|Year : 2020 | Volume
| Issue : 4 | Page : 88-90
Transmigration of mandibular cuspids: Review of literature
M Nazargi Mahabob
Department of Oral & Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, King Faisal University, Al Ahsa, Kingdom of Saudi Arabia
|Date of Submission||01-Sep-2020|
|Date of Acceptance||03-Oct-2020|
|Date of Web Publication||29-Dec-2020|
Dr. M Nazargi Mahabob
Department of Oral & Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, King Faisal University, Al Ahsa 31982.
Kingdom of Saudi Arabia
Source of Support: None, Conflict of Interest: None
Aim: The aim of this review was to summarize currently available data related to the prevalence and etiology of transmigrant mandibular canines and the different treatment options. Materials and Methods: A computer-based search of studies published from January 2016 to April 2020 was conducted. The studies were selected from various electronic databases such as Medline, Google Scholar, Epub, Embase, and Cochrane based on their title, study, design, keywords, Cochrane methodology, supplemented by a grey literature search and manually searched the references lists of the selected articles. Results: A total of 180 citations were searched initially and after proper screening, 19 relevant articles were included. According to the findings from our review, the incidence of canine impaction in the mandible ranges from 0.92% to 5.1%, whereas that of canine transmigration ranges from 0.1% to 0.31%. The literature search also shows that transmigration of canine almost exclusive in the mandible. Multiple factors have been attributed to the etiology of this condition. Cone beam computed tomography (CBCT) helps in giving clear details about their location, relation with adjacent structures, and pathology related to them. Conclusion: Early identification, proper treatment plan, and timely intervention needed to preserve the esthetic appearance and functional stability.
Keywords: Canine, impaction, malocclusion, mandible, transmigration
|How to cite this article:|
Mahabob M N. Transmigration of mandibular cuspids: Review of literature. Int J Oral Care Res 2020;8:88-90
| Introduction|| |
Transmigration of a tooth has been called in various names such as anomaly, impacted, migratory, malposed, and malerupted tooth. But the most suitable term is transmigration which has been coined by Ando et al. Tarsitano et al. defined transmigration as the phenomenon of an unerupted mandibular canine crossing the midline without the influence of any pathological cause. In the classical transmigratory pattern, the tooth has to cross the midline completely either in horizontal or vertical axis form. But Mupparapu considered that even half of the crown and root positioned on the other side of the midline as transmigration. Based on its level of transmigration and position, Mupparapu classified unilaterally transmigrated canine into five types [Figure 1]. This classification is applicable to unilateral transmigration not for bilateral transmigration because of their complexity of the transmigratory pattern. As the occurrence rate of bilateral transmigration of mandibular canines is very rare, previously there was no attempt was made to study and classify their transmigratory pattern of the impacted canines. But recently Mupparapu proposed a classification based on radiographic findings for bilaterally transmigrated mandibular canines [Figure 2].
|Figure 1: Mupparapu’s proposed classification of unilaterally transmigrating mandibular canines|
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|Figure 2: Mupparapu’s proposed classification of bilaterally transmigrating mandibular canines|
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| Materials and Methods|| |
Appropriate guidelines for a systematic review were followed. A computer-based search of studies published from January 2016 to April 2020 was conducted. The studies were selected from various electronic databases such as Medline, Google Scholar, Epub, Embase and Cochrane based on their title, study, design, keywords, Cochrane methodology, supplemented by a grey literature search and manually searched the references lists of the selected articles.
| Results|| |
A total of 180 citations were searched initially, and after proper screening, 19 relevant articles were included. According to the findings from our review, the incidence of canine impaction in the mandible ranges from 0.92% to 5.1%, whereas that of canine transmigration ranges from 0.1% to 0.31%. The literature search showed that the etiology of the condition is obscure; however, multiple factors have been attributed to the condition.
Prevalence of impacted mandibular canines
Impacted teeth are described as teeth with a delayed eruption time or that are not expected to erupt completely based on the clinical and radiographic assessment. Maxillary canines are the second-most frequently impacted teeth after the third molars and incidence of maxillary canine impaction is about 20 times more than mandibular canine impaction. In general population, the incidence of mandibular canine impaction is 0.31% and transmigration is almost exclusively reported in mandibular canines., Females seem to be more affected than males, with the left side being more prevalent than the right.
During development mandibular canines have a longer and difficult path of eruption reach their final position in occlusion. Development of mandibular canine occurs in three planes of space, mandibular canines travel almost 21 mm from their position at the age of 5 years to their position at 15 years.
Etiology of impacted canines
A wide variety of localized, systemic, and genetic reasons may cause disruption in eruption process, ranging from delayed eruption to a complete failure of eruption. The exact etiology of displaced mandibular canines is unknown yet hypothesized to be both multifactorial and genetic in origin. Abnormal displacement of the tooth germ in the embryonic life is a commonly accepted explanation.,
Consequences of canine impaction
The canine guidance disengages posterior teeth in the mandibular movements, thereby eliminating the lateral forces from posterior teeth and preventing fracture or excessive wear. The timely intervention will prevent one of the following consequences of canine impaction.,
Diagnosis of impacted canines
Identification and diagnosis of the impacted canine and its location are the most important steps in the management of impacted canine. It has to be done through clinical and radiographic examinations. During the clinical examination patient’s age and dentition should be correlated to determine eruption is occurring according to the chronology or not. During normal eruption of the mandibular canine, usually a labial bulge is noted on the mucosa inferior to the mandibular primary canine. When such a bulge is not visible, an intraoral palpation is required to get a clear localization of the permanent canine. Also mobility of all present teeth should be assessed during palpation.,
The accurate location can be partially obtained from conventional radiographs as the first step which includes periapical radiographs, occlusal films, and panoramic views and cone beam computed tomography (CBCT) is available to detect the exact location of the impacted tooth.
Classification of transmigrated mandibular canines
[Figure 1] shows Mupparapu’s proposed classification of unilaterally transmigrating mandibular canines.
According to previous literatures, 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%)., Similarly, [Figure 2] shows Mupparapu’s proposed another classification for bilaterally transmigrating mandibular canines. Previous researches have shown that bilateral transmigration of canines is very rare. From the literature review, the most common type of bilateral canine transmigration noticed was type I subtype A (60%), followed by type III subtype A (22%), and type II subtype A (9%).,
Treatment planning considerations
Treatment of impacted canines usually requires an interdisciplinary approach involving different sets off departments. After proper analysis and consultation with other specialists, the clinician should select explain various treatment options available.,, There are several options available such as no treatment, Interceptive treatment, extraction of the impacted canine, autotransplantation of the canine or surgical exposure, orthodontic alignment, or surgical removal., These treatment options should be based on the condition of the impacted transmigrated canine and consent of the patient.
| Conclusion|| |
Canines play an essential role in maintaining the arch stability, functional efficiency, and esthetic appearance. Because of these roles, they have been mentioned as corner stone’s of the dental arch. The successful management of dental arch’s functional stability, esthetic appearance, and oral health depends on the timely detection and correction of impacted canines.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]