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 Table of Contents  
CASE REPORT
Year : 2017  |  Volume : 6  |  Issue : 1  |  Page : 32-34

Transmigration of impacted mandibular canine with the development of dentigerous cyst: Surgical extraction or orthodontic alignment?


1 Department of Orthodontics and Dentofacial Orthopaedics, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
2 Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India

Date of Web Publication2-May-2017

Correspondence Address:
Akhilesh Kumar Singh
Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2277-4696.205437

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  Abstract 


Transmigration of impacted mandibular canine is an uncommon clinical entity. In this condition, not only the tooth fails to erupt in its normal position, but also it crosses the midline within the mandible. The orthodontic correction of this condition is rather impossible. In case of development of dentigerous cyst associated with the impacted canine, surgical extraction along with the enucleation of the cyst is the only treatment of choice. We present a similar case managed surgically in a 13-year-old male adolescent.

Keywords: Dentigerous cyst, mandibular canine, impacted canine, transmigration


How to cite this article:
Singh S, Singh AK, Sharma NK, Chaturvedi TP. Transmigration of impacted mandibular canine with the development of dentigerous cyst: Surgical extraction or orthodontic alignment?. J Dent Allied Sci 2017;6:32-4

How to cite this URL:
Singh S, Singh AK, Sharma NK, Chaturvedi TP. Transmigration of impacted mandibular canine with the development of dentigerous cyst: Surgical extraction or orthodontic alignment?. J Dent Allied Sci [serial online] 2017 [cited 2019 Sep 21];6:32-4. Available from: http://www.jdas.in/text.asp?2017/6/1/32/205437




  Introduction Top


Transmigration is an uncommon clinical tendency of impacted tooth to cross the midline. The term “Transmigration” was first introduced by Ando et al.[1] The condition is seen mostly in mandibular canine and in few cases of maxillary canine as well.[2] It has been reported more frequently in females than males in the ratio of 1.6:1.[3] Due to intraosseous movement, the tooth either remains impacted or erupts in the midline/contralateral position. Most of the time, it remains asymptomatic, but in few cases, it may lead to displacement of adjacent teeth or root resorption. Bilateral occurrence has also been reported in literature. The orthodontic correction of such condition is either very difficult or practically an impossible task. Untreated cases may develop dentigerous cyst. Transalveolar extraction of the impacted canine along with enucleation of cyst lining forms the treatment of choice in such conditions.


  Case Report Top


A 13-year-old male adolescent reported with a chief complaint of spacing between the lower right front teeth and wanted its correction. On clinical examination, a space was found between mandibular right lateral incisor and first premolar tooth [Figure 1]. The mandibular right canine was seen missing. He was advised an orthopantomogram and lateral cephalogram. The radiographs showed a horizontally placed impacted mandibular right canine with well-defined radiolucency surrounding the tooth [Figure 2] and [Figure 3]. The canine was present just above the inferior border of the mandible with its crown crossing the midline up to the level of the root of contralateral lateral incisor and canine. A provisional diagnosis of dentigerous cyst associated with transmigrated impacted mandibular right canine was made. His parents were counseled about the condition and treatment. The routine biochemical investigations were found to be within normal limits. He was planned for a transalveolar extraction and cyst enucleation through vestibular approach under local anesthesia. All aseptic measures were properly carried out, and preoperative antibiotic was subsequently given. On exposure, we found a dome-shaped hard swelling over the symphysis region [Figure 4]. The overlying bone was removed, and the crown was exposed. The tooth was found to be lying loosely in the space along with the surrounding cyst lining [Figure 5]. The tooth was then removed, and the cystic lining was enucleated [Figure 6]. Curettage of the remaining cavity was further done. Soft tissue closure was subsequently achieved in two layers (muscle and mucosa) with 3-0 vicryl suture. On histopathological study, a definitive diagnosis of dentigerous cyst was given. The patient is under a regular follow-up, and an orthodontic correction of the spacing is planned after a period of 3 months.
Figure 1: Preoperative intraoral photograph showing missing right mandibular canine with space between lateral incisor and first premolar

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Figure 2: Orthopantomogram showing horizontally impacted mandibular right canine present along the inferior border with its incisal tip present below the opposite lateral incisor

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Figure 3: Lateral cephalogram showing an impacted tooth present in anterior symphysis of mandible just above the inferior border of the mandible

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Figure 4: On reflection of mucoperiosteal flap, a dome-shaped enlargement of the symphysis region of mandible

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Figure 5: After removal of superficial bone, the crown portion of canine is visible in the bone cavity

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Figure 6: The mandibular canine and cyst lining after removal from the bone cavity

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  Discussion Top


Preeruptive tooth migration is a natural mechanism which is necessary for acquiring a proper position in the dental arch. Normally, permanent mandibular canine moves in a vertical and labial direction to obtain its position. However, in rare circumstances, the direction of movement changes which may lead it to cross the midline. The exact etiology of transmigration is unknown. Literature suggests various etiologies such as premature loss or retention of the deciduous canine, long path of eruption, trauma, no anatomical restriction in mandible midline, and genetic predisposition.[4],[5] According to Stafne and Gibilisco, the migration of unerupted teeth is possible due to rich blood circulation and active alveolar bone formation in the stage of development of the tooth apex.[6]

Transmigration of impacted canine is a rare clinical finding and it is more common in mandibular than maxillary canine. Transmigration of maxillary canine is uncommon due to the shorter distance between the roots of maxillary incisors and the floor of the nasal fossa and restriction of the path of tooth movement by the roots of adjacent teeth, the maxillary sinus, and the midpalatal suture, which probably act as a barrier.[7]

Clinically, a retained deciduous canine or delay in the eruption of permanent canine may lead to suspicion of an impacted canine. Other clinical symptoms are swelling or unusual feeling in labial vestibule region, sometimes leading to pain. Pain may be either due to secondary infection in the associated pathology or of neuralgic origin. Shapira and Kuftinec stated that this abnormality was associated with a cyst or odontome.[8] Joshi stated that it was difficult to differentiate whether these pathological conditions were responsible for transmigratory process or vice versa happened.[4] Panoramic radiography is advised for confirmatory diagnosis of it.

In 2002, Mupparapu [9] classified the pattern of intraosseous transmigration of impacted mandibular canine as follows:

  • Type-1 – Canine impacted mesioangularly across the midline, labial or lingual to the anterior teeth
  • Type-2 – Canine impacted horizontally near the lower border of the mandible, inferior to the apices of the incisors
  • Type-3 – Canine erupted either mesial or distal to the contralateral canine
  • Type-4 – Canine impacted horizontally near the inferior border of the mandible, below the apices of either premolars or molars on the opposite side
  • Type-5 – Canine positioned vertically in the midline, with the long axis of the tooth crossing the midline.


According to the above-mentioned classification, our case showed a “type 2” pattern of transmigration. The available treatment options for transmigrated canines are surgical removal, transplantation, and surgical exposure with orthodontic alignment. Surgical extraction is the most favored treatment in scientific literature.[10] If the patient is symptomatic and has any associated abnormality such as developing cyst, neuralgia, resorption of an adjacent tooth root, or displacement of teeth, surgical extraction should be planned immediately.[11] It is important to prevent damage to the root apices of the adjacent teeth while surgical removal.

If the mandibular incisors are in a normal position and space for the transmigrated canine is sufficient, transplantation may be undertaken.[10] Surgical exposure with orthodontic realignment can also be done for labially impacted transmigrated canine.[12] However, if the crown of the transmigrated canine moves past the opposite incisor area or if the apex is seen to have migrated past the apex of the adjacent lateral incisor, it might be mechanically impossible to bring the tooth back into place. In such cases, extraction is preferred.[4]


  Conclusion Top


Transmigration of an impacted mandibular canine is a rare clinical phenomenon usually diagnosed accidently in a routine radiographic study. Various treatment modalities are available but in cases where it is associated with a pathologic or cystic degeneration, surgical extraction of the impacted tooth is the definite management.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Ando S, Aizaea 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.
Aydin U, Yilmaz HH. Transmigration of impacted canines. Dentomaxillofac Radiol 2003;32:198-200.  Back to cited text no. 2
    
3.
Peck S. On the phenomenon of intraosseous migration of nonerupting teeth. Am J Orthod Dentofacial Orthop 1998;113:515-7.  Back to cited text no. 3
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4.
Joshi MR. Transmigrant mandibular canines: A record of 28 cases and a retrospective review of the literature. Angle Orthod 2001;71:12-22.  Back to cited text no. 4
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5.
Aktan AM, Kara S, Akgünlü F, Malkoç S. The incidence of canine transmigration and tooth impaction in a Turkish subpopulation. Eur J Orthod 2010;32:575-81.  Back to cited text no. 5
    
6.
Stafne EC, Gibilisco JA. Oral Roentgenographic Diagnosis. Philadelphia: WB Saunders; 1975.  Back to cited text no. 6
    
7.
Costello JP, Worth JC, Jones AG. Transmigration of permanent mandibular canines. Br Dent J 1996;181:212-3.  Back to cited text no. 7
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8.
Shapira Y, Kuftinec MM. Intrabony migration of impacted teeth. Angle Orthod 2003;73:738-43.  Back to cited text no. 8
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9.
Mupparapu M. Patterns of intra-osseous transmigration and ectopic eruption of mandibular canines: Review of literature and report of nine additional cases. Dentomaxillofac Radiol 2002;31:355-60.  Back to cited text no. 9
    
10.
Camilleri S, Scerri E. Transmigration of mandibular canines – A review of the literature and a report of five cases. Angle Orthod 2003;73:753-62.  Back to cited text no. 10
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11.
Auluck A, Nagpal A, Setty S, Pai KM, Sunny J. Transmigration of impacted mandibular canines – Report of 4 cases. J Can Dent Assoc 2006;72:249-52.  Back to cited text no. 11
    
12.
Wertz RA. Treatment of transmigrated mandibular canines. Am J Orthod Dentofacial Orthop 1994;106:419-27.  Back to cited text no. 12
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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