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MIH is a common developmental condition affecting primarily one or more first permanent molars. The central incisors may be affected as well, but this usually occurs to a lesser extent. Hypomineralisation of the second deciduous molars (HSPM) or canines may also occur as an early sign of possible MIH in the future.

Clinical appearance

  • Demarcated opacities, ranging from creamy white to yellow, brown discolouration depending on the severity of the lesions
  • Defective enamel has normal thickness (unless post eruptive breakdown has occurred). The quantity of enamel is normal, the quality of it is problematic
  • Lesions may occur asymmetrically
  • When a first molar is severely affected, there is an increased chance that the contralateral molar is also affected
  • Lesions of central incisors are usually milder, but they can sometimes be aesthetically unpleasant


  • Post eruptive breakdown
  • Rapid caries progression in affected teeth
  • Short restoration life time
  • In many cases, the child present with hypersensitivity and decreased response to local anaesthesia
  • Dental anxiety as a result of repeated invasive dental experiences at a young age
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Mild MIH – E. van Amerongen, The Netherlands

Moderate MIH – C. Baroni, Italy

Severe MIH – C. Baroni, Italy

Affected incisors as part of MIH – C. Baroni, Italy

Treatment plan

To provide the right answer to your patient is not always easy. GC developed the below treatment plan following Minimum Intervention philosophy to guide you in finding the right clinical solution for your patients.

Goals of treatment


What do you need?

  • Protect the surface
  • Prevent sensitivity
  • Prevent enamel

Products that can help


Fluid Glass Ionomer for surface protection

  • Fluid, penetrates in fissure & create a protective coating on teeth that helps fight against sensitivity
  • Bonds chemically even in a moist environment
  • Protects teeth even before they are fully erupted
  • The setting of the pink shade of Fuji TRIAGE can be accelerated with the dental curing light, reducing treatment time
  • The pink version is easy to control & monitor in time

MI Varnish

Enhanced fluoride varnish treatment with bio-available calcium and phosphate

  • Desensitizes the teeth thanks to the Recaldent™ (CPP-ACP) and 22 400 ppm Fluoride content
  • Is easy to apply on clean teeth, even without full OHI procedures
  • Is available in 2 nice strawberry & mint flavours, improving the treatment acceptance by patients
  • The film will disappear in a few days, but the protective effect of CPP-ACP should remain
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Fuji Triage
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MI Varnish

Goals of treatment


What do you need?

  • Strengthen the weak enamel with minerals
  • Desensitize & bring comfort
  • Ease of use with high compliance

Products that can help

Tooth Mousse

Protective cream with bio-available calcium and phosphate, without fluoride

  • Strengthen teeth by providing constituting minerals (Calcium, Phosphate) present in Recaldent (CPP-ACP)
  • Can be used below age of 6, as it does not contain fluoride
  • Desensitizes the teeth1,2
  • Gives extra protection, especially against acid attacks3,4
  • Is available in 5 delicious flavours for great patient’s acceptance

MI Paste Plus

Protective cream with bio-available calcium, phosphate and fluoride

  • Contains Recaldent (CPP-ACP) and 900 ppm Fluoride
  • Strengthens the teeth
  • Desensitizes the teeth1,2
  • Remineralises enamel lesions
  • Optimises the fluoride intake by enamel
  • Gives extra protection, especially against acid attacks3,4 & buffers the pH changes in plaque
  • Impairs the adhesion and growth of Streptococcus mutans and Streptococcus sobrinus to the tooth surface
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Goals of treatment


What do you need?

  • Chemical bond to demineralized tooth structure
  • Fast bulk fill application
  • Moisture tolerance

Products that can help


Bulk fill glass hybrid restorative system

  • Can be easily applied in bulk, even when moisture control & isolation is not possible
  • Bonds chemically without bonding agent – which is great advantage since adhesion to hypomineralised enamel is challenging
  • In case teeth are difficult to anesthetize, an atraumatic approach can be used; using manual caries excavation only
  • Displays a very low risk of post-operative sensitivity
  • Is fast: a finished restoration is already obtained in 3.5 minutes, which is an advantage for young anxious patients
  • Uses a protective coating which brings wear resistance and eliminates the need of finishing
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1. Reynolds EC & Walsh L J: Additional Aids to the remineralisation of tooth structure in Preservation and Restoration of Tooth Structure”, editors: Graham J Mount & W.R. Hume (ISBN 192082474X) Chapter 8, 111-118
2. Clinical effectiveness of a CPP-ACP crème for tooth hypersensitivity treatment. A. Poitevin, M. Peumans, J. De Munck, K. Van Landuyt, E. Coutinho, M. Braem, B. Van Meerbeek. EADR Istanbul, 25-28 August 2004 – Abstract 0136
3. Iijima Y, et al. Acid resistance of enamel subsurface lesions remineralized by a sugar-free chewing gum containing casein phosphopeptides-amorphous calcium phosphate. Caries Res 2004;38:551-556 9.
4. Kariya S, Sato T, Sakaguchi Y, Yoshii E, Fluoride effect on acid resistance capacity of CPP-ACP containing material, IADR, 82nd General Session, Honolulu, 2004 Abstract 2045.