|Year : 2018 | Volume
| Issue : 2 | Page : 31-35
Transmigration of the left mandibular canine observed during 2 years in cone-beam computed tomography examination
Ingrid Rozylo-Kalinowska1, Katarzyna Denkiewicz1, Zofia Cecherz2, T Katarzyna Różyło3
1 Independent Unit of Propaedeutics of Dental and Maxillofacial Radiology, Medical University of Lublin, Lublin, Poland
2 Private Dental Clinic “Orto-Dent”, Lublin, Poland
3 Department of Dental and Maxillofacial Radiology of Medical University of Lublin, Lublin, Poland
|Date of Web Publication||13-Aug-2018|
Independent Unit of Propaedeutics of Dental and Maxillofacial Radiology, Medical University of Lublin, Ul. Karmelicka 7, 20-081, Lublin
Source of Support: None, Conflict of Interest: None
Transmigration is considerably a rare preeruptive dislocation of an affected tooth across the midline. Cone-beam computed tomography (CBCT) is a relatively new technology in dentomaxillofacial radiology. The aim of the study is to present a case report of progressing transmigration in an 11-year-old girl examined by means of CBCT. A 9-year-old girl was referred for CBCT twice before and during orthodontic treatment. In the baseline examination, the impacted lower left canine was impacted and incorrectly positioned, but 9 months later, the canine had already crossed the midline. In conclusion, to the authors' best knowledge, this is the first case of observation of mandibular canine transmigration by means of CBCT that allows precise evaluation of the transmigrating tooth.
Keywords: Canine, cone-beam computed tomography, transmigration
|How to cite this article:|
Rozylo-Kalinowska I, Denkiewicz K, Cecherz Z, Różyło T K. Transmigration of the left mandibular canine observed during 2 years in cone-beam computed tomography examination. J Oral Maxillofac Radiol 2018;6:31-5
|How to cite this URL:|
Rozylo-Kalinowska I, Denkiewicz K, Cecherz Z, Różyło T K. Transmigration of the left mandibular canine observed during 2 years in cone-beam computed tomography examination. J Oral Maxillofac Radiol [serial online] 2018 [cited 2018 Nov 20];6:31-5. Available from: http://www.joomr.org/text.asp?2018/6/2/31/238929
| Introduction|| |
Transmigration is a preeruptive dislocation of an affected tooth across the midline. It is relatively a rare dental anomaly.,, According to Mesquita and Salgado et al. It was Tarsitano who defined this abnormality as a phenomenon of an unerupted mandibular canine crossing the midline. The first case of this phenomenon was reported by Thoma  and the term “transmigration” was first used by Ando et al. In 1964 as reported by Buyukkurt et al. According to Javid, the phenomenon can be diagnosed as transmigration when more than a half of the length of the tooth has passed through the midline.
Although the impaction is approximately twenty times more common in maxillary canines (after the third molars), their transmigration is more prevalent in the mandible.,, The disorder affects more commonly mandibular left than right canines. The phenomenon is more common in females than males., Unilateral canine transmigration is observed more often than bilateral one.,, Very few published case reports of bilateral transmigration are available in literature.
The etiology of this rare anomaly is not fully understood.,,,, The following probable causes are listed as follows: insufficient space in the dental arch, supernumerary teeth, persistent primary canine, premature loss of deciduous dentition, crowding, excessive length of crown, hormonal disorders, hereditary factors, avitaminoses, trauma, cysts, tumors, and diet.,,,,, It has been suggested by some authors that mesioangular and horizontal rotations of dental germs are the main cause of transmigration.
Numerous sources state that transmigration is observed in canines only. However, Alves et al. described a case of a transmigrated mandibular second premolar.
Mupparapu  studied 2150 cases of patients who reported for radiodiagnostics between July 1996 and July 2000. In the material consisting of full mouth series, panoramic radiographs with periapicals and bitewings, 9 transmigrated canines were found. Seven of them were detected in females (aed 17-38 years) and 2 in males (aged 30 and 69 years). Three canines changed localization from the left to the right side, three were in the midline, two migrated from the right side, and one was bilateral. Kara et al. found other types of transmigrated teeth: 13 central incisors, 27 lateral incisors, 5 first premolars, 3 second premolars and one first molar in Turkish population.
Two-dimensional radiography has been successfully applied in dentistry for many years. However, complex anatomy of maxillofacial region is responsible for rising number of applications of three-dimensional (3D) examination in dental diagnosis nowadays. Cone-beam computed tomography (CBCT), also known as dental volumetric tomography, is a relatively new technology in dentomaxillofacial radiology. Scanning of maxillofacial skeleton and teeth by means of a cone-shaped X-ray beam leads to creation of a data volume, from which multiplanar slices are derived. Value of CBCT has already been confirmed in numerous dental and maxillofacial as well as head and neck applications. The radiation dose required for CBCT is substantially lower than for medical CT, in comparison to studies performed due to the same, making it a valuable imaging diagnostic tool in the pediatric population for the same indications as CT was applied previously. Orthodontists use CBCT for accurate analysis of impacted, additional, supernumerary teeth position, developmental defects, external resorption, and ankylosis assessment. One of the drawback of CBCT is susceptibility to artifacts decreasing image quality. Patient motion artifacts affect children with higher prevalence than cooperating adults.
The aim of the study is to present a case report of progressing transmigration in an 11-year-old girl examined by means of CBCT.
| Case Report|| |
A 9-year-old girl was referred for CBCT before orthodontic treatment due to clinical indications [Figure 1] and [Figure 1]b. Consent from patient's parents was obtained. The examination was performed by means of the CS 9000 3D machine with a FoV 50 mm in diameter and 37 mm height. The examination quality was decreased due to motion artifacts, but the overall image quality was considered suitable for diagnostic purposed and no retake was requested. In the study, a persistent right mandibular deciduous canine as well as delayed eruption of the lower left canine [Figure 2]a and [Figure 2]b was found. The minimum distance between the milk and permanent canines was 5.6 mm. The crown of the tooth number 33 was located labially in relation to the roots of teeth number 31 and 32, with severe thinning of labial compact bone [Figure 2]c and [Figure 2]d. Minimum distance between the crown of the delayed canine and labial surface of the root of the first left incisor in half of its length was 0.7 mm, and the distance reached 1 mm in relation to the same surface of the second left mandibular incisor. The spatial relationship between the neck of the permanent canine and the apex of tooth number 32 was 0.1 mm. The root of the lateral incisor was displaced in a labial direction, with no evident root resorption. The delayed permanent canine was single rooted with two root canals, including the incompletely formed apical area. Periodontal ligament space was clearly visible around the delayed canine.
|Figure 2: Cone-beam computed tomography taken on December 30, 2013. (a) Cropped panoramic slice from cone-beam computed tomography. (b) Three-dimensional reconstruction. (c) Cross-sectional slice of tooth number 31. (d) Cross-sectional slice of tooth number 32|
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Orthodontic treatment had been started in February 2015, with fixation of upper and lower permanent metallic appliance. After 9 months of therapy, when the space for tooth number 33 was prepared, periapical radiograph which was taken showed migration of the left mandibular canine [Figure 3]. CBCT examination was again requested by the clinician. The second study was performed by the same machine. Transmigration of mandibular left canine was observed [Figure 4]a and [Figure 4]b. Its cusp crossed the midline by 4 mm and was located vestibularly in relation to the root of the right lower central incisor. The minimum distance between the crown of the transmigrating canine and the root of the tooth number 41 was 1.4 mm. The crown of the canine was located labially in relation to the apex of the left lower central incisor at a distance of 1.2 mm [Figure 4]c and [Figure 4]d. Significant thinning of outer mandibular cortex with slight expansion was detected above the crown of the canine. The axis of its root was first directed downward and distally within the basal part of the mandibular body, while in the middle of the root length, a C-shaped curvature of approximately 150° was evident. As a result, the apical half of the canine root was located along the inner surface of the inferior mandibular cortex and partly within this thick cortical plate. The development of the transmigrated canine has not been completed, with the apex still being open. Periodontal ligament space was clearly visible with no radiological signs of ankylosis. On the basis of CBCT examination, the orthodontist decided to continue treatment after exposure of canine crown.
|Figure 4: Cone-beam computed tomography taken on October 15, 2015. (a) Cropped panoramic slice from cone-beam computed tomography. (b) Three-dimensional reconstruction. (c) Cross-sectional slice of tooth number 31. (d) Cross-sectional slice of tooth number 32|
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The impacted tooth was surgically exposed and orthodontic bracket was fixed on its labial surface. Transmigrated canine reacted to the treatment method and was fortunately replaced to the dental arch. During progress of orthodontic treatment, periapical X-rays [Figure 5] and photos were taken [Figure 6]a, [Figure 6]b, [Figure 6]c.
|Figure 5: (a and b) Progress in the movement of left mandibular canine to a proper position visible on periapical radiographs taken during treatment|
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|Figure 6: (a-c) Photographic images of progression of orthodontic treatment|
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| Discussion|| |
To the authors' best knowledge, this is the first described case of transmigration demonstrated in CBCT. Many cases have not been described where the transmigration was observed during a short period. Mesquita and Salgado  published a case report of a 15-year-old girl, who complained of pain and sensitivity of the lower incisors. The deciduous right mandibular canine was present in the lower arch. Clinical examination did not show any abnormalities, while panoramic X-ray demonstrated transmigration of canine. Before treatment, the patient was referred to CT examination. Aydin and Yilmaz  reported four cases of transmigration and three of them concerned mandibular canines. One panoramic radiograph revealed bilateral transmigrated lower canines, one canine changed localization from the Right, and one from the left side. In all cases, only panoramic radiographs provided information about the presence of abnormality. Vaida et al. found a transmigrated canine in a period of 3 years during orthodontic treatment. The first panoramic X-ray showed only mesial inclination of the right mandibular canine germ. Three years after the beginning of treatment, lack of permanent right mandibular canine was observed in its normal location. The second panoramic taken revealed transmigrated right canine. The patient was then referred for CBCT examination to obtain precise bone evaluation before treatment planning.
| Conclusion|| |
To the authors' best knowledge, this is the first case of observation of mandibular canine transmigration by means of CBCT that allows precise evaluation of the transmigrating tooth.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Aydin U, Yilmaz HH, Yildirim D. Incidence of canine impaction and transmigration in a patient population. Dentomaxillofac Radiol 2004;33:164-9.
Vaida L, Todor BI, Corega C, Băciuţ M, Băciuţ G. A rare case of canine anomaly – A possible algorithm for treating it. Rom J Morphol Embryol 2014;55:1197-202.
Buyukkurt MC, Aras MH, Caglaroglu M, Gungormus M. Transmigrant mandibular canines. J Oral Maxillofac Surg 2007;65:2025-9.
Mesquita P, Salgado H. Transmigrant mandibular canine – Case report. Rev Port Estomatol Med Dent Cir Maxilofac 2015;56:63-6.
Vuchkova J, Farah CS. Canine transmigration: Comprehensive literature review and report of 4 new Australian cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109:e46-53.
Javid B. Transmigration of impacted mandibular cuspids. Int J Oral Surg 1985;14:547-9.
Huang YC, Lin YC, Hung CJ, Lai YL. Surgical considerations and management of bilateral labially impacted canines. J Dent Sci 2016;11:202-6.
Aras MH, Büyükkurt MC, Yolcu U, Ertaş U, Dayi E. Transmigrant maxillary canines. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;105:e48-52.
Kara MI, Ay S, Aktan AM, Sener I, Bereket C, Ezirganli S, et al.
Analysis of different type of transmigrant mandibular teeth. Med Oral Patol Oral Cir Bucal 2011;16:e335-40.
Aydin U, Yilmaz HH. Transmigration of impacted canines. Dentomaxillofac Radiol 2003;32:198-200.
Shapira Y, Kuftinec MM. Unusual intraosseous transmigration of a palatally impacted canine. Am J Orthod Dentofacial Orthop 2005;127:360-3.
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.
Gruszka K, Różyło TK, Różyło-Kalinowska I, Denkiewicz K, Masłowska K. Transmigration of mandibular canine – Case report. Pol J Radiol 2014;79:20-3.
Madiraju GS, Rao KS, Singamaneni V. A rare case of transmigration of mandibular canine associated with an odontoma. BMJ Case Rep 2013;2013. pii: bcr2013009658.
Alves DB, Pedrosa EF, Andreo JC, de Carvalho IM, Rodrigues Ade C. Transmigration of mandibular second premolar in a patient with cleft lip and palate – Case report. J Appl Oral Sci 2008;16:360-3.
Kiljunen T, Kaasalainen T, Suomalainen A, Kortesniemi M. Dental cone ceam CT: A review. Phys Med 2015;31:844-860. doi: 10.1016/j.ejmp.2015.09.004.
Jaju PP, Jain M, Singh A, Gupta A. Artefacts in cone beam CT. Open J Stomat 2013;3:292-297.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]