Page 9 - MDJ 2022 Jan-Jun, Volume 45 Number 1

Malaysian Dental Journal Volume 45 Issue 1/2022
 2022 The Malaysian Dental Association
MALAYSIAN DENTAL JOURNAL

Transmigration of Mandibular Canine in a Patient with Hypoplastic Mandible:
A case report

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Wan Mustafa WM Department of Oral and Maxillofacial Surgery, MAHSA University, Malaysia.

Ng LK Formerly Klinik Pergigian Dato' Keramat, Kuala Lumpur, Ministry of Health, Malaysia.

Lim KC Oral Maxillofacial Surgery, Hong Kong University.

Correspondence: Prof Dato’ Dr Wan Mahadzir Wan Mustafa, [email protected]
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ABSTRACT
Impacted maxillary canines are relatively common in clinical practice but impacted mandibular canines are rare. Even rarer is
the intraosseous movement of impacted canines crossing the midline; a condition known as transmigration. We report a case of
mandibular canine of Muparappu Type 4 transmigration in a patient with mandibular hypoplasia and have discussed the incidence,
aetiology, classification, and therapeutic options for such a case. In contrast with many previous cases we opted for a conservative
management of the lower canine.

Key words: hypoplastic mandible, canine transmigration, distraction osteogenesis.
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INTRODUCTION We report a case in which we opted to observe
and not to remove said tooth. The reasons for choosing
Pre-eruptive migration of a tooth across the such an option are discussed.
midline is termed transmigration. According to Koszowski
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et al. (2015), transmigration was first described by Thoma CASE REPORT
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in 1952 and the term itself was originally used by Ando et
al. (1964). This rare phenomenon usually affects the A 13 year old Malay girl was referred by her
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mandibular canine but has been reported to occur with orthodontist for the management of severe mandibular
maxillary canines as well. Bilateral transmigration may hypoplasia which had been present since childhood. Her
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also take place, though this is even more uncommon. mother admitted to consuming analgesics during her
pregnancy while studying in Egypt and attributed her
A transmigrated canine is usually an incidental daughter’s condition to this. Her past dental and medical
finding. The condition remains asymptomatic in many history was otherwise unremarkable. She was the eldest in
cases. Occasionally they present with pain and discomfort a family of four. Her parents had no medical issues and
or cause tilting of adjacent teeth. were not related to each other. There was no family history
of mandibular hypoplasia.
A 2017 systematic review by Dalessandri
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regarding impacted mandibular canines found that the There was severe mandibular hypoplasia with
treatment options for this condition differ if the affected retrusion. A pronounced dewlap was noted. The overjet
tooth is just impacted or if it is impacted and transmigrated. was 19 millimetres. The mouth opening was 31
For the first, surgical removal and orthodontic traction millimetres. Bimaxillary protrusion and a mild anterior
used to be the most common options; meanwhile, for the open bite was present (Figure 1, Figure 2). The lower
latter, surgical removal and a radiographic follow-up dental midline was shifted 4 millimetres to the left and
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tended to be the most frequent. upper dental midline was shifted 0.5 millimetres to the
right.

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