, Wright JT. Diagnosis and treatment of molar incisor hypomineralization. Compend Contin Educ Dent. 2006;27(11):604–11.
Elhennawy K, Schwendicke F. Managing molar-incisor hypomineralization: a systematic review. J Dent. 2016;55:16–24.
https://doi.org/10.1016/j.jdent.2016.09.012 DOI: https://doi.org/10.1016/j.jdent.2016.09.012
Jälevik B, Klingberg GA. Dental treatment, dental fear and behaviour management problems in children with severe enamel hypomineralization of their permanent first molars. Int J Paediatr Dent. 2002;12(1):24–32.
https://doi.org/10.1046/j.0960-7439.2001.00318.x DOI: https://doi.org/10.1046/j.0960-7439.2001.00318.x
Aiem E, Smaïl-Faugeron V, Muller-Bolla M. Aesthetic preformed paediatric crowns: systematic review. Int J Paediatr Dent. 2017;27(4):273–82.
https://doi.org/10.1111/ipd.12260 DOI: https://doi.org/10.1111/ipd.12260
Borges AF, Correr GM, Sinhoreti MA, Consani S, Sobrinho LC, Rontani RM. Compressive strength recovery by composite onlays in primary teeth. Substrate treatment and luting agent effects. J Dent. 2006;34(7):478–84.
https://doi.org/10.1016/j.jdent.2005.11.003 DOI: https://doi.org/10.1016/j.jdent.2005.11.003
Swami RS, Killedar SM. Comparative evaluation of accuracy of milled temporary crowns using metrology software: an in vitro study. Indian J Dent Sci. 2025;17(1):2–7.
https://doi.org/10.4103/ijds.ijds_11_25 DOI: https://doi.org/10.4103/ijds.ijds_11_25
Gagnier JJ, Kienle G, Altman DG, Moher D, Sox H, Riley D, et al. The CARE guidelines: consensus-based clinical case reporting guideline development. Headache. 2013;53(10):1541-1547.
https://doi:10.1111/head.12246 DOI: https://doi.org/10.1111/head.12246
Bekes K, Steffen R, Krämer N. Update of the molar incisor hypomineralization: Würzburg concept. Eur Arch Paediatr Dent. 2023;24(6):807–13.
https://doi.org/10.1007/s40368-023-00848-5 DOI: https://doi.org/10.1007/s40368-023-00848-5
Bussaneli DG, Restrepo M, Fragelli CMB, Santos-Pinto L, Jeremias F, Cordeiro RCL, et al. Genes Regulating Immune Response and Amelogenesis Interact in Increasing the Susceptibility to Molar-Incisor Hypomineralization. Caries Res. 2019;53(2):217-227.
https://doi:10.1159/000491644. DOI: https://doi.org/10.1159/000491644
Fagrell TG, Salmon P, Melin L, Norén JG. Onset of molar incisor hypomineralization (MIH). Swed Dent J. 2013;37(2):61–70.
Kevrekidou A, Kosma I, Kotsanos I, Arapostathis KN, Kotsanos N. Enamel opacities in all other than Molar Incisor Hypomineralisation index teeth of adolescents. Int J Paediatr Dent. 2021;31(2):270–7.
https://doi.org/10.1111/ipd.12735 DOI: https://doi.org/10.1111/ipd.12735
Martı Akgün O, Yıldırım C, Oflaz U, Topaclıoglu B. Investigating the causes of molar incisor hypomineralization: a cross-sectional study on maternal and child health factors. Rev Cient Odontol (Lima). 2024;12(4):e216.
https://doi.org/10.21142/2523-2754-1204-2024-216 DOI: https://doi.org/10.21142/2523-2754-1204-2024-216
Garg N, Jain AK, Saha S, Singh J. Essentiality of early diagnosis of molar incisor hypomineralization in children and review of its clinical presentation, etiology and management. Int J Clin Pediatr Dent. 2012;5(3):190–6.
https://doi.org/10.5005/jp-journals-10005-1164 DOI: https://doi.org/10.5005/jp-journals-10005-1164
da Cunha Coelho ASE, Mata PCM, Lino CA, Macho VMP, Areias CMFGP, Norton APMAP, et al. Dental hypomineralization treatment: A systematic review. J Esthet Restor Dent. 2019;31(1):26-39.
https://doi:10.1111/jerd.12420 DOI: https://doi.org/10.1111/jerd.12420
Butera A, Pascadopoli M, Gallo S, Lelli M, Tarterini F, Giglia F, et al. SEM/EDS Evaluation of the Mineral Deposition on a Polymeric Composite Resin of a Toothpaste Containing Biomimetic Zn-Carbonate Hydroxyapatite (microRepair®) in Oral Environment: A Randomized Clinical Trial. Polymers (Basel). 2021;13(16):2740. Published 2021 Aug 16.
https://doi:10.3390/polym13162740 DOI: https://doi.org/10.3390/polym13162740
Khanduri N, Kurup D, Mitra M. Quantitative evaluation of remineralizing potential of three agents on artificially demineralized human enamel using scanning electron microscopy imaging and energy-dispersive analytical X-ray element analysis: an in vitro study. Dent Res J (Isfahan). 2020;17(5):366–72.
https://doi.org/10.4103/1735-3327.294329 DOI: https://doi.org/10.4103/1735-3327.294329
Biondi AM, Cortese SG, Babino L, Fridman DE. Comparison of mineral density in molar incisor hypomineralization applying fluoride varnishes and casein phosphopeptide-amorphous calcium phosphate. Acta Odontol Latinoam. 2017;30(3):118–23.
Olgen IC, Sonmez H, Bezgin T. Effects of different remineralization agents on MIH defects: a randomized clinical study. Clin Oral Investig. 2022;26(3):3227–38.
https://doi.org/10.1007/s00784-021-04305-9 DOI: https://doi.org/10.1007/s00784-021-04305-9
Somani C, Taylor GD, Garot E, Rouas P, Lygidakis NA, Wong FSL. An update of treatment modalities in children and adolescents with teeth affected by molar incisor hypomineralisation (MIH): a systematic review. Eur Arch Paediatr Dent. 2022;23(1):39–64.
https://doi.org/10.1007/s40368-021-00635-0 DOI: https://doi.org/10.1007/s40368-021-00635-0
Al-Halabi MN, Bshara N, Nassar JA, Comisi JC, Rizk CK. Clinical performance of two types of primary molar indirect crowns fabricated by 3D printer and CAD/CAM for rehabilitation of large carious primary molars. Eur J Dent. 2021;15(3):463–8.
https://doi.org/10.1055/s-0040-1721905 DOI: https://doi.org/10.1055/s-0040-1721905
Rayyan MM, Aboushelib M, Sayed NM, Ibrahim A, Jimbo R. Comparison of interim restorations fabricated by CAD/CAM with those fabricated manually. J Prosthet Dent. 2015;114(3):414–9.
https://doi.org/10.1016/j.prosdent.2015.03.007 DOI: https://doi.org/10.1016/j.prosdent.2015.03.007
Banateanu AM, Cumpata CN, Burcea A. Digital PMMA: when and which. Rom J Oral Rehabil. 2024;16(4):427–38.
https://doi.org/10.62610/RJOR.2024.4.16.41 DOI: https://doi.org/10.62610/RJOR.2024.4.16.41
Abad-Coronel C, Calle C, Abril G, Paltán CA, Fajardo JI. Fracture resistance analysis of CAD/CAM interim fixed prosthodontic materials: PMMA, graphene, acetal resin and polysulfone. Polymers (Basel). 2023;15(7):1761.
https://doi.org/10.3390/polym15071761 DOI: https://doi.org/10.3390/polym15071761
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