It depends on patient's personal caries risk assessment 

you can choose by using fluoride barnish therapy or a glass ionomer sealant

It is very common for the child to have hypersensitivity due to the hypoplastic molars, so one option is to cover them with glass ionomer cement as we awaits their full eruption. Once the teeth complete their eruption, one can think of a more permanent solution.

Depends on several aspects as patient age, risk to caries and the severity of the enamel defects. When it is opacities without fractures of the enamel structury, glass ionomer (conventional) selant or fluoride vanish should be applied. However, If it is fractures of enamel, you should treat with glass ionomer (conventional) selant and follow up.

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DearPrashanth,

It depends upon how much it is involved. intially  it can be restored with glass ionomer, when the tooth is completely erupted stainless steel crown should  be given.

Very interesting the article of Juliana. I hope it were helpful for you... regards

Hypoplasia should be checked. 

The reason for which should be evaluated and if possible the cause if identified should be treated. Florid varnish,  every three months ch. Up and GIC restoration is ideal solution with use of GC TOOTH Mousse. 

Personally if they are badly affected permanent molar stainless steel crowns work really well to tide over the critical period as the child is growing as most other options fail and the teeth land up umrestorable , Permanent PFMC work really well as interim restorations.

I agree, based on my own experience, individually adjusted stainless crowns may work really well for vast majority of cases as interim solution (if molars are fully erupted).

How old is the child? Is there still room for eruption? Is it MH without post eruption breakdown?

If there is room for eruption and no post eruption breakdown, Fl therapy/GIC based fissure sealant and when fully erupted, SSC.

If there is room for eruption and with post eruption breakdown, GIC restoration and when fully erupted, SSC.

If there is no room for eruption, and child is 8 to 9 years and X-ray finding showing the crown of the second molar in bone and root one third formed, review with the orthodontic for possible extraction, so that the second molar can move in bodily into the space of first molar

If there is no room for eruption, and child above 9 years and X-ray finding showing the crown of the second molar in bone and root two third formed or even erupted, review with the orthodontic for possible extrusion

ome small hypoplastic and hypocalcified defects do not require any treatment. If an enamel malformation is located in an area of low stress, there is no caries present, and the patient reports no tooth sensitivity, a reasonable treatment approach is to continually re-evaluate the status of that tooth, periodically apply fluoride, and teach the parent and child how to keep the tooth clean.

When the tooth structure breaks down from usual wear and tear, a caries lesion is detected, or if the patient complains of sensitivity, some type of clinical intervention is required. The methods for treating malformed permanent molars can summarized as follows:

• Application of a resin-bonded sealant to eliminate sensitivity

• Restoration using a resin-based composite alone

• Restoration using a glass-ionomer system, such as a powder/liquid or an encapsulated, chemically hardened glass-ionomer cement

• Restoration using a stratified resin-based composite overlying RMGI cement

• Complete interim coronal coverage using preformed stainless-steel crown forms.

The treatment goals for hypoplastic/hypocalcified permanent molars in young patients include restoring the tooth so that it no longer has sensitive dentin; re-creating coronal form to re-establish normal function, occlusion, and proximal contacts; eliminating caries infection and preventing further caries involvement; and preserving the tooth structure so that future preparation for precision indirect restoration will not be compromised.

There are cases in which a permanent first molar is so severely malformed, either with or without caries involvement, that the best treatment is extraction with the goal of the adjacent permanent second molar migrating mesially to replace the missing tooth However, case selection is critically important in these circumstances. Ideally, the second molar would have minimal root development and appear on the radiograph to have a slight mesioangular position. In addition, the third molar also would have to be evident on the radiograph, so that it too has a high likelihood of replacing the second molar by natural shifting. Severely malformed second molars can be removed if there is adequate assurance that the third molar is evident and can migrate mesially into position. Consultation with an orthodontic specialist is helpful in these cases. When treatment planning, the clinician must weigh the risks of the replacement teeth also being malformed, and parents need to know that orthodontic intervention may be needed in the future.

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