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Wan Mustafa / Ng / Lim

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the findings of Plakwiczw et al. (2019), who reported considered in the diagnosis. This can then be confirmed by
finding type 4 transmigration only in those above 15.5 radiographic investigation when treatment planning is
years of age. underway.

Management When impacted teeth are discovered within the

Figure 7: Proposed clinical management by Sinko et al.
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Different options for managing canine impaction jaws, a decision must be made as to what to do with these
or transmigration have been described in the literature teeth. We felt surgical management of the transmigrated
(Figure 7), and the choice of method depends on the canine was not a prerequisite to complete the distraction of
severity of the transmigration. These include surgical the mandible. Thus, we opted for conservative
extraction, autotransplantation, surgical exposure of a management. In this patient, the unerupted tooth was
transmigrated tooth, the alignment of the tooth in the asymptomatic and not associated with pathological
dental arch using a fixed orthodontic appliance, and changes. Removal would involve the destruction and loss
observation of the displaced tooth without active of significant amounts of bone in a patient with poor
intervention. development of the mandible. Despite opting for
radiographic follow-up instead of surgical removal of the
In the majority of reported cases, the offending transmigrated lower left canine, we were able to
tooth was extracted. Early diagnosis is important if accomplish the goals of mandibular advancement to
conservation of the unerupted transmigrating canine is to improve aesthetics and space creation within the
be attempted. When a mandibular canine is absent on the mandibular arch to relieve crowding and to improve tooth
opposite side, then transmigration of the tooth must be alignment for the patient. When surgery is performed there

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