487H
Fig. 9.37 Place a glass ionomer base
over the calcium hydroxide.488H
Fig. 9.38 Restore with etched, bonded,
composite resin to provide a hermetic
seal. There is no need to re-investigate
the site, so consider the restoration as
definitive.9.11 HYPOMINERALIZED, HYPOMATURE, OR HYPOPLASTIC FIRST
PERMANENT MOLARS
9.11.0 Introduction
As caries has declined generally, it has become more apparent that there is another
problem that commonly affects first permanent molars and incisors. Very recently this
condition has been called 'molar-incisor hypomineralization' (MIH). This term covers
a range of developmental anomalies from small white, yellow, or brown patches to
extensive loss of tissue from almost the whole enamel surface. It is characterized by a
very rapid breakdown of the enamel, which can be extremely sensitive. The
breakdown may even occur in a few months while the tooth is still erupting. The
difficulties of cleaning a partially erupted tooth are then compounded by the
sensitivity. This produces an area where plaque builds up and which leads to rapid
carious attack. As is always the case with first permanent molars, exfoliation of
primary molars does not precede their eruption, so children and parents are often
unaware of their presence and thus they do not seek treatment until the teeth start to