Complex orthodontic and surgical treatment of a patient with a transmigrated mandibular canine. Case report

Introduction
Transmigration is a type of tooth impaction. According to Tarsiano et al., transmigration can be diagnosed when an unerupted mandibular canine crosses the midline. It is observed mainly in the case of lower canines, and its aetiology is not fully known. Diagnostic tests are aimed to confirm the presence of a persistent canine in the intraoral examination and to evaluate panoramic radiographs of 8-9-year-old patients.

Aim
The aim of the study is to describe the diagnostic tests, treatment planning and stages, as well as the use of a lipbumper as a useful device for the introduction of a transmigrated mandibular canine of type 1 according to Mupparapu into the arch.

Case report
A 14-year-old male patient came to the SmileArtStudio clinic for an orthodontic consultation. The intraoral examination revealed a persistent canine and second deciduous molar on the right in the lower arch. The panoramic radiograph provided by the patient showed the transmigration of a permanent lower canine on the right. Orthodontic documentation including impressions, photographs and imaging tests with CBCT was prepared. The patient and his parents showed motivation to undertake treatment to preserve the impacted canine. The treatment plan included surgical exposure of the canine, attaching a metal chain clip and making a modified lip bumper to be a place of force application.

Discussion
The method of treatment in the case of canine transmigration depends on many factors, including the degree of development of a root of an impacted canine and its location. The treatment strategies under consideration include orthodontic extrusion, extraction, leaving a tooth in its position and radiological follow-up.

Summary
The majority of transmigrated canines have a favourable position (Mupparapu type 1), and therefore it is possible to make an attempt to introduce the canine into the dental arch.