The aim of this study is to compare the clinical outcome of using direct esthetic composite restorations and the use of preformed metal crowns in managing MIH cases among a group of Egyptian children.

Inclusion Criteria:

• Children with MIH in one fully erupted molar or more.
• Age ranging from 7-12 years.
• Cooperative children
• Good general health.

Exclusion Criteria:

• patients participating in other experiments.
• Patients with parents planning to move away within the following year.
• Patients with only mildly affected MIH molars that do not require extensive restorative treatment.
• MIH-affected molars that have a very poor prognosis and require extraction.
• First permanent molars that are affected with other developmental defects, such as hypoplasia, dental fluorosis or amelogenesis imperfecta