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A Rare Occurrence of Non-Syndromic Macrodontia and Microdontia of Permanent Maxillary Canine and First Premolar in a Child Patient | OMICS International
ISSN: 2165-7920
Journal of Clinical Case Reports
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A Rare Occurrence of Non-Syndromic Macrodontia and Microdontia of Permanent Maxillary Canine and First Premolar in a Child Patient

Afroz A Ansari*, Madhulika Yadav, Seema Malhotra and Ramesh K Pandey
Department of Pediatric and Preventive Dentistry, Saraswati Dental College, Lucknow, U.P, India
Corresponding Author : Afroz A Ansari
Department of Pediatric and Preventive Dentistry
Saraswati Dental College
Lucknow, U.P, India, 226003
Tel: +91945212176
E-mail: [email protected]
Received February 03, 2014; Accepted March 12, 2014; Published March 14, 2014
Citation: Ansari AA, Yadav M, Malhotra S, Pandey RK (2014) A Rare Occurrence of Non-Syndromic Macrodontia and Microdontia of Permanent Maxillary Canine and First Premolar in a Child Patient. J Clin Case Rep 4:351. doi:10.4172/2165-7920.1000351
Copyright: © 2014 Ansari AA, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Keywords
Macrodontia; Microdontia; Dental anomalies
Introduction
The etiology of dental anomalies remains largely unclear [1], but some anomalies in tooth structure, shape and size result by many factors from disorders during the histo-differentiation and morpho-differentiation stages of development [2,3]. Macrodontia (or Megadontia or megalodontia) is a rare dental anomaly [4,5] characterized by the teeth that are larger than normal while microdontia is a condition in which teeth appear smaller than normal [6]. Both may be generalized or localized [6]. The affected teeth may be of normal or abnormal morphology. Macrodontia can be categorized as follows: true generalized, relative generalized and isolated macrodontia of a single tooth [6]. Macrodontia of a single tooth is a relatively uncommon condition, and frequently have been reported in mandibular molars or premolars [7,8]. Some authors have described that macrodontia is most frequently found in incisors and canines [4,9], while others reported that they are more observed in mandibular second premolars [5,10]. Microdontia of a single tooth can be further classified into true generalized microdontia, relative generalized microdontia, and isolated microdontia involving a single tooth [6]. It commonly affects the maxillary teeth, mainly the lateral incisors and third molars [6].
The prevalence of unilateral macrodontia of permanent canine with simultaneous occurrence of microdontia of adjoining first premolar is rare. The aim of this article is to describe this case along with the treatment of the carious exposed canine for the interest of the dentists.
Case Report
A 13-year-old boy reported to the Department of Pediatric and Preventive Dentistry, K.G.’S Medical University, Lucknow (UP), India with the chief complaint of occasional pain in upper left anterior region.
Extra-oral examination
Extra orally, no abnormality was detected.
Intra oral examination
Visual intraoral examination revealed generalized presence of mild plaque and calculus. Hard tissue examination revealed presence of carious exposed left permanent canine, which was exceptionally large while its adjoining premolar was abnormally small. Both were of unusual shapes. Clinical examination revealed that though caries was not much extended laterally, the explorer went deep into the pulp chamber without any pain. Thus, the canine was suspected non-vital. Moreover, the patient experienced slight pain on percussion in relation to the canine. No caries or pain on percussion was detected in relation to the premolar. No history of any trauma was present in relation to the canine and premolar as was revealed by the patient and parent. Medical and family history was non-contributory.
An Intra-Oral Periapical Radiograph (IOPA) of the canine and premolar region was advised. Radiographically, both the canine and premolar presented with single roots. The canine presented with an abnormally large size and of an unusual shape having a large root and root canal with open apex while the premolar presented with an abnormally small and unusual shape of crown with a thin and reduced root and a closed apical foramen (Figure 1). The pulp vitality was tested, which revealed non-vital canine and vital premolar. Based on the dental findings a non-syndromic occurrence of localized macrodontia and microdontia of permanent canine and premolar was made. Since the patient did not present any history of trauma in relation to this region, the open apex of the canine was not planned for apexification as the tooth was supposed to be congenitally abnormal. Root Canal Treatment (RCT) of the canine with retrograde filling of gutta percha cones after raising the gingival flap was planned. Treatment procedure was explained to the patient but he was not ready for any surgical procedure. As an alternate, orthograde obturation was considered. After access opening, the canal was measured, which was much larger and wider than usual (Figure 2). The length of the canal as measured by a file was 20 mm, 3 mm more than usual length of 17 mm. The pulp was necrosed, which was extirpated. The canal was prepared. Finally, the tooth was obturated with gutta percha (GP) cones when it became asymptomatic in the following visits (Figure 3). During obturation, a large number of GP cones were required. Since no master cone was available for the canal due to its exceptional width, initially five GP cones of 80 numbers were used. Then, a number of accessory cones were required. Considering the age of the patient, he was advised temporary crown fabrication on the affected premolar for aesthetic purpose, but he refused the treatment for this premolar. After completion of the treatment, the patient was advised to visit after six months for recall check-up or any day in case of any pain or discomfort in the root canal treated tooth, but he did not turn up in the following dental visit. However, he informed telephonically that he did not have any problem in the treated tooth.
Discussion
Though the exact aetiology of dental anomalies is unknown, many theories have been postulated in the past to describe development of these anomalies. Mutation in developmental regularity genes causes variety of dental defects [11]. According to some studies, the determination of the form of the crown is related to different regions of the oral epithelium or to the ectomesenchyme while some studies have shown that different regions of the oral epithelium rather than the underlying ectomesenchyme are initially responsible for the shape of the crown [12]. Dental anomalies with sub phenotypes, including macrodontia and microdontia, may be caused by complex multifactorial interactions including genetic, epigenetic and environmental factors during the long process of dental development [13,14]. The variation in size of a particular tooth arises during the period when the form of the tooth is being determined by the enamel organ and hertwig’s sheath at the bell stage of enamel organ [12]. In our case, the unilateral presence of both macrodont and microdont simultaneously may be the consequence of any one of the above mechanisms or combination of two or more. One more possibility may also be there that neural crest cells, which form the tooth bud, have migrated differently during the process of morpho-differentiation but how did this occur could not be ascertained.
This patient presented a unilateral macrodont canine with adjoining microdont premolar in the maxilla. Such occurrence is rare. According to the classification of macrodontia, this case corresponds to an isolated macrodontia of canine and simultaneous microdontia of adjoining premolar. It is uncommon to see localized macrodontia alone, because generally, it is associated with a syndrome [15]; but this patient and his family history did not present any other condition or syndrome. The differential diagnosis of the macrodont canine may be dense in dente but it could not be expected, as the typical appearance of this anomaly was not found. In addition, the premolar form cannot be correlated with it.
It is important to take care of these anomalies because they could create disturbances in maxillary and mandibular arch lengths and occlusions [15]. In addition, these teeth are more predisposed to caries and related with disruption of the developing occlusion by occlusal morphology [4]. In our case, both the affected teeth did not pose any problem with occlusion as one tooth (canine) was larger, while its adjoining tooth (premolar) was correspondingly smaller. Moreover, the canine was an anterior tooth with sufficient over jet. However, the canine caught caries early and got exposed, which agreed to the findings of Dugmore [4] who stated that these teeth are more predisposed to caries.
Conclusion
Dentists should have a deeper knowledge about these anatomical variations, as well as must be prepared to perform a careful management of such dental anomalies to avoid unexpected problems during dental treatment procedures generated by ignorance of morphology of these anatomical variations. The dental findings seen in this case are rare. The case is also sporadic, with no positive family history. The wide variation in clinical manifestations in cases of non-syndromic occurrence of dental anomalies is challenging and is an area for further research.
References

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