Solitary median maxillary central incisor in association with hemifacial microsomia: A rare case report and review of literature

Solitary median maxillary central incisor in association with taurodontism and oligodontia: A case report

In this case report, we have highlighted the probability of coinciding multiple dental anomalies, such as SMMCI, taurodontism, and oligodontia. Thus, further research is necessary to establish a correlation between oligodontia, taurodontism, and SMMCI.

Clinical Evaluation of Solitary Median Maxillary Central Incisor Syndrome

Solitary median maxillary central incisor (SMMCI) is a rare dental anomaly. It is estimated to occur in 1 : 50,000 live births. The SMMCI tooth differs from the normal central incisor in that the crown form is symmetric and it develops and erupts precisely in the midline of the maxillary dental arch in both primary and permanent dentitions. The presence of SMMCI with hemifacial microsomia (HFM) is a very rare clinical condition. We report a case of SMMCI in a female of African ethnic origin, who presented with SMMCI in permanent dentition with mild nasal stenosis. An early diagnosis of SMMCI is important, since it may be a sign for other severe congenital or developmental abnormalities. Therefore, systematic follow-up and close monitoring of the growth and development of SMMCI patients are crucial.

Alterations in Tooth Structure and Associated Systemic Conditions

A variety of factors can affect the normal development of tissues and may lead to variation in the normal compliment of teeth and development of alterations in the shape and size of teeth. These anomalies can be congenital, developmental, or acquired. Dental anomalies can present as isolated traits or be associated with systemic conditions and syndromes for which early diagnosis and genetic testing may result in better treatment outcomes and quality of life. Dentists play an essential role in the multidisciplinary management of these abnormalities. This article discusses some of these tooth alterations and associated systemic and genetic conditions.

Solitary median maxillary central incisor syndrome (SMMCI) with congenital nasal puriform aperture stenosis: literature review and case report with comprehensive dental treatment and 14 years follow-up

BACKGROUND

Solitary median maxillary central incisor syndrome [SMMCI] is an extremely rare anomaly, especially when no other abnormalities are present. The defect is often found together with various nasal abnormalities and short stature with or without decreased levels of growth hormone. In more severe cases, SMMCI has been associated with holoprosencephaly, the CHARGE and the VACTERL association. Also, published sporadic cases have been related with rare variants of ectodermal dysplasia, chromosomal abnormalities, precocious puberty, hypothalamic hamartoma, congenital heart defects, physical/mental retardation, genital hypoplasia and ear abnormalities. For these reasons when the initial diagnosis is made by the paediatric dentist, ENT, neurological and paediatric evaluations are essential.

CASE REPORT

A 4-year-old boy with SMMCI was referred for dental treatment. Clinical/radiographic examination revealed a symmetrical primary and permanent SMMCI, a skeletal Class I and a unilateral crossbite. Medical history indicated respiratory distress and surgery soon after birth due to congenital nasal puriform aperture stenosis. Gradual orthodontic treatment started at the age of 4 years and completed at the age of 13 years. Following maxillary expansion, upper lateral segments were moved backwards and anterior space was created for accommodating a second central incisor. Retainers with a supplementary acrylic incisor were provided for aesthetic and functional replacement until the age of 16 years, when a fixed Maryland ceramic bridge was placed.

FOLLOW-UP

Two years recall, at the age of 18 years, revealed a satisfactory and stable aesthetic and functional result.

CONCLUSION

Successful dental management of SMMCI patients is possible, following a detailed long-lasting treatment plan requiring multidisciplinary paediatric dental, orthodontic and prosthetic approach.