Hindawi Publishing Corporation

Case Reports in Dentistry

Volume 2016, Article ID 5043801, 6 pages
http://dx.doi.org/10.1155/2016/5043801

Case Report
Mandibular Symmetrical Bilateral
Canine-Lateral Incisors Transposition: Its Early Diagnosis
and Treatment Considerations

Yehoshua Shapira, Tamar Finkelstein, Rana Kadry, Shirley Schonberger, and Nir Shpack
Department of Orthodontics, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel

Correspondence should be addressed to Yehoshua Shapira; [email protected]

Received 12 July 2016; Accepted 30 November 2016

Academic Editor: Asja Celebić

Copyright © 2016 Yehoshua Shapira et al. This is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly
cited.

Bilateral mandibular tooth transposition is a relatively rare dental anomaly caused by distal migration of the mandibular lateral
incisors and can be detected in the early mixed dentition by radiographic examination. Early diagnosis and interceptive intervention
may reduce the risk of possible transposition between the mandibular canine and lateral incisor. This report illustrates the
orthodontic management of bilateral mandibular canine-lateral incisor transposition. Correct positioning of the affected teeth
was achieved on the left side while teeth on the right side were aligned in their transposed position. It demonstrates the outcome
of good alignment of the teeth in the dental arch.

1. Introduction Tooth transposition is defined as an interchange in posi-

tion of two adjacent permanent teeth in the same quadrant
A tooth may deviate from its normal path of eruption usually of the dental arch or eruption of a tooth in a place normally
as a result of severe crowding or presence of an obstacle such occupied by another tooth [8]. It is a type of ectopic eruption
as a supernumerary tooth or an odontoma. Such eruption that results in an abnormal sequence of the permanent teeth
deviation can occur with no apparent local or systemic cause, in the dental arch. Transposition occurs most frequently
resulting in ectopic eruption of the tooth in a place normally between the maxillary canine and first premolar and occa-
occupied by another permanent tooth. The most frequently sionally between the maxillary canine and lateral incisor [9,
ectopically erupted tooth is the mandibular permanent lateral 10]. Rare cases of transposition between a canine and a second
incisor which may occur unilaterally and bilaterally [1–4]. A premolar or an incisor have been reported [11]. Transposition
study on the occurrence of ectopic erupting permanent teeth of a tooth may be complete, where both the crowns and roots
has shown that 30% involved the mandibular permanent of the involved teeth are in transposed position. It may be
lateral incisors unilaterally and bilaterally [5]. incomplete when only the crown is transposed but the root
Early diagnosis of a disturbed eruption of a mandibular is within its normal place. Unilateral transpositions are more
permanent lateral incisor can be made in young children often than bilateral ones, with left side predominance, and are
during the early mixed dentition at the age of 6–8 years, found more often in females than in males [11, 12].
though some variation in timing of eruption of that tooth Transposition in the mandible is relatively rare and
has been reported [6]. The permanent lateral incisor during occurs between the canine and lateral incisor and is usually
this period is in its preeruptive migration and the deciduous unilateral. Only few cases of bilateral transposition of a canine
lateral incisor root is resorbing. The lateral incisor may, for and lateral incisor in the mandible have been reported [13,
unknown reasons, deviate from its normal eruption path and 14]. The prevalence of tooth transposition varies according
become distally displaced, resulting in overretention of the to different studies and was found to be 0.43% of patients
deciduous lateral incisor, and could ectopically erupt in a in India [15], 0.38% in Turkish population [16], and 0.14%
transposed position with the permanent canine [7]. of patients in Nigeria [17, 18], whereas the prevalence of
 2415, 2016, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1155/2016/5043801 by Cochrane Philippines, Wiley Online Library on [11/09/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
2 Case Reports in Dentistry

mandibular canine-lateral incisor transposition is only 0.03%

[19].
The etiology of transposition is unknown and the reason
why a tooth deviates from its normal path of eruption is
still obscure. Several theories have been suggested such as
genetic factors [20, 21], interchange in the position of the
developing tooth buds, early loss or prolonged retention of
deciduous teeth, and trauma and mechanical interference to
the erupting permanent teeth [11, 21]. Figure 1: Panoramic radiograph of a 6-year-old boy with normal
Tooth transposition has been reported to be associated dental position and development of the mandibular permanent
with other dental anomalies such as missing teeth, small lateral incisors.
or peg-shaped maxillary lateral incisors, retained deciduous
mandibular lateral incisors and canines, rotations and malpo-
sition of adjacent teeth, and root dilacerations and impactions
[22].
The literature on early detection and treatment proce-
dures for this abnormality is relatively sparse. The purpose
of this article is primarily to emphasize early diagnosis and
detection of bilateral mandibular tooth transposition and
describe its orthodontic management and outcome.
Figure 2: Panoramic radiograph at the age of 8 years, showing
the mandibular permanent lateral incisors ectopically erupted and
2. Clinical Diagnosis and Evaluation rotated in the place of the first deciduous molars causing their early
exfoliation.
The early mixed dentition period, between 6 and 8 years,
is the best time for assessing the development and path of
eruption of the mandibular permanent lateral incisors. These will allow the canines and first premolars to erupt into
age group children are usually first examined by a pediatric their normal place and avoid the possible development of
or general dentist who should evaluate both the dental health transposition between the canines and lateral incisors.
condition and the dental development. Using a panoramic
radiograph is very useful for early diagnosis of the position
and path of eruption of the unerupted teeth. 5. Treatment Plan, Procedure, and Outcome
The early diagnosis is of crucial importance for establishing
3. Clinical and Radiographic Examination a correct treatment planning. The retained deciduous lateral
incisors and canines were immediately removed at the age of 8
A routine panoramic radiograph of a 6-year-old boy, taken at years (Figure 4). Edgewise fixed appliances were used, first to
the Pedodontic Department of Tel Aviv University School of correct the severely rotated lateral incisors and upright them
Dental Medicine, demonstrated normal dental position and and then to move them mesially to their normal place next to
development of the mandibular permanent lateral incisors, the central incisors (Figure 5).
which are expected to erupt into their proper position in Periodic radiographs taken during treatment showed that
the arch uneventfully (Figure 1). Surprisingly enough and for the right permanent canine was already erupting between
unknown reason, a follow-up panoramic radiograph taken the central and lateral incisors, while the left canine and
two years later, at the age of 8 years, demonstrated bilateral lateral incisor were almost overlapping each other (Figure 6).
distal deflection of the mandibular permanent lateral incisors It would have been dangerous to continue the movement of
bypassing the deciduous lateral incisors and canines and the right lateral incisor to its normal position as it could cause
ectopically erupted rotated in the place of the deciduous interference between their roots and possible root resorption.
first molars causing their early exfoliation (Figure 2). His Therefore, it was decided at that point that it would be safer
intraoral examination revealed Class I interarch relationship to align them in their transposed position. The left lateral
with normal overbite and overjet in the early mixed dentition. incisor was uprighted and moved to its normal place next
The mandibular permanent lateral incisors have ectopically to the central incisor allowing the left canine to erupt into
erupted bilaterally distal to the deciduous canines with 90 its normal position in the arch, while the right permanent
degrees of rotation, causing early exfoliation of the deciduous canine was erupting in transposition with the lateral incisor
first molars (Figure 3). (Figure 7). The right canine’s cusp tip was slightly reshaped to
resemble an incisor. Following completion of the orthodontic
4. Treatment Objectives treatment at the age of 12 years permanent retainers were
bonded on the upper and lower anterior teeth. The very
The primary objectives were to derotate the mandibular nice outcome of the treatment is presented in the final
permanent lateral incisors and upright and reposition them intraoral photographs (Figure 8) and panoramic radiograph
to their normal position next to the central incisors. This (Figure 9).
 2415, 2016, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1155/2016/5043801 by Cochrane Philippines, Wiley Online Library on [11/09/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
Case Reports in Dentistry 3

Figure 3: Pretreatment intraoral photographs showing the mandibular right and left lateral incisors ectopically erupted rotated in the place
of the early exfoliated first deciduous molars.

Figure 4: Extraction of the deciduous lateral incisors and canines.

(a) (b)

Figure 5: Derotation (a) and mesial movement of the permanent lateral incisors (b).

6. Discussion a factor causing the deflection and migration of a tooth.

Several theories have been suggested as etiological factors
The developing mandibular permanent lateral incisor nor- to explain why a tooth deviates from its normal path of
mally resorbs the root of the deciduous tooth during the eruption to become transposed: interchange in position of
process of eruption into the oral cavity. It is still unclear the anlage at the very early stage of tooth development
what causes a tooth to deviate from its normal path of [23], genetic control within the dental follicle [20, 21, 24],
eruption and erupt ectopically. The presence of an obstacle prolonged retention of the deciduous lateral incisor [25, 26],
such as a supernumerary tooth or an odontoma could be crowding and inadequate arch length [2]. Crowding did not
 2415, 2016, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1155/2016/5043801 by Cochrane Philippines, Wiley Online Library on [11/09/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
4 Case Reports in Dentistry

(a) (b)

Figure 6: Panoramic radiograph (a) and intraoral photograph (b) showing the right permanent canine in position to erupt between the
lateral and central incisors.

Figure 7: The right permanent canine is erupting in transposition with the lateral incisor. The left permanent canine is erupting into its
normal position in the arch.

Figure 8: Posttreatment intraoral photographs showing mandibular right canine in complete transposition with the lateral incisor, while the
left canine is in its normal position in the arch.

seem to be a primary cause of the anomaly as sufficient space Treatment considerations for transposed teeth include
to accommodate all the permanent teeth was found in the repositioning them in their normal place in the dental arch,
presented case, which is in agreement with previous reported maintaining them in their transposed position, or extracting
cases [11]. Another possible explanation suggested that the one of the transposed teeth.
retained mandibular deciduous lateral incisor could be the In managing treatment for mandibular tooth transpo-
cause of the displacement of the permanent lateral incisor sition several factors should be considered such as the
resulting in transposition [27]. amount of distally displaced lateral incisor and the intrabony
It is not yet clear whether the retained deciduous tooth position of the permanent canine. Early detection of the
is the cause or the result of the displacement and ectopic abnormal eruption path of the lateral incisor allows for early
eruption of its successor. intervention by uprighting and moving the lateral incisor
 2415, 2016, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1155/2016/5043801 by Cochrane Philippines, Wiley Online Library on [11/09/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
Case Reports in Dentistry 5

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6 Case Reports in Dentistry

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