ABORDAGENS REMINERALIZANTES COM CPP-ACP E VERNIZES FLUORETADOS NO MANEJO DA HIPOMINERALIZAÇÃO MOLAR-INCISIVO: REVISÃO DE LITERATURA
DOI:
https://doi.org/10.56238/revgeov17n6-003Palavras-chave:
Hipomineralização Molar-Incisivo, CPP-ACP, Verniz Fluoretado, Remineralização Dentária, Esmalte DentárioResumo
A Hipomineralização Molar-Incisivo (HMI) caracteriza-se como um defeito qualitativo do esmalte dentário de origem sistêmica que acomete, principalmente, primeiros molares permanentes e incisivos, podendo causar sensibilidade dentária, fragilidade estrutural do esmalte e maior suscetibilidade ao desenvolvimento de lesões cariosas. Considerando a dificuldade clínica no manejo dessa condição e a necessidade de abordagens conservadoras, o presente estudo teve como objetivo revisar a literatura acerca da eficácia do CPP-ACP e dos vernizes fluoretados no manejo da Hipomineralização Molar-Incisivo. Para tanto, realizou-se uma revisão narrativa da literatura por meio de buscas nas bases de dados PubMed/MEDLINE, Scopus, Web of Science e Google Scholar, incluindo estudos publicados entre 2015 e 2025. Foram selecionados artigos relacionados às terapias remineralizantes, controle da hipersensibilidade, prevenção de perda estrutural do esmalte e manejo clínico da HMI. Observou-se que o CPP-ACP e os vernizes fluoretados apresentam resultados satisfatórios na remineralização do esmalte hipomineralizado, redução da sensibilidade dentária e melhora da resistência estrutural do esmalte afetado. Além disso, essas abordagens demonstraram importante contribuição para prevenção de fraturas pós-eruptivas e maior conforto clínico aos pacientes. Conclui-se que as terapias remineralizantes com CPP-ACP e vernizes fluoretados constituem estratégias conservadoras e eficazes no manejo clínico da Hipomineralização Molar-Incisivo, favorecendo preservação estrutural, controle da sensibilidade e promoção da saúde bucal.
Downloads
Referências
1. Acosta de Camargo MG, Giunta Crescente C. Opciones de agentes desensibilizantes en Hipomineralización Molar Incisivo: revisión de la literatura. Rev Odontopediatr Latinoam. 2023;13.
2. Afzal SH, et al. Molar-incisor hypomineralization: severity, caries and hypersensitivity. J Dent. 2024;142:104881.
3. Al-Nerabieah Z, AlKhouli M, Dashash M. Preventive efficacy of 38% silver diamine fluoride and CPP-ACP fluoride varnish on molars affected by molar incisor hypomineralization in children: a randomized controlled trial. F1000Research. 2024;12:1052.
4. Baccolini V, da Silva LP, Teixeira L, de Sousa RT, Manarte-Monteiro P. The role of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) in white spot lesion remineralization: a systematic review. J Funct Biomater. 2025;16(8):272.
5. Bandeira Lopes L, et al. Molar-incisor hypomineralization: an umbrella review. Acta Odontol Scand. 2021;79(5):359-369.
6. Biondi AM, et al. Comparison of mineral density in molar-incisor hypomineralization applying fluoride varnish and casein phosphopeptide-amorphous calcium phosphate. Acta Odontol Latinoam. 2017;30:118-123.
7. Cardoso M, Moreira KMS, Cardoso AA, Rontani RMP. CPP-ACP complexe as an alternative to treatment of incisor molar hypomineralization: case report. RGO (Porto Alegre). 2019;67:e20190035.
8. Cardoso-Martins I, Arantes-Oliveira S, Coelho A, Pessanha S, Marques PF. Evaluation of the efficacy of CPP-ACP remineralizing mousse in MIH white and yellow opacities: in vitro Vickers microhardness analysis. Dent J (Basel). 2022;10(10):186.
9. Cardoso-Martins I, Pessanha S, Coelho A, Arantes-Oliveira S, Marques PF. Evaluation of the efficacy of CPP-ACP remineralizing mousse in molar-incisor hypomineralized teeth using polarized Raman and scanning electron microscopy: an in vitro study. Biomedicines. 2022;10(12):3086.
10. Cavalcante BGN, Mlinkó É, Szabó B, Teutsch B, Hegyi P, Vág J, et al. Non-invasive strategies for remineralization and hypersensitivity management in molar-incisor hypomineralization: a systematic review and meta-analysis. J Clin Med. 2024;13(23):7154.
11. Chowdhury AR, et al. Molar incisor hypomineralization: prevalence and treatment needs in children aged 7–9 years. Int J Clin Pediatr Dent. 2024;17(7):790-795.
12. de Carvalho Godinho VB, Silva IAPS, de Andrade RS, de Mendonça MB, Borges DC, Pereira LB, et al. Hipomineralização do molar incisivo e protocolos de tratamento na clínica odontológica integrada. Res Soc Dev. 2022;11(6):e49511629344.
13. de Moura MV. Hipomineralização molar incisivo (HMI) em odontopediatria: diagnóstico diferencial e tratamento. RECIMA21. 2022;3(8):e381855.
14. Demostene-Raymundo AV, De Lima-Martinez PA, Acosta-de Camargo MG. Efecto del tratamiento desensibilizante para pacientes pediátricos con diagnóstico de hipomineralización molar incisivo (HMI). Rev Fac Odontol Univ Antioquia. 2024;36(1):20-30.
15. Elhennawy K, Schwendicke F. Managing molar-incisor hypomineralization: a systematic review. J Dent. 2016;55:16-24.
16. Enax J, Amaechi BT, Farah R, Liu JA, Schulze zur Wiesche E, Meyer F. Remineralization strategies for teeth with molar incisor hypomineralization (MIH): a literature review. Dent J (Basel). 2023;11(3):80.
17. Garot E, et al. An update of the etiological factors involved in molar-incisor hypomineralization: a systematic review and meta-analysis. Eur Arch Paediatr Dent. 2022;23(1):23-38.
18. Gevert M, et al. How is the quality of the available evidence on molar-incisor hypomineralization treatment? An overview of systematic reviews. Clin Oral Investig. 2022;26(10):5989-6002.
19. Golzio Navarro Cavalcante B, Schulze Wenning A, Szabo B, László Márk C, Hegyi P, Borbely J, et al. Combined casein phosphopeptide-amorphous calcium phosphate and fluoride is not superior to fluoride alone in early carious lesions: a meta-analysis. Caries Res. 2024;58(1):1-16.
20. Graf P, Lorenz T, Busch J. Approaches to remineralizing teeth affected by molar-incisor hypomineralization (MIH): a review of the literature. Int J Dent Res Allied Sci. 2023;3(1):46-56.
21. 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;12(22):7194.
22. Irmaleny I, Hidayat OT, Arofah AN. Analysis of penetration depth ability of three remineralization agents fluoride varnish, calcium phosphate paste (CPP-ACP) and calcium phosphate paste with fluoride (CPP-ACPF) on enamel. J Int Dent Med Res. 2024;17(4):1386-1392.
23. Jiménez ADP, et al. Caries prevention in pediatric patients with molar-incisor hypomineralization: a scoping review. J Clin Pediatr Dent. 2023;47(4):9-15.
24. Kumar A, Goyal A, Gauba K, Kapur A, Singh SK, Mehta SK. An evaluation of remineralised MIH using CPP-ACP and fluoride varnish: an in-situ and in-vitro study. Eur Arch Paediatr Dent. 2022;23(1):79-87.
25. Kumar A, et al. A comparative evaluation of CPP-ACP cream and fluoride varnish in remineralization of MIH-affected teeth using laser fluorescence. J South Asian Assoc Pediatr Dent. 2022;5(2):75-80.
26. Linner T, et al. Hypersensitivity in teeth affected by molar-incisor hypomineralization (MIH). Sci Rep. 2021;11(1):17922.
27. Nefzaoui M, Chalbi M, Chemli MA. How to make incisor opacities disappear in children and adolescents with molar incisor hypomineralization? A systematic review. J Esthet Restor Dent. 2025;37(9):2072-2082.
28. Olgen IC, Sonmez H, Bezgin T. Effects of different remineralization agents on MIH defects: a randomized clinical study. Clin Oral Investig. 2022;26(3):3227-3238.
29. Pérez AG, Chávez JAR, Ruiz HMF, Gutiérrez TV, Navarrete KAM. Effect of two remineralization agents on mild and moderate molar incisor hypomineralization defects in Mexican schoolchildren: a double-blind randomized controlled clinical trial. J Clin Pediatr Dent. 2025;49(3):39-45.
30. Prathima GS, et al. Effects of xylitol and CPP-ACP chewing gum on salivary properties in children with MIH. Int J Clin Pediatr Dent. 2021;14(3):412-415.
31. Sezer B, Çarıkçıoğlu B. Treatment strategies for incisors of children affected by molar incisor hypomineralization: a narrative review. Oral. 2024;4(1):74-89.
32. Sezer B, Kargul B. Effect of remineralization agents on molar-incisor hypomineralization-affected incisors: a randomized controlled clinical trial. J Clin Pediatr Dent. 2022;46(3):192-198.
33. Sezer B, Tuğcu N, Calışkan C, Durmuş B, Kupets T, Bekiroğlu N, et al. Effect of casein phosphopeptide amorphous calcium fluoride phosphate and calcium glycerophosphate on incisors with molar-incisor hypomineralization: a cross-over, randomized clinical trial. Bio-Med Mater Eng. 2022;33(4):325-335.
34. 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;23(1):39-64.
35. Wang W, Mao T. Silver diamine fluoride versus atraumatic restorative treatment for management of childhood caries: a systematic review and meta-analysis. BMC Oral Health. 2025.
36. Zachi DTRS, Machado LS, Oliveira EC, Borges T, Villibor FF. Possibilidades de tratamento em hipomineralização molar incisivo (HMI). Res Soc Dev. 2024;13(2):e2313244922.
37. Zuhair AN, Muaaz A, Mayssoon D. Preventive efficacy of 38% silver diamine fluoride and CPP-ACP fluoride varnish on molars affected by molar incisor hypomineralization in children: a randomized controlled trial. F1000Research. 2024;12.
