Molar incisor hypomineralization (MIH) presents significant clinical challenges due to tooth hypersensitivity, young patient age, and often extensive defects. Treatment approaches vary for posterior and anterior teeth, following a „composite first-ceramic second“ principle based on patient age. Alternative treatments include silver diamine fluoride or flowable glass ionomer cements. For posterior teeth, direct restorations are preferred in younger patients (7-9 years old), while indirect restorations may be more suitable for adults or extensive defects. Anterior teeth in younger patients are primarily treated with composite restorations to accommodate ongoing skeletal growth, while indirect restorations are used for older patients (>20-25 years) to improve esthetics. Key is multilayer composite material for better esthetics in anterior teeth and also to avoid bonding to MIH-affected enamel. Successful MIH management requires a tailored approach balancing minimally invasive techniques with long-term functional and esthetic outcomes.
