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Patterns of intra-osseous transmigration and

ectopic eruption of mandibular canines: Review
of literature and report of nine additional cases

Article in Dentomaxillofacial Radiology December 2002

DOI: 10.1038/sj.dmfr.4600732 Source: PubMed

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 Dentomaxillofacial Radiology (2002) 31, 355 360
2002 Nature Publishing Group. All rights reserved 0250 832X/02 $25.00
www.nature.com/dmfr

RESEARCH

Patterns of intra-osseous transmigration and ectopic eruption of

mandibular canines: review of literature and report of nine
additional cases
M Mupparapu*,1
1
University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania, USA

Objectives: The purpose of this study is to (1) investigate the patterns of transmigration and
eruption of permanent mandibular canines, plus the mechanisms aecting the eruption path, (2)
classify the transmigration paths.
Material and methods: A retrospective radiographic study using full mouth (FMX) and
panoramic radiographs of dental radiology patients between July 1996 and July 2000.
Transmigrated canines were identied from the radiographic records of 2150 new patients. The
literature was reviewed regarding the individual patterns of canine transmigration and their
nal position within the mandible. A pattern classication was developed using literature data
and the additional nine cases reported here.
Results: In the present study, mandibular canines were found transmigrated on nine occasions
and, in a further six cases, found impacted without transmigration. Out of the nine cases, seven
were female (ages 17 38) and two were male (ages 20 and 69). One female patient had a
bilateral transmigration of the mandibular canines. A total of 127 transmigrated canines were
reported in 50 published studies from the literature. Transmigrated canines appear to fall into
ve patterns (Type 1 5) depending on their path of deviation. Type 1 was most common
(45.6%) followed by Type 2 (20%), Type 4(17%), Type 3(14%) and Type 5 (1.5%).
Conclusions: Patterns of mandibular canine transmigration can be classied into ve distinct
patterns. The majority of cases demonstrated Type 1 transmigratory pattern. No clear aetiology
of this disorder could be found.
Dentomaxillofacial Radiology (2002) 31, 355 360. doi:10.1038/sj.dmfr.4600732

Keywords: tooth migration; transmigration; tooth, cuspid; tooth, impacted

Introduction describe the clinical and radiographic presentations of

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. There are currently at least 50 published
reports on canine transmigration with the rst reported
in 1951.1 It is believed that transmigration is unique to
the mandibular permanent canines2 as it has not been
reported for other teeth.
The aim of this study is to examine the path of travel
and eruption of all reported transmigratory canines, to
*Correspondence to: Dr M Mupparapu, Department of Oral Medicine, Division
of Oral and Maxillofacial Radiology, University of Pennsylvania School of
Dental Medicine, 4001 Spruce Street, Philadelphia, PA 19104, USA;
E-mail: murali96@pobox.upenn.edu
Received 14 November 2001; revised 13 March 2002; accepted 12 June 2002
these anomalous teeth, to compare the features of nine
new cases to existing cases and to classify the patterns
of transmigration of the mandibular canines.
Materials and method
Records of a total number of 2150 patients who
attended the Radiology clinics of our Dental School
between July 1996 and July 2000 were studied to
identify transmigrated mandibular canines. Records
were selected based on the presence of either a full
mouth radiographic series (FMX) or a panoramic
radiograph with selected periapicals (PA) and bitewings
(BW). If patient records had any missing radiographs,
they were excluded from the study. Patients' demo-
graphic information were obtained from the records.
 Canine transmigration
M Mupparapu
356
Table 1 Clinical and radiographic features of transmigrated mandibular canines observed in the present series of nine patients
Patient Position of the Eruption Primary Associated
number Age Sex transmigrated canine status canine pathology/remarks
1 17 F Positioned mesio-angularly labial Impacted CR None
to the incisors. Crown crossing the
midline (Type 1)
2 20 M Positioned mesial to the opposite canine Impacted CE None
(Type 3)
3 22 F Horizontally positioned near the lower Impacted CE None
border apical to incisors (Type 2)
4 19 F Positioned horizontally at the lower Impacted CR Compound odontoma
border below the apices of premolars
on the opposite side (Type 4)
5 30 F Positioned mesio-angularly near the Impacted CE None
incisors, crown crossing the midline
(Type 1)
6 26 F Bilaterally crossing midline below incisor Impacted CR-1 None
apices (Type 1) CE-1
7 69 M Midline position enveloped in a cystic Impacted Edentulous Large dentigerous cyst
lesion (Type 5)
8 19 F Midline eruption of canine (Type 5) Erupted CR Tooth rotated
9 21 F Midline eruption of canine (Type 5) Erupted CE Tooth rotated
CE=primary canine exfoliated; CR=primary canine retained; F=Female; M=Male

Table 2 Chronological listing of cases and data for transmigrated mandibular canines
Study Erupted or Retained Type Type Type Type Type Associated
Author/s Year T Uni/Bi impacted primary Sex-Age I II III IV V anomalies
1 Bluestone 1951 2 Uni NR NA Dentigerous
cyst
2 Thoma 1952 1 Uni I NR NA 1 None
3 Caldwell 1955 1 Uni I NR F-31 1 None
4 Bruszt 1958 2 Uni E CE F,M-NA 2 None
5 Stafne 1963 1 Uni I NR NA 1 None
6 Ando et al 1964 1 Uni I CE M-8 1 None
7 Kaufman et al 1967 1 Uni E NR F-19 1
8 Fiedler and Alling 1968 1 Uni I CR F-16 1 None
9 Pratt 1969 1 Uni E CR M-19 1 None
10 Pindborg 1970 2 Uni I CR M-15
11 Tarsitano et al 1971 3 Uni I CR-2 M-NA 2 1
CE-1
12 Heiman 1973 1 Uni I CR F-30 1
13 Wechsler 1973 1 Uni I NR F-12
14 Black and Zallen 1973 1 Uni I CR M-23 1 None
15 Miranti and Levbarg 1974 1 Uni I CR F-17 1 None
16 Grenberg and Orlian 1976 1 Uni I NR M-8 1 Dentigerous
cyst (1)
17 Howard 1976 8 Uni I CR-2 M(2) 5 1 2 None
CE-6 12-13
F(6)11-20
18 Barnett 1977 1 Uni E labial CE F-24 1 None
19 Cowman and Wootton 1979 1 Bi I CR-2 M-16 2 None
20 Abbot et al 1980 1 Uni E CR F-62 1 None
21 Hebda et al 1980 1 Uni I NR M-21 1 None
22 Zvolanek et al 1981 1 Uni I NR M-31 1 None
23 Joshi et al 1982 1 Bi I CR-1 M-19 2 None
24 Shapira et al 1982 3 Uni E-1 NR M-11 2 1 Odontoma (1)
25 Kerr 1982 1 Uni I CR F-9 1
26 Sofat 1983 1 Uni E CR M-20 1
27 O'Carroll 1984 1 Uni I CR F-28 1 Complex
odontoma
28 Vascova et al 1984 1 Uni I CR NA-14 1 None
29 Barsley 1984 1 Uni I CR F-24 1 None
30 Nashashibi et al 1984 2 Uni I NR M-19, 1 1
24
31 Javid 1985 13 8 Uni I CR-9 F(8)13-52 3 Infected
3Bi CR-1 M(5)17-33 Dentigerous cyst(1)
NR-3 chronic intraoral
fistula(2)
Continued

Dentomaxillofacial Radiology

Canines were considered transmigrated if the path of
eruption had been altered and the tooth drifted to the
opposite side of the mandible with at least half the
length of the crown crossing the midline. Observations
were made on the number and status of missing
permanent mandibular canines; retained deciduous
canines; transmigratory pattern of canines and any
other associated pathology (Table 1).
A literature search was made of all reported
transmigrated cases of mandibular canines and added
to the new case reports. The total number of cases in
each study, position and transmigration status
(unilateral or bilateral), the gender and the age of the
patients and any associated pathology were recorded
(Table 2).
The following criteria were used to describe
transmigration patterns: inclination of the long axis
of the canine, relationship of the canine and, in
particular, the crown with the midline, adjacent teeth
and contralateral erupted canine. The transmigrated
Canine transmigration
M Mupparapu
357
teeth were classied (Types 1 5) based on their
migratory pattern and the nal position within the
jaw when diagnosed. The following criteria were used
to classify the transmigrated canines.
. Type 1: Canine positioned mesio-angularly across
the midline within the jaw bone, labial or lingual to
anterior teeth, and the crown portion of the tooth
crossing the midline.
. Type 2: Canine horizontally impacted near the
inferior border of the mandible below the apices
of the incisors
. Type 3: Canine erupting either mesial or distal to
the opposite canine
. Type 4: Canine horizontally impacted 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
( the long axis of the tooth crossing the midline)
irrespective of eruption status.

Table 2 Continued
Study Erupted or Retained Type Type Type Type Type Associated
Author/s Year T Uni/Bi impacted primary Sex-Age I II III IV V anomalies
32 Jalili 1986 1 Bi I CE-1 M-16 1 1 None
33 Zvolanek 1986 1 Uni I NR F-25 1
34 Dhooria et al 1986 3 Uni I NR F-17 2 1 None
M-19,22
35 Gadgil 1986 1 Bi I CR-2 M-26 2 Impacted
23,24,25,26
apart from
canines
36 Mehta et al 1986 1 Bi I CE F-19 2
37 Broadway 1987 1 Uni I CR F-15 1 None
38 Gadalla 1987 1 Uni E CE F-22 1 Crown
erupted
39 Ripari et al 1988 1 Uni I CR M-9 1 Extra-orally
40 Vichi Franchi 1991 15 14 I-14 CR-11 F(11)10-42 11 1 1 2
Uni1 E-1 CE-4 M(4)9-13
Bi
41 Shanmuhasuntharam 1991 2 Uni I NR F-20 1 1 Compound
and Boon M-52
42 Mitchell 1993 1 Uni I CR M-13 1 None
43 Brezniak 1993 1 Uni I CR F-19 1 None
44 Joshi et al 1994 2 Uni I CR-1 F(2) 14 1 1
CE-1
45 Wertz 1994 4 Uni I CR-3 M(2) 12-13 4 Cyst(1)
CE-1 F(2)9,
12
46 Karbanda and 1994 2 Uni I NR M-11 1 1
Choudhury F-12
47 Kuftinec et al 1995 1 Bi I CE NA 2
48 Al-Waheidi 1996 5 2 Bi I CR-3 F(5) 9-20 2 3 Dentigerous
3 Uni CE-1 cyst
NR-2
49 Costello et al 1996 2 Uni F-19 1 1
M-33
50 Alaejos-Algarra 1998 6 5 Uni I CR-1 F(1) 28 3 3 None
et al 1 Bi NR-5 M(4) 16-28
51 Joshi 2001 28 24 I-23 CR-22 F(18)9-23 11 4 9 4 Odontoma(1)
Uni E-1 CE-10 M(10)11-22
4 Bi
Total number of impacted 127 59 26 19 22 2
canines
T=Total number of cases reported; Uni/Bi=Unilateral/bilateral; NA=not available; CR=Retained primary canine; CE=Exfoliated primary
canine; NR=status not reported; F=Females; M=Males; E=Erupted; I=Impacted

Dentomaxillofacial Radiology
 Canine transmigration
M Mupparapu
358
A scheme of the canine position for each Type is the literature (Table 2) showed that out of 127 reported
depicted in Figure 1. canine transmigrations worldwide, 58 teeth t into the
criteria for Type 1(45.6%), 26 into Type 2 (20%), 19

Results

A total of nine patients (Table 1) had transmigrated

canines with seven in females (ages 17 38 ) and two in
males (ages 20, 69). Three canines migrated from the
left side, two from the right, one was bilateral and
three were in the midline. Four patients had retained
primary canines and the rest exfoliated primary
canines. In the three midline cases, the canines were
rotated on their long axes. One canine was impacted in
the midline of the mandible enveloped in a large cystic
lesion (Figure 2). The other two erupted into the oral
cavity in the midline (Figure 3). The rest of the
transmigrated canines were in varying stages of intra-
osseous travel and positioning within the mandible
(Figure 4 and 5). Out of the nine cases in the present
study, three canines exhibited Type 1 transmigratory
pattern (33%), Types 2, 3 and 4 had one each (11%),
and three of the canines were classied as Type 5
transmigration (33%). The analysis of the data from

Figure 3 Periapical radiograph showing transmigrated mandibular

left canine to the midline

Figure 1 Diagramatic representation of the ve distinct patterns of

transmigration Types 1 5. Retained deciduous tooth (tooth #83) is
also represented in the schematic

Figure 4 Impacted, transmigrated left mandibular canine seen at the

lower border of the mandible below the apices of right mandibular
Figure 2 Transmigrated mandibular canine in the midline enveloped premolars on a cropped panoramic radiograph. Notice the retained
in a large cystic radiolucency deciduous canine and an odontoma apical to it

Dentomaxillofacial Radiology

Figure 5 Cropped panoramic radiograph showing the right
mandibular canine seen transmigrating to the left side. No associated
pathology is seen
into Type 3(14%), 22 into Type 4(17%) and only two
in Type 5 (1.5%). The majority of the patients had a
retained deciduous tooth at the time of diagnosis of
this condition.
Discussion
Transmigration of mandibular canines is a rare
phenomenon with the review of the literature1 55
showing only 127 instances (Table 2). The canines
were bilaterally transmigrated in at least 14 instances
among 10 published reports.3 12 It has been reported
that impactions of maxillary canines are 20 times as
high as mandibular cuspids.13
In early reports, a precise denition of transmigra-
tion, in terms of tooth position, was lacking, leading to
spurious case reports.14 Javid5 suggested that a tooth be
classied as transmigrated when more than half of the
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