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Table of Contents
CASE REPORT
Year : 2020  |  Volume : 8  |  Issue : 4  |  Page : 103-105

Transmigration of cuspids: Report of three rare cases


Department of Oral and Maxillofacial Surgery & Diagnostic Sciences, College of Dentistry, King Faisal University, Al-Ahsa, Kingdom of Saudi Arabia

Date of Submission24-Jun-2020
Date of Acceptance06-Sep-2020
Date of Web Publication27-Nov-2020

Correspondence Address:
Dr. Nazargi Mahabob Mahabob Basha
Department of Oral and Maxillofacial Surgery & Diagnostic Sciences, College of Dentistry, King Faisal University.
Kingdom of Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/INJO.INJO_30_20

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  Abstract 

The pre-eruptive and intraosseous migration of teeth across the midline is called as transmigration. This rare phenomenon is common in the mandible compared to the maxilla. The occurrence of bilateral transmigration of mandibular canine is even rarer than unilateral transmigration. In these three cases, two of them were unilateral transmigration and the third was bilateral transmigration. In unilateral transmigration cases, one among them showed compound odontome-induced transmigration of canine and displaced premolar toward the third molar of the same side and another with unilateral transmigration of canine just crossing the midline. The case had bilaterally transmigrated canines. The occurrence of bilateral transmigration of the mandibular canine is very rare than the unilateral transmigration. Many factors had been suggested as causative agents for transmigration of mandibular canines, but there is no clear, established etiology for this phenomenon. Mupparapu proposed classifications for unilateral and bilateral transmigration of mandibular canines after reviewing literature.

Keywords: Bilateral, compound odontome, mandibular canine, transmigration, transposition


How to cite this article:
Mahabob Basha NM. Transmigration of cuspids: Report of three rare cases. Int J Oral Care Res 2020;8:103-5

How to cite this URL:
Mahabob Basha NM. Transmigration of cuspids: Report of three rare cases. Int J Oral Care Res [serial online] 2020 [cited 2021 Jan 24];8:103-5. Available from: https://www.ijocr.org/text.asp?2020/8/4/103/301700




  Introduction Top


An unerupted tooth’s intraosseous movement across the midline is called as transmigration and it is a rare developmental anomaly phenomenon. It has been called in various names such as anomaly, impacted, migratory, malposed, and malerupted tooth. But the most suitable term “Transmigration” has been coined by Ando et al.[1] Tarsitano et al. defined transmigration as the phenomenon of an unerupted mandibular canine crossing the midline without the influence of any pathological cause.[2] Studies have suggested that transmigration of canines is a rare phenomenon with an incidence of about only 0.31%.[3],[4] Transmigration most commonly affects the mandibular canines, but rarely in maxillary canines also. Most of the time transmigrated canines remain impacted and asymptomatic but sometimes they erupt ectopically and with pathologies.[5],[6] In the classical transmigratory pattern, the tooth has to cross the midline completely either in horizontal or in vertical axis form. But Mupparapu considered that even half of the crown and root positioned on the other side of the midline as transmigration and based on its level of transmigration and position, he classified unilaterally transmigrated canine into five types.[7] Since the occurrence rate of bilateral transmigration of mandibular canines is very rare, there was no attempt was made to classify. But in 2007, Mupparapu proposed a classification based on radiographic findings for bilateral transmigrated mandibular canines.[8]


  Case 1 Top


A 23-year-old male patient reported to the outpatient department with the chief complaint of a mobile tooth in the left lower back region of the jaw for 3 weeks. An intraoral examination revealed retained 74 with grade I mobility and missing 33 and 34. An intraoral periapical radiograph was advised, which showed a radio-opaque mass below the apex of 74 and missing 33 and 34. To evaluate further, orthopantomogram (OPG) [Figure 1] was recommended, which showed a radio-opaque mass with different radio densities below the apex of 74, impacted, and 33 canine below the root apices 43,44,45, and 46. The missed 34 was located below the root apices of 36,37, and 38 in the horizontal position. The radio-opaque mass was diagnosed as a compound odontome. The retained 73 and odontome were surgically removed. The radiopaque mass was sent for histopathological study and the report confirmed it as a compound composite odontome. Since the patient was not willing for removal of impacted canine and premolar and also the canine (33) and premolar (34), they were left in their position. And the patient was advised to report periodically for check up and the extracted site for prosthetic rehabilitation.
Figure 1: Retained 73 with a compound odontome and unilaterally transmigrated 33

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  Case 2 Top


An 18-year-old female reported to the outpatient department with the chief complaint of crowding of teeth in the mandibular anterior region. On intraoral examination, retained 73 was present with a clinical absence of 33. An OPG [Figure 2] was taken, which revealed the presence of an impacted 33 below the root apices of 34,73,32,31, and 41. A part of the coronal portion of 33 was crossed the midline of the mandible.
Figure 2: Retained 73 with unilaterally transmigrated 33

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  Case 3 Top


A 21-year-old female reported to the outpatient department with the chief complaint of forwardly placed upper teeth and small-sized teeth in the mandibular anterior region. On intraoral examination, retained 73 and 83 were noted. An OPG [Figure 3] was advised which showed horizontally impacted canines below the apices of 31 and 41 and one above the other of the midline of the mandible. Both the canines partially crossed the midline. After consultation with an orthodontist, orthodontic corrections initiated and the impacted canines (33 and 43) were surgically removed [Figure 4].
Figure 3: Bilaterally transmigrated 33 and 43

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Figure 4: Postextraction of 33 and 43

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  Discussion Top


According to the previous studies, a mandibular canine is the only tooth that migrates and crosses the midline of the mandible, and has been reported that they occur more frequently in females than males in the ratio of 1.6:1.[9],[10] The left side of the mandible is affected more frequently than the right side. In these case reports, two of the three cases are affected on the left side of the mandible.[11] In cases of clinically missing mandibular canines if intraoral periapical radiograph fails to detect any abnormality or impacted tooth, transmigration of the tooth should be suspected and it emphasizes the need for panoramic radiograph.[12] In cases 1, 2, and 3, transmigrations were only detected on panoramic radiographs. Javid proposed that transmigration should be considered when at least half the length of the crown crosses the midline.[13] Recently, it has been suggested that the tendency of canines to cross the midline is significant than the distance.[7],[14] In these case reports, second and third of the conditions the crowns had crossed the midline and, in the first condition, the impacted mandibular canines had migrated a significant distance on the opposite side. Mupparapu had proposed two types of classification for mandibular canine transmigration based on the migratory pattern and position of the canines in the jaw based on his studies.[7],[8] According to previous literature, the prevalence of these types varies with Type 1 (45.6%) being the most common, followed by Type 2 (20%), Type 4 (17%), Type 3 (14%), and Type 5 (1.5%).[9],[11],[15] According to this classification, case 1 comes under the type 4 transmigration and case 2 comes under type 1. Similarly, based on previous researches, bilateral transmigration of canines is a very rare and most common type of bilateral canine transmigration noticed was a type I subtype A (60%), followed by type III subtype A (22%) and type II subtype A (9%).[11],[15] According to this classification, case 3 comes under the category of type III subtype A and as per the previous studies the prevalence rate of this type is 22%.

About the etiology of transmigration, several factors had been suggested local or pathologic factors suggested by several researchers, but the exact etiology is still not clear.[16] In case 1, the transmigration of 33 and displacement of 34 happened due to the presence of odontome. In cases 2 and 3, transmigration occurred due to retained deciduous teeth. In most of the patients, transmigration of the tooth occurs asymptomatically. In some scenario, transmigrated teeth can cause roots resorption and displacement of adjacent teeth, neuralgic symptom, and migration of teeth to adjacent structures causing pain and unaesthetic appearance to the patient. The clinical findings associated with transmigration of the canine include missing of permanent mandibular canine in the dental arch or retained primary mandibular canine.[11],[13] On the basis of the stage of development, the distance of migration, angulation, and whether the patient’s condition is symptomatic or asymptomatic, treatment options can be considered for a transmigrated canine is either surgical removal or autotransplantation or surgical exposure with orthodontic alignment.[11],[12] If the patient is symptomatic or has any associated abnormalities, surgical extraction is the most preferred treatment.[13] A transplantation and orthodontic management can be possible only if the other teeth in the arch are in normal position and space for the transmigrated canine is sufficient.[14],[15] In our patient, orthodontists opted for surgical removal of transmigrated canine due to the unfavorable position of the impacted teeth [Figures 3] and [4]. In asymptomatic conditions, the transmigrated canine should be kept under periodic observation.[16],[17]


  Conclusion Top


Transmigration of the mandibular canine either unilaterally or bilaterally is a rare condition. Whenever clinicians noticed the presence of retained deciduous canine or ectopically erupted permanent canines, it should always be investigated properly. Since the canine plays a vital role in aesthetic as well as functional point of view, early detection and interception are essential at a younger age, to produce effective treatment and aesthetics.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Ando S, Aizawa K, Nakashima T, Sanka Y, Shimbo K, Kiyokawa K Transmigration process of impacted mandibular cuspid. J Nihon Univ Sch Dent 1964;6:66-71.  Back to cited text no. 1
    
2.
Tarsitano JJ, Wooten JW, Burditt JT Transmigration of non erupted mandibular canines: Report of cases. Jan Dent Assoc 1971;82:1395-7.  Back to cited text no. 2
    
3.
Dalessandri D, Parrini S, Rubiano R, Gallone D, Migliorati M Impacted and transmigrant mandibular canines incidence, aetiology, and treatment: A systematic review. Eur J Orthod 2017;39:161-9.  Back to cited text no. 3
    
4.
Hong Bin Y, Yue Su H, Ling Peng Z, Min Jie H, Xiang Hong Y A clinical analysis of 11 mandibular impacted canines. Int J Clin Exp Med 2019;12:11504-10.  Back to cited text no. 4
    
5.
Muhammad A, Ambreen A, Zubair A, Munawar M, Arfan U, Waheed U Investigation of transmigrated mandibular canines. Dental Press J Orthod 2019;24:65-8.  Back to cited text no. 5
    
6.
Michael H, Clemens F, Kristina B, Katharina G, André G, Georg D Impacted and transmigrated mandibular canines: An analysis of 3D radiographic imaging data. Clin Oral Investig 2018;22:2389-99.  Back to cited text no. 6
    
7.
Mupparapu M Patterns of intra osseous transmigration and ectopic eruption of mandibular canines: Review of literature and report of nine additional cases. DentomaxillofacRadiol 2003;31:355-60.  Back to cited text no. 7
    
8.
Mupparapa M, Aluluck A, Suhaz S, Pai KM, Nagpal A Pattern of intra-osseous transmigration and ectopic eruption of bilaterally transmigrating mandibular canines: Radiographic study and proposed classification. Quintessence International 2007;38:821-8.  Back to cited text no. 8
    
9.
Plakwicz P, Abramczyk J, Wojtaszek-Lis J, Sajkowska J, Warych B, Gawron K, et al. The retrospective study of 93 patients with transmigration of mandibular canine and a comparative analysis with a control group. Eur J Orthod 2019;41:390-6.  Back to cited text no. 9
    
10.
Bhullar MK, Aggarwal I, Verma R, Uppal AS Mandibular canine transmigration: Report of three cases and literature review. J Int Soc Prev Community Dent 2017;7:8-14.  Back to cited text no. 10
    
11.
Ashok Dongol, Pradeep Acharya, Ram Prasad Yadav, Arun Kumar Mahat, Anjani Kumar Yadav, Ashish Shrestha, et al. Kissing canines associated with dentigerous cyst, a case report of transmigrated bilateral impacted mandibular canines. Int J Oral CraniofacSci 2017;3:14-6.  Back to cited text no. 11
    
12.
José Antonio Vera G, José Rubén Herrera A, Gabriel Eduardo Colomé R Orthodontic treatment of bilateral impacted mandibular canines and a mupparapu type 2 transmigration. Case Reports in Dentistry2019;2019:1-5.  Back to cited text no. 12
    
13.
Javid B Transmigration of impacted mandibular cuspids. Int J Oral Surg 1985;14:547-9.  Back to cited text no. 13
    
14.
Cavuoti Serena, Matarese Giovanni, Isola Gaetano, Abdolreza Jamilian, Femiano Felice, Perillo Letizia. Combined orthodontic-surgical management of a transmigrated mandibular canine. Angle Orthodontist 2016;86:681-91.  Back to cited text no. 14
    
15.
Ingrid R, Katarzyna D, Zofia C, Katarzyna RT Transmigration of the left mandibular canine observed during 2 years in cone beam computed tomography examination. J Oral Maxillofac Radiol2018;6:31-5.  Back to cited text no. 15
    
16.
Shreya S, Akhilesh K, Naresh K, Thakur P Transmigration of impacted mandibular canine with the development of dentigerous cyst: Surgical extraction or orthodontic alignment? J Dental Allied Sci 2017;6:31-4.  Back to cited text no. 16
    
17.
Sinko K, Nemec S, Seemann R, Eder-Czembirek C Clinical management of impacted and transmigrated lower canines. J Oral Maxillofac Surg 2016;74:2142.e1-2142.e16.  Back to cited text no. 17
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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