|Year : 2009 | Volume
| Issue : 1 | Page : 46-49
Transmigration of mandibular canine: A case report and review of literature
Department of Oral Medicine and Radiology, B.V.U.D.C, Pune, India
|Date of Web Publication||14-Nov-2009|
Department of Oral Medicine and Radiology, B.V.U.D.C, Pune
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Transmigration of mandibular permanent canine is a rare event, the etiology of which is not clear. Pre-eruptive migration of a tooth across the midline is termed "transmigration. Here we present a case report. The literature on this rare condition is reviewed, its etiological possibilities are discussed.
Keywords: Canine, transmigration
|How to cite this article:|
Charantimath S. Transmigration of mandibular canine: A case report and review of literature. J Indian Acad Oral Med Radiol 2009;21:46-9
|How to cite this URL:|
Charantimath S. Transmigration of mandibular canine: A case report and review of literature. J Indian Acad Oral Med Radiol [serial online] 2009 [cited 2020 Jan 23];21:46-9. Available from: http://www.jiaomr.in/text.asp?2009/21/1/46/57779
| Introduction|| |
Failure of eruption of the mandibular canine is an unusual event. Grover and Larton found 11 mandibular canines on 5000 individuals. 
An unerupted tooth occasionally migrates to a location some distance away from the side in which it developed but it usually remains within the same side of the arch.
The movement of an unerupted canine across the dental midline is unusual and therefore worthy of investigation. Tarsitino et al. described this anomaly as transmigration or movement of an unerupted tooth across the midline without the influence of any pathologic entity.  Because this phenomenon is so rare, it was thought that this case of canine transmigration across the mandibular midline observed at the B.V.U.D. College Pune merited reporting.
| Case Report|| |
A healthy 14-year-old male patient reported to the Department of Oral Medicine, Diagnosis and Radiology with the chief compliant of mobility of teeth in the lower front region of the jaw since one week.
Intraoral examination revealed retained deciduous canine in the third quadrant [Figure 2] with Grade I mobility. An intraoral periapical radiograph was advised which showed impacted canine and radiolucency with defined corticated border around the crown situated in relation to 43, 44 as seen in [Figure 3].
An orthopantomograph was advised to determine the placement of impacted canine, which revealed horizontally impacted canine (33), at the root apices of canine and premolar (43,44). A well-defined radiolucency around the crown with defined corticated border extending from the cemento-enamel junction and crossing the midline as seen in [Figure 4]. was observed.
Further occlusal radiograph was taken which confirmed labially placed canine and expansion of buccal cortical plate as seen in [Figure 5].
Based on clinical examination and radiological features, provisional diagnosis of transmigration of mandibular canine with cyst was given.
| Discussion|| |
Displacement of an unerupted tooth is not an uncommon occurrence and the tooth most frequently malposed in the dental arch is the maxillary canine but the displacement of mandibular canine is uncommon and its transmigration across the midline to the opposite side is extremely rare because of embryonic sutural closures. 
Mupparappu  used five criteria to classify the transmigrated canine. These are summarized as follows.
Type I: The canine is impacted mesioangularily across the midline, labially or lingual to the anterior teeth with the crown partition of the tooth crossing the midline.
Type II: The canine is horizontally impacted near the inferior border of the mandible below the apices of the incisors.,
Type III: The canine has erupted either mesial or distal to the opposite canine.
Type IV: The canine is horizontally impacted near the inferior border of the mandible below the apices of either the premolar or molars on the opposite side.
Type V: The canine is positioned vertically in the midline with the long axis of the tooth crossing the midline.
Etiology of transmigration of mandibular canine
The etiology and exact mechanism of transmigration is still not clear, although a number of factors have been suggested. Tumors, cyst, and odontomos may cause malposition of teeth if they lie in the path of eruption of teeth. Other factors suggested by some authors as possible etiological factors are premature loss of deciduous teeth, retention of deciduous canine, crowding, spacing, supernumerary teeth and excessive, length of the crown of mandibular canines. ,
Howard observed that those unerupted canines that lie between 25 0 and 30 0 in the midsagittal plane do not migrate across the mandibular midline. Those canine between 300 and 950 tend to cross the midline. An overlap appears to exist between 300 and 500 when the angle exceeds 500, crossing the midline becomes a rule. 
Javid, Joshi and Shetye suggested that the cause of transmigration may be an abnormally strong eruption force which drives the canine through the dense symphysis. They also noted that the conical shape of the teeth aids its passage through the bone, ,,
Thoma  , Fiedler and Alling.  reported cases in which a radiolucent area resembling a cystic lesion surrounded the transmigrated canine. However, it is difficult to say whether these pathological conditions were responsible for the transmigration or whether the pathological condition occurred after the migration of canine.
Vechi and Frenchi  suggested that agenesis of the adjacent teeth, in particular the lateral incisor, may favor retention of the primary canine and that the excess space in the dental arch may account for the absence of a correct guide for eruption. They observed proclination of the lower incisors, increased axial inclination of the unerupted canine and an enlarged symphyseal cross-sectional area of the chin in nearly all their cases. They suggested that these factors could play an important role in
Alaejsos Algarra et al. stated that canine tooth germs are located further from the normal site of eruption than are germs of other teeth. An anomalous portion of the tooth germ may also be involved in the pathogenesis of canine transmigration. 
Although the migration of teeth is a well-recognized phenomenon transmigration of mandibular canine is rare and not many cases are reported with pathology. However, in this case, transmigration of canine was associated with cyst.This was in accordence to Thoma, who reported cases with radiolucent area resembling a cystic lesion surrounding the transmigrated canine.  In the present case the canine had migrated to the right side and was lying horizontally near the inferior border of mandible below the root apices of the canine and premolars, crossing the midline, which is in Type II category
Mitchel and Nixon  and Lowely presented reports of cases in which the probable etiology of the displacement of a lower canine was a mandibular fracture through the developing crypt.
Peck  cited the role of genetics in the etiology of ectopic mandibular canine. He noted bilateral occurrence and the elevated occurrence of hypodontia and palatally displaced canines in the 12 cases of Vichi and Frenchi. according to Mupparapu's classification of transmigrated canine.
In our case, the patient was asymptomatic although a cystic lining was present in the radiograph which was in accordance with the study done by Al-wahedi who suggested that transmigrated canines are usually associated with a cystic lesion and that the presence of a cyst at the crown of the canine may facilitate the migration process.
As in our case the transmigration of canine was associated with cystic lining surgical extraction with enucleation of cyst was advised rather than a heroic effort to bring the tooth back to its original place.
It is advised that, if deciduous canines do not exfoliate in time, it is mandatory to determine the position of the developing permanent canines radiographically and if a slight change in the direction of the tip of mandibular canine is detected, the prompt removal of deciduous canine may be carried out to encourage its eruption in its normal position.
| Summary|| |
A case of transmigration of mandibular canine with cystic change is reported. Early extraction of over-retained deciduous canine to prevent malpositioning of permanent canine and early radiological evaluation of position of developing permanent canine before occurrence of any pathology with surgical orthodontic management to prevent transmigration are suggested.[Figure 1]
| References|| |
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]