Clinical Oral Investigations

, Volume 22, Issue 6, pp 2389–2399 | Cite as

Impacted and transmigrated mandibular canines: an analysis of 3D radiographic imaging data

  • Michael H. Bertl
  • Clemens Frey
  • Kristina Bertl
  • Katharina Giannis
  • André Gahleitner
  • Georg D. StrbacEmail author
Original Article



Impacted and transmigrated mandibular canines differ greatly in incidence, etiopathology, associated anomalies, and treatment prospects, when compared to their maxillary counterparts. The aim of this study was to provide a detailed analysis of 3D radiographic imaging data of impacted mandibular canines.

Materials and methods

In a retrospective cross-sectional study, CT/CBCT data of 88 patients with a total of 94 impacted mandibular canines were analysed. Evaluated parameters included location, morphology, neighbouring structures, associated anomalies, the influence of those factors on mandibular canine transmigration, as well as applied treatment.


Transmigration was found to occur in 40.4% of impacted mandibular canines. Transmigrated canines were located significantly more basally and horizontally angulated. Further, transmigration was significantly associated with a lack of contact to adjacent teeth and the canine’s apex not contacting the mandibular cortical bone. The overall incidence of root resorptions of adjacent teeth related to impacted mandibular canines was 7.3% and was more likely, if the canine was lingually impacted. While about half of the non-transmigrated impacted canines were orthodontically aligned, half of the transmigrated canines were surgically removed. Monitoring was the second most applied treatment strategy for both groups, and no canines were autotransplantated.


Root resorption of adjacent teeth and transmigration are commonly occurring phenomena related to impacted mandibular canines.

Clinical relevance

Treatment often entails the surgical removal of the canine—especially in cases of transmigration. The findings emphasise the importance of early diagnosis and CT/CBCT imaging for further diagnostics and future research of impacted mandibular canines.


Mandibular canine Impaction Root resorption Transmigration CT CBCT 3D imaging 



The work was supported by the Divisions of Oral Surgery, Orthodontics, Radiology, and Dental Student Training and Patient Care, School of Dentistry, Medical University of Vienna, Vienna, Austria, as well as the Department of Periodontology, Faculty of Odontology, University of Malmö, Malmö, Sweden.

Compliance with ethical standards

Conflict of interest

Michael H. Bertl declares that he has no conflict of interest. Clemens Frey declares that he has no conflict of interest. Kristina Bertl declares that she has no conflict of interest. Katharina Giannis declares that she has no conflict of interest. André Gahleitner declares that he has no conflict of interest. Georg D. Strbac declares that he has no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study, formal consent is not required.


  1. 1.
    Alqerban A, Jacobs R, Lambrechts P, Loozen G, Willems G (2009) Root resorption of the maxillary lateral incisor caused by impacted canine: a literature review. Clin Oral Investig 13(3):247–255. CrossRefPubMedGoogle Scholar
  2. 2.
    Sacerdoti R, Baccetti T (2004) Dentoskeletal features associated with unilateral or bilateral palatal displacement of maxillary canines. Angle Orthod 74(6):725–732.<0725:DFAWUO>2.0.CO;2 PubMedGoogle Scholar
  3. 3.
    Dalessandri D, Parrini S, Rubiano R, Gallone D, Migliorati M (2017) Impacted and transmigrant mandibular canines incidence, aetiology, and treatment: a systematic review. Eur J Orthod 39(2):161–169. CrossRefPubMedGoogle Scholar
  4. 4.
    Joshi MR (2001) Transmigrant mandibular canines: a record of 28 cases and a retrospective review of the literature. Angle Orthod 71(1):12–22.<0012:TMCARO>2.0.CO;2 PubMedGoogle Scholar
  5. 5.
    Aras MH, Halicioglu K, Yavuz MS, Caglaroglu M (2011) Evaluation of surgical-orthodontic treatments on impacted mandibular canines. Med Oral Patol Oral Cir Bucal 16:e925–e928CrossRefPubMedGoogle Scholar
  6. 6.
    Celikoglu M, Kamak H, Oktay H (2010) Investigation of transmigrated and impacted maxillary and mandibular canine teeth in an orthodontic patient population. J Oral Maxillofac Surg 68(5):1001–1006. CrossRefPubMedGoogle Scholar
  7. 7.
    Sinko K, Nemec S, Seemann R, Eder-Czembirek C (2016) Clinical management of impacted and transmigrated lower canines. J Oral Maxillofac Surg 74(11):2142.e1–2142.e16. CrossRefGoogle Scholar
  8. 8.
    Yavuz MS, Aras MH, Buyukkurt MC, Tozoglu S (2007) Impacted mandibular canines. J Contemp Dent Pract 8(7):78–85PubMedGoogle Scholar
  9. 9.
    Strbac GD, Foltin A, Gahleitner A, Bantleon HP, Watzek G, Bernhart T (2013) The prevalence of root resorption of maxillary incisors caused by impacted maxillary canines. Clin Oral Investig 17(2):553–564. CrossRefPubMedGoogle Scholar
  10. 10.
    Gahleitner A, Watzek G, Imhof H (2003) Dental CT: imaging technique, anatomy, and pathologic conditions of the jaws. Eur Radiol 13(2):366–376. PubMedGoogle Scholar
  11. 11.
    Lai CS, Bornstein MM, Mock L, Heuberger BM, Dietrich T, Katsaros C (2013) Impacted maxillary canines and root resorptions of neighbouring teeth: a radiographic analysis using cone-beam computed tomography. Eur J Orthod 35(4):529–538. CrossRefPubMedGoogle Scholar
  12. 12.
    McDonnell D, Reza Nouri M, Todd ME (1994) The mandibular lingual foramen: a consistent arterial foramen in the middle of the mandible. J Anat 184:363–369PubMedPubMedCentralGoogle Scholar
  13. 13.
    Sekerci AE, Sisman Y, Payveren MA (2014) Evaluation of location and dimensions of mandibular lingual foramina using cone-beam computed tomography. Surg Radiol Anat 36(9):857–864. CrossRefPubMedGoogle Scholar
  14. 14.
    Sherwood RJ, Hlusko LJ, Duren DL, Emch VC, Walker A (2005) Mandibular symphysis of large-bodied hominoids. Hum Biol 77(6):735–759. CrossRefPubMedGoogle Scholar
  15. 15.
    Wang YM, Ju YR, Pan WL, Chan CP (2015) Evaluation of location and dimensions of mandibular lingual canals: a cone beam computed tomography study. Int J Oral Maxillofac Surg 44(9):1197–1203. CrossRefPubMedGoogle Scholar
  16. 16.
    Mupparapu M (2002) Patterns of intra-osseous transmigration and ectopic eruption of mandibular canines: review of literature and report of nine additional cases. Dentomaxillofac Radiol 31(6):355–360. CrossRefPubMedGoogle Scholar
  17. 17.
    Moorrees CF, Fanning EA, Hunt EE (1963) Age variation of formation stages for ten permanent teeth. J Dent Res 42(6):1490–1502. CrossRefPubMedGoogle Scholar
  18. 18.
    Ericson S, Bjerklin K, Falahat B (2002) Does the canine dental follicle cause resorption of permanent incisor roots? A computed tomographic study of erupting maxillary canines. Angle Orthod 72:95–104PubMedGoogle Scholar
  19. 19.
    Walker L, Enciso R, Mah J (2005) Three-dimensional localization of maxillary canines with cone-beam computed tomography. Am J Orthod Dentofac Orthop 128(4):418–423. CrossRefGoogle Scholar
  20. 20.
    Ericson S, Bjerklin K (2001) The dental follicle in normally and ectopically erupting maxillary canines: a computed tomography study. Angle Orthod 71(5):333–342.<0333:TDFINA>2.0.CO;2 PubMedGoogle Scholar
  21. 21.
    White SC, Pharoah MJ (2009) Oral radiology: principles and interpretation. Mosby Elsevier, St. LouisGoogle Scholar
  22. 22.
    Ericson S, Kurol J (2000) Incisor root resorptions due to ectopic maxillary canines imaged by computerized tomography: a comparative study in extracted teeth. Angle Orthod 70(4):276–283.<0276:IRRDTE>2.0.CO;2 PubMedGoogle Scholar
  23. 23.
    Ericson S, Kurol PJ (2000) Resorption of incisors after ectopic eruption of maxillary canines: a CT study. Angle Orthod 70(6):415–423.<0415:ROIAEE>2.0.CO;2 PubMedGoogle Scholar
  24. 24.
    Aydin U, Yilmaz HH, Yildirim D (2004) Incidence of canine impaction and transmigration in a patient population. Dentomaxillofac Radiol 33(3):164–169. CrossRefPubMedGoogle Scholar
  25. 25.
    Mazinis E, Zafeiriadis A, Karathanasis A, Lambrianidis T (2012) Transmigration of impacted canines: prevalence, management and implications on tooth structure and pulp vitality of adjacent teeth. Clin Oral Investig 16(2):625–632. CrossRefPubMedGoogle Scholar
  26. 26.
    Sajnani AK, King NM (2014) Impacted mandibular canines: prevalence and characteristic features in southern Chinese children and adolescents. J Dent Child (Chic) 81:3–6Google Scholar
  27. 27.
    Sudhakar S, Patil K, Mahima VG (2009) Localization of impacted permanent maxillary canine using single panoramic radiograph. Indian J Dent Res 20(3):340–345. CrossRefPubMedGoogle Scholar
  28. 28.
    Howard RD (1976) The anomalous mandibular canine. Br J Orthod 3(2):117–121.Google Scholar
  29. 29.
    Urias D, Mustafa FI (2005) Anchorage control in bioprogressive vs straight-wire treatment. Angle Orthod 75(6):987–992.Google Scholar
  30. 30.
    Puricelli E (2007) Apicotomy: a root apical fracture for surgical treatment of impacted upper canines. Head Face Med 3(1):33. CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Ando S, Aizawa K, Nakashima T, Sanka Y, Shimbo K, Kiyokawa K (1964) Transmigration process of the impacted mandibular cuspid. J Nihon Univ Sch Dent 6(2):66–71. CrossRefGoogle Scholar
  32. 32.
    Stafne EC (1963) Malposed mandibular canine. Oral Surg Oral Med Oral Pathol 16(11):1330. CrossRefPubMedGoogle Scholar
  33. 33.
    Sutton P (1969) Migration and eruption of non-erupted teeth: a suggested mechanism. Aust Dent J 14(4):269–270. CrossRefPubMedGoogle Scholar
  34. 34.
    Becker A, Smith P, Behar R (1981) The incidence of anomalous maxillary lateral incisors in relation to palatally-displaced cuspids. Angle Orthod 51:24–29PubMedGoogle Scholar
  35. 35.
    Bertl K, Benkö G, Bertl MH, Breu M, Gahleitner A, Ulm C (2013) A retrospective study on the influence of maxillary canine impaction on premolar root morphology. Clin Oral Investig 17(3):943–948. CrossRefPubMedGoogle Scholar
  36. 36.
    Bishara SE (1992) Impacted maxillary canines: a review. Am J Orthod Dentofac Orthop 101(2):159–171. CrossRefGoogle Scholar
  37. 37.
    Kara MI, Ay S, Aktan AM, Sener I, Bereket C, Ezirganli S, Demirkol M (2011) Analysis of different type of transmigrant mandibular teeth. Med Oral Patol Oral Cir Bucal 16:e335–e340CrossRefPubMedGoogle Scholar
  38. 38.
    Baccetti T (1998) A controlled study of associated dental anomalies. Angle Orthod 68(3):267–274.<0267:ACSOAD>2.3.CO;2 PubMedGoogle Scholar
  39. 39.
    Alqerban A, Jacobs R, Fieuws S, Willems G (2016) Predictors of root resorption associated with maxillary canine impaction in panoramic images. Eur J Orthod 38(3):292–299. CrossRefPubMedGoogle Scholar
  40. 40.
    Alqerban A, Jacobs R, Fieuws S, Nackaerts O, SEDENTEXCT PC, Willems G (2011) Comparison of 6 cone-beam computed tomography systems for image quality and detection of simulated canine impaction-induced external root resorption in maxillary lateral incisors. Am J Orthod Dentofac Orthop 140(3):e129–e139. CrossRefGoogle Scholar
  41. 41.
    da Silveira HL, Silveira HE, Liedke GS, Lermen CA, Dos Santos RB, de Figueiredo JA (2007) Diagnostic ability of computed tomography to evaluate external root resorption in vitro. Dentomaxillofac Radiol 36(7):393–396. CrossRefPubMedGoogle Scholar
  42. 42.
    Czochrowska EM, Stenvik A, Bjercke B, Zachrisson BU (2002) Outcome of tooth transplantation: survival and success rates 17–41 years posttreatment. Am J Orthod Dentofac Orthop 121(2):110–119; quiz 193. CrossRefGoogle Scholar
  43. 43.
    Tsukiboshi M (2002) Autotransplantation of teeth: requirements for predictable success. Dent Traumatol 18(4):157–180. CrossRefPubMedGoogle Scholar
  44. 44.
    Hudson AP, Harris AM, Mohamed N (2011) Early identification and management of mandibular canine ectopia. SADJ 66(462–4):466Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Michael H. Bertl
    • 1
  • Clemens Frey
    • 2
  • Kristina Bertl
    • 2
    • 3
  • Katharina Giannis
    • 4
  • André Gahleitner
    • 5
    • 6
  • Georg D. Strbac
    • 2
    Email author
  1. 1.Division of Orthodontics, School of DentistryMedical University of ViennaViennaAustria
  2. 2.Division of Oral Surgery, School of DentistryMedical University of ViennaViennaAustria
  3. 3.Department of Periodontology, Faculty of OdontologyUniversity of MalmöMalmöSweden
  4. 4.Division of Dental Student Training and Patient Care, School of DentistryMedical University of ViennaViennaAustria
  5. 5.Division of Radiology, School of DentistryMedical University of ViennaViennaAustria
  6. 6.Department of Diagnostic Radiology, Division of Osteoradiology, General HospitalMedical University of ViennaViennaAustria

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