Management of a transmigrated mandibular canine

Characteristics, Diagnosis and Treatment of Compound Odontoma Associated with Impacted Teeth

Compound odontoma is a malformation typical of young adults below the age of 20, with a slight preference for the male gender and the anterior region of the maxilla. Clinically asymptomatic, it can be detected during a radiological investigation in connection with the persistence of deciduous dental elements and the impaction of definitive ones. The treatment of choice is excisional surgery and recurrence is a rare event. The need for orthodontic therapy for impacted elements is usually not necessary because in most cases, odontomas are small, circumscribed lesions the size of a permanent tooth. In this article, the diagnostic and therapeutic surgical excision procedure is presented in three patients at developmental age with large compound odontomas associated with at least one retained canine, and in two of the cases, with serious transmigration to the impacted tooth elements.

Treatment options for mandibular canine transmigration - a case series based on dental literature

The present case series, based on dental literature, aimed to identify factors that influence the final treatment decision for patients affected by mandibular canine transmigration using individual data from case reports in the literature. The protocol used for data synthesis was prepared following the Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) guidelines. An online search was conducted and included studies published up until September of 2019 (MEDLINE, Google Scholar, Scielo, and Conricyt). A chi squared test was used to evaluate associations between the treatment choice and gender, age, Mupparapu classification, and the presence of oral pathologies or dental anomalies (p < 0.05). A multinomial logistic regression was used to evaluate the individual case report data to determine the effect of the explanatory variables for treatment selection. Seventy-six papers fulfilled the inclusion criteria. Surgical removal (46.71%) and radiographic monitoring (38.16%) were the most common treatments reported. Age, Muppararu classification, and the presence of oral pathologies were significantly associated with the treatment option (p < 0.05). In conclusion, surgical removal and radiographic monitoring are the most frequently reported treatments for mandibular canine transmigration. Age, Mupparapu type, presence of oral pathologies, and qualitative aspects such as emotional reasons are relevant for the decision regarding treatment approach.

Cone-beam computed tomography evaluation of impacted and transmigrated mandibular canines: a retrospective study

OBJECTIVES

The purpose of this study is to evaluate CBCT images of impacted mandibular canines in detail and to discuss implications for diagnosis and treatment.

METHODS

CBCT images of dental patients applied between December 2015 and December 2017 were evaluated retrospectively. 2591 CBCT images, including mandible in their field of view, were determined and evaluated regarding the presence of mandibular canine impaction. 66 impacted mandibular canines of 58 patients were analyzed in detail regarding their location, morphology, associated pathologies, and their relationship with the neighboring anatomic structures, the role of these factors on transmigration, as well as treatments applied. The Pearson Chi square test was used between the groups.

RESULTS

Transmigration was observed in 53% of impacted mandibular canines. Teeth with transmigration were localized horizontally, below the apex of adjacent teeth frequently, and had no contact with mandibular cortical bone mostly. 62% of mandibular canines were in contact/proximity with the incisive mandibular canal. The most applied treatment for transmigrated teeth was surgical removal, followed by radiographic monitoring, but orthodontic traction was not preferred in any case. For non-transmigrated teeth, the most applied treatment options were surgical removal, orthodontic traction, and radiographic monitoring, respectively. Autotransplantation was not preferred in any case of impacted teeth. Vertical position of the crown tip (p < 0.05) and the presence of deciduous mandibular canines and their resorption showed significant relation to transmigration (p < 0.05).

CONCLUSION

Transmigration is common among impacted mandibular canines. Resorption of adjacent teeth roots was one of the possible complications of impaction and likely contact/proximity of incisive mandibular canal with impacted mandibular canines, which may pose difficulties in surgical treatment, can be better detected by CBCT.

Orthodontic Treatment of Bilateral Impacted Mandibular Canines and a Mupparapu Type 2 Transmigration

Dental transmigration is a rare condition that mainly affects the mandibular canines. Since the tooth involved is usually impacted and its crown has crossed the midline towards the opposite side, the treatment options frequently are surgical removal or radiographic follow-up, and, in some cases, orthodontic traction is possible. In 2002, Mupparapu presented a classification for lower canines in transmigration according to their position within the mandible. This paper is aimed at describing the orthodontic treatment of a female patient with two impacted mandibular canines, one of them in a Mupparapu type 2 transmigration position (horizontal impaction position near the lower mandibular border and below the incisors' root apices). Additionally, the paper discusses the biomechanical orthodontic design and the alternative treatment options for these complex cases.

Orthodontic management of a dental anomaly pattern (DAP) including mandibular canine transmigration: A case report: A challenging treatment but worth it!

Orthodontic technology has advanced to the point where management of cases with multiple dental anomalies should be within an orthodontist's daily armamentarium. A patient with bilateral agenesis of lower second premolars, delayed development, and transmigration of a mandibular canine was treated with the aid of hemisection, indirect/closed exposure, application of continuous force, targeted delivery, and strict attention to keeping the roots as much in bone as possible. This was accomplished without implants or flattening the facial profile, yet with excellent periodontal status and a fully functioning occlusion.

Mandibular Canine Transmigration: Report of Three Cases and Literature Review

Aims and Objectives:

Transmigration is a rare phenomenon seen almost exclusively in the mandibular canines. The aim of the present study is to review transmigration phenomenon.

Materials and Methods:

Appropriate guidelines for a systematic review were followed. The time period selected for the present systematic review was 2001–2016. The studies were selected from various electronic databases on the basis of their title, study, design, keywords, and abstracts. A total of 150 citations were searched initially, and after proper screening, 59 relevant articles were included. Additional data was obtained by searching journals and reference lists.

Results:

The literature search shows that transmigration is more frequent in the mandible than maxilla. The etiology of the condition is obscure; however, multiple factors have been attributed to the condition. They are more readily recognized now with the advent of panoramic radiographs. Transmigration is a rare anomaly causing varied manifestations and requires an interdisciplinary approach for management.

Conclusion:

Early diagnosis of impacted canines is mandatory for timely treatment to ensure facial harmony and improved function.

Clinical Management of Impacted and Transmigrated Lower Canines

PURPOSE

Impacted, in particular transmigrated, lower canines are rare. If they transmigrate, then the most common treatment is extraction. Alternatively, the native tooth can be preserved; however, management is complex. This report describes a decision-making flowchart (DMFC) with surgical strategies for the management of impacted lower canines.

MATERIALS AND METHODS

Fifty-six patients had impacted lower canines, of which 16 were transmigrated. A preliminary version of the DMFC was used for the development of treatment plans to decide which strategy to apply to these complex cases. After removal of associated pathologies (for experimental tooth-preserving therapies), miniscrews were used as transient skeletal anchorage devices (TADs). The TADs allowed a closed surgical approach for impacted and transmigrated lower canine eruption. For autotransplantation, a dummy tooth was used for socket preparation to minimize the period of no blood supply to the graft.

RESULTS

After surgical exposure and TAD insertion, orthodontic treatment was performed in 4 patients. One patient was selected for successful autotransplantation. Nine patients had the transmigrated canines surgically removed. The remaining patients opted for "leave and observe." Based on the satisfactory long-term results with orthodontic treatment and autotransplantation and on published reports, the resulting DMFC presents key aspects of the treatment plan, namely 1) associated pathology, 2) patient age, 3) compliance, and 4) root tip position.

CONCLUSIONS

TAD-assisted orthodontic treatment and autotransplantation of impacted lower canines are tooth-preserving alternatives to extraction. The developed DMFC assists the complex treatment planning of impacted and transmigrated lower canines.

Transmigration of mandibular canines

The purpose of this paper is to present the first case of unusual reverse oblique (110 degrees to midsagittal plane) migration of mandibular right canine crossing the jaw midline and piercing the lower border of the mandible at the level of the opposite canine and also to report two more cases of transmigrated mandibular canine and one case of transmigrating mandibular canine. Mandibular canines are "cornerstone" of dental arch; their importance is manifested by their efficiency in masticatory function, stability of dental arch, and aid in maintaining natural facial expression. Early detection of this anomaly can help preserving these canines by orthodontic intervention or by surgical transplantation. This developmental anomaly is properly diagnosed by radiographic evaluation, which is primarily based on the panoramic radiograph. In patients with overretained deciduous canines or missing permanent canines, an intraoral radiograph should be supplemented with panoramic radiograph. This paper discusses the importance of early diagnosis of canine transmigration in treatment planning and reviews the various possible treatment options.