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 Table of Contents  
CASE REPORT
Year : 2014  |  Volume : 26  |  Issue : 1  |  Page : 82-84

Kissing mandibular canines: Serendipity at its best


Department of Oral Medicine and Radiology, Seema Dental College and Hospital, Rishikesh, Uttarakhand, India

Date of Submission15-Aug-2014
Date of Acceptance14-Jul-2014
Date of Web Publication26-Sep-2014

Correspondence Address:
Sonali Sharma
D/o Shri R.K. Bedi, 2-Mohendra Complex, Kheri Gujjran Road, Patiala - 147 001, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-1363.141867

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   Abstract 

Transmigration of teeth is a relatively less well known phenomenon. Its etiology is not so well understood. We present a case of bilateral transmigration of mandibular canines with a type 5 classification pattern (Muparappu) in a 21 year old male patient with emphasis on its etiology and complications accompanying its management.

Keywords: Bilateral transmigration, canine impaction, kissing canines, paraesthesia


How to cite this article:
Sharma S, Raghavan V, Kumari S. Kissing mandibular canines: Serendipity at its best . J Indian Acad Oral Med Radiol 2014;26:82-4

How to cite this URL:
Sharma S, Raghavan V, Kumari S. Kissing mandibular canines: Serendipity at its best . J Indian Acad Oral Med Radiol [serial online] 2014 [cited 2020 Jun 1];26:82-4. Available from: http://www.jiaomr.in/text.asp?2014/26/1/82/141867


   Introduction Top


Although migration of teeth is a well documented ectopia, pre-eruptive migration of a tooth across the midline of the jaw (termed "transmigration"), is a rare phenomenon. [1] Prevalence of mandibular canine impaction ranges from 0.35 to 0.44%. [2] Studies have suggested that transmigration of canines is a rare phenomenon with a prevalence of about only 0.31%. [3] Qaradaghi [1] reported 2 cases and labeled them as "Kissing Canines" or "Mirror Image Canines". Similar cases have been reported by Batra et al.[4] and Ahmad et al. [5] The present case throws light upon this relatively rare phenomenon.


   Case Report Top


A 21 year old male patient reported to Oral Medicine and Radiology department with a complaint of stains on the teeth. A positive history of tobacco chewing 2-3 packets/day since 2-3 years was given by the patient. Intraoral examination revealed extrinsic stains with asymptomatic caries with respect to 37. Retained deciduous canines were seen bilaterally in the mandibular arch with a small swelling in the labial sulcus related to lower anterior teeth [Figure 1]. The swelling was about 2 cms medio-laterally and 1 cm antero-posteriorly, bony hard in consistency and non tender on palpation. A provisional diagnosis of impacted 33 and 43 was made with the possible presence of Dentigerous Cyst related to one or either of them. Radiographs were advised.
Figure 1: Retained deciduous canines with swelling in the lower labial vestibule

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Radiographic interpretation

Intraoral periapical radiograph (IOPAR) [Figure 2] showed presence of impacted 33 and 43 positioned obliquely with their labial surfaces facing one another at the midline and their roots spread apart. The teeth appeared to have a common follicular space. Orthopantomograph (OPG) [Figure 3] showed appearance similar to periapical film. Occlusal radiograph [Figure 4] revealed 33 and 43 in horizontal position with the tip of cusps at the midline. The very unique position of the impacted mandibular canines with their labial surfaces in contact, at the midline, an extremely rare occurrence, urged the authors to label it as a case of "Kissing Mandibular Canines". Patient was advised to get the impacted canines surgically removed.
Figure 2: IOPAR showing impacted 33 and 43 with their labial surfaces facing each other in the midline and their roots spread apart

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Figure 3: OPG showing impacted 33 and 43 with their labial surfaces facing each other and sharing a common follicular space

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Figure 4: Occlusal radiograph showing impacted 33 and 43 with their cusp tips in the midline

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   Discussion Top


Dental transmigration is an infrequent eruptive disorder that happens almost exclusively to mandibular canines. The rarity of transmigrant canines makes it difficult to establish their prevalence, and most cases documented in the literature correspond to isolated cases. [6] Transmigration of canines has been reported more frequently in females than males in the ratio 1.6:1.8. [7] The present case is being reported in a 21 year old male.

The term transmigration was first coined by Ando, et al. [8] Transmigration of tooth is generally a unilateral phenomenon, but 16 cases of bilateral transmigrations have been reported. In 2002, Muparappu [9] classified the impacted transmigrated canines into five categories based on their angulation and relation to tooth apices and lower border of mandible.

Type 1: Canine is impacted mesioangularly across the midline, labial or lingual to the anterior teeth with the crown portion of tooth crossing the midline.

Type 2: Canine is horizontally impacted near the inferior border of the mandible below the apices of incisors.

Type 3: Canine has erupted either mesial or distal to the opposite canine.

Type 4: Canine is horizontally impacted near the inferior border of the mandible below the apices of either premolars or molar on the opposite side.

Type 5: Canine is positioned vertically in the midline with the long axis of the tooth crossing the midline.

Qaradaghi added a 6 th type, which is defined as "the parallel migration of both canines at the same rate to the contralateral site". [1] In other words, it is a combination of type 1 and type 2. [1] Qaradaghi IF has reported two cases wherein mandibular canines have undergone transmigration bilaterally and kissed each other with their labial surfaces. [1] Ahmad, et al. [5] reported a similar case in the Indian population which was categorized as pattern 2 in accordance with Muparappu's classification. The present case belongs to pattern 5 as per Muparappu's classification which is the rarest of all the types.

The etiology of transmigration is unknown; however, abnormal displacement of the tooth bud or deviation during development is the most commonly accepted explanation. [10] The movement takes place along the path of least resistance. [3],[6],[11] The crown deviates to a more horizontal position and an abnormally strong eruptive force directs it through the dense mandibular symphysis. [12] The absence or delayed eruption of permanent mandibular canines in the arch or over-retained primary canines is common clinical findings suggestive of impacted or transmigrated canines. [3],[6] In our case, the retained deciduous canines served as an impediment to eruption of permanent canines, leading to their impaction.

The larger cross-sectional area of the anterior mandible compared with the anterior maxilla may be a reason for the higher frequency of mandibular canine transmigration. [8]

Clinical importance of transmigration can be judged from the fact that even though the teeth have transmigrated to the contralateral side, they maintain their nerve connection to the originating side. [11] Therefore, it is important to anesthetize the nerve on the originating side.

Treatment options proposed for transmigrated mandibular canines are surgical removal, transplantation and surgical exposure with orthodontic alignment. [6] Surgical extraction is the most favored treatment. [6] If the patient is symptomatic and has any associated abnormalities, such as a developing apical cyst, neuralgia, resorption of an adjacent tooth root or displacement of teeth, then surgical extraction should be planned immediately. If the patient is asymptomatic, the transmigrated canine can be left in place. [6] However, regular follow-up with radiographs is required to monitor movement of these teeth. Since our patient was completely asymptomatic, a periodic radiographic follow up was advised.

 
   References Top

1.Qaradaghi IF. Bilateral transmigration of impacted mandibular canines: Report of two cases and review. Rev Clín Pesq Odontol 2010;6:271-5.  Back to cited text no. 1
    
2.Aydin U, Yilmaz HH, Yildirim D. Incidence of canine impaction and transmigration in a patient population. Dentomaxillofac Radiol 2004;33:164-9.  Back to cited text no. 2
    
3.Alaejos-Algarra C, Berini-Aytes L, Gay-Escoda C. Transmigration of mandibular canines: Report of six cases and review of the literature. Quintessence Int 1998;29:395-8.  Back to cited text no. 3
    
4.Batra P, Duggal R, Parkash H. Canine ectopia: Report of two cases. J Indian Soc Pedod Prev Dent 2003;21:113-6.  Back to cited text no. 4
[PUBMED]    
5.Ahmad SA, Ahmad SS, Poddar RN, Masood R. Bilateral transmigration of mandibular canines: A case report and review of literature. J Dent Med Sci 2013;3:56-9.  Back to cited text no. 5
    
6.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. 6
    
7.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. 7
    
8.Ando S, Aizawa K, Nakashima T, Sanka Y, Shimbo K, Kiyokawa K. Transmigration process of the impacted mandibular cuspid. J Nihon Univ Sch Dent 1964;6:66-71.  Back to cited text no. 8
    
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.Javid B. Transmigration of impacted mandibular cuspids. Int J Oral Surg 1985;14:547-9.  Back to cited text no. 10
    
11.Shapira Y, Kuftinec MM. Intrabony migration of impacted teeth. Angle Orthod 2003;73:738-44.  Back to cited text no. 11
    
12.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. 12
    


    Figures

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



 

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