Unusual permanent maxillary and mandibular canine transmigration – Report of two new Indian cases

@ 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 @ 2025 | PUBLISHED BY GJR PUBLICATION, INDIA 37 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 @ 2025 | PUBLISHED BY GJR PUBLICATION, INDIA 38 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 @ 2025 | PUBLISHED BY GJR PUBLICATION, INDIA 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 40 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 1. Mohan, M., Pillai, S. B., & S eeji h Kuma , G. (n.d.). P e alence o canine ansmig a ion: In oducing a no el classi ica ion o mandibula canine ansmig a ion. 2. Joshi, M. R. (2001). T ansmig an mandibula canines: A eco d o 28 cases and a e ospec i e e iew o he li e a u e. Angle O hodon is , 71(1), 12–22. 3. Naga eni, N. B., Mahan esh, S. P., Sa a , S., & Umashanka , K. V. (2025). T ansmig a ion o pe manen canines in Sou h Indian popula ion: A adiog aphic p e alence s udy. Jou nal o Medical Resea ch and Su ge y, 2(1), 1–6. 4. Naga eni, N. B. (2023). T ansmig a ion o pe manen maxilla y cen al inciso . Global Jou nal o Resea ch in Den al Sciences, 3(4), 5–8. 5. Naga eni, N. B. (2023). In aosseous ansmig a ion o pe manen maxilla y igh canine: Repo o a a e case. O al Heal h and Den is y, 6(1), 22–26. 6. Muppa apu, M. (2002). Pa e ns o in a-osseous ansmig a ion and ec opic e up ion o mandibula canines: Re iew o li e a u e and epo o nine addi ional cases. Den omaxillo acial Radiology, 31(6), 355–360. 7. Naga eni, N. B. (2023). Type I ansmig a ion o pe manen mandibula igh canine: Repo o a a e case. Jou nal o Pa hology and Allied Medicine, 4, 1–5. 8. Naga eni, N. B., Radhika, N. B., Umashanka a, K. V., & Sa isha, T. S. (2011). Concomi an occu ence o canine ansmig a ion and symme ical agenesis o mandibula inciso s: A case epo . Bangladesh Jou nal o Medical Science, 10(2), 133–136. 9. Naga eni, N. B. (2024). Mi o image canines in associa ion wi h mul iple den al anomalies: Repo o a unique case. Den al Science Inno a ion Resea ch, 3(1). h ps://doi.o g/10.61148/DSIR/004 10. Ak an, A. M., Ka a, S., Akgunlu, F., & Malkoc, S. (2010). The incidence o canine ansmig a ion and oo h impac ion in a Tu kish subpopula ion. Eu opean Jou nal o O hodon ics, 32(5), 575–581. 11. Naga eni, N. B. (2023). Pe manen mandibula in abony canine ansmig a ion ( ype I): A a e case epo . Jou nal o Su ge y and Anes hesia, 1(1), 1–2. 12. Naga eni, N. B. (2023). T ansmig a ion o maxilla y canine in associa ion wi h bila e al agenesis o pe manen mandibula canines: Repo o a a es case wi h li e a u e e iew. Jou nal o O al Heal h and Den is y, 6, 596–602. 13. Naga eni, N. B. (2012). An unusual occu ence o mul iple den al anomalies in a single non-synd omic pa ien : A case epo . Case Repo s in Den is y, 2012, A icle ID 426091. h ps://doi.o g/10.1155/2012/426091 14. Sa hyana ayana, H. P., Nucci, L., d’Apuzzo, F., Pe illo, L., Padmanabhan, S., & G assia, V. (2023). P e alence, e iology, clinical ea u es and managemen associa ed wi h impac ed and ansmig a ed mandibula canines: A sys ema ic e iew. BMC O al Heal h, 23, 975. h ps://doi.o g/10.1186/s12903-023-03327-1 15. Naga eni, N. B., & Umashanka , K. V. (2024). Cu sed canines: The a e o une up ed pe manen canine ee h. Global Jou nal o Resea ch in Den al Sciences, 4(5), 18–21. 16. Naga eni, N. B. (2024). Maxilla y canine ansmig a ion: Repo o an unusual oo h e up ion phenomenon. Global Jou nal o Resea ch in Den al Sciences, 4(4), 4–7. 17. Naga eni, N. B. (2024). Co-exis ence o mandibula dens e omola and canine ansmig a ion in a single non- synd omic pa ien : A a es case epo . Global Jou nal o Resea ch in Den al Sciences, 4(4), 13–16. 18. Naga eni, N. B. (2024). A hidden u h: Repo o a unique case wi h mul iple anomalies in an Indian pa ien . Global Jou nal o Resea ch in Den al Sciences, 4(1), 22–25.