SANGHAMITRA SUMAN
| SANGHAMITRA SUMAN |
Sanghamitra Seman
Mel Mupparapu
Division of Radiology, Oral Medicine, University of Pennsylvania School of Dental Medicine
Introduction
To report a rare developmental anomaly of transmigration of impacted maxillary canine across the mid-palatal suture. This deviates from the previous hypothesis that maxillary canine crossing to the contralateral side may be a possibility in spite of the maxillary suture acting as a barrier.
Methods
A 25-year-old patient with no significant medical history reports to Orthodontic department of University of Pennsylvania, School of dental medicine for possible orthodontic treatment for a retained primary tooth. Clinical examination revealed a Class I malocclusion, with decreased overjet, moderate mandibular crowding, mildly rotated maxillary right lateral with retained deciduous left maxillary canine. The panoramic radiograph showed that the missing permanent maxillary canine is horizontally impacted very high in the palatal vault, above the apices of incisors. The crown of impacted canine appears to have transmigrated across the midpalatine suture to the opposite side, approximating the central incisor of opposite side. A cone beam CT image further confirmed the transmigration through the mid palatal suture with no signs of deviation detected in the suture.
Results
Although intraosseous migration of unerupted tooth in both maxilla and mandible is well documented., intraosseous transmigration of impacted tooth across the midline of jaw is rare. Until recently, it was considered that transmigration is unique to mandibular canines and has not been reported with other teeth. As of now there are only a few published reports about maxillary canine transmigration. It is widely believed that unlike mandibular symphysis, maxillary palatal suture acts as a barrier preventing the movement of displaced tooth to the other side of jaw. It was hypothesized that the impacted tooth when perpendicular to midpalatine suture, has significant eruptive forces to cross the suture barrier.
Conclusion
Transmigration of impacted canines are rarely noted in the maxilla due to the compact midpalatine sutures disallowing transmigration of teeth across them. On rare occasions, like in this instance, transmigration can occur due to the nature of the angulation of the impacted canine.