@ 2025 | PUBLISHED BY GJR PUBLICATION, INDIA
36
Global Jou nal o Resea ch in Den al Sciences
ISSN: 2583-2840 (Online)
Volume 05 | Issue 05 | Sep . – Oc . | 2025
Jou nal homepage: h ps://gj publica ion.com/gj ds/
Case Repo
Unusual pe manen maxilla y and mandibula canine ansmig a ion – Repo o wo new
Indian cases
*D . Naga eni NB1, D . Umashanka a KV2, D . Kamala DN3, Muggalla Annie Glo y4
1 Specialis in Pedia ic Den is y, P o esso , Academic Resea che Ga ike Den al Ca e, Da ange e, Ka na aka, India.
2 O al and Maxillo acial Su ge y
3 Ad iso (O al Ca e), Bangalo e, Ka na aka, India.
4 Unde -G adua e S uden , Malla Reddy Ins i u e o Den al Sciences, Hyde abad, Telangana, India.
*Co esponding au ho : D . Naga eni NB
Specialis in Pedia ic Den is y, P o esso , Academic Resea che Ga ike Den al Ca e, Da ange e, Ka na aka, India.
In oduc ion
Va ious e up ion ela ed oo h de elopmen al dis u bances a e encoun e ed in ou ine den al p ac ice such as ec opic
e up ion, oo h ansposi ion and oo h ansmig a ion and delayed e up ion. Among hese, ec opic e up ion and oo h
ansmig a ion a e clinically diagnosed as hey a e no iced a e oo h e up ion. Whe eas, oo h ansmig a ion is no iced
only on adiog aphic examina ion as i is always ound wi hin he bone. ‘Too h ansmig a ion’ e e s o a condi ion
whe e ‘an impac ed oo h mo es wi hin he den al a ch c osses he den al midline and seen in opposi e side o he
a ch.’[1]. The oo h mos commonly a ec ed by his condi ion is he mandibula canine ollowed by maxilla y canine
[2,3]. Repo s showing ansmig a ion o maxilla y and mandibula pe manen cen al inciso s a e e y ew in numbe
[4]. In ansmig a ion cases, he impac ed oo h is comple ely de eloped and ound asymp oma ic wi hin he bone.
Clinically he e may be o e - e ained p ima y oo h o missing oo h o wi h space exis ed. In such ins ances, he subjec
is made o unde go ho ough adiog aphic e alua ion [5]. In some cases, he ansmig a ed oo h is ound associa ed wi h
ei he cys ic changes o umo mal o ma ion. The e o e, whene e a clinician come ac oss e ained p ima y oo h
exceeding i s no mal ex olia ion ime o any pe manen oo h missing, he o she always should hink o oo h
ansmig a ion. The e is no exac e iology behind why he impac ed oo h mo es wi hin he den al a ch and c osses he
den al midline. Wha o ce enables he oo h o mo e is also no p ope ly explained in he den al li e a u e [1-3]. Based
on he posi ion o he mig a ed impac ed oo h, Muppa apu [6] classi ied oo h ansmig a ion in o i e ypes (Table 1).
Muppa apu classi ica ion is applicable only o mandibula canines, as he incidence o occu ence o maxilla y canine
ansmig a ion is a a e en i y [6]. Wi h his b ie in oduc ion, he p esen esea ch pape aims o show case occu ence
o one maxilla y canine ansmig a ion and ype V mandibula canine ansmig a ion case in wo Indian pa ien s.
Abs ac
An unusual and uncommon den al anomalies and oo h de elopmen al abno mali ies a e encoun e ed in human
being due o na u e’s cons an e olu iona y phenomenon. Den al anomalies can a ec any pa o he oo h
including ei he c own o oo s uc u e esul ing a ious de elopmen al mal o ma ions wi h espec o size, oo h
numbe , oo h s uc u e, oo h composi ion and oo h shape. Too h de elopmen al a ia ions include ec opic
e up ion, delayed e up ion, impac ion, oo h ansposi ion and oo h ansmig a ion. Mos o hese de elopmen al
a ia ions a e always ound hidden in he bone and bypassing om he clinical examina ion. The pu pose o his
esea ch pape is o p esen occu ence o unusual maxilla y canine and ype V mandibula pe manen canine
ansmig a ion which occu ed in wo Indian pa ien s. The esea ch pape also c i ically discusses he di e en
opog aphic classi ica ion o he mandibula canine ansmig a ion e iden in he li e a u e.
Keywo ds: Canine impac ion, Canine ansmig a ion, Den al anomalies, Too h impac ion, T ansmig a ion
classi ica ion.
Global J Res Den Sci. 2025; 5(5), 36-40
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Table 1: Muppa apu Classi ica ion on Pe manen Mandibula Canine T ansmig a ion [6]
Type
Desc ip ion
Type 1
The impac ed canine is mesioangula ly c ossing he midline, labial o lingual o he
an e io ee h, wi h he c own po ion o he oo h c ossing he midline.
Type 2
The canine is ho izon ally impac ed nea he in e io bo de o he mandible below he
apices o he inciso s.
Type 3
The canine has e up ed ei he mesial o dis al o he opposi e canine.
Type 4
The canine is ho izon ally impac ed nea he in e io bo de o he mandible below he
apices o ei he p emola s o mola s on he opposi e side.
Type 5
The canine is posi ioned e ically in he midline wi h he long axis o he oo h c ossing
he midline.
Case S udy
T ansmig a ion o maxilla y igh canine and mandibula pe manen igh canine was no iced in wo Indian pa ien s.
Demog aphic de ails o he pa ien a e desc ibed in Table 2. Bo h pa ien s we e appa en ly no mal and did no show any
signs and symp oms o sys emic, me abolic o synd omic diso de s. To a end he chie complain in bo h pa ien s’
adiog aphic examina ion using o hopan omog aph was ca ied ou . On adiog aphic examina ion ansmig a ion o
maxilla y igh canine and mandibula igh canine was obse ed. As bo h impac ed and ansmig a ed canines we e no
associa ed wi h any pa hology o symp oms, wai and wa ch app oach was ollowed a ending only chie complain o he
pa ien .
Table 2: Demog aphic de ails o pa ien s wi h ansmig a ion o pe manen canines.
Case
No.
Age/
Gende /
E hnici y
Chie Complain
Clinical Fea u es
Radiog aphic Fea u es
(Figu es 1 & 2)
1.
38 yea s
Male
Indian
Complaining o pain
in he igh lowe
back oo h egion
om pas one week
Clinically missing
mandibula igh
canine. Remaining
all pe manen ee h
e up ed including
hi d mola s.
A ho izon ally impac ed and ansmig a ed
mandibula pe manen igh canine obse ed
(Figu e 1).
Th ee ou h pa o he impac ed canine
ansmig a ed o he opposi e side o he a ch
c ossing he den al midline.
The ansmig a ed canine was loca ed a he
in e io bo de o he mandible below he oo s
o mandibula inciso s in ho izon al posi ion.
2.
35 yea s
Male
Indian
Complaining o pain
in he igh lowe
back oo h egion
om pas 4 days
Deep p oximal
den al ca ies
in ol ing
mandibula igh
second mola .
Clinically missing
maxilla y igh
pe manen canine
O e - e ained
p ima y igh
canine
A mesioangula ly impac ed and ansmig a ing
maxilla y pe manen igh canine was obse ed.
One hi d c own po ion o he impac ed canine
was ansmig a ed c ossing he den al midline
owa ds he opposi e side.
Congeni al agenesis o maxilla y le hi d mola
(Figu e 2)
Global J Res Den Sci. 2025; 5(5), 36-40
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Figu e 1: Pano amic adiog aph showing mandibula igh canine ansmig a ion ( ed a ow). Almos ¾ h po ion o he
canine has ansmig a ed o he opposi e side c ossing he den al midline (blue line).
Figu e 2: O hopan omog aph showing ansmig a ing maxilla y igh canine ( ed a ow). Re ained igh p ima y canine
is also p esen (yellow a ow).
Discussion
The p e alence o canine ansmig a ion is ela i ely a a e phenomenon. The p e alence a ies among di e en
popula ion ac oss he wo ld [7-9]. Mohan e al iden i ied 341 cases o canine ansmig a ion among 30,000 pano amic
adiog aphs showing a p e alence o 1.1% in Indian popula ion [1]. Ano he s udy epo ed a p e alence o 0.8% o
mandibula canine ansmig a ion among Tu kish popula ion [10]. Naga eni e al [3] om India has pe o med an
ex ensi e esea ch wo k on den al anomalies including pe manen canine ansmig a ion in con ex o Indian e hnic
popula ion. Au ho has published nume ous case s udies [4,5,7-9,11-13] showcasing an a ay o ansmig a ed bo h
maxilla y and mandibula canine, ansmig a ed canine associa ed wi h o he den al anomalies and de elopmen al
dis u bances among child en and adul s [4,5,7-9,11-13]. The same esea che ecen ly pe o med a adiog aphic
p e alence s udy on occu ence o canine ansmig a ion in Indian popula ion [3]. Naga eni e al ha e also epo ed
ansmig a ion o maxilla y cen al inciso s [4] and maxilla y canines [5,9,12] which is a a e den al en i y.
Diagnosis and classi ica ion o any den al pa hology is impo an o ace challenges in ca ego iza ion and p o iding
app op ia e ea men [12-17]. The c edi o classi ying di e en ypes o canine ansmig a ion i s goes o a g ea
esea che , Muppa apu [6]. Howe e , a ious au ho s/ esea che s ha e gi en di e en explana ion o he e m
ansmig a ion. Joshi [2] explained ha i is no how a he oo h mo es wi hin he jaw, bu a he i s endency o a emp
o c oss he den al midline o midline su u e. Muppa apu has gi en classi ica ion based on he pa e n o in abony
Global J Res Den Sci. 2025; 5(5), 36-40
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39
mig a ion o he mandibula canine a he han he maxilla y canine [6]. He classi ied canine ansmig a ion in o i e
ypes. Al hough his classi ica ion has been used hese days, bu ecen ly ew o he esea che s ha e aised abou some o
i s disad an ages. Muppa apu [6] has add essed only abou he unila e al occu ence bu no abou he bila e al
occu ence o canine ansmig a ion. The e a e some publica ions showing bila e al p esen a ion o mandibula canine
ansmig a ion. Mo eo e , he gene al c i e ia o his classi ica ion can cause subjec i e in e p e a ions and inconsis en
diagnoses. This classi ica ion also ocuses on he posi ional aspec o he canines wi hou p o iding comp ehensi e
guidance on he implica ions o ea men planning. As a esul , science/li e a u e aises a ‘ques ’ o he in en ion o
new classi ica ion as den al anomalies can de elop/appea /p esen in any o m. A g oup o Indian au ho s based on hei
su ey ca ied ou a a e ia y den al heal h ca e cen e using pano amic adiog aphs in oduced a no el classi ica ion
sys em o mandibula canine ansmig a ion consis ing o g oup I, II, III, IV and V ypes [1]. This classi ica ion is
e med as MBS classi ica ion. In his classi ica ion, he ansmig a ion pa e ns o mandibula canines we e ca ego ized
using he c i e ia like, he axial inclina ion o he canine, he dis ance a elled by he ansmig a ed canine and whe he
ansmig a ed canine is unila e al o bila e al (Table 3) [1]. Ano he Indian s udy using pano amic adiog aphs as a s udy
ool ound a p e alence o 1.88% in Indian popula ion. In his s udy he age o pa ien s anged om 15 o 35 yea s
consis ing o 216 emales and 209 males [14]. Abou 75% o mandibula canines we e ound on he le side, wi h 25%
on he igh . No bila e al occu ence o ansmig a ion was no iced in his s udy [14]. In he a icle p esen ed he e, in
case 1, he ansmig a ed canine was classi ied as ype II acco ding o Muppa apu and G oup III, Ho izon al acco ding o
MBS classi ica ion. In case 2, as he ansmig a ed canine was in he maxilla, he e is no any classi ica ion c i e ia gi en
in he li e a u e. so based on i s posi ion i was desc ibed as mesio-angula impac ion wi h oblique o ien a ion. This
s ongly indica es lacunae in p e alence s udies o explo e la ge numbe o maxilla y canine ansmig a ion cases in o de
o ame p ecise classi ica ion guidelines.
Table 3: MBS classi ica ion o pe manen mandibula canine ansmig a ion [1]
Classi ica ion
Desc ip ion
G oup I
Pa ial c own ansmig a ion. I can be
• Ve ical
• Oblique
• Ho izon al
G oup II
Comple e c own ansmig a ion. I can be
• Ve ical
• Oblique
• Ho izon al
G oup III
Comple e c own wi h pa ial/comple e oo ansmig a ion: Mesial o men al
o amen. I can be
• Ve ical
• Oblique
• Ho izon al
G oup IV
T ansmig a ion – dis al o men al o amen
Mos ly ho izon al
G oup V
Bila e al ansmig a ion
The exac e iology behind ansmig a ion o mandibula canines is no known. Howe e , li e a u e p o ides nume ous
ac o s as a possible causa i e ac o . Few au ho s ela ed he mechanism wi h espec o posi ion o he oo h wi h i s
long axis. Howa d esea che explained ha when he inclina ion o he impac ed canine anges om 25 o 30 deg ee in
he midsagi al plane, he oo h can mo e bu does no mig a e ac oss he midline. When he inclina ion alls be ween 30
and 95 deg ee he canine ends o c oss he midline o midline su u e. Compa ed o mandible, ansmig a ion o canines
in he maxilla is a a e phenomenon. The eason behind his inciden is due o he s ong mid-sagi al su u e and ype o
he maxilla y bone. Hence, impac ed canines a ely c oss comple ely by mo ing h ough he mid-sagi al su u e.
The e o e, he e a e no epo s showing comple e o h ee ou h o maxilla y canine ansmig a ing o he opposi e side
o he den al a ch. In numbe o case se ies epo ed by Indian au ho [9,12,16,18] illus a ed mos o oblique ype o
canine impac ion wi h only one hi d o c own po ion c ossing he mid-sagi al su u e.
The p ecise classi ica ion o canine ansmig a ion helps in planning app op ia e ea men s a egies. Based on MBS
classi ica ion, au ho s sugges ed ha g oup I and II e ical o oblique ype cases can be ea ed wi h su gical emo al o
au o- ansplan a ion. Ho izon al cases usually equi e su gical emo al when hey become symp oma ic. I is sugges ed in
he li e a u e ha o hodon ic eposi ioning o ansmig a ed oo h is no possible when he c own ip mig a es beyond he
la e al inciso oo apex. In cases wi h G oups III, IV and V, su gical emo al is essen ial due o se e e mig a ion and
isks o adjacen s uc u es. Howe e , in he cases p esen ed he e, as he e we e no any pa hology o symp oms associa ed
wi h ansmig a ed canines, only obse a ion was sugges ed o he pa ien s wi hou ende ing any ea men .
Global J Res Den Sci. 2025; 5(5), 36-40
@ 2025 | PUBLISHED BY GJR PUBLICATION, INDIA
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Conclusion
All he ansmig a ed mandibula canines a e une up ed and hidden in he bone escaping om ea ly de ec ion and
diagnosis. The e o e, e e y den al p o essional should ha e enough knowledge abou p e alence in di e en popula ion,
hei diagnosis, classi ica ion in o de o p o ide age-app op ia e den al ea men he eby a oiding u u e complica ions
and consequences.
Re e ences
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