From September to spring , the YPG forces in Kobanî Canton, supported by some Free Syrian Army militias and leftist international and Kurdistan Workers' Party (PKK) volunteers, fought and finally repelled an assault by the Islamic State of Iraq and the Levant (ISIL) during the Siege of Kobanî, and in the YPG's Tell Abyad offensive of summer of , the regions of Jazira and Kobanî · Table 1 MIH-TNI by Steffen et al. Reprinted by permission from Springer Nature, Eur Arch Paediatr Dent, The Würzburg MIH concept: the MIH treatment The Isla Vista killings were a series of deadly attacks in Isla Vista, blogger.com the evening of May 23, year old Elliot Rodger killed six people and injured fourteen others – by gunshot, stabbing and vehicle ramming – near the campus of the University of California, Santa Barbara (UCSB), and then killed himself.. Rodger stabbed three men to death in his apartment, apparently
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Recent data indicates that molar-incisor hypomineralisation MIH is a frequently — encountered dental condition worldwide. The condition could be associated with dental complications that might affect patients' quality of life as well as create treatment challenges to dentists. The affected teeth are more prone to caries and post-eruptive enamel breakdown, therefore, single party würzburg 2014, it is believed that this condition might be responsible for a substantial proportion of childhood caries since the condition has high prevalence.
MIH is common, single party würzburg 2014 as such it should be diagnosed and managed in primary care wherever possible. Early diagnosis can lead to more effective and conservative management, single party würzburg 2014. This article aims to highlight different aspects related to MIH, from its prevalence to treatment options in young patients. The term molar-incisor hypomineralisation MIH was first introduced in by Weerheijm et al.
Therefore, the aim of this article is to highlight the most important aspects of MIH from its prevalence to treatment options in young patients. Epidemiological studies from different parts of the world show a wide variation in the prevalence of MIH which can range between 2. A manual has also been recently published 9 to facilitate and standardise its use in future epidemiological studies.
Single party würzburg 2014 et al, single party würzburg 2014. Currently, it is estimated that this condition affects one in six children worldwide. The causative mechanism of MIH is still unclear, 713 but the clinical presentation of localised and asymmetrical lesions suggests a systemic origin with the disruption in the amelogenesis process most probably occurring in the early maturation stage or even earlier at single party würzburg 2014 late secretory phase.
The ideal time to diagnose MIH is as soon as it is clinically apparent either in primary or permanent dentition. The examination should be performed on clean wet teeth. The clinical presentation of MIH depends on its severity and can range from white-creamy opacities, yellow-brown opacities, post-eruptive enamel breakdown to atypical caries located on at least one FPM with or without incisor involvement.
Figures 1 to 7 show some examples of different clinical presentations of MIH. Reprinted by permission from Springer Nature, European Archives of Paediatric Dentistry, Molar incisor hypomineralisation MIH training manual for clinical field single party würzburg 2014 and practice, A. Ghanim, M. Silva, single party würzburg 2014, M.
Patient with severe MIH affecting all FPMs and causing atypical caries and post-eruptive enamel breakdown, single party würzburg 2014. Mathu-Muju and Wright 18 had classified MIH into three severity levels:. Mild MIH: the demarcated opacities located at non-stress bearing areas, no caries associated with the affected enamel, no hypersensitivity and incisor involvement is usually mild if present.
Moderate MIH: the demarcated opacities present on molars and incisors, the post-eruptive enamel breakdown limited to one or two surfaces without cuspal involvement, atypical restorations can be needed and normal dental sensitivity. Severe MIH: post-eruptive enamel breakdown, crown destruction, caries associated with affected enamel, single party würzburg 2014, history of dental sensitivity and aesthetic concerns. The same demarcated defects that present on some molars and incisors in MIH have also been observed on other teeth such as second primary molars and tips of permanent canine cusps in some MIH cases.
Furthermore, Negre-Barber et al. A significant association between MIH and hypomineralised permanent canines has also been described in a paper by Schmalfuss et al. Conditions which can present with hypomineralised lesions and should be distinguished from MIH include: 9 This is associated with history of fluoride ingestion during enamel development. Clinically, fluorosis presents as diffuse, linear, patchy or confluent white opacities without a clear boundary.
The severity can range from barely perceptible striations in the enamel to gross disfiguration with almost complete loss of the external part of the enamel. It affects teeth in a symmetrical, bilateral pattern unlike MIH which is asymmetrical. Moreover, teeth affected by fluorosis are caries-resistant while in MIH they are caries-prone. This is a quantitative defect with reduced enamel thickness.
The borders of hypoplastic enamel lesions are mostly regular and smooth, indicating developmental and pre-eruptive lack of enamel. The margins in MIH with post-eruptive enamel breakdown are sharp and irregular due to post-eruptive shearing of weakened enamel. This is a genetic condition which results in enamel that is hypoplastic, hypomature, or hypomineralised. In this condition, all teeth in both dentitions are affected and a familial history is often present, single party würzburg 2014.
This is the earliest clinical sign of caries. The lesions appear chalkier, matt or more opaque than the adjacent sound enamel. They can be distinguished from MIH because they occur in areas of plaque stagnation, such as the cervical margin of the tooth. This is associated with a history of dental trauma single party würzburg 2014 the primary predecessor tooth. Periapical infection of the primary tooth can disturb mineralisation of the underlying tooth germ.
It has a wide variety of clinical presentations differing in shape, outline, localisation and colour. It is often limited to one tooth and asymmetrical. The histopathological data relating to MIH, reveals that, unlike other types of enamel defects, hypomineralisation in MIH begins at the amelodentinal junction ADJ and not at the surface of the enamel. In severe MIH the whole enamel layer is hypomineralised.
The following are the most commonly reported clinical problems for patients with MIH: 59 Post-eruptive enamel breakdown leading to dentine exposure and this makes the tooth at risk of pulp involvement. Tooth sensitivity, single party würzburg 2014, which might lead to poor oral hygiene and therefore, caries susceptibility increases.
Behavioural management problems due to dental fear and anxiety which is related to the pain experienced by the patients during multiple treatment appointments. Identification of patients at risk of MIH and early diagnosis can lead to more effective and conservative management. In recent years, this topic has received a lot of attention by researchers, for example in Australia in 'The D3 Group' a translational research and educational network by a group of scientists and practitioners who are interested in the developmental dental defects has launched an official website to provide education resources and updates especially about MIH and they aim by their research to develop guidelines for MIH management.
More recently, the Würzburg MIH work group an international working group with representatives from universities in Germany, Austria and Switzerland introduced a treatment need index for MIH MIH TNI. Creation of a standardised approach for dental treatment for MIH could be possible after validation of this index.
These measurements are as follows: maxillary right; maxillary front; maxillary left; and the same thing for the mandible. In a recent article 6Dr M Hubbard the founder and the director of the D3 Group stated that MIH is a common dental problem affects one in six children on average worldwide and affected molars may face more than a ten-fold higher risk of developing caries when severely hypomineralised.
Therefore, MIH accounts for a substantial proportion of childhood caries due to its high prevalence. Further research into better clinical management and ultimately medical prevention is needed and recommended. The following, however, are some management and treatment options, which have been suggested in the literature so far:. It is very important to commence enhanced prevention as soon as MIH teeth erupt as they are prone to post-eruptive enamel breakdown and caries due to the greater porosity of enamel and its lower mechanical resistance especially in severe MIH lesions.
They should be encouraged to use fluoridated toothpaste with at least ppm F to reduce caries risk and tooth sensitivity. The combined use of fluoride and CPP-ACP has been shown to give enhanced benefits than using either agent alone.
Another effective product that can be used is Enamelon Treatment Gel Premier Dental, USAit contains both fluoride ppm F and amorphous calcium phosphate ACP. Studies have shown that this product provides substantive amounts of fluoride and ACP ions to enhance remineralisation with similar benefits when compared to 5, ppm fluoride products. This material mineralises tiny holes in the dentine leading to decreased sensitivity.
As a part of prevention at the dental clinic, it is recommended to fissure seal MIH molars. If the enamel surface of MIH molars is intact, resin-based fissure sealants can be used with adhesive application before placement as this will increase fissure sealant retention. It has to be noted that the intention here is different from conventional fissure sealants. Entire single party würzburg 2014 surface coverage, with glass ionomer cement, flowable or filled composite is often desired up to cusp level.
Generally, single party würzburg 2014, all applied fissure sealants should be regularly monitored and replaced when lost. Difficulty to anaesthetise the MIH molars is well reported in the literature. As a result, the tooth becomes hypersensitive to hot and cold temperatures.
To overcome this difficulty, multiple options have been suggested in the literature. Some researchers suggest the use of inhalation sedation to increase the pain single party würzburg 2014 during dental treatment.
Studies that compare the effectiveness of these LA agents in inferior alveolar nerve block, found that none has been shown to have a superior effect over the other, 4849 single party würzburg 2014, 50 while studies that compare their effectiveness in infiltration anaesthesia showed that articaine was significantly more effective. Some preoperative management techniques have also been single party würzburg 2014, such as the use of desensitising toothpaste before the restorative appointment.
Sedative interim restorations such as glass ionomer cements can be used single party würzburg 2014 case the pain is uncontrollable and it is difficult to complete the restorative treatment.
This two-step technique can offer shorter and more comfortable appointments for young patients. Finally, in cases where there is extreme difficulty to perform the proposed treatment and all the options have failed, general anaesthesia could be the last option, however, in these situations a more radical treatment should be planned.
It has been reported that these teeth have five to ten times more dental treatment need than molars without MIH. Also known as erosion-infiltration, this technique uses a very low viscosity resin which is capable of penetrating demineralised enamel. The hydrochloric acid is used to eliminate the relatively intact surface layer and open access to the body of the lesion, then the fluid resin is infiltrated into the broad channels of communication.
Denis et al. Therefore, this technique is not yet strongly recommended and requires further investigation. When restoring hypomineralised teeth, dentists frequently face difficulty in defining the cavity margins. Cavity design plays a critical role, as defective enamel remnants compromise the end result. It is recommended that the cavity design should involve removal of all the porous but not necessarily discoloured enamel, until resistance to the bur or to the probe is achieved.
Glass ionomer cement GIC or resin modified GIC restorations can be considered only as an intermediate approach until definitive restoration is placed, single party würzburg 2014. Amalgam should be avoided due to atypically shaped cavities in MIH molars so further breakdown often occurs at the margins, it is a non-adhesive so does not restore the strength of the tooth, and is a poor insulator.
Preformed metal crowns PMCs can be used successfully in severely damaged MIH molars with high long-term survival rates. Preformed malleable composite temporary crowns that come in different sizes Protemp Crown Temporisation Material by 3M ESPE can offer an aesthetic option. For severely affected FPMs with poor prognosis, extraction might be considered at the dental age of eight to ten years.
Before a decision to extract the molars is made, full dental assessment should be carried out to check for the presence, position and normal formation of the developing permanent dentition to ensure favourable orthodontic conditions.
Molar incisor hypomineralisation (MIH) – an overview | British Dental Journal
From September to spring , the YPG forces in Kobanî Canton, supported by some Free Syrian Army militias and leftist international and Kurdistan Workers' Party (PKK) volunteers, fought and finally repelled an assault by the Islamic State of Iraq and the Levant (ISIL) during the Siege of Kobanî, and in the YPG's Tell Abyad offensive of summer of , the regions of Jazira and Kobanî · Table 1 MIH-TNI by Steffen et al. Reprinted by permission from Springer Nature, Eur Arch Paediatr Dent, The Würzburg MIH concept: the MIH treatment The Isla Vista killings were a series of deadly attacks in Isla Vista, blogger.com the evening of May 23, year old Elliot Rodger killed six people and injured fourteen others – by gunshot, stabbing and vehicle ramming – near the campus of the University of California, Santa Barbara (UCSB), and then killed himself.. Rodger stabbed three men to death in his apartment, apparently
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