Molar incisor hypomineralization (MIH) presents a clinical challenge for paediatric dentists. In this paper, restorative options for severely affected first permanent molars are given, focusing on MIH-TNI (treatment need index) classifications 2 and 4. A technique for semi-indirect, chairside restoration is presented as an alternative to other types of restoration, offering good sealing and esthetics, while maintaining healthy enamel and offering excellent longevity.