Dentomaxillofacial Radiology (2004) 33, 164–169

q 2004 The British Institute of Radiology

http://dmfr.birjournals.org

RESEARCH

Incidence of canine impaction and transmigration in a patient

population
U Aydin*, HH Yilmaz and D Yildirim

Department of Oral Diagnosis and Radiology, School of Dentistry, Süleyman Demirel University, Isparta, Turkey

In this study, 4500 consecutive panoramic radiographs were prospectively reviewed. The incidence
of canine impaction was found to be 3.58% and the incidence of canine transmigration was 0.31%.
There were six maxillary and eight mandibular transmigrant canines. The incidence of impacted
canine teeth and transmigration of maxillary and mandibular canines may be more frequent than was
previously thought, at least in some populations.
Dentomaxillofacial Radiology (2004) 33, 164–169. doi: 10.1259/dmfr/15470658

Keywords: tooth, migration; cuspid; tooth, impacted; radiography, panoramic

Introduction

Maxillary canine impaction is a well known dental
anomaly and the incidence is in the range 0.8 – 2.8%.1 – 3
Mandibular canine impaction is less frequent and the
incidence was reported to be 20 times lower than that for
maxillary canines.4 Migration of a tooth across the midline
is an even rarer anomaly; however, at least 157 cases of
mandibular canine transmigration have been published.5 –
10
Although the vast majority of the cases were impacted,
erupted cases were also presented.5,11 – 13 Most of the cases
were unilateral, but transmigration may also be bilat-
eral.6,11,14 – 17 Previously this condition had been described
only in mandibular canine teeth.5,11 In a recent publication,
however, one case of an impacted maxillary canine was
reported.6 There are few reports on the incidence of
transmigration.14,18 In addition, owing to the lack of
published reports on maxillary cases, little is known
about their transmigration patterns.
In this study, we attempted to determine the incidence of
transmigrant maxillary and mandibular canine teeth in a Turkish
subpopulation. Another purpose of the study was to evaluate
transmigrant maxillary and mandibular canine teeth with regard
to their transmigration patterns. The incidence of impacted
maxillary and mandibular canines was also determined.
Materials and methods
In this study, 4500 consecutive panoramic radiographs
made in our Department of Oral Diagnosis and Radiology
*Correspondance to: Ulkem Aydin, Süleyman Demirel Universitesi, Dishekimligi
Fakultesi, Oral Diagnoz ve Radyoloji Bolumu, Dogu Kampusu, 32200 Çunur,
Isparta, Turkey; E-mail: ulkem_aydin@yahoo.com
Received 12 January 2004; accepted 2 March 2004
were prospectively reviewed. Intraoral examination was
also performed for all patients. A tooth was accepted as
impacted if the tooth was not exposed to the oral cavity and
the age of the patient was above 16 years. The incidence of
canine impaction and transmigration was determined, and
the features of the transmigration cases were evaluated,
including demographic information.
Tracings of the radiographs showing transmigrated
canine teeth were made on acetate paper using a 0.5 mm
lead pencil, in a room with subdued lighting on a standard
viewbox, which was masked to cover all but the radio-
graph. The impacted teeth and all the anterior teeth
(if present) were traced. The inferior orbital margin was
used as a horizontal reference plane. A vertical line was
drawn from the midpoint of this horizontal line, to
demonstrate the midline. Transmigration was defined as
migration of a tooth across the midline regardless of the
distance. The case was excluded if transmigration could
not be confirmed by occlusal radiography. The mesial
angle formed between the long axis of the transmigrant
canine teeth and the mid sagittal plane was also recorded.
Figures 1a and 1b show a tracing superimposed on the
panoramic radiograph, and the occlusal radiograph,
respectively.
The transmigrant mandibular canines were classified
according to Mupparapu.5 The classification can be
summarized as: Type 1, canine positioned mesio-angularly
across the midline, labial or lingual to the anterior teeth;
Type 2, canine horizontally impacted near the inferior
border of the mandible inferior to the apices of the incisor
teeth; Type 3, canine erupting on the contralateral side;
Type 4, canine horizontally impacted near the inferior
border of the mandible below the apices of posterior teeth
 Impaction and transmigration
U Aydin et al 165

Figure 1 Patient 1 (maxillary). (a) Panoramic radiograph and superimposed tracing demonstrating canine transmigration. (b) Occlusal radiograph
showing right canine transmigration

on the contralateral side; Type 5, canine positioned
vertically in the midline with the long axis of the tooth
crossing the midline.
Results
In the present study, the incidence of canine impaction was
found to be 3.58%. Thirty-three (20.49%) patients had
more than one impacted maxillary or mandibular canine.
The number, incidence, age and gender ratio for impacted
canines are shown in Table 1. Among the 4500 patients
who had panoramic radiographs, 14 had transmigrant
canines. The incidence of canine transmigration was
0.31%. The number, incidence, age and gender ratio for
transmigrated canine teeth are given in Table 2.
Among the six transmigrant maxillary canine teeth, three
canines migrated from the left side and three from the right,
and only their crowns were crossing the midline up to half of
their length. Figure 2 shows a case of a transmigrated
maxillary canine. Three patients had retained deciduous
canines at the time of diagnosis. Three patients had dental
developmental anomalies, but none of the patients had
associated pathologies. Figure 3 shows a transmigrated
maxillary canine and microdont lateral incisors. The clinical
and radiographic features of the cases are shown in Table 3.
Five of the patients were not aware of the condition and
there were no complaints related to the transmigrant canine
teeth. The patients attended because of orthodontic or
prosthetic purposes or other dental problems. One patient
was complaining of trauma to the soft tissues, as the tooth
was partially erupted (Figures 4a and 4b). In four of the
patients, the decision was to keep the patient under
observation with periodic panoramic examinations as they
denied surgical treatment. Two patients were operated for
extraction and there were no intraoperative or post-
operative complications.
There were eight transmigrant mandibular canines. Five
canines migrated from the left side and three from the right.
Two patients had retained deciduous canines and six had
exfoliated deciduous canines. All of the patients had dental
developmental anomalies and/or associated pathologies.
Classification of transmigrant mandibular canines, and
clinical and radiographic presentations of the cases are
shown in Table 4. Figure 5 demonstrates a case classified
as Type 1. There were no related complaints and seven of
the patients were not aware of the condition. One patient
was aware of her impacted tooth because of a previous
radiographic examination made in another centre, and she
attended for a follow-up radiographic evaluation (Figure 6).
In five of the patients, the decision was observation with
regular panoramic examinations as they denied surgery.
Three of the patients were operated through intraoral
approaches and there were no intraoperative or post-
operative complications.
Axial inclinations of the transmigrant maxillary canine
teeth varied from 438 to 828 (mean 62.58) and the
mandibular cases varied from 408 to 938 (mean 66.388).
The mean axial inclination for all transmigration cases was
64.718.
Discussion
The incidence of maxillary canine impaction varies
between 0.8% and 2.8%, depending on the population
studied.1 – 3 Mandibular canine impaction is regarded as
a much rarer phenomenon and there are limited number of

Table 1 Incidence, age and gender ratio for canine impaction

Cases Incidence (%) No. of teeth Males Females Gender ratio Mean age (years) Age range (years)
Canine impaction 161 3.58 198 64 97 M1:F1.51 32.70 11 – 81
Maxillary canine impaction 148 3.29 176 56 92 M1:F1.64 33.20 16 – 81
Mandibular canine impaction 20 0.44 22 9 11 M1:F1.22 29.35 11 – 70

Table 2 Incidence, age and gender ratio for transmigrant canines

Cases Incidence (%) Males Females Gender ratio Mean age (years) Age range (years)
Canine transmigration 14 0.31 9 5 M1:F0.56 36.14 11 – 74
Maxillary canine transmigration 6 0.13 3 3 M1:F1 38.67 16 – 74
Mandibular canine transmigration 8 0.18 6 2 M1:F0.33 34.25 11 – 70

Dentomaxillofacial Radiology
 Impaction and transmigration
166 U Aydin et al

the results indicated that 3.6% had at least one impacted

Figure 2 Patient 5 (maxillary). Cropped panoramic radiograph reveal-
ing transmigrated left maxillary canine, absence of left incisor, retained
left deciduous canine and microdont right lateral
Figure 3 Patient 4 (maxillary). Occlusal radiograph showing transmi-
grated right maxillary canine
studies revealing its frequency of occurence. In one study,
eight unerupted mandibular canines were found in 7886
individuals, and in another study 11 impacted mandibular
canines were found in 5000 individuals, resulting in an
incidence of 0.10%.1,19 In our patient population, the
incidence of maxillary canine impaction was 3.29% and
the incidence of impacted mandibular canines was 0.44%.
In another study made on 1000 Turkish patients, the
incidence of maxillary canine impaction was 2.9% and
mandibular canine impaction was 0.3%.20 The results of
our study are in line with this report. In one study, 4898
Saudi patients aged 13 years and older were examined and
cuspid.21 Another study analysed 1858 11 – 18-year-old
children presented for orthodontic treatment and the results
revealed 101 cases of impacted cuspids (5.43%).22 These
results indicate that the incidence of canine impaction may
be higher in some populations.
Transmigration of canine teeth is regarded as a rare
entity, but there are a limited number of studies on its
incidence. Javid14 reported a radiographic survey of
1000 students that revealed one transmigrant impacted
mandibular canine, and Zvolanek18 reviewed 4000 patient
records but failed to find any cases. In our prospective study
of 4500 patients’ panoramic radiographs, 14 cases of canine
transmigration were found, revealing an incidence of
0.31%. Further studies are necessary to reveal the incidence
of transmigration in other populations. In the present study,
males tend to have this condition more frequently than
females, possibly owing to the limited number of cases.
When the results of the present study were added to the
available data, the gender ratio for mandibular canine
transmigration was found to be 1M: 1.30F in a total of 150
cases in which the gender of the patient was mentioned.
Despite the differences reported in case series and reviews,
an overall evaluation shows that canine transmigration
is encountered more frequently in females than in
males.5,6,8 – 11
Transmigration was defined as movement of an
unerupted mandibular canine across the midline without
the influence of any pathological entity.14 However, it was
also noted that it may not be possible to decide whether
pathological conditions were responsible for the transmi-
gration of the teeth or not.5,11 Therefore, teeth that were
associated with dentigerous cysts and odontomas and
crossing the midline were considered as transmi-
grant.6,9,11,14,23 – 26 Another definition for transmigration
was “an impacted tooth that has crossed the midline more
than half of its length”.14 On the other hand, it was also
stated that the more important consideration should be the
tendency of the tooth to cross the midline, not the distance
of the migration, and the stage of transmigration will
depend on the time of diagnosis.11 Transmigration was also
defined as pre-eruptive migration of a tooth across the
midline.27 Peck28 states that intraosseous migration of
unerupted, horizontally impacted mandibular canine has
been called transmigration because of the mesial move-
ment of the tooth across the mandibular symphysis to the
opposite of the lower jaw. These descriptions present the
need for a consensus definiton for transmigration and

Table 3 Features of transmigrant maxillary canine cases

Case No. Axial inclination Right/left Retained deciduous Dental anomalies Associated pathologies Age (years) Sex
1 518 Right 2 — (edentulous) — 47 F
2 678 Right 2 Impacted maxillary left canine (partially — 52 F
edentulous)
3 438 Left þ — — 16 F
4 658 Right þ Microdont maxillary lateral incisors — 22 M
Microdont right maxillary third molar
5 678 Left þ Absence of left maxillary lateral incisor — 21 M
Microdont right lateral incisor
6 828 Left 2 — (edentulous) — 74 M

Dentomaxillofacial Radiology
 Impaction and transmigration
U Aydin et al 167

Figure 4 Patient 3 (maxillary). (a) Intraoral photograph showing partially erupted maxillary canine tooth. (b) Occlusal radiograph revealing
transmigrated canine tooth

Table 4 Classification of transmigrant mandibular canines and features of the cases

Case Axial Retained deciduous Age
No. Type inclination Right/left canine Dental anomalies Associated pathologies (years) Sex
1 1 628 Right 2 — Pericoronal radiolucency 11 M
2 1 768 Left 2 — Pericoronal radiopacity 47 M
(odontoma ?)
3 1 708 Right 2 — (partially edentulous) — 54 M
4 1 668 Left 2 Partially impacted third molars Enlargement of the follicle 18 M
5 2 938 Right þ Partially impacted mandibular third molars — 22 F
Retained maxillary right deciduous canine
Absence of right maxillary lateral incisor
6 1 408 Left þ Impacted right maxilary canine and retained — 28 F
right deciduous maxillary canine
Impacted right mandibular canine and retained
right deciduous mandibular canine
Partially impacted right mandibular third molar
7 1 678 Left 2 Partially impacted mandibular third molars — 24 M
8 1 578 Left — (edentulous) Crown resorption 70 M
Pericoronal radiolucency

Figure 6 Patient 5 (mandibular). Cropped panoramic radiograph

Figure 5 Patient 2 (mandibular). Cropped panoramic radiograph
showing left canine positioned mesio-angularly across the midline (Type 1)
elimination of terms limiting the definition with mandib-
ular canine transmigration.
Although a number of factors have been suggested, the
aetiology and exact mechanism of transmigration is still
unclear.10 Rotation of tooth buds was proposed as an
showing transmigrated canine tooth horizontally impacted near the
inferior border of the mandible (Type 2)
aetiologic factor for impaction. Therefore, in the presence
of a strong eruptive force, mesioangular or horizontal
rotation of the tooth bud may result in transmigration unless
the tooth faces a resistance from tooth roots, neighbouring
anatomic structures or dense bone. To date, only one case of
maxillary canine transmigration had been reported and we
encountered six cases of maxillary canine transmigration in

Dentomaxillofacial Radiology
 Impaction and transmigration
168 U Aydin et al
a total of 4500 patients.6 The rarity of maxillary canine
transmigration may be attributed to the shorter distance
between the roots of maxillary incisors and the floor of the
nasal fossa as well as the larger roots of maxillary incisors,
which may be a barrier for transmigration. In addition, the
larger cross-sectional area of the mandibular anterior region
in comparison with the anterior maxilla may be a reason for
the higher frequency of mandibular canine transmigration.
Mandibular canine transmigration was suggested to have
genetic determinants, as there were other associated dental
developmental anomalies suggesting genetic origins, such
as hypodontia, palatally displaced canines and bilateral
occurrence of this anomaly.28 Palatally displaced canines,
hypodontia and diminutive lateral incisors were suggested
to have a genetic aetiology and are interrelated.29 – 31 In the
present study, four out of six patients with transmigrant
maxillary canines had such dental developmental anomalies
and two of the patients were edentulous. Two of the patients
with transmigrant mandibular canines had dental anomalies
and two of them were partially or totally edentulous.
However, no common aetiology was found in our study and
the genetic aetiology of transmigration needs further
investigation.
In the present study, the transmigrated maxillary
canines did not show variations in their location; their
crowns were crossing the midline up to half of their length,
but their axial inclinations varied between 438 and 828.
Although seven of the mandibular cases were classified as
Type 1 (mesio-angularly impacted), their axial inclinations
References
1. Grover PS, Lorton L. The incidence of unerupted permanent teeth and
related clinical cases. Oral Surg Oral Med Oral Pathol 1985; 59:
420 –425.
2. Kramer RM, Williams AC. The incidence of impacted teeth. A survey at
Harlem hospital. Oral Surg Oral Med Oral Pathol 1970; 29: 237–241.
3. Dachi SF, Howell FV. A survey of 3,874 routine full-mouth
radiographs: II. A study of impacted teeth. Oral Surg Oral Med
Oral Pathol 1961; 14: 1165– 1169.
4. Rohrer A. Displaced and impacted canines. Orthod Oral Surg Int J
1929; 15: 1002 –1004.
5. 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: 355–360.
6. Aydın Ü, Yılmaz HH. Transmigration of impacted canines.
Dentomaxillofac Radiol 2003; 32: 198 –200.
7. Dhawan P, Roychoudhury A, Prakash H, Duggal R. Transmigrated
mandibular permanent canine: a case report. J Indian Soc Pedod Prev
Dent 2001; 19: 80 –83. [Abstract.]
8. Rebellato J, Schabel B. Treatment of a patient with an impacted
transmigrant mandibular canine and a palatally impacted maxillary
canine. Angle Orthod 2003; 73: 328 – 336.
9. Shapira Y, Kuftinec MM. Intrabony migration of impacted teeth.
Angle Orthod 2003; 73: 738 – 743.
10. Camilleri S, Scerri E. Transmigration of mandibular canines—a
review of the literature and a report of five cases. Angle Orthod 2003;
73: 753 –762.
11. Joshi MR. Transmigrant mandibular canines: a record of 28 cases and a
retrospective review of the literature. Angle Orthod 2001; 71: 12–22.
12. Kaufman AY, Buchner A. Transmigration of mandibular canine.
Oral Surg Oral Med Oral Pathol 1969; 26: 405 – 406.
13. Gadalla GH. Mandibular incisor and canine ectopia: a case of two
teeth erupted in the chin. Br Dent J 1987; 163: 236.
Dentomaxillofacial Radiology
ranged between 408 and 768. Impacted canines that are
between 308 and 958 of angulation have the tendency of
crossing the midline.11,32 In our study, axial inclinations of
all the cases were greater than 308 (40 – 938), in accordance
with previous findings. However, with regard to such great
variations, it may be useful to refer to the axial inclinations
of the cases for ease of classification. Seven of the
mandibular cases in the present study fitted into Type 1.
This result supports the finding that most of the
transmigrant canines are positioned mesio-angularly
across the midline, labial or lingual to the anterior teeth.5
However, determining the transmigration patterns with
regard to their relationship with other teeth is not possible
when the patient is totally or even partially edentulous. In
addition, dental midlines may not always be coincident
with each other and with the mid sagittal plane. Therefore,
although the relationship of the transmigrated teeth with
other teeth is important, classifications should also be
based on the relationship of the transmigrant teeth with the
midline or with anatomic structures other than teeth,
provided that there are no patient positioning errors during
the radiographic examinations.
In conclusion, the incidence of impacted canine teeth
and transmigration of maxillary and mandibular canines
may be more frequent than was previously thought, at least
in some populations. Future studies may reveal other
cases in varying stages of intraosseous migration and
positioning in the maxilla and establishment of a
classification system will be possible.
14. Javid B. Transmigration of impacted mandibular cuspids. Int J Oral
Surg 1985; 14: 547 –549.
15. Gadgil RM. Impacted mandibular anterior teeth. Oral Surg Oral Med
Oral Pathol 1986; 61: 106.
16. Kuftinec MM, Shapira Y, Nahlieli O. A case report: bilateral
transmigration of impacted mandibular canines. J Am Dent Assoc
1995; 126: 1022 –1024.
17. Alaejos-Algarra C, Berini-Aytes L, Gay-Escoda C. Transmigration of
mandibular canines: report of six cases and review of literature.
Quintessence Int 1998; 29: 395 –398.
18. Zvolanek JW. Transmigration of an impacted mandibular canine.
Ill Dent J 1986; 55: 86 –87.
19. Shah RM, Boyd MA, Vakil TF. Studies of permanent tooth anomalies
in 7,886 Canadian individuals. I: impacted teeth. J Can Dent Assoc
1978; 44: 262 –264.
20. Saglam AA, Tuzum MS. Clinical and radiologic investigation of
the incidence, complications, and suitable removal times for fully
impacted teeth in the Turkish population. Quintessence Int 2003; 34:
53–59.
21. Zahrani AA. Impacted cuspids in a Saudi population: prevalence,
aetiology and complications. Egypt Dent J 1993; 39: 367 –374.
[Abstract.]
22. Rozsa N, Fabian G, Szadeczky B, Kaan M, Gabris K, Tarjan I.
Prevalence of impacted permanent upper canine and its treatment in
11 –18-year-old orthodontic patients. Fogorv Sz 2003; 96: 65 – 69.
[Abstract.]
23. Al-Waheidi EM. Transmigration of unerupted mandibular canines: a
literature review and a report of five cases. Quintessence Int 1996; 27:
27 –31.
24. O’Carroll MK. Transmigration of the mandibular right canine with
development of odontoma in its place. Oral Surg Oral Med Oral
Pathol 1984; 57: 349.

25. Greenberg SN, Orlian AI. Ectopic movement of an unerupted
mandibular canine. J Am Dent Assoc 1976; 93: 125 –128.
26. Shapira Y, Mischler WA, Kuftinec MM. The displaced mandibular
canine. ASDC J Dent Child 1982; 49: 362 – 364.
27. Tarsitano JJ, Wooten JW, Burditt JT. Transmigration of nonerupted
mandibular canines: report of cases. J Am Dent Assoc 1971; 82:
1395 –1397.
28. Peck S. On the phenomenon of intraosseous migration of
nonerupting teeth. Am J Orthod Dentofacial Orthop 1998; 113:
515 –517.
Impaction and transmigration
U Aydin et al 169
29. Bjerklin K, Kurol J, Valentin J. Ectopic eruption of
maxillary first permanent molars and association with other
tooth and developmental disturbances. Eur J Orthod 1992; 14: 369–375.
30. Bacetti T. A controlled study of associated dental anomalies. Angle
Orthod 1998; 68: 267 –274.
31. Pirinen S, Arte S, Apajalahti S. Palatal displacement of canine is
genetic and related to congenital absence of teeth. Angle Orthod
1996; 75: 1742– 1746.
32. Howard RD. The anomalous mandibular canine. Br J Orthod 1976; 3:
117 – 119.
Dentomaxillofacial Radiology