STOMATOLOGY EDU JOURNAL 2017, Volume 4, Issue 3 SEJ_3-2017_Online - Page 70

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. 220 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