JIOS

10.5005/jp-journals-10021-1034
CASE REPORT
Bilateral Maxillary Canine-Premolar Transposition

Bilateral Maxillary Canine-Premolar

Transposition
1
Nishant Kuttapa, 2US Krishna Nayak, 3Ashutosh Shetty, 4PS Murali

ABSTRACT

Tooth transposition is a severe disturbance of tooth order and eruptive position, involving certain teeth that may occur at any of the several
sites in the mouth. Maxillary canine-first premolar (MxCP1) transposition is the most frequent tooth transposition. This case report presents
the treatment of female patient with bilateral maxillary canine-premolar transposition. The order of transposition was maintained during the
treatment.
Keywords: Bilateral canine transposition, Maxillary canine to first premolar, Ectopic eruption, Orthodontic management.

How to cite this article: Kuttapa N, Nayak USK, Shetty A, Murali PS. Bilateral Maxillary Canine-Premolar Transposition. J Ind Orthod Soc
2011;45(4):193-197.

INTRODUCTION left canine had erupted buccally between the premolars and
Transposition of maxillary teeth is a disturbance of eruptive the left first premolar was rotated. On radiographic examination,
position, occurring approximately in one of 300 orthodontic there was no resorption of the root of the deciduous canine and
patients. 1 Maxillary canine-first premolar (MxCP1) transposition of the crowns and the roots of the maxillary right
transposition is the most frequent tooth transposition. Tooth canine and first premolar, with the roots diverging apically
transposition is defined as the positional interchange of two (Fig. 2). The interarch relationship was Angle Class I, with
adjacent teeth, especially their roots, or the development or 30% over bite and normal overjet. Cephalometric analysis
eruption of a tooth in a position occupied normally by a showed a skeletal Class I relationship (ANB angle = 3°) with
nonadjacent tooth.2 Treatment planning for this anomaly centers an average growth pattern (SNGoGn = 32°).
on whether to maintain the transposed tooth order or correct it. Etiologic possibilities for the transposition included genetics
There is general agreement3,4 on keeping the transposed tooth (although there were no similar cases in the patient’s family),
order in most cases, especially in adults. But when detected retained primary teeth, deviation of the affected tooth during
early enough, transpositions can sometimes be corrected without the path of eruption, and abnormality in the sequence of eruption
damaging the canine and the first premolar roots.3-6 with consequent lack of space for the maxillary canine.
CASE REPORT
Treatment Objectives
A 21-year-old female patient reported to the department of
orthodontics with a complaint of retained milk teeth and Because facial appearance was satisfactory, correction of
forwardly placed adjacent teeth. Her face was proportional and crowding while maintaining a pleasing profile was the treatment
symmetric, with a straight profile (Fig. 1). All permanent teeth goal. The treatment objectives were to (1) maintain Class I
(except the third molars in the third quadrant) were erupted, molar and canine relationship, (2) maintain ideal overjet and
and the deciduous maxillary canines were retained. There was over bite, (3) correct the alignment of transposed canines and
mild dental crowding in both arches. The maxillary right and first premolars, (4) maintain facial balance.

Treatment Alternatives
1,3 2 4
Professor, Dean Academics, Professor and Head, Postgraduate • Correcting the order of transposed teeth
Student
1-4
Department of Orthodontics, AB Shetty Memorial Institute of Dental
• Maintaining the order of transposed teeth
Sciences, Mangalore, Karnataka, India • Extraction of one of the transposed teeth.

Corresponding Author: Krishna Nayak, Dean Academics Treatment Plan

Professor and Head, Department of Orthodontics, AB Shetty
Memorial Institute of Dental Sciences, Mangalore, Karnataka The orthodontic treatment plan of choice involved the correction
India, e-mail: [email protected] of transposition (in the order of transposition) without the
extraction of the premolars. A 0.022" preadjusted edgewise
Received on: 27/8/11 system (MBT prescription) was used and the right deciduous
Accepted after Revision: 11/11/11 canine was extracted in the initial stages of the treatment.

The Journal of Indian Orthodontic Society, October-December 2011;45(4):193-197 193

Nishant Kuttapa et al

Fig. 1: Pretreatment extraoral and intraoral photographs

Fig. 2: Pretreatment lateral cephalogram and OPG

Fig. 3: Creation of space for canine using open-coil spring and alignment of the canine into the arch

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Bilateral Maxillary Canine-Premolar Transposition

Treatment Progress of the left lateral and canine (1.3 mm diameter and 8 mm length).
After extraction of the deciduous canines, the permanent first A TMA archwire was bent so that one end could be inserted
molars were banded; during the bonding procedure, the canine into the bracket slot while the other end is connected to the
bracket was bonded onto the first premolar crown to achieve miniscrew head, creating a lever arm (Fig. 4B). A pullout force
the canine prominence. Alignment was carried out upto 0.016" was applied onto the implant, which brought about the palatal
NiTi progressively and then 0.018" Australian stainless steel root movement while the base archwire (Fig. 4C) prevented
archwire was placed with open-coil spring between first and the buccal flaring or extrusion of the teeth.
the second premolars to gain space for the buccally transposed
RESULTS
canine (Fig. 3). The canine was then bonded with the premolar
bracket and aligned into the arch. The maxillary canines and the first premolars were successfully
During the mesialization, the roots of left first premolar aligned into the arch maintaining the order of transposition
became prominent (Fig. 4A). For effective torque control, the (Fig. 5). Ideal overjet and over bite with Angle’s Class I molar
miniscrew (bracket head type) was inserted between the roots relationships were maintained. Good intercuspation and root

Figs 4A to C: (A) Increased prominence of maxillary left first premolar root, (B and C) Miniscrew placed between the roots of left lateral and
canine roots and engagement of long lever arm made of 0.017 × 0.025 TMA

Fig. 5: Posttreatment intraoral and extraoral photographs

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Nishant Kuttapa et al

Figs 6A and B: Posttreatment lateral cephalogram and OPG

parallelism were achieved in the area of transposition (Figs 6A the miniscrew-assisted technique for torque control described,
and B). Patient’s pleasing facial profile was maintained. can reduce the required force to about 125 gm. Huja et al
reported that the pull-out strength of miniscrews was sufficient
DISCUSSION to support tooth-moving force,10 but the associated moment
The best time for intervention in maxillary canine transposition may result in flaring or extrusion of the teeth. To minimize
is, when the cusp tip of the maxillary canine tooth germ is these undesirable side effects, the archwire should be kept in
positioned superior to the root of the first premolar. In this contact with the incisal third of the labial crown surfaces.12
situation, the first premolar root can be tipped distally, thus The disadvantages of maintaining the order of transposition
correcting the transposition, so that the permanent canine can included possible finishing difficulties and interferences during
be guided into its correct position. As the patient age was 21 mandibular movements, which would require occlusal
years, the favorable stage described by Peck for correcting tooth adjustments. The differences in the size, shape, and tooth color
transposition had already passed.2 between canine and premolar sometimes cause anterior esthetic
To achieve the treatment objectives, two possibilities were problems. The gingival contour of the premolar is lower, relative
considered: treating the patient with or without premolar to the canine, and this may require a gingival recontouring
extractions. Treatment with extractions of the four first procedure. The palatal cusp of the transposed premolar
premolars and the deciduous canine would make the elimination (maintained in the position of the canine) might cause functional
of the dental crowding and the correction of position of the interference despite control of its angulations, torques and
transposed canine easier; it would also be a faster treatment reshaping. Prosthetic restoration after pulpectomy may be
with simpler mechanics. However, it would impair the patient’s necessary to recontour the premolar, to resemble a canine.
facial profile, which was already straight. Treatment without Although these procedures were explained to the patient as a
premolar extractions included two possibilities: aligning the necessary part of treatment plan, if the order of transposition is
teeth in the transposed order or correcting the transposition. maintained, the patient opted not to have gingival contouring
Correcting the transposition would take longer and require and coronoplasty done. Therefore, occlusal equilibration for
patient compliance. Also, it would be difficult to correct the the premolar was done to achieve optimum intercuspation.
transposition without causing damage to the supporting tissues
CONCLUSION
and avoiding root resorption due to root interference. This
approach would provide a dental esthetics with gingival contour, Management of transpositions must be assessed on a case-to-
root eminence, crown morphology and functional occlusion with case basis. Dental transposition can be corrected
good intercuspation.7 Aligning the teeth in the transposed order orthodontically, but the mechanics are complex, treatment time
would probably require less treatment time than correcting the is long, and damage is possible to the supporting dental tissues.
transposition but would have still been difficult because space Patient compliance, the practitioner’s skill and experience,
had to be obtained before aligning the canine into its transposed esthetics and function should all be considered when deciding
position. whether treatment of the transposition should involve tooth
In this case, decidous canines were extracted and created extractions, tooth alignment in the transposed order or complete
space for the transposed canines by mesialization of the first correction of the transposition orthodontically.
premolar. Even though it was a simpler method of treatment,
REFERENCES
was encountered root prominence of upper left first premolar
(Fig. 4A). To correct this root prominence using conventional 1. Sandham A, Harvie H. Ectopic eruption of the maxillary canine
mechanics, a force of as much as 2000 gm per side (about resulting in transposition with adjacent teeth. Tandlaegebladet
1985;89:9-11.
1250 gm of moment in the slot) is needed,8,9,11 this force may 2. Peck L, Peck S, Attia Y. Maxillary canine-first premolar
result in damage to the periodontium. By increasing the length transposition, associated dental anomalies and genetic basis.
of the lever arm (distance between the forces) by about 10 mm Angle Orthod 1993;63:99-109.

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Bilateral Maxillary Canine-Premolar Transposition

3. Peck S, Peck L. Classification of maxillary tooth transpositions. 8. Burstone CJ. The mechanics of the segmented arch techniques.
Am J Orthod Dentofacial Ortho 1995;107:505-17. Angle Orthod 1966;36:99-120.
4. Shapira Y. Transposition of canines. J Am Dent Assoc 9. Kusy RP, Tulloch JF. Analysis of moment/force ratios in the
1980;100:710-12. mechanics of tooth movement. Am J Orthod 1986;90:127-31.
5. Sato K, Yokozeki M, Takagi T, Moriyama K. An orthodontic
10. Haskell BS, Spencer WA, Day M. Auxiliary springs in
case of transposition of the upper right canine and first premolar.
continuous arch treatment, Part 1: An analytical study employing
Angle Orthod 2002;72:275-78.
the finite-element method. Am J Orthod 1990;98:387-97.
6. Bocchieri A, Braga G. Correction of a bilateral maxillary canine
first premolar transposition in the late mixed dentition. Am J 11. Meling TR, Odegaard J. The effect of second-order couple on
Orthod Dentofacial Orthop 2002;121:120-28. the application of torque. Am J Orthod 1998;113:256-62.
7. Daniel CS Ngam, Om P Kharpanda, M Ali Darendeliler. 12. Huja SS, Litsky AS, Beck FM, Johnson KA, Larsen PE. Pull-
Cosideration in management of transposed teeth. Aust Orthod J out strength of monocortical screws placed in the maxillae and
2004;20:41-50. mandibles of dogs. Am J Orthod 2005;127:307-13.

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