Macrodontia of tooth 12 and early orthopedic management with rapid maxillary expansion

Abstract

Introduction: Isolated macrodontia is an uncommon dental anomaly characterized by a morphologically normal tooth that is significantly larger than average. In pediatric patients, rapid maxillary expansion increases the transverse width of the arch, facilitates tooth eruption, and optimizes respiratory function, with reported benefits in reducing obstructive sleep apnea syndrome (OSAS) and improving nasal breathing. Case Report: This report describes the early orthopedic management of an 8-year-old female patient with true unilateral macrodontia of the upper right lateral incisor (tooth 1.2), in the context of anterior crowding, mouth breathing, and allergic rhinitis. Following clinical evaluation and CBCT, rapid maxillary expansion with a butterfly-type expander was indicated. Seven days after expansion, an interincisal diastema and the initial eruption of tooth 2.2 were observed; on day fourteen, the screw was locked. After three months, a correction in the eruptive path of tooth 1.2 was noted. At six months, the expander was removed, and the eruption of tooth 1.2 in a functional position was confirmed. The patient’s mother reported improvement in respiratory symptoms and discontinuation of nasal corticosteroids as prescribed by the otolaryngologist. Conclusion: This case highlights the importance of timely and interdisciplinary orthopedic intervention, which not only facilitated proper tooth eruption but also improved respiratory function. It is recommended to incorporate objective functional airway assessment into the comprehensive diagnosis of dentofacial anomalies.