Treatment management of extensive defects of vital first permanent molars in children

The integrity of the dental arch is crucial for normal oral and maxillofacial function and aesthetics. Due to a low degree of enamel and dentin mineralization, poor oral hygiene and risk of molar incisor hypomineralization (MIH), children’s first permanent molars can be associated with an increased risk of caries and defects. Dental hygiene requires proper instruction and continuous support by the parents to enable healthy tooth development in children. Otherwise enamel and dentin defects can progress rapidly and eventually impact the dental pulp and even periapical tissues. When treating children with mixed dentition, treatment methods must consider important factors including the development of soft and hard tissues, occlusal remodeling, patient cooperation and control of pain and discomfort, as well as child-specific treatment approaches tailored to the developing dental and oral system. This article provides a retrospective summary and discussion of the latest treatment methods for extensive enamel and dentin defects in vital first permanent molars in pediatric patients, serving as a reference for clinical treatment.

Dental restoration; Molar; Permanent; Dental materials; Pediatric dentistry; Tooth extraction; Children

[1] Zou J, Meng M, Law CS, Rao Y, Zhou X. Common dental diseases in children and malocclusion. International Journal of Oral Science. 2018; 10: 7.

[2] Gilchrist F, Marshman Z, Deery C, Rodd HD. The impact of dental caries on children and young people: what they have to say? International Journal of Paediatric Dentistry. 2015; 25: 327–338.

[3] Al-Samadani KH, Ahmad MS. Prevalence of first permanent molar caries in and its relationship to the dental knowledge of 9–12-year olds from jeddah, kingdom of saudi arabia. ISRN Dentistry. 2012; 2012: 391068.

[4] Lakhani S, Noble F, Rodd H, Cobourne MT. Management of children with poor prognosis first permanent molars: an interdisciplinary approach is the key. British Dental Journal. 2023; 234: 731–736.

[5] Lu HX, Tao DY, Lo ECM, Li R, Wang X, Tai BJ, et al. The 4th national oral health survey in the mainland of China: background and methodology. Chinese Journal of Dental Research. 2018; 21: 161–165.

[6] Lygidakis NA, Garot E, Somani C, Taylor GD, Rouas P, Wong FSL. Best clinical practice guidance for clinicians dealing with children presenting with molar-incisor-hypomineralisation (MIH): an updated European Academy of Paediatric Dentistry policy document. European Archives of Paediatric Dentistry. 2022; 23: 3–21.

[7] Lihong Ge, Yuming Zhao, Man Qin. Paediatric dentistry. 5th edn. People’s Medical Publishing House: Beijing. 2020.

[8] Jetpurwala M, Sawant KR, Jain PS, Dedhia SP. Parental perception of the importance of the permanent first molar in their children. Journal of Dentistry for Children. 2020; 87: 26–30.

[9] Zhao D, Dong B, Yu D, Ren Q, Sun Y. The prevalence of molar incisor hypomineralization: evidence from 70 studies. International Journal of Paediatric Dentistry. 2018; 28: 170–179.

[10] Soliman S, Meyer-Marcotty P, Hahn B, Halbleib K, Krastl G. Treatment of an adolescent patient with dentinogenesis imperfecta using indirect composite restorations—a case report and literature review. The Journal of Adhesive Dentistry. 2018; 20: 345–354.

[11] Coffield KD, Phillips C, Brady M, Roberts MW, Strauss RP, Wright JT. The psychosocial impact of developmental dental defects in people with hereditary amelogenesis imperfecta. The Journal of the American Dental Association. 2005; 136: 620–630.

[12] Elhennawy K, Schwendicke F. Managing molar-incisor hypomineralization: a systematic review. Journal of Dentistry. 2016; 55: 16–24.

[13] Dhareula A, Goyal A, Gauba K, Bhatia SK, Kapur A, Bhandari S. A clinical and radiographic investigation comparing the efficacy of cast metal and indirect resin onlays in rehabilitation of permanent first molars affected with severe molar incisor hypomineralisation (MIH): a 36-month randomised controlled clinical trial. European Archives of Paediatric Dentistry. 2019; 20: 489–500.

[14] Chin JR. Dental caries in the child and adolescent. In Dean JA (ed.) McDonald and Avery’s dentistry for the child and adolescent (pp. 155–176). 10th edn. Elsevier: St. Louis, Missouri. 2016.

[15] Klingberg G, Broberg AG. Dental fear/anxiety and dental behaviour management problems in children and adolescents: a review of prevalence and concomitant psychological factors. International Journal of Paediatric Dentistry. 2007; 17: 391–406.

[16] American Academy of Pediatric Dentistry. Clinical Affairs Committee—Sedation and General Anesthesia Subcommittee. Guideline on use of anesthesia personnel in the administration of office-based deep sedation/general anesthesia to the pediatric dental patient. Pediatric Dentistry Journal. 2012; 34: 170–172.

[17] Liu F, Zhou ZF, Wu LZ. Investigation on cog-nition and acceptance level on dental general ane-sthesia of 1 002 parents in the city of Xi’an. Journal of Clinical Stomatology. 2013; 29: 156–158.

[18] Mai S, Wei X, Ling JQ. Development strategies and progress of composite resin filling material. Chinese Journal of Stomatology. 2021; 56: 51–56. (In Chinese)

[19] Sengupta A, Naka O, Mehta SB, Banerji S. The clinical performance of bulk-fill versus the incremental layered application of direct resin composite restorations: a systematic review. Evidence-Based Dentistry. 2023; 24: 143.

[20] Lynch CD, Opdam NJ, Hickel R, Brunton PA, Gurgan S, Kakaboura A, et al. Guidance on posterior resin composites: academy of Operative Dentistry—European Section. Journal of Dentistry. 2014; 42: 377–383.

[21] Downer MC, Azli NA, Bedi R, Moles DR, Setchell DJ. How long do routine dental restorations last? A systematic review. British Dental Journal. 1999; 187: 432–439.

[22] Soares CJ, Faria-E-Silva AL, Rodrigues MP, Vilela ABF, Pfeifer CS, Tantbirojn D, et al. Polymerization shrinkage stress of composite resins and resin cements—what do we need to know? Brazilian Oral Research. 2017; 31: e62.

[23] Rolim TZC, da Costa TRF, Wambier LM, Chibinski AC, Wambier DS, da Silva Assunção LR, et al. Adhesive restoration of molars affected by molar incisor hypomineralization: a randomized clinical trial. Clinical Oral Investigations. 2021; 25: 1513–1524.

[24] Heintze SD, Rousson V. Clinical effectiveness of direct class II restorations—a meta-analysis. The Journal of Adhesive Dentistry. 2012; 14: 407–431.

[25] Mejare I, Bergman E, Grindefjord M. Hypomineralized molars and incisors of unknown origin: treatment outcome at age 18 years. International Journal of Paediatric Dentistry. 2005; 15: 20–28.

[26] Opdam NJ, van de Sande FH, Bronkhorst E, Cenci MS, Bottenberg P, Pallesen U, et al. Longevity of posterior composite restorations: a systematic review and meta-analysis. Journal of Dental Research. 2014; 93: 943–949.

[27] Ástvaldsdóttir Á, Dagerhamn J, van Dijken JW, Naimi-Akbar A, Sandborgh-Englund G, Tranæus S, et al. Longevity of posterior resin composite restorations in adults—a systematic review. Journal of Dentistry. 2015; 43: 934–954.

[28] Park HY, Kloxin CJ, Abuelyaman AS, Oxman JD, Bowman CN. Novel dental restorative materials having low polymerization shrinkage stress via stress relaxation by addition-fragmentation chain transfer. Dental Materials. 2012; 28: 1113–1119.

[29] Marovic D, Tarle Z, Hiller KA, Müller R, Rosentritt M, Skrtic D, et al. Reinforcement of experimental composite materials based on amorphous calcium phosphate with inert fillers. Dental Materials. 2014; 30: 1052–1060.

[30] Afrashtehfar KI, Emami E, Ahmadi M, Eilayyan O, Abi-Nader S, Tamimi F. Failure rate of single-unit restorations on posterior vital teeth: a systematic review. The Journal of Prosthetic Dentistry. 2017; 117: 345–353.e8.

[31] Rocca GT, Rizcalla N, Krejci I, Dietschi D. Evidence-based concepts and procedures for bonded inlays and onlays. Part II. Guidelines for cavity preparation and restoration fabrication. International Journal of Esthetic Dentistry. 2015; 10: 392–413.

[32] Krifka S, Anthofer T, Fritzsch M, Hiller KA, Schmalz G, Federlin M. Ceramic inlays and partial ceramic crowns: influence of remaining cusp wall thickness on the marginal integrity and enamel crack formation in vitro. Operative Dentistry. 2009; 34: 32–42.

[33] da Veiga AM, Cunha AC, Ferreira DM, da Silva Fidalgo TK, Chianca TK, Reis KR, et al. Longevity of direct and indirect resin composite restorations in permanent posterior teeth: a systematic review and meta-analysis. Journal of Dentistry. 2016; 54: 1–12.

[34] Josic U, D’Alessandro C, Miletic V, Maravic T, Mazzitelli C, Jacimovic J, et al. Clinical longevity of direct and indirect posterior resin composite restorations: an updated systematic review and meta-analysis. Dental Materials. 2023; 39: 1085–1094.

[35] Wiegand A, Buchalla W, Attin T. Review on fluoride-releasing restorative materials--fluoride release and uptake characteristics, antibacterial activity and influence on caries formation. Dental Materials. 2007; 23: 343–362.

[36] Zhang Q, Guan L, Guo J, Chuan A, Tong J, Ban J, et al. Application of fluoride disturbs plaque microecology and promotes remineralization of enamel initial caries. Journal of Oral Microbiology. 2022; 14: 2105022.

[37] Dionysopoulos P, Kotsanos N, Koliniotou-Koubia E, Tolidis K. Inhibition of demineralization in vitro around fluoride releasing materials. Journal of Oral Rehabilitation. 2003; 30: 1216–1222.

[38] Tyas MJ. Milestones in adhesion: glass-ionomer cements. The Journal of Adhesive Dentistry. 2003; 5: 259–266.

[39] Berg JH, Croll TP. Glass ionomer restorative cement systems: an update. Pediatric Dentistry Journal. 2015; 37: 116–124.

[40] Jalevik B, Dietz W, Noren JG. Scanning electron micrograph analysis of hypomineralized enamel in permanent first molars. International Journal of Paediatric Dentistry. 2005; 15: 233–240.

[41] William V, Burrow MF, Palamara JE, Messer LB. Microshear bond strength of resin composite to teeth affected by molar hypomineralization using 2 adhesive systems. Pediatric Dentistry Journal. 2006; 28: 233–241.

[42] Manisha S, Shetty SS, Mehta V, Sa R, Meto A. A comprehensive evaluation of zirconia-reinforced glass ionomer cement’s effectiveness in dental caries: a systematic review and network meta-analysis. Dentistry Journal. 2023; 11: 211.

[43] Kamath UB, Salam ART. Fracture resistance of maxillary premolars with mod cavities restored with zirconomer: an in vitro comparative study. International Journal of Applied Dental Sciences. 2016; 2: 77–80.

[44] Khoroushi M, Keshani F. A review of glass-ionomers: from conventional glass-ionomer to bioactive glass-ionomer. Dental Research Journal. 2013; 10: 411–420.

[45] Bassir MM, Labibzadeh A, Mollaverdi F. The effect of amount of lost tooth structure and restorative technique on fracture resistance of endodontically treated premolars. Journal of Conservative Dentistry. 2013; 16: 413–417.

[46] Mixuezi Li, Chen Zhang. Clinical consideration on the application of computer-aided design/computer-aided manufacturing endocrown in molar restoration after root canal therapy. International Journal of Stomatology. 2021; 48: 274–279.

[47] Mangold JT, Kern M. Influence of glass-fiber posts on the fracture resistance and failure pattern of endodontically treated premolars with varying substance loss: an in vitro study. The Journal of Prosthetic Dentistry. 2011; 105: 387–393.

[48] Christensen GJ. Considering tooth-colored inlays and onlays versus crowns. The Journal of the American Dental Association. 2008; 139: 617–620.

[49] Mezied MS, Alhazmi AK, Alhamad GM, Alshammari NN, Almukairin RR, Aljabr NA, et al. Endocrowns Versus post-core retained crowns as a restoration of root canal treated molars—a review article. Journal of Pharmacy and Bioallied Sciences. 2022; 14: S39–S42.

[50] Costa VCD, Machado AC, Soares PV, Raposo LH, Vasconcellos AB. Influence of material and loading location on stress distribution of inlays. American Journal of Dentistry. 2021; 34: 171–176.

[51] Mangano F, Gandolfi A, Luongo G, Logozzo S. Intraoral scanners in dentistry: a review of the current literature. BMC Oral Health. 2017; 17: 149.

[52] Burhardt L, Livas C, Kerdijk W, van der Meer WJ, Ren Y. Treatment comfort, time perception, and preference for conventional and digital impression techniques: a comparative study in young patients. American Journal of Orthodontics and Dentofacial Orthopedics. 2016; 150: 261–267.

[53] Fan J, Xu Y, Si L, Li X, Fu B, Hannig M. Long-term clinical performance of composite resin or ceramic inlays, onlays, and overlays: a systematic review and meta-analysis. Operative Dentistry. 2021; 46: 25–44.

[54] Michaud PL, Dort H. Do onlays and crowns offer similar outcomes to posterior teeth with mesial-occlusal-distal preparations? A systematic review. Journal of Esthetic and Restorative Dentistry. 2024; 36: 295–302.

[55] Edelhoff D, Sorensen JA. Tooth structure removal associated with various preparation designs for posterior teeth. International Journal of Periodontics & Restorative Dentistry. 2002; 22: 241–249.

[56] Davidovich E, Shay B, Nuni E, Mijiritsky E. An innovative treatment approach using digital workflow and CAD-CAM Part 1: the restoration of endodontically treated molars in children. International Journal of Environmental Research and Public Health. 2020; 17: 1364.

[57] McLaren EA, Whiteman YY. Ceramics: rationale for material selection. Compendium of Continuing Education in Dentistry. 2010; 31: 666–668, 670, 672 passim; quiz 680, 700.

[58] Mante FK, Ozer F, Walter R, Atlas AM, Saleh N, Dietschi D, et al. The current state of adhesive dentistry: a guide for clinical practice. Compendium of Continuing Education in Dentistry. 2013; 34: 2–8.

[59] Ng YL, Mann V, Gulabivala K. Tooth survival following non-surgical root canal treatment: a systematic review of the literature. International Endodontic Journal. 2010; 43: 171–189.

[60] Koch MJ, García-Godoy F. The clinical performance of laboratory-fabricated crowns placed on first permanent molars with developmental defects. The Journal of the American Dental Association. 2000; 131: 1285–1290.

[61] Goodacre CJ, Campagni WV, Aquilino SA. Tooth preparations for complete crowns: an art form based on scientific principles. The Journal of Prosthetic Dentistry. 2001; 85: 363–376.

[62] Mele M, Felice P, Sharma P, Mazzotti C, Bellone P, Zucchelli G. Esthetic treatment of altered passive eruption. Periodontology 2000. 2018; 77: 65–83.

[63] Clark D, Khademi J. Modern molar endodontic access and directed dentin conservation. Dental Clinics of North America. 2010; 54: 249–273.

[64] Sadan A, Blatz MB, Lang B. Clinical considerations for densely sintered alumina and zirconia restorations: part 2. International Journal of Periodontics & Restorative Dentistry. 2005; 25: 343–349.

[65] Miyazaki T, Nakamura T, Matsumura H, Ban S, Kobayashi T. Current status of zirconia restoration. Journal of Prosthodontic Research. 2013; 57: 236–261.

[66] Blatz MB, Vonderheide M, Conejo J. The effect of resin bonding on long-term success of high-strength ceramics. Journal of Dental Research. 2018; 97: 132–139.

[67] Soleimani F, Jalali H, Mostafavi AS, Zeighami S, Memarian M. Retention and clinical performance of zirconia crowns: a comprehensive review. International Journal of Dentistry. 2020; 2020: 8846534.

[68] Ausiello P, Rengo S, Davidson CL, Watts DC. Stress distributions in adhesively cemented ceramic and resin-composite Class II inlay restorations: a 3D-FEA study. Dental Materials. 2004; 20: 862–872.

[69] Gracis S, Thompson VP, Ferencz JL, Silva NR, Bonfante EA. A new classification system for all-ceramic and ceramic-like restorative materials. The International Journal of Prosthodontics. 2015; 28: 227–235.

[70] Awada A, Nathanson D. Mechanical properties of resin-ceramic CAD/CAM restorative materials. The Journal of Prosthetic Dentistry. 2015; 114: 587–593.

[71] El-Damanhoury HM, Haj-Ali RN, Platt JA. Fracture resistance and microleakage of endocrowns utilizing three CAD-CAM blocks. Operative Dentistry. 2015; 40: 201–210.

[72] Aktas G, Yerlikaya H, Akca K. Mechanical failure of endocrowns manufactured with different ceramic materials: an in vitro biomechanical study. Journal of Prosthodontics. 2018; 27: 340–346.

[73] Fathy H, Hamama HH, El-Wassefy N, Mahmoud SH. Clinical performance of resin-matrix ceramic partial coverage restorations: a systematic review. Clinical Oral Investigations. 2022; 26: 3807–3822.

[74] Seale NS, Randall R. The use of stainless steel crowns: a systematic literature review. Pediatric Dentistry Journal. 2015; 37: 145–160.

[75] Dhar V, Hsu KL, Coll JA, Ginsberg E, Ball BM, Chhibber S, et al. Evidence-based update of pediatric dental restorative procedures: dental materials. Journal of Clinical Pediatric Dentistry. 2015; 39: 303–310.

[76] Mink JR, Bennett IC. The stainless steel crown. The Journal of the Ontario Dental Association. 1968; 45: 420–430.

[77] Kindelan SA, Day P, Nichol R, Willmott N, Fayle SA; British Society of Paediatric Dentistry. UK National Clinical Guidelines in Paediatric Dentistry: stainless steel preformed crowns for primary molars. International Journal of Paediatric Dentistry. 2008; 18: 20–28.

[78] American academy of pediatric dentistry reference manual 2009–2010. Pediatric Dentistry Journal. 2009; 31: 1–302.

[79] Heidari A, Shahrabi M, Hosseini Z, Sari NM. Periodontal assessment of permanent molar teeth restored with stainless steel crown in terms of pocket depth, bleeding on probing, gingival color and inflammation. International Journal of Clinical Pediatric Dentistry. 2019; 12: 116–119.

[80] Boyd DH, Thomson WM, Leon de la Barra S, Fuge KN, van den Heever R, Butler BM, et al. A primary care randomized controlled trial of hall and conventional restorative techniques. JDR Clinical & Translational Research. 2021; 6: 205–212.

[81] Innes NP, Evans DJ, Stirrups DR. The hall technique; a randomized controlled clinical trial of a novel method of managing carious primary molars in general dental practice: acceptability of the technique and outcomes at 23 months. BMC Oral Health. 2007; 7: 18.

[82] Elamin F, Abdelazeem N, Salah I, Mirghani Y, Wong F. A randomized clinical trial comparing hall vs. conventional technique in placing preformed metal crowns from Sudan. PLOS ONE. 2019; 14: e0217740.

[83] Guerra BMdS, Jorge RC, Reis PPGd, Bonifácio CC, Hesse D, Fidalgo TKdS, et al. Hall technique for the management of hypomineralized first permanent molars: a protocol of a randomized controlled trial with 3-year follow-up. Research, Society and Development. 2024; 13: 1–14.

[84] Talekar AL, Waggoner WF, Silotry TMH, Musale PK, Chaudhari GS. Prospective, randomized, clinical evaluation of preformed zirconia crowns and stainless steel crowns on permanent first molars: 12-month results. Pediatric Dentistry Journal. 2023; 45: 232–239.

[85] Geduk N, Ozdemir M, Erbas Unverdi G, Ballikaya E, Cehreli ZC. Clinical and radiographic performance of preformed zirconia crowns and stainless-steel crowns in permanent first molars: 18-month results of a prospective, randomized trial. BMC Oral Health. 2023; 23: 828.

[86] Ashima G, Sarabjot KB, Gauba K, Mittal HC. Zirconia crowns for rehabilitation of decayed primary incisors: an esthetic alternative. Journal of Clinical Pediatric Dentistry. 2014; 39: 18–22.

[87] Kelly N, Lamont T. Are zirconia crowns the superior choice when restoring primary posterior molars? Evidence-Based Dentistry. 2022; 23: 72–73.

[88] Morrow LA, Robbins JW, Jones DL, Wilson NH. Clinical crown length changes from age 12–19 years: a longitudinal study. Journal of Dentistry. 2000; 28: 469–473.

[89] Reeh ES, Messer HH, Douglas WH. Reduction in tooth stiffness as a result of endodontic and restorative procedures. Journal of Endodontics. 1989; 15: 512–516.

[90] Chaipattanawan N, Chompu-Inwai P, Manmontri C, Cherdsatirakul P, Nirunsittirat A, Phinyo P. Tooth fracture and associated risk factors in permanent molars treated with vital pulp therapy and restored with direct resin composites: a retrospective survival analysis in young patients. European Endodontic Journal. 2023; 8: 37–46.

[91] Morimoto S, Rebello de Sampaio FB, Braga MM, Sesma N, Özcan M. Survival Rate of resin and ceramic inlays, onlays, and overlays: a systematic review and meta-analysis. Journal of Dental Research. 2016; 95: 985–994.

[92] Maltz M, Jardim JJ, Mestrinho HD, Yamaguti PM, Podestá K, Moura MS, et al. Partial removal of carious dentine: a multicenter randomized controlled trial and 18-month follow-up results. Caries Research. 2013; 47: 103–109.

[93] Bjørndal L, Reit C, Bruun G, Markvart M, Kjaeldgaard M, Näsman P, et al. Treatment of deep caries lesions in adults: randomized clinical trials comparing stepwise vs. direct complete excavation, and direct pulp capping vs. partial pulpotomy. European Journal of Oral Sciences. 2010; 118: 290–297.

[94] Bjorndal L, Larsen T, Thylstrup A. A clinical and microbiological study of deep carious lesions during stepwise excavation using long treatment intervals. Caries Research. 1997; 31: 411–417.

[95] Lula EC, Monteiro-Neto V, Alves CM, Ribeiro CC. Microbiological analysis after complete or partial removal of carious dentin in primary teeth: a randomized clinical trial. Caries Research. 2009; 43: 354–358.

[96] Orhan AI, Oz FT, Orhan K. Pulp exposure occurrence and outcomes after 1- or 2-visit indirect pulp therapy vs complete caries removal in primary and permanent molars. Pediatric Dentistry Journal. 2010; 32: 347–355.

[97] Ricketts D, Lamont T, Innes NP, Kidd E, Clarkson JE. Operative caries management in adults and children. Cochrane Database of Systematic Reviews. 2013; CD003808.

[98] Maltz M, Koppe B, Jardim JJ, Alves LS, de Paula LM, Yamaguti PM, et al. Partial caries removal in deep caries lesions: a 5-year multicenter randomized controlled trial. Clinical Oral Investigations. 2018; 22: 1337–1343.

[99] Schwendicke F, Dorfer CE, Paris S. Incomplete caries removal: a systematic review and meta-analysis. Journal of Dental Research. 2013; 92: 306–314.

[100] Maltz M, Garcia R, Jardim JJ, de Paula LM, Yamaguti PM, Moura MS, et al. Randomized trial of partial vs. stepwise caries removal: 3-year follow-up. Journal of Dental Research. 2012; 91: 1026–1031.

[101] Dietschi D, Duc O, Krejci I, Sadan A. Biomechanical considerations for the restoration of endodontically treated teeth: a systematic review of the literature—Part 1. Composition and micro- and macrostructure alterations. Quintessence International. 2007; 38: 733–743.

[102] Soares PV, Santos-Filho PC, Gomide HA, Araujo CA, Martins LR, Soares CJ. Influence of restorative technique on the biomechanical behavior of endodontically treated maxillary premolars. Part II: strain measurement and stress distribution. The Journal of Prosthetic Dentistry. 2008; 99: 114–122.

[103] Cagidiaco MC, García-Godoy F, Vichi A, Grandini S, Goracci C, Ferrari M. Placement of fiber prefabricated or custom made posts affects the 3-year survival of endodontically treated premolars. American Journal of Dentistry. 2008; 21: 179–184.

[104] Dastouri M, Kowash M, Al-Halabi M, Salami A, Khamis AH, Hussein I. United Arab Emirates dentists’ perceptions about the management of broken down first permanent molars and their enforced extraction in children: a questionnaire survey. European Archives of Paediatric Dentistry. 2020; 21: 31–41.

[105] Saber AM, Altoukhi DH, Horaib MF, El-Housseiny AA, Alamoudi NM, Sabbagh HJ. Consequences of early extraction of compromised first permanent molar: a systematic review. BMC Oral Health. 2018; 18: 59.

[106] Brusevold IJ, Kleivene K, Grimsøen B, Skaare AB. Extraction of first permanent molars severely affected by molar incisor hypomineralisation: a retrospective audit. European Archives of Paediatric Dentistry. 2022; 23: 89–95.

[107] Nordeen KA, Kharouf JG, Mabry TR, Dahlke WO, Beiraghi S, Tasca AW. Radiographic evaluation of permanent second molar substitution after extraction of permanent first molar: identifying predictors for spontaneous space closure. Pediatric Dentistry Journal. 2022; 44: 123–130.

[108] Patel S, Ashley P, Noar J. Radiographic prognostic factors determining spontaneous space closure after loss of the permanent first molar. American Journal of Orthodontics and Dentofacial Orthopedics. 2017; 151: 718–726.

[109] Cobourne MT, Williams A, Harrison M. National clinical guidelines for the extraction of first permanent molars in children. British Dental Journal. 2014; 217: 643–648.

[110] Yu H, Zhao Y, Li J, Luo T, Gao J, Liu H, et al. Minimal invasive microscopic tooth preparation in esthetic restoration: a specialist consensus. International Journal of Oral Science. 2019; 11: 31.

[111] Simonsen RJ. From prevention to therapy: Minimal intervention with sealants and resin restorative materials. Journal of Dentistry. 2011; 39: S27–S33.

[112] Dietschi D, Duc O, Krejci I, Sadan A. Biomechanical considerations for the restoration of endodontically treated teeth: a systematic review of the literature, Part II (evaluation of fatigue behavior, interfaces, and in vivo studies). Quintessence International. 2008; 39: 117–129.

[113] Lander E, Dietschi D. Endocrowns: a clinical report. Quintessence International. 2008; 39: 99–106.

[114] Veneziani M. Adhesive restorations in the posterior area with subgingival cervical margins: new classification and differentiated treatment approach. The European Journal of Esthetic Dentistry. 2010; 5: 50–76.

[115] Dablanca-Blanco AB, Blanco-Carrión J, Martín-Biedma B, Varela-Patiño P, Bello-Castro A, Castelo-Baz P. Management of large class II lesions in molars: how to restore and when to perform surgical crown lengthening? Restorative Dentistry & Endodontics. 2017; 42: 240–252.

[116] Linner T, Khazaei Y, Bücher K, Pfisterer J, Hickel R, Kühnisch J. Comparison of four different treatment strategies in teeth with molar-incisor hypomineralization-related enamel breakdown—a retrospective cohort study. International Journal of Paediatric Dentistry. 2020; 30: 597–606.

[117] Jälevik B, Klingberg G. Treatment outcomes and dental anxiety in 18-year-olds with MIH, comparisons with healthy controls—a longitudinal study. International Journal of Paediatric Dentistry. 2012; 22: 85–91.