Bonding to Molar-Incisor Hypomineralization Affected Teeth: A Scoping Review of Adhesive Strategies, In Vitro Performance, and Clinical Outcomes
Abstract
Molar‑incisor hypomineralization (MIH) poses major restorative challenges due to compromised enamel and its reduced bonding capacity. This scoping review evaluated treatment options for MIH‑affected young permanent teeth following PRISMA‑ScR guidelines. A systematic search in PubMed, Cochrane, Science Direct and gray literature identified 21 eligible studies published between 2013 and 2025, including in‑vitro and clinical studies. Laboratory findings demonstrated lower bond strengths in MIH enamel compared with the sound enamel. Etch‑and‑rinse adhesives performed more reliably than that of self‑etch systems, while pretreatment procedures improved adhesion in some settings. Clinical studies showed resin‑based sealants and composites bonded with etch‑and‑rinse adhesives achieved higher retention. Glass ionomer and glass hybrid restorations offered mostly short-term success and are best used as an interim option. Investigated indirect restorations provided superior longevity in severe cases. Preventive adjuncts such as applying varnishes reduced hypersensitivity and caries risk. Finally, this review highlights the central role of adhesive performance in MIH management.
1. Weerheijm KL, Jälevik B, Alaluusua S. Molar-incisor hypomineralisation. Caries Res. 2001 Sep-Oct;35(5):390-1.
2. Weerheijm KL. Molar incisor hypomineralisation (MIH). Eur J Paediatr Dent. 2003 Sep;4(3):114-20.
3. Zhao D, Dong B, Yu D, Ren Q, Sun Y. The prevalence of molar incisor hypomineralization: evidence from 70 studies. Int J Paediatr Dent. 2018 Mar;28(2):170-179..
4. Da Costa-Silva CM, Ambrosano GM, Jeremias F, De Souza JF, Mialhe FL. Increase in severity of molar-incisor hypomineralization and its relationship with the colour of enamel opacity: a prospective cohort study. Int J Paediatr Dent. 2011 Sep;21(5):333-41.
5. Elhennawy K, Manton DJ, Crombie F, Zaslansky P, Radlanski RJ, Jost-Brinkmann PG, et al. Structural, mechanical and chemical evaluation of molar-incisor hypomineralization-affected enamel: A systematic review. Arch Oral Biol. 2017 Nov;83:272-281.
6. Inchingolo AM, Inchingolo AD, Viapiano F, Ciocia AM, Ferrara I, Netti A, et al. Treatment Approaches to Molar Incisor Hypomineralization: A Systematic Review. J Clin Med. 2023 Nov 20;12(22):7194.
7. Bastos-Bitencourt NA, Mosquim V, Zabeu GS, Rios D, Ishikiriama SK, Wang L. MIH-Affected Teeth: Clinical Challenges from Diagnosis to Restorative Management. Int J Periodontics Restorative Dent. 2022 Mar-Apr;42(2):225-231.
8. Jälevik B, Sabel N, Robertson A. Can molar incisor hypomineralization cause dental fear and anxiety or influence the oral health-related quality of life in children and adolescents?-a systematic review. Eur Arch Paediatr Dent. 2022 Feb;23(1):65-78.
9. Somani C, Taylor GD, Garot E, Rouas P, Lygidakis NA, Wong FSL. An update of treatment modalities in children and adolescents with teeth affected by molar incisor hypomineralisation (MIH): a systematic review. Eur Arch Paediatr Dent. 2022 Feb;23(1):39-64.
10. Lagarde M, Vennat E, Attal JP, Dursun E. Strategies to optimize bonding of adhesive materials to molar-incisor hypomineralization-affected enamel: A systematic review. Int J Paediatr Dent. 2020 Jul;30(4):405-420.
11. Weber KR, Wierichs RJ, Meyer-Lueckel H, Flury S. Restoration of teeth affected by molar-incisor hypomineralisation: a systematic review. Swiss Dent J. 2021 Dec 6;131(12):988-997.
12. Moreira P, Correia MN, Ferreira M, Moreira A, Feitosa VP, Jose-Burbano M, et al. Influence of 45S5 bioactive glass on the bonding properties to molar incisor hypomineralization-affected enamel: A 1-year in vitro evaluation. J Dent. 2026 Jan;164:106211.
13. Ozsoy M, Erken Gungor O. Management of severity lesions of hypomineralized molars (MIH) with different treatment alternatives: 9-month results of a clinical trial. J Clin Pediatr Dent. 2024 May;48(3):68-75.
14. Shah M, Patel MC, Patel F, Fernandes M, Makwani D, Mehta M. Evaluation of Glass Ionomer Cement and Composite Resin Restorations in Hypomineralized Permanent First Molars: A Systematic Review and Meta-Analysis. Cureus. 2025 Mar 27;17(3):e81265.
15. Fragelli CM, Souza JF, Jeremias F, Cordeiro Rde C, Santos-Pinto L. Molar incisor hypomineralization (MIH): conservative treatment management to restore affected teeth. Braz Oral Res. 2015;29:S1806-83242015000100271.
16. Theocharidou A, Arapostathis K. Adhesion to enamel of teeth affected by molar incisor hypomineralization: Literature review. Balkan Journal of Dental Medicine. 2018;22(2):57-63.
17. Ekambaram M, Yiu CK. Bonding to hypomineralized enamel–A systematic review. International Journal of Adhesion and Adhesives. 2016 Sep 1;69:27-32.
18. Baroni C, Marchionni S. MIH supplementation strategies: prospective clinical and laboratory trial. J Dent Res. 2011 Mar;90(3):371-6.
19. Krämer N, Bui Khac NN, Lücker S, Stachniss V, Frankenberger R. Bonding strategies for MIH-affected enamel and dentin. Dent Mater. 2018 Feb;34(2):331-340.
20. Solanke C, Shokoohi-Tabrizi H, Schedle A, Bekes K. Shear Bond Strengths of Composite Resin Bonded to MIH-Affected Hard Tissues with Different Adhesives and Pre-Treatments. Dent J (Basel). 2025 Aug 20;13(8):377.
21. Lygidakis NA, Dimou G, Stamataki E. Retention of fissure sealants using two different methods of application in teeth with hypomineralised molars (MIH): a 4 year clinical study. Eur Arch Paediatr Dent. 2009 Dec;10(4):223-6.
22. Bekes K, Amend S, Priller J, Zamek C, Stamm T, Krämer N. Hypersensitivity relief of MIH-affected molars using two sealing techniques: a 12-week follow-up. Clin Oral Investig. 2022 Feb;26(2):1879-1888.
23. Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med. 2018 Oct 2;169(7):467-473.
24. Lygidakis NA, Wong F, Jälevik B, Vierrou AM, Alaluusua S, Espelid I. Best Clinical Practice Guidance for clinicians dealing with children presenting with Molar-Incisor-Hypomineralisation (MIH): An EAPD Policy Document. Eur Arch Paediatr Dent. 2010 Apr;11(2):75-81.
25. Steffen R, Krämer N, Bekes K. The Würzburg MIH concept: the MIH treatment need index (MIH TNI) : A new index to assess and plan treatment in patients with molar incisior hypomineralisation (MIH). Eur Arch Paediatr Dent. 2017 Oct;18(5):355-361.
26. Arab M, Al-Sarraf E, Al-Shammari M, Qudeimat M. Microshear bond strength of different restorative materials to teeth with molar-incisor-hypomineralisation (MIH): a pilot study. Eur Arch Paediatr Dent. 2019 Feb;20(1):47-51.
27. Özgür B, Kargın ST, Ölmez MS. Clinical evaluation of giomer- and resin-based fissure sealants on permanent molars affected by molar-incisor hypomineralization: a randomized clinical trial. BMC Oral Health. 2022 Jul 5;22(1):275.
28. Fragelli CMB, Souza JF, Bussaneli DG, Jeremias F, Santos-Pinto LD, Cordeiro RCL. Survival of sealants in molars affected by molar-incisor hypomineralization: 18-month follow-up. Braz Oral Res. 2017 Apr 27;31:e30.
29. de Souza JF, Fragelli CB, Jeremias F, Paschoal MAB, Santos-Pinto L, de Cássia Loiola Cordeiro R. Eighteen-month clinical performance of composite resin restorations with two different adhesive systems for molars affected by molar incisor hypomineralization. Clin Oral Investig. 2017 Jun;21(5):1725-1733.
30. 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. Clin Oral Investig. 2021 Mar;25(3):1513-1524.
31. Sönmez H, Saat S. A Clinical Evaluation of Deproteinization and Different Cavity Designs on Resin Restoration Performance in MIH-Affected Molars: Two-Year Results. J Clin Pediatr Dent. 2017;41(5):336-342.
32. Durmus B, Sezer B, Tugcu N, Caliskan C, Bekiroglu N, Kargul B. Two-Year Survival of High-Viscosity Glass Ionomer in Children with Molar Incisor Hypomineralization. Med Princ Pract. 2021;30(1):73-79.
33. Grossi JA, Cabral RN, Ribeiro APD, Leal SC. Glass hybrid restorations as an alternative for restoring hypomineralized molars in the ART model. BMC Oral Health. 2018 Apr 18;18(1):65.
34. Sezer B, Şen Yavuz B, İşseven Cİ, Tuğcu N, Çalışkan C, Durmuş B, et al. Six-year survival and clinical performance of glass hybrid restorations following selective caries removal in teeth with molar incisor hypomineralization: a prospective cohort study. Clin Oral Investig. 2025 May 5;29(5):284.
35. Mahfouz RA, Hanno AG, Rahman AMAE. Zirconia-reinforced glass ionomer restorations in molar incisor hypomineralization: a randomized controlled clinical trial. Clin Oral Investig. 2025 May 8;29(6):290.
36. Saad AE, Alhosainy AY, Abdellatif AM. "Evaluation of Silver Diamine Fluoride Modified Atraumatic Restorative Treatment (SMART) on hypomineralized first permanent molar"- a randomized controlled clinical study. BMC Oral Health. 2024 Oct 4;24(1):1182.
37. Erbas Unverdi G, Ballikaya E, Cehreli ZC. Clinical comparison of silver diamine fluoride (SDF) or silver-modified atraumatic restorative technique (SMART) on hypomineralised permanent molars with initial carious lesions: 3-year results of a prospective, randomised trial. J Dent. 2024 Aug;147:105098.
38. Hakmi A, Dashash M. Direct or indirect composite for restoring permanent first molars affected by Molar Incisor Hypomineralisation (MIH): a randomized clinical controlled trial. BDJ Open. 2023 Aug 12;9(1):37.
39. 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. Eur Arch Paediatr Dent. 2019 Oct;20(5):489-500.
40. Gaardmand E, Poulsen S, Haubek D. Pilot study of minimally invasive cast adhesive copings for early restoration of hypomineralised first permanent molars with post-eruptive breakdown. Eur Arch Paediatr Dent. 2013 Feb;14(1):35-9.
41. 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. Int J Paediatr Dent. 2020 Sep;30(5):597-606.
42. D’Amario M, Vitocco E, Jahjah A, Capogreco A, Mauro S, D’Arcangelo C, De Angelis F. Comparative Survival of Restorations in MIH-Affected Pediatric Teeth Using Total-Etch Versus Self-Etch Adhesive Systems: A Systematic Review and Meta-Analysis. Applied Sciences. 2025 Nov 24;15(23):12445.
43. Gatón-Hernandéz P, Serrano CR, da Silva LAB, de Castañeda ER, da Silva RAB, Pucinelli CM, Manton D, Ustrell-Torrent JM, Nelson-Filho P. Minimally interventive restorative care of teeth with molar incisor hypomineralization and open apex-A 24-month longitudinal study. Int J Paediatr Dent. 2020 Jan;30(1):4-10.
2. Weerheijm KL. Molar incisor hypomineralisation (MIH). Eur J Paediatr Dent. 2003 Sep;4(3):114-20.
3. Zhao D, Dong B, Yu D, Ren Q, Sun Y. The prevalence of molar incisor hypomineralization: evidence from 70 studies. Int J Paediatr Dent. 2018 Mar;28(2):170-179..
4. Da Costa-Silva CM, Ambrosano GM, Jeremias F, De Souza JF, Mialhe FL. Increase in severity of molar-incisor hypomineralization and its relationship with the colour of enamel opacity: a prospective cohort study. Int J Paediatr Dent. 2011 Sep;21(5):333-41.
5. Elhennawy K, Manton DJ, Crombie F, Zaslansky P, Radlanski RJ, Jost-Brinkmann PG, et al. Structural, mechanical and chemical evaluation of molar-incisor hypomineralization-affected enamel: A systematic review. Arch Oral Biol. 2017 Nov;83:272-281.
6. Inchingolo AM, Inchingolo AD, Viapiano F, Ciocia AM, Ferrara I, Netti A, et al. Treatment Approaches to Molar Incisor Hypomineralization: A Systematic Review. J Clin Med. 2023 Nov 20;12(22):7194.
7. Bastos-Bitencourt NA, Mosquim V, Zabeu GS, Rios D, Ishikiriama SK, Wang L. MIH-Affected Teeth: Clinical Challenges from Diagnosis to Restorative Management. Int J Periodontics Restorative Dent. 2022 Mar-Apr;42(2):225-231.
8. Jälevik B, Sabel N, Robertson A. Can molar incisor hypomineralization cause dental fear and anxiety or influence the oral health-related quality of life in children and adolescents?-a systematic review. Eur Arch Paediatr Dent. 2022 Feb;23(1):65-78.
9. Somani C, Taylor GD, Garot E, Rouas P, Lygidakis NA, Wong FSL. An update of treatment modalities in children and adolescents with teeth affected by molar incisor hypomineralisation (MIH): a systematic review. Eur Arch Paediatr Dent. 2022 Feb;23(1):39-64.
10. Lagarde M, Vennat E, Attal JP, Dursun E. Strategies to optimize bonding of adhesive materials to molar-incisor hypomineralization-affected enamel: A systematic review. Int J Paediatr Dent. 2020 Jul;30(4):405-420.
11. Weber KR, Wierichs RJ, Meyer-Lueckel H, Flury S. Restoration of teeth affected by molar-incisor hypomineralisation: a systematic review. Swiss Dent J. 2021 Dec 6;131(12):988-997.
12. Moreira P, Correia MN, Ferreira M, Moreira A, Feitosa VP, Jose-Burbano M, et al. Influence of 45S5 bioactive glass on the bonding properties to molar incisor hypomineralization-affected enamel: A 1-year in vitro evaluation. J Dent. 2026 Jan;164:106211.
13. Ozsoy M, Erken Gungor O. Management of severity lesions of hypomineralized molars (MIH) with different treatment alternatives: 9-month results of a clinical trial. J Clin Pediatr Dent. 2024 May;48(3):68-75.
14. Shah M, Patel MC, Patel F, Fernandes M, Makwani D, Mehta M. Evaluation of Glass Ionomer Cement and Composite Resin Restorations in Hypomineralized Permanent First Molars: A Systematic Review and Meta-Analysis. Cureus. 2025 Mar 27;17(3):e81265.
15. Fragelli CM, Souza JF, Jeremias F, Cordeiro Rde C, Santos-Pinto L. Molar incisor hypomineralization (MIH): conservative treatment management to restore affected teeth. Braz Oral Res. 2015;29:S1806-83242015000100271.
16. Theocharidou A, Arapostathis K. Adhesion to enamel of teeth affected by molar incisor hypomineralization: Literature review. Balkan Journal of Dental Medicine. 2018;22(2):57-63.
17. Ekambaram M, Yiu CK. Bonding to hypomineralized enamel–A systematic review. International Journal of Adhesion and Adhesives. 2016 Sep 1;69:27-32.
18. Baroni C, Marchionni S. MIH supplementation strategies: prospective clinical and laboratory trial. J Dent Res. 2011 Mar;90(3):371-6.
19. Krämer N, Bui Khac NN, Lücker S, Stachniss V, Frankenberger R. Bonding strategies for MIH-affected enamel and dentin. Dent Mater. 2018 Feb;34(2):331-340.
20. Solanke C, Shokoohi-Tabrizi H, Schedle A, Bekes K. Shear Bond Strengths of Composite Resin Bonded to MIH-Affected Hard Tissues with Different Adhesives and Pre-Treatments. Dent J (Basel). 2025 Aug 20;13(8):377.
21. Lygidakis NA, Dimou G, Stamataki E. Retention of fissure sealants using two different methods of application in teeth with hypomineralised molars (MIH): a 4 year clinical study. Eur Arch Paediatr Dent. 2009 Dec;10(4):223-6.
22. Bekes K, Amend S, Priller J, Zamek C, Stamm T, Krämer N. Hypersensitivity relief of MIH-affected molars using two sealing techniques: a 12-week follow-up. Clin Oral Investig. 2022 Feb;26(2):1879-1888.
23. Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med. 2018 Oct 2;169(7):467-473.
24. Lygidakis NA, Wong F, Jälevik B, Vierrou AM, Alaluusua S, Espelid I. Best Clinical Practice Guidance for clinicians dealing with children presenting with Molar-Incisor-Hypomineralisation (MIH): An EAPD Policy Document. Eur Arch Paediatr Dent. 2010 Apr;11(2):75-81.
25. Steffen R, Krämer N, Bekes K. The Würzburg MIH concept: the MIH treatment need index (MIH TNI) : A new index to assess and plan treatment in patients with molar incisior hypomineralisation (MIH). Eur Arch Paediatr Dent. 2017 Oct;18(5):355-361.
26. Arab M, Al-Sarraf E, Al-Shammari M, Qudeimat M. Microshear bond strength of different restorative materials to teeth with molar-incisor-hypomineralisation (MIH): a pilot study. Eur Arch Paediatr Dent. 2019 Feb;20(1):47-51.
27. Özgür B, Kargın ST, Ölmez MS. Clinical evaluation of giomer- and resin-based fissure sealants on permanent molars affected by molar-incisor hypomineralization: a randomized clinical trial. BMC Oral Health. 2022 Jul 5;22(1):275.
28. Fragelli CMB, Souza JF, Bussaneli DG, Jeremias F, Santos-Pinto LD, Cordeiro RCL. Survival of sealants in molars affected by molar-incisor hypomineralization: 18-month follow-up. Braz Oral Res. 2017 Apr 27;31:e30.
29. de Souza JF, Fragelli CB, Jeremias F, Paschoal MAB, Santos-Pinto L, de Cássia Loiola Cordeiro R. Eighteen-month clinical performance of composite resin restorations with two different adhesive systems for molars affected by molar incisor hypomineralization. Clin Oral Investig. 2017 Jun;21(5):1725-1733.
30. 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. Clin Oral Investig. 2021 Mar;25(3):1513-1524.
31. Sönmez H, Saat S. A Clinical Evaluation of Deproteinization and Different Cavity Designs on Resin Restoration Performance in MIH-Affected Molars: Two-Year Results. J Clin Pediatr Dent. 2017;41(5):336-342.
32. Durmus B, Sezer B, Tugcu N, Caliskan C, Bekiroglu N, Kargul B. Two-Year Survival of High-Viscosity Glass Ionomer in Children with Molar Incisor Hypomineralization. Med Princ Pract. 2021;30(1):73-79.
33. Grossi JA, Cabral RN, Ribeiro APD, Leal SC. Glass hybrid restorations as an alternative for restoring hypomineralized molars in the ART model. BMC Oral Health. 2018 Apr 18;18(1):65.
34. Sezer B, Şen Yavuz B, İşseven Cİ, Tuğcu N, Çalışkan C, Durmuş B, et al. Six-year survival and clinical performance of glass hybrid restorations following selective caries removal in teeth with molar incisor hypomineralization: a prospective cohort study. Clin Oral Investig. 2025 May 5;29(5):284.
35. Mahfouz RA, Hanno AG, Rahman AMAE. Zirconia-reinforced glass ionomer restorations in molar incisor hypomineralization: a randomized controlled clinical trial. Clin Oral Investig. 2025 May 8;29(6):290.
36. Saad AE, Alhosainy AY, Abdellatif AM. "Evaluation of Silver Diamine Fluoride Modified Atraumatic Restorative Treatment (SMART) on hypomineralized first permanent molar"- a randomized controlled clinical study. BMC Oral Health. 2024 Oct 4;24(1):1182.
37. Erbas Unverdi G, Ballikaya E, Cehreli ZC. Clinical comparison of silver diamine fluoride (SDF) or silver-modified atraumatic restorative technique (SMART) on hypomineralised permanent molars with initial carious lesions: 3-year results of a prospective, randomised trial. J Dent. 2024 Aug;147:105098.
38. Hakmi A, Dashash M. Direct or indirect composite for restoring permanent first molars affected by Molar Incisor Hypomineralisation (MIH): a randomized clinical controlled trial. BDJ Open. 2023 Aug 12;9(1):37.
39. 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. Eur Arch Paediatr Dent. 2019 Oct;20(5):489-500.
40. Gaardmand E, Poulsen S, Haubek D. Pilot study of minimally invasive cast adhesive copings for early restoration of hypomineralised first permanent molars with post-eruptive breakdown. Eur Arch Paediatr Dent. 2013 Feb;14(1):35-9.
41. 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. Int J Paediatr Dent. 2020 Sep;30(5):597-606.
42. D’Amario M, Vitocco E, Jahjah A, Capogreco A, Mauro S, D’Arcangelo C, De Angelis F. Comparative Survival of Restorations in MIH-Affected Pediatric Teeth Using Total-Etch Versus Self-Etch Adhesive Systems: A Systematic Review and Meta-Analysis. Applied Sciences. 2025 Nov 24;15(23):12445.
43. Gatón-Hernandéz P, Serrano CR, da Silva LAB, de Castañeda ER, da Silva RAB, Pucinelli CM, Manton D, Ustrell-Torrent JM, Nelson-Filho P. Minimally interventive restorative care of teeth with molar incisor hypomineralization and open apex-A 24-month longitudinal study. Int J Paediatr Dent. 2020 Jan;30(1):4-10.
| Issue | Vol 23 (Continuously Published Article-Based) | |
| Section | Review Article | |
| Keywords | ||
| Hypomineralization Bonding Composite Resins Glass Ionomer Dental Restoration | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Mahmoodi Khorandi F, Moradi S, Tayebi G, Hooshmand T. Bonding to Molar-Incisor Hypomineralization Affected Teeth: A Scoping Review of Adhesive Strategies, In Vitro Performance, and Clinical Outcomes. Front Dent. 2026;23.
