Treatment of Molar-Incisor Hypomineralization and Its Impact on Child and Adolescent Oral Health: A Comprehensive Bibliometric Analysis

Abstract

Molar-incisor hypomineralization (MIH) is a developmental enamel defect that poses significant challenges to achieving long-term restorative success. The aim of this bibliometric review is to map the research landscape on treatment strategies for teeth affected by MIH and to provide insights that will guide future research and clinical practice. A comprehensive search of the Web of Science (WoS) and PubMed/MEDLINE databases was conducted for studies on MIH treatment published between 2014 and 2024, using defined keywords related to MIH treatment. Eligible studies were analyzed using VOSviewer, Bibliometrix R-tool, and Carrot2 software to assess publication trends, authorship, citations, and thematic focus. The comprehensive database search of the databases retrieved 933 studies, of which 230 met the inclusion criteria. A notable increase in publications was observed from 2018 to 2022, accompanied by a substantial rise in citations from 2019 onwards. Most of the research is concentrated in pediatric dentistry journals. Key topics include “children”, “resin infiltration”, “resin composite”, and “management/performance”, with an increasing emphasis on innovative and conservative approaches. Although international collaboration remains limited, Brazil (18.7%), Germany (15.5%), and England/Italy (7.7%) lead in research output. This highlights the need for international collaboration and the development of standardized, effective treatment protocols.

1. Introduction

Molar-incisor hypomineralization (MIH) has emerged as a significant challenge in dentistry due to its high global prevalence (13.5%) [1,2,3]. It is estimated that 17.5 million new cases are reported annually, with the highest prevalence at 18% [2] occurring in South America. MIH is characterized as a qualitative enamel defect that presents clinically as white and/or brown opacities in the first permanent molars and, in some cases, the permanent incisors [4,5,6]. Affected teeth are strongly associated with dental caries, which exacerbates lesion severity and accelerates disease progression [7,8].

MIH is a significant public health problem, highlighting the need to assess its impact using Global Burden of Disease (GBD) study methods [1]. Over the past decade, there has been a steady increase in scientific publications on MIH [9,10]. However, further research is essential, especially in areas that have not yet been explored [11], such as clinical trials evaluating effective treatment strategies for this condition [9,10]. A key challenge in rehabilitating affected teeth, especially in young patients, is the difficulty in achieving optimal adhesion of dental materials to MIH-altered enamel and dentin [12].

Despite being among the most extensively studied topics, the etiology and prevalence of MIH remain largely unknown, making the development of effective prevention protocols and therapeutic approaches particularly challenging [13]. As research in this field expands, promising prevention and treatment strategies are being investigated and developed. Nevertheless, uncertainties persist regarding the optimal therapeutic approach, which may vary depending on the severity of the defects and the patient’s age [14].

To advance evidence-based strategies in the management of MIH, it is essential to understand global research trends and knowledge gaps. Bibliometric reviews play a key role in this process, mapping scientific output and identifying emerging themes to guide future research into effective treatment options for this condition [15].

Given the high prevalence of MIH and the significant challenges in formulating effective treatment strategies, it is important to identify and implement appropriate therapies. Despite the limited range of therapeutic options for MIH, the literature shows that treating this condition can lead to an improvement in oral health-related quality of life [16]. A novel approach is to conduct a thorough analysis focusing on the treatment of MIH-affected teeth while simultaneously identifying global research trends and existing knowledge gaps.

This study provides a comprehensive bibliometric analysis of treatment strategies for MIH. The PICO framework was adopted to guide this critical review: population (patients with molar-incisor hypomineralization (MIH) teeth); intervention (treatment strategies and therapeutic approaches); comparison (different strategies and materials used in different types of MIH lesions); and outcomes (clinical success, restorative longevity, improved adhesion, reduced sensitivity, and overall clinical performance). This study aims to clarify how the literature surrounding therapeutic options has evolved and consolidated. It reveals an upward trend in publications and citations, identifies influential studies, and examines the most frequently used terms within the evidence map. Furthermore, by analyzing keywords and global publication trends, this study outlines key research areas and emerging research directions, offering valuable insights to inform clinical decision-making.

2. Materials and Methods

This review and bibliometric analysis were designed to assess key metrics, including bibliographic coupling, co-occurrence, sources, keywords, and country networks. The focus was on presenting the results clearly and objectively. These metrics have been carefully selected to provide a comprehensive overview of how research topics have evolved and become relevant, offering strategic insights for researchers and institutions. To address the potential variability in terminology related to MIH, the search strategy incorporated the most common synonyms, acronyms, and spelling variants reported in the literature. Including these variations, as detailed in Section 2.1 and

Table 1. Search criteria used in WoS and PubMed.

Database	Search Criteria	Period
WoS	(All Fields) molar incisor hypomineralization OR (All Fields) molar-incisor hypomineralization OR (All Fields) molar incisor hypomineralisation OR (All Fields) molar-incisor-hypomineralisation OR (All Fields) molar incisor hypomineralisation (MIH) OR (All Fields) MIH AND (All Fields) (treatment *)	1 January 2014 to 31 December 2024
PubMed	((((((molar incisor hypomineralization) OR (molar-incisor hypomineralization)) OR (molar incisor hypomineralisation)) OR (molar-incisor-hypomineralisation)) OR (molar incisor hypomineralisation (MIH))) OR (MIH)) AND (treatment or treatments)

The use of the asterisk (*) in the WoS search expression acted as a wildcard, allowing variations of a term to be captured.

, ensured broader coverage of relevant studies, minimized the impact of regional differences in terminology, and reduced the likelihood of omitting pertinent publications.

The first part of the review focused on identifying the importance of the topics associated with each metric, highlighting the most productive and highly cited papers related to MIH treatment, based on the specific unit of analysis. For this purpose, treatment-focused articles were defined as those addressing clinical strategies, restorative materials, operative techniques, or therapeutic protocols specifically aimed at managing lesions associated with molar-incisor hypomineralization (MIH).

Several bibliometric techniques were then employed to examine the structures of knowledge. Specifically, conceptual structures explored the main themes and emerging trends in recent years, intellectual structures assessed the influence of key works within the scientific community, and social structures revealed the collaborative dynamics between authors and countries. The bibliometric analysis was conducted in a series of sequential steps, beginning with data collection, followed by a descriptive analysis, and finally a comprehensive bibliometric evaluation, as outlined in the next section.

2.1. Data Collection

This review presents a systematic documentary analysis based on the identification of the main works dealing with treatments for teeth affected by MIH. The data were obtained from the Web of Science (WoS) and PubMed/MEDLINE. WoS is a database of over 21,000 journals, commonly used by researchers to select studies, while PubMed contains over 37 million biomedical citations of the literature from Medline, life science journals, and online books. A four-step search strategy, outlined below, was developed to collect the data:

2.1.1. Search Strategy

Initially, data were collected using a query that included relevant terms related to the study topic (MIH and treatment). Due to the frequent occurrence of the acronym MIH (molar-incisor hypomineralization) in the literature, a combination of keywords in Web of Science (WoS) and PubMed/MEDLINE, along with Boolean operators, was used to construct the search terms shown in Table 1. The search covered a 10-year period from 1 January 2014 to 31 December 2024. The records were exported in plain text format, including full records and cited references. For PubMed/MEDLINE, the search strategy mirrored that of WoS in terms of terminology and timeframe but was adapted to the different search interfaces [17]. Figure 1 shows that a total of 933 publications were retrieved from WoS and PubMed, 150 from WoS and 783 from PubMed. The last search for both databases was performed on 15 January 2025.

2.1.2. Inclusion Criteria for Document Analysis

The search included original research articles, review articles, and case reports/series that were published within the specified time period. The relevance of these documents to the topic of treatment options for MIH was then evaluated.

2.1.3. Exclusion Criteria

Filters were applied to the total number of documents retrieved (Figure 1), to exclude letter-type documents, corrections, in vitro studies, and abstracts. Furthermore, trained researchers excluded laboratory studies and any documents that were not directly related to the treatment of MIH.

2.1.4. Data Sorting and Analysis

A more detailed analysis was performed after obtaining the results. The screening process, which involved applying filters and exclusions after reviewing titles and abstracts, resulted in 243 relevant references. Duplicates were then removed, leaving a total of 230 articles for further analysis (see Figure 1). Following the established workflow from database analysis through screening and eligibility assessment, the selected references were exported as a text (txt) file for subsequent loading into bibliometric tools.

2.2. Data Analysis

This review focuses on two key types of analysis: keyword co-occurrences (specifically those appearing in both the Author Keywords and KeyWord Plus sections), and bibliographic coupling of sources and countries. The data extraction process encompassed multiple fields—authors, year of publication, country of origin, journal title, document type, study design, main objectives, keywords, and citation count were systematically retrieved to ensure a comprehensive evaluation. To enhance reliability, two trained researchers, A.A.P. and L.M.F., with an average Cohen’s kappa score greater than 0.80, conducted an independent extraction and selection of the data. They carefully reviewed all retrieved records according to the predefined inclusion and exclusion criteria. In cases of disagreement regarding eligibility or data interpretation, a third researcher was consulted for an independent assessment.

A comprehensive bibliometric analysis was performed using three robust, complementary tools: VOSviewer (version 1.6.20), Bibliometrix R-Tool (version 5.0), and Carrot2 (version 4.8.1).

VOSviewer was used to create and visualize high-resolution bibliometric networks, which allowed us to identify research trends, keyword co-occurrences, bibliographic coupling, and structural relationships among authors, countries, and sources. The Bibliometrix R Tool provided advanced statistical analyses, thematic mapping, and studies of temporal evolution, offering deeper insights into the conceptual, intellectual, and social structures of the field. Carrot2 employed natural language processing and clustering algorithms to group the retrieved studies by textual similarity. This facilitated the recognition of central themes and niche research areas that extend beyond citation or keyword-based connections.

Integrating network-based, statistical, and semantic perspectives in a logical sequence ensured this multi-tool approach provided a comprehensive, methodologically diverse overview of global research on MIH treatment. The analysis was conducted in the following order: first, network construction and visualization with VOSviewer; then, thematic and trend analysis with Bibliometrix; and finally, thematic clustering from a textual perspective with Carrot2.

To provide a comprehensive understanding of the research landscape, this study employed two complementary approaches. The bibliometric analysis focused on quantitative indicators, such as publication trends, citation counts, co-authorship networks, and bibliographic coupling. Data for this analysis were extracted from the selected database. In parallel, a content analysis was conducted to critically evaluate the most influential and frequently cited articles, identifying their clinical contributions and thematic relevance to MIH treatment research.

3. Results

Following a thorough assessment of the titles, abstracts, and scope of the studies, a total of 230 documents were identified as relevant and included in this review. The selection process is outlined in the flowchart presented in Figure 1.

3.1. Growth Trend in Publications and Citations

The volume of scientific research on MIH and the corresponding number of citations have shown a significant upward trend from 2014 to 2024, as illustrated in Figure 2. Initially, the number of publications remained relatively low until 2016, after which there was a modest increase. However, a notable decline in publications is observed since 2023. In contrast, citation rates have steadily increased, particularly since 2019, reaching a peak of 578 citations in 2024. All publications and citation counts were recorded up to the cutoff date of 31 December 2024.

The top journals publishing and citing papers related to MIH treatment during the period analyzed are shown in Figure 3. Of the top ten journals, (i) European Archives of Paediatric Dentistry (22 papers published), (ii) BMC Oral Health (19 papers published), and (iii) International Journal of Paediatric Dentistry (16 papers published) are particularly noteworthy (Figure 3a). The highest number of citations was recorded mainly in (i) European Archives of Paediatric Dentistry (892 citations) and (ii) International Journal of Paediatric Dentistry (886 citations) (Figure 3b).

The bibliographic coupling analysis of sources was performed using VOSviewer (Figure 3c), with a minimum threshold of two occurrences. This generated a map analyzing 33 sources and revealing four distinct clusters, each represented by different colors, which were evaluated using the Total Link Strength (TLS) metric. In bibliometric analysis, TLS quantifies the strength of connections between items, in this case, the extent to which journals share references with others in the network. Cluster 1 (red) is led by European Archives of Paediatric Dentistry, which has 22 papers, 32 links, and a Total Link Strength (TLS) of 10,590, indicating a high degree of reference sharing with other journals. Cluster 2 (green) highlights Journal of Dentistry, with 8 papers and a TLS of 4281. Cluster 3 (blue) features Dentistry Journal, with 4 papers, while Cluster 4 (yellow) is dominated by the BMC Oral Health Journal, with 19 papers and a TLS of 7701.

3.2. Highly Cited Articles on the Treatment of MIH and Frequently Occurring Terms in the Evidence Map

The bibliographic details of the ten most cited articles on the treatment of MIH are summarized in

Table 2. Top 10 cited papers on MIH treatment.

Rank	Citations	Year	Authors	Title	Journal Impact Fator (Year)	Ref.
1°	138	2022	Lygidakis et al.	Best clinical practice guidance for clinicians dealing with children presenting with molar-incisor-hypomineralisation (MIH): an updated European Academy of Paediatric Dentistry policy document	2.0 (2024)	[14]
2°	106	2016	Elhennawy et al.	Managing molar-incisor hypomineralization: A systematic review	5.5 (2025)	[18]
3°	82	2018	Almuallem et al.	Molar incisor hypomineralisation (MIH)—an overview	2.3 (2024)	[19]
4°	81	2020	Seifo et al.	The use of silver diamine fluoride (SDF) in dental practice	2.3 (2024)	[20]
5°	58	2015	Fragelli et al.	Molar incisor hypomineralization (MIH): conservative treatment management to restore affected teeth	1.3 (2025)	[21]
6°	54	2022	Somani et al.	An update of treatment modalities in children and adolescents with teeth affected by molar incisor hypomineralisation (MIH): a systematic review	2.0 (2024)	[22]
7°	50	2023	Butera et al.	Biomimetic hydroxyapatite paste for molar-incisor hypomineralization: A randomized clinical trial	2.9 (2024)	[23]
8°	48	2017	Bekes et al.	Efficacy of desensitizing products containing 8% arginine and calcium carbonate for hypersensitivity relief in MIH-affected molars: an 8-week clinical study	3.1 (2024)	[24]
9°	44	2019	Coelho et al.	Dental hypomineralization treatment: A systematic review	4.1 (2024)	[25]
10°	42	2018	Grossi et al.	Glass hybrid restorations as an alternative for restoring hypomineralized molars in the ART model	3.1 (2024)	[26]

. Over the ten-year period analyzed, the number of citations ranged from 138 to 42, with publications spanning from 2015 to 2023. As shown in Table 2, two articles received over 100 citations each. Both scientific papers focus on clinical practice and treatment options for patients with MIH, particularly emphasizing the updated guidelines of the European Academy of Pediatric Dentistry (EAPD), which cover the etiology, diagnosis, and clinical management of the condition.

The co-occurrence analysis was conducted using VOSviewer software to identify research trends in the treatment of MIH, focusing on the “All Keywords” variable (Figure 4a). This analysis generated a network map identifying a total of 145 keywords when a minimum co-occurrence threshold of three was applied. After filtering, 120 keywords remained for mapping. The bibliometric analysis revealed six clusters with a Total Link Strength (TLS) of 1716, highlighting the most prominent keywords: “children” (TLS: 255), “resin infiltration” (TLS: 103), “hypersensitivity” (TLS: 82), “management” (TLS: 64), “performance” (TLS: 50), and “demarcated opacities” (TLS: 32).

The strong connections between the clusters of the keywords children and caries notably link these terms not only to each other but also to all other clusters. In addition, a clear relationship exists between various signs (such as demarcated opacities, defects, white spot lesions, demineralization) and symptoms (for example, hypersensitivity and pain), as well as between treatment options (such as resin infiltration, fluoride, extraction, restorations, adhesive restorations, fissure sealants, and amorphous calcium phosphate). A distinct niche within this theme focuses on management and the role of dental practitioners in addressing these issues. Additionally,

Table 3. Top 18 keywords in terms of frequency.

Cluster	Keyword	TLS	Frequency
Children	Caries	75	23
	Treatment association	62	14
	Diagnosis	41	10
Resin infiltration	Tooth defects	84	21
	Microabrasion	66	14
	White spot lesions	43	9
Hypersensitivity	Casein phosphopeptide	81	12
	Fluoride	59	11
	Remineralization	55	09
Management	General dental practitioners	51	13
	Diagnosis	41	10
	Dental enamel hypoplasia	31	10
Performance	Composite resin	38	07
	Restorations	33	08
	Extraction	30	11
Demarcated opacities	Fissure sealants	24	04
	Restorative treatment	15	04
	Orthodontic treatment	07	03

presents the most frequent keywords organized by cluster along with their TLS and frequency values regarding MIH. This overview illustrates the field’s evolution towards integrated clinical practices and more effective therapeutic solutions.

An analysis of the clusters generated by Carrot2 (Figure 4b) reveals a wide range of research approaches, reflecting the key areas within the field. The most prominent clusters are Extraction (13), Dentists (12), Risk Factors (10), Composite Restorations (10), and Restorative Options (9). These clusters examine various restorative techniques and materials for treating affected teeth, taking into account etiological factors and the challenges posed by compromised enamel and tooth structure. Additionally, smaller clusters, such as Silver Diamine Fluoride (SDF) (4), highlight the growing interest in minimally invasive treatment alternatives, cost-effective interventions, and the development of novel remineralizing and restorative materials.

The thematic evolution of authors’ keywords reveals significant shifts in MIH treatment research during different periods (Figure 5a). From 2014 to 2016, the literature focused on keywords such as children and lesions. In the subsequent period (2017–2019), keywords such as performance and management emerged. In the most recent periods (2020–2022 and 2023–2024), the research themes deepened, and the keywords diversified; notably, enamel became a central focus during the intermediate phase, while terms such as caries, pain, and defects emerged in the most recent period (2023–2024). This likely reflects an increased focus on investigating MIH comorbidities and sequelae, including the increased vulnerability of hypomineralized teeth.

The thematic clusters, which are mapped according to centrality and density, are positioned across the quadrants (Figure 5b), with each cluster representing a distinct research theme. In the diagram, the size of each circle reflects the frequency with which the keywords occur, and the label denotes the keyword that occurs most frequently within that cluster.

Niche themes, characterized by high density but low centrality, offer specialized insights into areas such as restoration and aesthetics. These clusters examine the durability and long-term performance of composite restorations—particularly those requiring root canal treatment—and address issues relating to caries lesions, color stability, and spot lesions in hypomineralized enamel. Attention is given to both aesthetic and functional outcomes.

Motor themes are characterized by high centrality and density and focus on diagnostic and preventive strategies. These clusters reflect advancements in diagnostic methodologies, such as the use of laser fluorescence, and emphasize strategies for managing enamel defects and protecting compromised enamel areas. This is essential for optimizing the management of MIH.

Basic and transversal themes, characterized by high centrality but low density, highlight critical challenges in management and prevalence. These clusters highlight the widespread occurrence of MIH-related defects and their correlation with dental caries. They also highlight emerging management strategies, such as microabrasion and remineralization techniques, which aim to improve patient care and treatment efficacy.

Themes that are emerging or declining, characterized by low centrality and density, suggest new opportunities for innovation. Notably, one cluster explores the use of mineral trioxide aggregate to restore incisors affected by MIH. This represents a promising area for further research and innovative therapeutic approaches.

3.3. Worldwide Publishing Trends

For the bibliographic coupling and country interaction analysis, a minimum threshold of two documents and two citations per country was applied for the period 2014–2024. This approach resulted in a network of 39 countries, which were grouped into four clusters. Figure 6a shows a density map revealing that Brazil leads in terms of the number of published papers (43 documents, TLS: 27,194), followed by Germany (36 documents, TLS: 26,148), England (17 documents, TLS: 110,429), and Italy (17 documents, TLS: 9716). Together, these four countries account for around 50% of all MIH publications. Figure 7 shows a similar geographical distribution, highlighting South America (with Brazil as the most prolific country), Europe, and Oceania as the main regions contributing to this research area.

The overlay visualization map from the bibliographic coupling analysis of countries (Figure 6b) complements the density map by showing that the intensities of blue, green, and yellow correspond to documents published in the periods 2019–2020, 2021–2022, and 2023–2024, respectively. Notably, the map reveals an increase in interactions around 2022 among countries with the highest publication densities (Brazil, Germany, Italy, and England), while publications from Eastern countries, such as Turkey, Syria, and Vietnam, begin to emerge in 2024.

In North America, the United States emerges as one of the top contributors to the field, whereas regions such as Africa and parts of Asia exhibit limited contributions. This is evident from the predominance of gray areas on the map, indicating lower participation compared to the leading countries (Figure 7).

The most productive countries in MIH research produced publications that were classified as either Single Country Publications (SCPs) or Multiple Country Publications (MCPs). This bibliometric analysis reveals varying levels of international collaboration: some countries prioritize national research, while others actively engage in global partnerships (Figure 8).

Brazil leads with the highest number of publications (39), demonstrating a strong national research focus (31 SCPs) while also collaborating internationally (8 MCPs). Germany follows with 26 publications—19 SCPs and 7 MCPs—indicating a moderate level of international cooperation. Austria, on the other hand, shows the opposite pattern, with a higher proportion of MCPs (7) than SCPs (3), highlighting its emphasis on global collaboration. Meanwhile, India and Norway display a complete dominance of SCPs, with no MCPs reported (Figure 8).

Complementing the country-level analysis, institutional collaborations were also identified. Several universities occupy important positions in the co-authorship network. Notably, the University of São Paulo (Brazil, TLS = 7), Federal University of Paraná (Brazil, TLS = 6), and São Paulo State University (Brazil, TLS = 5) are among these. The University of Melbourne (Australia), University of Bordeaux (France, TLS = 11), Medical University of Vienna (Austria, TLS = 9), and University of Groningen (Netherlands, TLS = 9) also stand out as key contributors. These institutions play a pivotal role in fostering multicenter collaborations, strengthening international partnerships, and advancing global research on MIH treatment.

4. Discussion

The high global prevalence of MIH, coupled with the challenge of establishing effective therapies for affected teeth, represents not only a significant clinical obstacle but also an urgent need for research into effective treatments [1,3]. Patients with MIH experience the greatest negative impact on oral health-related quality of life in term of emotional and social well-being subscales [11]. The global analysis and visualization presented in this study highlight a variety of approaches to MIH management and emphasize several promising areas for future scientific and clinical investigation.

Teeth affected by MIH directly impact patients’ quality of life. These teeth are associated with increased tooth sensitivity, an elevated risk of caries, and an earlier need for complex restorative treatments [27,28]. The cumulative costs of management can also be significant over time, which underscores the importance of cost-effective strategies in clinical practice [29]. Systematic reviews also emphasize that the heterogeneity of clinical manifestations necessitates individualized protocols and a multidisciplinary approach [14,30]. In this context, ongoing research on MIH improves clinical recommendations and supports oral health policies aimed at early prevention and management of the condition, which can prevent early loss of dental structure.

Additionally, bibliometric analysis is a fundamental tool for evaluating scientific production, identifying trends, identifying collaborations, and measuring the impact of publications within a specific field [31]. Tailored bibliometric methods can address specific research questions and provide unique insights depending on the focus of the study [32,33]. Science mapping, in particular, has emerged as a pivotal technique, enabling a comprehensive visualization of the structural and relational dynamics of scientific disciplines [34]. In this review, we identified and analyzed the key characteristics of publications related to MIH treatment from the WoS and PubMed/MEDLINE databases. We examined patterns of knowledge development, identified influential topics and publications, and analyzed the connections between researchers and institutions using science mapping [35]. Mapping research trends via bibliometric analysis provides a robust foundation for guiding future investigations in this field [22].

According to the inclusion and exclusion criteria of this study, a total of 230 documents related to MIH treatment were found between January 2014 and December 2024. There was an increase in publications, rising from one in 2014 to over 500 in 2022. The following year (2023), a decrease in the number of publications was observed, probably due to the changes in priorities and possible interruptions brought about by the period of the pandemic, especially in clinical research activities [36]. However, an upward trend in the number of publications was observed in 2024, and the number of citations continued to increase steadily until the end of the analyzed period. This increase in the literature (publications/citations) is based on the high incidence of MIH worldwide [2,3], indicating that more relevant studies are likely to be published in the future.

This bibliometric review revealed that one of the top ten most influential articles was the updated “Best Clinical Practice Guidance for Clinicians Dealing with Children Presenting with Molar-Incisor-Hypomineralisation (MIH): an updated European Academy of Paediatric Dentistry policy document” [14], originally published in 2010 by the European Archives of Paediatric Dentistry (EAPD). The EAPD ranks highest in both publication output and citation counts for MIH-related research (Figure 3) and exhibits extensive reference sharing with other journals, as evidenced by its high Total Link Strength (TLS) (Figure 4). Additionally, eight of the ten most-cited articles were published after 2017, coinciding with a significant increase in both publication output and citation counts (Figure 2).

The thematic evolution analysis reveals that during the initial phase (Figure 5), the dominant keywords driving publication trends were children and lesions, highlighting the characterization of MIH manifestations. Moreover, the evidence map shows that children have the highest Total Link Strength (TLS), which is likely to reflect the results of prevalence studies indicating that MIH predominantly affects children under the age of 10 [2]. This pattern is consistent with the observation that the leading journals in terms of citations and publications [13] specialize in pediatric dentistry (Figure 3).

Among the therapeutic approaches, keywords such as resin infiltration, resin composite, and restorative options emerged prominently in the evidence map (Figure 4a), the Carrot2 treemap (Figure 4b), and the thematic niche identified by Bibliometrix (Figure 5b). Analysis of the evolution of authors’ keywords indicates that this focus has grown significantly since 2017 (Figure 5a). Resin infiltration, in particular, has been recognized as a minimally invasive treatment that can mitigate fractures and conceal aesthetic defects, particularly in mild to moderate cases [37]. This technique is particularly relevant given the high incidence of incisor lesions [3]. Moreover, the prominence of resin composite and restorative options highlights the requirement for the restoration of teeth affected by MIH with atypical caries and severe lesions affecting the cusps [28]. In advanced cases, the progression of the condition has even necessitated the extraction of affected tooth, as illustrated by the Carrot2 treemap in this study [28].

It is also noteworthy that the emerging themes identified through thematic analysis (Figure 5) and the evidence map emphasize the use of remineralizing agents—such as silver diamine fluoride (SDF), amorphous calcium phosphate, and casein phosphopeptide—in MIH treatment. The keywords illustrated in Figure 4a capture the inherent characteristics of the affected tissues, highlighting signs (such as demarcated opacities, defects, white spot lesions, areas of demineralization) and symptoms (such as hypersensitivity and pain). Consequently, the complexity of these altered tissues and the difficulty of achieving adequate adhesion of dental materials [12] have led to greater investigation into minimally invasive remineralization strategies. This trend likely reflects a broader shift in clinical practice towards less invasive techniques that preserve tooth structure [14,22]. Moreover, keywords such as “performance” and “management” emphasize the clinical impact of MIH treatment by addressing early challenges in pediatric populations and exploring methods to prevent lesion progression [2]. Here, “management” encompasses not only the selection of appropriate treatments but also the long-term “follow-up” of patients—which is a critical consideration in severe MIH cases where enamel sensitivity and fragility may require multiple interventions to delay or avoid more invasive procedures such as extractions [16,21].

The results of this study show that Brazil leads in the number of publications on MIH treatment, followed by several European countries, most notably Germany, England, and Italy. These countries also dominate in terms of both Single Country Publications (SCPs) and Multiple Country Publications (MCPs), reflecting robust global collaborations in MIH research. Brazil’s prominence may be due to several factors, such as the high prevalence of MIH in South America [2], coupled with the significant investment in research and academic collaborations and a public health emphasis on children’s dental care [1,38,39]. Furthermore, our review confirms that the Americas contribute the largest proportion of scientific output on MIH treatment. This finding is consistent with the high incidence of the condition on the continent [3] and with global prevalence analyses of MIH [1,40]. The number of studies per country may be affected by factors such as financial implications, multidisciplinary care, clinical decision-making, and the degree of knowledge about this dental condition [41]. Similarities and differences in MIH knowledge and treatment, as well as in the performance of healthcare systems in managing MIH, is observed between the United Kingdom and Australia [41], which, as noted in this study, have different degrees of contribution (Figure 6) and SCP/MCP ratios (Figure 8).

Notably, Austria has a different pattern with a higher proportion of MCPs than SCPs, which highlights its commitment to international collaboration. International multicenter studies deserve special attention because they enrich the research landscape by incorporating diverse perspectives, methodologies, and clinical experiences, thereby fostering a more integrated scientific discourse [42]. In contrast, India and Norway demonstrate a complete dominance of SCPs, suggesting a research focus that is predominantly national. Meanwhile, dental health professionals in countries such as Norway acknowledge the necessity of ongoing education regarding the etiology, diagnosis, and treatment of MIH [43].

In light of the current context and the progression of knowledge to date, this critical bibliometric analysis has verified that clinical recommendations for managing molar-incisor hypomineralization (MIH) require an accurate assessment of lesion severity to guide treatment decisions [14]. This assessment should consider the degree of hypomineralization, post-eruptive fractures, hypersensitivity, and aesthetic concerns. Minimally invasive techniques should be prioritized whenever possible to preserve sound dental structure. For mild defects, resin infiltration [37], microabrasion [25], composite resins, and infiltrating sealants are recommended [18,22] to improve aesthetics and prevent further mineral loss. In cases involving marked hypersensitivity, desensitizing agents and remineralizing biomaterials [18], such as fluoride varnishes [25], and bioactive restorative materials [23] are recommended to reduce dentin permeability and/or strengthen enamel. For more extensive defects, direct composite resin restorations [18,22], resin-modified glass ionomer cements (RMGICs) [26], and other bioactive restorative materials are preferred due to their ion release properties and better bonding to porous enamel. In cases of severe structural loss, indirect restorations or full-coverage crowns may be necessary to restore the tooth aesthetically and functionally [18,22]. Despite promising outcomes with several materials, there is still no consensus on the most effective approach. These findings can guide the design of future high-quality clinical trials and support the development of more reliable scientific evidence. They also highlight the need for well-defined, standardized clinical protocols and additional long-term studies.

In addition to contributing to a consensus in line with the existing literature, this review aimed to establish a solid foundation for innovation in the treatment and management of MIH [18,19,22]. However, due to the requirements of the analysis tools used in this study, the scope of the review is limited to studies indexed in Web of Science and PubMed/MEDLINE, and only publications in English were considered. Although English is a widely used scientific language, this may have resulted in the exclusion of some studies.

Despite these limitations, our findings highlight significant advances in the diagnosis, management, and restorative strategies for MIH, with Brazil and Europe leading the research efforts. This study highlights the need for updated clinical guidelines and enhanced international collaboration. Furthermore, advances in smart material development, as well as in bioactive and biomimetic materials, show promise in addressing challenges related to MIH, such as dentin hypersensitivity and improving adhesion to compromised dental tissue. Future research should focus on minimally invasive techniques, novel remineralization strategies, and long-term clinical outcomes while promoting multicenter trials and global partnerships to standardize protocols and enhance patient care. Additionally, advancements in digital tools, artificial intelligence, and machine learning will enable future studies to perform more comprehensive and sophisticated analyses.

5. Conclusions

This bibliometric analysis of MIH treatment reveals an increasing research interest in the field, with Brazil and Europe leading both independent and collaborative studies. However, the global analysis revealed that research remains concentrated in a limited number of countries, emphasizing the need for broader global participation. Additionally, this study underscores the importance of international collaboration in advancing diagnostic methods, optimizing restorative solutions, and improving long-term clinical outcomes. By consolidating existing knowledge, this study identifies key trends, influential publications, and thematic shifts, particularly the transition towards minimally invasive treatments, such as resin infiltration and remineralization techniques.