|Year : 2021 | Volume
| Issue : 5 | Page : 423-428
A review on prevalence rate, etiology, and management of impacted and transmigrated mandibular canines
Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, King Faisal University, Al Ahsa, Kingdom of Saudi Arabia
|Date of Submission||21-Jun-2020|
|Date of Decision||04-Feb-2021|
|Date of Acceptance||15-Feb-2021|
|Date of Web Publication||11-Oct-2021|
Dr. Nazargi Mahabob
Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, King Faisal University, Al Ahsa 31982,
Kingdom of Saudi Arabia
Source of Support: None, Conflict of Interest: None
Aim: To identify and analyze recently available data related to the incidence of occurrence, etiology, and treatment options for transmigrated mandibular canines. Materials and Methods: A computer-based search of studies published from January 2010 to May 2020 was conducted. The studies were selected from various electronic databases such as Medline, Google Scholar, Epub, Embase, and Cochrane on the basis of their title, study, design, keywords, Cochrane methodology, supplemented by a gray literature search, and reference lists of selected papers were manually scanned. Results: A total of 503 transmigrated mandibular canines were reported from 53 articles and 19 different countries. Based on the number of articles published, India topped with 22 publications followed by Turkey with eight publications. Based on the number of transmigrated mandibular canines reporting, Turkey topped the list with 167 teeth, followed by Poland with 99 canines. The frequency of canine impact in the mandible ranges from 0.92% to 5.1%, according to the results of our study, whereas that of canine transmigration ranges from 0.1% to 0.3%. The quest for literature also reveals that canine transmigration is almost limited to the mandible. The etiology of this disease has been due to several causes. Cone beam computerized tomography helps to provide specific information about their position, relationship with adjacent structures, and associated pathology. Conclusion: Early diagnosis, appropriate treatment plan, and prompt intervention to maintain the appearance of the esthetic and functional stability are the conclusions drawn.
Keywords: Canine, Impaction, Malocclusion, Mandible, Transmigration
|How to cite this article:|
Mahabob N. A review on prevalence rate, etiology, and management of impacted and transmigrated mandibular canines. J Int Oral Health 2021;13:423-8
|How to cite this URL:|
Mahabob N. A review on prevalence rate, etiology, and management of impacted and transmigrated mandibular canines. J Int Oral Health [serial online] 2021 [cited 2022 Aug 18];13:423-8. Available from: https://www.jioh.org/text.asp?2021/13/5/423/327863
| Introduction|| |
Migration of a tooth from its original position to a different position has been referred as an anomaly, impacted, migratory, malposed, or malerupted tooth. During the migratory movement when such a tooth crosses the midline, it is referred to as dental transmigration. The transmigration of the tooth is documented for several years and named in several words. But Ando et al. initially coined the term transmigration. Tarsitano and his associates defined transmigration because of the phenomenon of crossing the midline without the influence of any pathological cause by an unerupted tooth. The prevalence of transmigration in several populations and ethnic groups is found to be 0.33–0.46%. According to the previous researches, incidence of occurrence of transmigration is more common in female mandibles., Transmigrated tooth infrequently may erupt ectopically from other position either at the midline or on the other side of the arch. The prevalence rate of bilaterally transmigrated canine is rare than unilateral transmigration. The conclusive etiology for this rare phenomenon remains unclear. According to the classical pattern of classification, if a tooth to be mentioned as transmigrated tooth, the tooth has got to cross the midline completely either in vertical or horizontal direction.
Although Javid proposed that when the midline has reached quite half the length of the tooth, a tooth must be classified as transmigrated. However, Joshi considered that the tendency of a canine to cross the barrier of the mandibular midline suture was more important than the space of migration after crossing the midline., According to Mupparapu even half the crown or root of a tooth has crossed the midline, it is enough to be called as transmigrated tooth and he classified into five types based on their position and distance of migration. Because of complexity in their transmigratory pattern, this classification is applicable just for unilaterally transmigrated mandibular canines. Due to the fact that the prevalence rate of bilateral transmigrated mandibular canines is very rare, earlier there was no attempt made to classify them. In 2007, Mupparapu supported radiographic findings and proposed a suitable classification for bilaterally transmigrated mandibular canines.
Clinically, transmigration of tooth usually occurs without symptoms or any sort of alteration. In some cases, however, there have been symptoms, as there was an associated follicular cyst or a chronic infection with fistulation. The degree of canine inclination on a radiograph needed in early treatment plan is analyzed. Howard noted that the axial inclination of canines between 30o and 95o is a category that appears to cross the midline. For this, dentists should require a correct imaging technique, which can help in making correct treatment plan. Learning the precise anatomical morphology of the patient’s mouth reduces the danger of uncontrolled tooth eruption and thus the amount of changes within the treatment plan. Cone beam computerized tomography (CBCT) is a relatively new diagnostic method utilized in dentistry and is beneficial altogether.,
| Materials and Methods|| |
Based on the principles of Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) and CRD (Centre for Reviews and Dissemination, University of York) statements, the current review was conducted.
In the following electronic databases, a computerized systematic search of literature was carried out: Medline (via PubMed), Cochrane, ISI Web of Information, and Scopus and a limited gray literature search was conducted with the help of Google. Transmigration, canine migration, mandibular canine migration, or migrating canines and only articles mentioned in the English language were included in the search for articles published from January 2010 to May 2020 that answered the oriented research question using MeSH terminology. The reference lists of articles were scanned and relevant references were searched.
Research that involved patients with transmigration of mandibular canine original case reports, prospective and retrospective original studies on human subjects, original case reports with analysis, studies that had detailed explanations of the methods and original case reports of orthodontic and surgical care were included in only publications published in the English language.
Syndromes, abstracts, discussions, and incomplete presentation-related case studies were exclusion criteria.
The investigator independently collected data from the selected papers that addressed the clinical research questions.
The relevant data extracted from each of the included studies included the name of the author, year of publication, origin of the population studied, and occurrence of transmigration. To evaluate the quality of the reviewed articles, the Newcastle-Ottawa Scale (NOS) was introduced and the quality of the selected articles was independently assessed.
| Results|| |
The selection process for the article is shown by the PRISMA flow diagram shown in [Figure 1]. The search for electronic databases yielded 683 articles. It detected conflicting data between the databases and eliminated duplicates, after which 281 papers were screened. A total of 128 articles which were insignificant were omitted and 83 articles were chosen for full-article analysis. Fifty-three related publications that were included in the qualitative review defined the implementation of the inclusion and exclusion criteria. A total of 503 canines transmigrated from 53 papers and 19 separate countries have been registered [Table 1]. Based on the publication of the report, India was in the lead with 22 publications, followed by Turkey with eight publications [Graph 1]. Turkey topped the list with 167 teeth on the basis of the number of transmigrated mandibular canines, followed by Poland with 99 canines [Table 2].
|Table 1: Summary of transmigration of mandibular canines from 2010 January to 2020 May|
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|Graph 1: Sum of published articles related to TMC between January 2009 and May 2020|
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| Discussion|| |
This extensive systematic search resulted in the discovery of 53 papers published between January 2009 and May 2020 from different countries. All the knowledge related to this research was summarized in [Tables 1] and . An assessment of the occurrence of mandibular canine transmigration was one of the objectives of this study. The occurrence of transmigrated mandibular canine varied between 0.1% and 1.8% of the confirmed values already recorded in previous narrative analyses, according to this analysis., The prevalence of mandibular canine effect is 0.31% in the general population. Women tend to have more incidence compared with males and the left side of the mandible has more incidence than the right side.
In all 53 articles, etiology was considered and when possible it was investigated.
The suggested causes of the impact included irregular dental lamina displacement during embryonic life, inherited factors, diseases, failure of the endocrine glands, mandibular incisor vestibular inclination, and mandibular traumatic fracture near the site of mandibular canine eruption.
The suggested causes of the impact included irregular dental lamina displacement during embryonic life, inherited influences, cancers, endocrine gland dysfunction, mandibular incisor vestibular inclination, mandibular traumatic fracture near the site of mandibular canine eruption, and other local factors such as odontomas, cysts, adjacent teeth shape defects, and retained root stump. These observations are in line with those from previous reviews.,,,
Timely intervention will prevent one of the following consequences of canine impaction:,,,
- Malpositioning of the impacted tooth,
- Displacement of adjacent teeth leads to changes in arch length/shape,
- Internal resorption/external resorption,
- Cystic changes,
- Infection from partially erupted tooth,
- Tempero mandibular joint (TMJ) problems and myofacial pain distress syndrome.
The moment of diagnosis plays a vital role in handling the transmigrated tooth. The most significant steps in the treatment of infected canines are the detection and diagnosis of the affected canine and its location., Via proper clinical and radiographic examinations, it can be achieved. In order to assess whether or not the eruption pattern of teeth happens according to the chronology, the patient’s age should be compared with dentition during the clinical review.
For effective care, it is important to accurately locate transmigrated canines and to evaluate their relationship to adjacent anatomical structures., Only with radiographic techniques that have a 3D viewing facility can this precision be achieved., For this reason, CT was previously widely used. 3D CBCT is now possible to detect the exact location of the infected tooth and its relationship to the adjacent structures, and CBCT is economical and offers less radiation compared to CT., CBCT images have been shown to be helpful for precise diagnosis, treatment preparation, and related structure detection.
Various types of techniques have been implemented for the treatment of impacted and transmigrant mandibular canines, such as orthodontic traction, auto transplantation, and surgical removal of impacted canines; and orthodontic traction, auto transplantation, surgical removal, and radiographic monitoring of transmigrant canines.,
Since it is considered simpler and quicker to get the canine to its normal position, the most commonly practiced therapy technique for transmigrated mandibular canines was surgical removal and followed by orthodontic management. In order to achieve ideal function and esthetics, orthodontic traction was designed by repositioning the tooth whenever the root development stage is favorable. It is the most effective method to restore physiological occlusion, while orthodontic traction is potentially more complex and complicated.,,
A selection bias such as including and excluding papers, searching for key terms, etc., which variably affects all systematic reviews, is the potential shortcoming of this systematic review. The non-homogeneous nature of the study and the low prevalence rate of transmigrated mandibular canines resulted in a limited sample size. In addition, available data mainly derived from particular populations (mainly Indian, Turkish, and Polish) may not be entirely representative of the general population. This can be remedied by carrying out new research of more broader groups of representative populations.
| Conclusions|| |
- The incidence of transmigrated mandibular canine ranges between 0.1% and 1.8%.
- There was no concise on the precise etiology.
- For treatment choices and prognosis, the time of diagnosis plays a critical role.
However, the most preferred treatment options are surgical extraction followed by orthodontic management.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
Ethical policy and institutional review board statement
Patient declaration of consent: (if in-vivo study/case reports)
Data availability statement
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[Figure 1], [Figure 2]
[Table 1], [Table 2]