Evaluation of tooth development and bone trabeculation structure in pediatric patients with molar-incisor hypomineralization and investigation of the relationship between risk factors and intraoral findings

Molar incisor hypomineralization (MIH) is a developmental defect of the enamel characterized by insufficient mineralization, frequently accompanied by hypersensitivity, increased susceptibility to dental caries and aesthetic concerns. The aim of this study was to evaluate dental development and bone trabeculation in pediatric patients with MIH and to investigate the relationship between risk factors and intraoral findings. The study included a total of 180 pediatric patients aged between 7,99 and 9.99 years, comprising 90 with MIH and 90 healthy controls. Dental development was assessed on panoramic radiographs using the Willems, Cameriere, Nolla, and Haavikko methods. From the same radiographs, trabecular bone structure in six predetermined regions was evaluated using fractal analysis. Data regarding the prenatal, perinatal and postnatal periods of the participants were collected through questionnaires and intraoral findings were recorded via clinical examination. The obtained data were subjected to statistical analysis. The majority of families of children with MIH were found to reside in rural areas with mothers being unemployed, fathers working as laborers and the families having a low socioeconomic status. Examination of prenatal data revealed that a history of febrile illness during pregnancy was reported more frequently in association with increased MIH severity (p < 0.05). Evaluation of perinatal data demonstrated a significant relationship between mode of delivery and MIH severity; the rate of cesarean delivery was highest in the severe MIH group (p < 0.05). In the postnatal period, it was observed that most children with severe MIH had been breastfed for 12–24 months (p = 0.05). Increasing MIH severity was associated with higher DMFT and DMFS scores (p < 0.05). Regarding dental development, Nolla method–based dental age values were higher in the MIH group compared to the control group, whereas Cameriere method–based dental age values were lower in the MIH group than in controls (p < 0.05). Fractal analysis results indicated that children with MIH had significantly lower fractal dimension values, particularly in the right condyle, right angulus, and left angulus regions, compared to the control group (p < 0.05). This study demonstrates that MIH is not merely a localized enamel defect but may be a component of a systemic condition capable of delaying dental development and causing microstructural alterations in the trabecular bone. This association strengthens the proposed role of systemic factors in the etiopathogenesis of MIH and underscores the need for further investigation of the relationship between MIH and systemic development using larger sample sizes and advanced imaging techniques. Keywords: MIH, dental age, tooth development, fractal analysis, pediatric dentistry