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Transmigration of Nonerupted Mandibular Canines: Report of Cases
Transmigration of nonerupted mandibular canines: report of cases
John J. Tarsitano, DDS, MS James W. Wooten, DDS John T. Burditt, DDS, Chanute AFB, III Three patients were seen in whom panoramic radiographic examinations revealed that left m andibular canines had transmigrated. A search of the litera ture indicated that only five instances of such trans migration have been reported.
In the fall of 1968, through apanoram ic radiograph, it was discovered that a patient had a left mandibu lar unerupted canine that appeared to have trans migrated (Fig 1). By transmigrate we mean that this unerupted tooth had moved away from its normal developmental position and crossed the midline (symphysis).
■ Review o f literature: Since this was thought to be a reportable case, a search of the literature was made. Reports of only five instances of transm i gration of nonerupted mandibular canines could be found.1-4 T hat the teeth had actually transm i grated was proved in three of the patients; attem pt ed removal during inferior alveolar nerve block of the side where the teeth were elicited pain on the opposite side, from where they had originated.2-3 Proof of an even more positive nature was demon strated in the patient reported by Ando;4 serial ra diographs taken over a period of eight years showed the left mandibular canine moving through the body of the left side of the mandible, through the symphysis, and over to a spot beneath the m en tal foramen on the opposite side. ■ Report o f cases: While we were trying to learn something about this apparently rare occurrence, another patient appeared with an identical condi tion (Fig 2). The left canine was involved in both
Fig 1 ■ Leftuneruptedcaninehasmigrated to position just under right mental foramen. Note retained left deciduous canine.
JADA, Vol. 82, June 1971 ■ 1395
Fig 2 ■ In second patient canine has mi grated even further. Note that patient’s con dition is not evident in periapical radio graphs.
patients, and the left deciduous canines were re tained in the dental arch. Full-mouth radiographs did not demonstrate the condition in either patient. Of interest is the history given by our second pa tient; his family dentist had noticed the deciduous canine and had taken radiographs of the left side of the mandible in an attempt to locate the perma nent tooth. When the search proved fruitless, it was concluded that the tooth was congenitally absent. Soon afterward a patient was referred to us for removal of a composite odontoma, compound, which was occupying the space normally taken by the root of the mandibular left canine; the canine was missing. It had been assumed that the odonto m a represented the blighted tooth bud of the miss ing canine, and the periapical radiographs seemed to bear this out. However, on panoramic examina
Fig 3 ■ In third patient composite odonto ma, compound, occupies left canine space. Left canine, now on right side, could not be observed in periapical radiograph.
1396 ■ JADA, Vol. 82, June 1971
tion, the missing canine was located over on the right side where it had transmigrated. The com pound composite odontoma had probably arisen from a supernumerary tooth bud (Fig 3). A number of possibilities are apparent: ■ Transmigration of an unerupted mandibular canine is, in fact, extremely rare. Our discovery of three patients is, therefore, a remarkable one. ■ Transmigration is not very rare, just rarely re ported. Perhaps it has not appeared sufficiently unique to dentists to warrant reporting. ■ Transmigration is not rare, just rarely seen. The condition lies just outside the limits of the usu al radiographic survey, that is, bitewings and fullmouth series of periapical films. A combination of possibilities two and three seems most likely.
S u m m a r y a n d c o n c lu s io n
T he advent of a new technique, the panoramic ra diograph, has extended the limits of radiographic examinations. Ideas regarding the relative rarity of certain conditions, for example, the transmigration of unerupted mandibular canines, have changed. Undoubtedly, as further study is made of the masses o f panoramic radiographs accumulating in dental practices, further revelations will be made. When one or more teeth are thought to be con genitally absent, it would be wise to have an extra oral series or panoramic film taken to visualize the complete mandible and maxilla.
F o le y 's
The views expressed herein are those of the authors and do not necessarily reflect the views of the US Air Force or the De partment of Defense. Doctor Tarsitano is a colonel, USAF, and a base dental sur geon, USAF Regional Hospital, Chanute (ATC), Chanute Air Force Base, III 6X866. Doctor Wooten isa lieutenant colonel, USAF, and an oral surgeon, 483 USAF Hospital, APO San Francisco, 96326. Doctor Burditt is a former dental intern and now is in general practice in Kerrville, Tex 78028.
1. Stafne, E.C. Malposed mandibular canine, Oral Surg 16 1330 Nov 1963. 2. Thoma, K.H. Oral surgery, ed 4. St. Louis, C. V. Mosby Co., 1963, p 273. 3. Fiedler, L.D., and Ailing, C.C. Malpositioned mandibu lar right canine: report of case. J Oral Surg 26:405 June 1968. 4. Ando, S., and others. Transmigration process of the im pacted mandibular cuspid. J Nihon Univ Sch Dent 6:66 July 1964.
F o o tn o te s
The “Home and Society” section of Scribner’s Monthly for December 1880 performed a good public service by admonishing readers to observe a few simple rules for good dental health care. In 1970 we may consider the advice to be quaint; however, since the importance of the teeth was a rarely considered subject in the lay literature of that time, the Scribner's note merits our later-day ap preciation. TEETH—The quality of the teeth is in a great degree hereditary, but can be materially improved by attention to the food of the child during the first and second periods of den tition. Oatmeal, limestone water, strict prohibition of what is significantly called “slop diet,” may prevent all the future misery which belongs to aching teeth, dentists, and bad digestion. Gardner P. H. Foley
Tarsitano—others: TRANSMIGRATION OF CANINES ■
1397
John J. Tarsitano, DDS, MS James W. Wooten, DDS John T. Burditt, DDS, Chanute AFB, III Three patients were seen in whom panoramic radiographic examinations revealed that left m andibular canines had transmigrated. A search of the litera ture indicated that only five instances of such trans migration have been reported.
In the fall of 1968, through apanoram ic radiograph, it was discovered that a patient had a left mandibu lar unerupted canine that appeared to have trans migrated (Fig 1). By transmigrate we mean that this unerupted tooth had moved away from its normal developmental position and crossed the midline (symphysis).
■ Review o f literature: Since this was thought to be a reportable case, a search of the literature was made. Reports of only five instances of transm i gration of nonerupted mandibular canines could be found.1-4 T hat the teeth had actually transm i grated was proved in three of the patients; attem pt ed removal during inferior alveolar nerve block of the side where the teeth were elicited pain on the opposite side, from where they had originated.2-3 Proof of an even more positive nature was demon strated in the patient reported by Ando;4 serial ra diographs taken over a period of eight years showed the left mandibular canine moving through the body of the left side of the mandible, through the symphysis, and over to a spot beneath the m en tal foramen on the opposite side. ■ Report o f cases: While we were trying to learn something about this apparently rare occurrence, another patient appeared with an identical condi tion (Fig 2). The left canine was involved in both
Fig 1 ■ Leftuneruptedcaninehasmigrated to position just under right mental foramen. Note retained left deciduous canine.
JADA, Vol. 82, June 1971 ■ 1395
Fig 2 ■ In second patient canine has mi grated even further. Note that patient’s con dition is not evident in periapical radio graphs.
patients, and the left deciduous canines were re tained in the dental arch. Full-mouth radiographs did not demonstrate the condition in either patient. Of interest is the history given by our second pa tient; his family dentist had noticed the deciduous canine and had taken radiographs of the left side of the mandible in an attempt to locate the perma nent tooth. When the search proved fruitless, it was concluded that the tooth was congenitally absent. Soon afterward a patient was referred to us for removal of a composite odontoma, compound, which was occupying the space normally taken by the root of the mandibular left canine; the canine was missing. It had been assumed that the odonto m a represented the blighted tooth bud of the miss ing canine, and the periapical radiographs seemed to bear this out. However, on panoramic examina
Fig 3 ■ In third patient composite odonto ma, compound, occupies left canine space. Left canine, now on right side, could not be observed in periapical radiograph.
1396 ■ JADA, Vol. 82, June 1971
tion, the missing canine was located over on the right side where it had transmigrated. The com pound composite odontoma had probably arisen from a supernumerary tooth bud (Fig 3). A number of possibilities are apparent: ■ Transmigration of an unerupted mandibular canine is, in fact, extremely rare. Our discovery of three patients is, therefore, a remarkable one. ■ Transmigration is not very rare, just rarely re ported. Perhaps it has not appeared sufficiently unique to dentists to warrant reporting. ■ Transmigration is not rare, just rarely seen. The condition lies just outside the limits of the usu al radiographic survey, that is, bitewings and fullmouth series of periapical films. A combination of possibilities two and three seems most likely.
S u m m a r y a n d c o n c lu s io n
T he advent of a new technique, the panoramic ra diograph, has extended the limits of radiographic examinations. Ideas regarding the relative rarity of certain conditions, for example, the transmigration of unerupted mandibular canines, have changed. Undoubtedly, as further study is made of the masses o f panoramic radiographs accumulating in dental practices, further revelations will be made. When one or more teeth are thought to be con genitally absent, it would be wise to have an extra oral series or panoramic film taken to visualize the complete mandible and maxilla.
F o le y 's
The views expressed herein are those of the authors and do not necessarily reflect the views of the US Air Force or the De partment of Defense. Doctor Tarsitano is a colonel, USAF, and a base dental sur geon, USAF Regional Hospital, Chanute (ATC), Chanute Air Force Base, III 6X866. Doctor Wooten isa lieutenant colonel, USAF, and an oral surgeon, 483 USAF Hospital, APO San Francisco, 96326. Doctor Burditt is a former dental intern and now is in general practice in Kerrville, Tex 78028.
1. Stafne, E.C. Malposed mandibular canine, Oral Surg 16 1330 Nov 1963. 2. Thoma, K.H. Oral surgery, ed 4. St. Louis, C. V. Mosby Co., 1963, p 273. 3. Fiedler, L.D., and Ailing, C.C. Malpositioned mandibu lar right canine: report of case. J Oral Surg 26:405 June 1968. 4. Ando, S., and others. Transmigration process of the im pacted mandibular cuspid. J Nihon Univ Sch Dent 6:66 July 1964.
F o o tn o te s
The “Home and Society” section of Scribner’s Monthly for December 1880 performed a good public service by admonishing readers to observe a few simple rules for good dental health care. In 1970 we may consider the advice to be quaint; however, since the importance of the teeth was a rarely considered subject in the lay literature of that time, the Scribner's note merits our later-day ap preciation. TEETH—The quality of the teeth is in a great degree hereditary, but can be materially improved by attention to the food of the child during the first and second periods of den tition. Oatmeal, limestone water, strict prohibition of what is significantly called “slop diet,” may prevent all the future misery which belongs to aching teeth, dentists, and bad digestion. Gardner P. H. Foley
Tarsitano—others: TRANSMIGRATION OF CANINES ■
1397