Table 5: Summary of treatment modalities for treating hypomineralized first permanent molar

Restoring hypomineralized first permanent molars
Preventive		Topical fluoride application Desensitizing toothpaste Apply a CPP-ACP topical creme daily using a cotton bud Glass ionomer cement (GIC) sealants can provide caries protection and reduce surface permeability
Direct restoration		Cavity margin placement   –  All defective enamel is removed   –  Only the very porous enamel is removed, until good resistance of the bur to enamel is felt GIC restorations   –  Conventional GIC, resin modified GICs (RMGIC)   –  Adhesive capability to both enamel and dentine   –  Long term fluoride release   –  Poorer mechanical properties   ‒  Not recommended to be used in stress bearing areas   ‒  Be used as an intermediate restoration Composite resin restorations   –  Longer-term stability compared with other restorative materials   –  The polyacid modified resin composites   ‒  Have good handling characteristics   ‒  Release and take up fluoride; and   ‒  Have tensile and flexural strength properties superior to GIC and RMGIC, but inferior to that of resin composite   ‒  Use of PMRCs in permanent teeth is restricted to nonstress-bearing areas
Full coverage restoration		When PFMs have moderate to severe PEB, preformed stainless steel crowns (SSCs) are the treatment of choice47   –  Prevent further tooth deterioration   –  Control tooth sensitivity   –  Establish correct interproximal contacts and proper occlusal relationships   –  Are not as technique sensitive or costly as cast restorations   –  Require little time to prepare and insert   –  If not adapted properly may produce an open bite, gingivitis or both   –  Properly placed, SSCs can preserve PFMs with MIH until cast restorations are feasible Partial and full coverage indirect adhesive or cast crown and onlays   –  Compared to SSCs, cast restorations   ‒  Require minimal tooth reduction   ‒  Minimize pulpal trauma   ‒  Protect tooth structure   ‒  Provide high strength for cuspal overlays   ‒  Control sensitivity   ‒  Maintain periodontal health due to their supragingival margins
Extraction and orthodontic consideration		Timely extraction is a feasible treatment option in cases of:   –  Severe hypomineralization   –  Severe sensitivity or pain   –  Large multi surface lesions   –  Difficulty of restoration   –  Inability to achieve local anesthesia   –  Behavior management problems preventing restorative treatment   –  Apical pathosis   –  Orthodontic space requirements, where FPM are heavily restored in the presence of healthy premolars   –  Crowding distally in the arch and third permanent molars reasonably positioned   –  Financial considerations precluding other forms of treatment If the orthodontic condition were favorable, the ideal dental age for extracting the defective FPM would be 8.5 to 9 years of age