Interdisciplinary approach for a congenital agenesis of upper central incisor

Aim: Solitary Median Maxillary Central Incisor (SMMCI) Syndrome (originally called "solitary median maxillary central incisor short stature, choanal atresia/midnasal stenosis syndrome) is a rare malformation characterized by the presence of a single central incisor in the median position. It is associated with bone and median soft tissue defects, along with an increased risk of brain and pituitary malfunction. The etiology of SMMCI is still unknown, however it may be related to an ab-normal development of the premaxilla during the gestational period connected to a missense mutation in the SHH gene Q111F) at 7q36. It affects females more frequently. The aim of this scientific work is to illustrate the combined orthodontic and implant-prosthetic treatment plan of a 50-year-old female patient affected by SMMCL. Methods: the patient had a lack of the left upper central incisor (element 21) associated with poor self-confidence and psychological discomfort. Intra and extra oral photos, orthopantomography, latero-lateral teleradiography, CBCT, cephalometric analysis and digital study were performed. The chosen therapy was composed by two phases: the orthodontic phase and the surgical one. In the first phase the extractions of the upper second premolars {elements 15 and 25) and the use for 18 months of aligners (Invisalign) supported by an orthodontic movement accelerator device {Ortho-Pulse) were planned. The second implant-prosthetic phase involved the implantation of an osseointegrated fixture (JD Evolution). Results: at the end of the orthodontic and implant-prosthetic treatment, the patient showed an important improvement in the dento-facial aesthetics and referred psychologically a significant improvement in her self-esteem. Conclusions: combined orthodontic and implant-prosthetic therapy represents a valid therapeutic strategy for the treatment of SMMC1 syndrome. The multidisciplinary approach proves to be fundamental for the resolution of complex cases with high aesthetic value.