Hipomineralização molar incisivo: tratamento precoce e tardio: relato de casos
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Data
2022-04-29
Autores
Marcos, Letícia Oliva [UNESP]
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Universidade Estadual Paulista (Unesp)
Resumo
A hipomineralização molar incisivo (HMI) é uma anomalia caracterizada por displasia do esmalte que se apresenta poroso e opaco, com manchas delimitadas e assimétricas, sua coloração varia de branco à marrom, atingindo 2/3 ou mais das superfícies oclusal e/ou incisal. Apresenta-se nos primeiros molares permanentes, podendo também afetar os incisivos permanentes. Vários fatores etiológicos são citados como causa da alteração, mas sua etiologia permanece desconhecida. A classificação da severidade está relacionada de acordo com o escurecimento da lesão e tende a afetar diretamente a estética e a funcionalidade. Neste trabalho abordaremos os aspectos dessa enfermidade em relação ao tratamento, considerando três situações clínicas em diferentes níveis de severidade da HMI. O primeiro caso é uma abordagem precoce, em que podemos notar uma redução de danos mais completa a partir de medidas de prevenção à cárie dentária, incluindo a aplicação frequente de flúor e uma alimentação com baixa ingestão de açúcares, principalmente a sacarose. No segundo caso, o paciente apresentava intensa sensibilidade com os molares permanentes comprometidos pela HMI, apresentando sinais clínicos de destruição coronária e lesões de cárie. Foram realizados tratamentos restauradores e aplicação tópica de flúor. No terceiro caso, cujo diagnóstico ocorreu tardiamente, em idade avançada, identificamos dentes extensamente comprometidos, optando-se pela extração. Conclui-se que a terapêutica de escolha para a hipomineralização molar incisivo dependerá em muito do estágio em que se diagnosticar a alteração, bem como, o acompanhamento odontológico para estes casos deve ser enfatizado como parte do processo terapêutico, visando melhores resultados.
The molar-incisor hypomineralization (MIH) is an anomaly characterized by enamel dysplasia that is porous and opaque, with delimited and asymmetrical spots, its color varies from white to brown, reaching 2/3 or more of the occlusal and/or incisal surfaces. It appears in the first permanent molars and can also affect the permanent incisors. Various etiological factors are cited as the cause of the change, but its etiology remains unknown. The classification of severity is related to the darkening of the lesion and tends to directly affect aesthetics and functionality. In this work we will approach the aspects of this disease in relation to the treatment, considering three clinical situations in different levels of severity of the MIH. In the first case, an early approach occurred as soon as the teeth erupted and were diagnosed with MIH. Measures to prevent tooth decay were adopted, including the frequent application of fluoride and a diet with a low intake of sugar, especially sucrose. In the second case, the patient had intense sensitivity with the permanent molars compromised by MIH, showing clinical signs of coronary destruction and caries lesions. Restorative treatments and topical application of fluoride were performed. In the third case, whose diagnosis was delayed in the elderly child, the teeth with MIH were extensively compromised, opting for their extraction. It is concluded that the therapy of choice for molar incisor hypomineralization will depend largely on the stage at which the alteration is diagnosed, as well as, the dental follow-up for these cases should be emphasized as part of the therapeutic process, aiming at better results.
The molar-incisor hypomineralization (MIH) is an anomaly characterized by enamel dysplasia that is porous and opaque, with delimited and asymmetrical spots, its color varies from white to brown, reaching 2/3 or more of the occlusal and/or incisal surfaces. It appears in the first permanent molars and can also affect the permanent incisors. Various etiological factors are cited as the cause of the change, but its etiology remains unknown. The classification of severity is related to the darkening of the lesion and tends to directly affect aesthetics and functionality. In this work we will approach the aspects of this disease in relation to the treatment, considering three clinical situations in different levels of severity of the MIH. In the first case, an early approach occurred as soon as the teeth erupted and were diagnosed with MIH. Measures to prevent tooth decay were adopted, including the frequent application of fluoride and a diet with a low intake of sugar, especially sucrose. In the second case, the patient had intense sensitivity with the permanent molars compromised by MIH, showing clinical signs of coronary destruction and caries lesions. Restorative treatments and topical application of fluoride were performed. In the third case, whose diagnosis was delayed in the elderly child, the teeth with MIH were extensively compromised, opting for their extraction. It is concluded that the therapy of choice for molar incisor hypomineralization will depend largely on the stage at which the alteration is diagnosed, as well as, the dental follow-up for these cases should be emphasized as part of the therapeutic process, aiming at better results.
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Palavras-chave
Desmineralização do dente, Criança, Dentística operatória, Tooth demineralization