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Beware the solitary maxillary median central incisor

Department of Orthodontics, East Kent Hospitals NHS Trust, Canterbury, Kent, UK

Martyn T. Cobourne

Department of Orthodontics and Craniofacial Development, King’s Dental Institute, King’s College London, London, UK

Address for correspondence: Dr Martyn Cobourne, Senior Lecturer/Hon Consultant in Orthodontics, Department of Orthodontics and Craniofacial Development, Floor 22, King’s Dental Institute, King’s College London, London SE1 9RT, UK. Email: martyn.cobourne{at}kcl.ac.uk

	Abstract

The incidence of a solitary maxillary median central incisor (SMMCI) tooth in the general population is low, in either the primary or secondary dentition. The most common cause of a missing maxillary central incisor is trauma, or more rarely hypodontia. However, SMMCI is also a recognized genetic anomaly and affected individuals can be carriers for a potentially more serious condition affecting midline development of the brain and face, holoprosencephaly (HPE). The presence of an SMMCI of unknown aetiology is therefore considered a risk factor for HPE, even in the absence of any other clinical signs. The orthodontist may be responsible for diagnosing cases of SMMCI with no obvious cause, and in these subjects due consideration should be given to referral for the appropriate genetic testing and counselling.

Key words: Solitary median maxillary central incisor, genetic testing, orthodontics, sonic hedgehog