MOLAR INCISOR HYPOMINERALIZATION IN MONOZYGOTIC TWINS: A CASE REPORT
Figure 6. Intraoral front view, SB.
Figure 7. Right buccal view, SB.
Figure 8. Left buccal view, SB.
Figure 9. Upper occlusal, SB.
Figure10. Lower occlusal, SB.
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An orthodontic consultation was done and
recommendations were made to correct the
posterior crossbite using a quadhelix expander. 12
The appliance was activated for 8 months which
accomplished the correction of the crossbite
relation in both MB and SB.
On the subsequent 6 month recall visit, the
patients reported pain from one of the MIH-
affected teeth, MB from tooth16 and SB from tooth
26. Although all the FPMs had retained the fissure
sealants, the teeth causing sensitivity showed
further enamel breakdown. Due to that sensitivity
and in order to avoid further breakdown of the
enamel, 13 prefabricated stainless steel crowns
were the treatment of choice.
The patients continued to remain caries free and
good oral hygiene was continuously maintained
at the subsequent recall visits (Figs. 11-14).
3. Discussion
Molar incisor Hypomineralization is a qualitative
developmental defect of the enamel, that affects
at least one FPM and is often associated with
affected incisors. 4
There are several etiological factors suggested
in the literature related to the development of
MIH, but none of them is a clear definitive cause.
These factors are complications that might
occur during the prenatal, perinatal or postnatal
period and disrupt the enamel formation during
amelogenesis. They include low birth weight,
premature delivery, malnutrition during the last
trimester of pregnancy and maternal urinary
tract infections. Prolonged childhood illnesses,
especially during the first year of life, are also
implicated as causative agents of MIH and
include otitis media, asthma, pneumonia and
prolonged high fever due to infections. Exposure
to environmental toxins (dioxins) and diseases
like mumps, measles and chicken pox have also
been cited as possible causes. 4,5
Since the early mineralization phase of the FPMs
occurs close to birth until the first year of life, the
teeth are susceptible to the various etiological
factors causing MIH during this critical stage of
tooth development. 8
Lygidakis et al. 5 found that MIH was more common
in a study group with perinatal complications of
Caesarean section, premature birth, prolonged
delivery and twinning.
This case report presented monozygotic twins
that were born on term, via Caesarean section
delivery with a normal birth weight. The mother
did report taking antibiotics on one instance
during the pregnancy for an infection that she
could not recall. The twins also took antibiotics on
two occasions for otitis media during the first year
of life.
The diagnosis of MIH was confirmed with the
characteristic clinical appearance of the affected
molars and incisors in combination with the
medical history, which could have been a
contributing factor.
Stoma Edu J. 2017;4(3): 218-223
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