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 Table of Contents  
CASE REPORT
Year : 2016  |  Volume : 6  |  Issue : 1  |  Page : 45-47

Autotransplantation of palatally impacted maxillary canine


Department of Oral and Maxillofacial Surgery, YMT Dental College and Hospital, Kharghar, Navi Mumbai, Maharashtra, India

Date of Web Publication11-Aug-2016

Correspondence Address:
Punam N Nagargoje
Department of Oral and Maxillofacial Surgery, YMT Dental College and Hospital, Navi Mumbai - 410 210, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2229-6360.188232

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  Abstract 

The occurrence of canine impaction is not a rare phenomenon. We report a case of horizontally placed palatally impacted maxillary canine in a 21-year-old male patient. The purpose of this report was to describe a patient undergoing autotransplantation of an impacted maxillary canine to its normal position in the dental arch.

Keywords: Autotransplantation; impacted canine; maxillary canine


How to cite this article:
Vora MM, Nagargoje PN. Autotransplantation of palatally impacted maxillary canine. Indian J Multidiscip Dent 2016;6:45-7

How to cite this URL:
Vora MM, Nagargoje PN. Autotransplantation of palatally impacted maxillary canine. Indian J Multidiscip Dent [serial online] 2016 [cited 2019 Jan 17];6:45-7. Available from: http://www.ijmdent.com/text.asp?2016/6/1/45/188232


  Introduction Top


Impacted teeth are those with a delayed eruption time or those which are not expected to erupt completely based on clinical and radiographic assessment. [1] Impaction of the maxillary canine has been reported in 1-3%. Palatal impactions are reported to occur 2-3 times more frequently than buccal ones. Treatment plan for maxillary canine impaction should be decided among extraction, orthodontic traction, and autotransplantation according to several factors such as direction and position of the unerupted tooth, degree of developing root apex, eruption space, existence of supernumerary tooth, odontoma, or cyst. Surgical exposure of impacted canines, often together with orthodontic traction, has long been advocated (von der Heydt, 1975; Andreasen, 1971). Another treatment possibility is autotransplantation of the maxillary canine, and this was first reported by Widman in 1915.


  Case Report Top


A male patient, 21-year-old was referred by an orthodontist to remove a left canine impacted in the maxilla. The patient reported that the tooth was asymptomatic. During intraoral physical examination, absence of tooth #23 was detected, and primary canine was over-retained. Cone beam computed tomography revealed that the mentioned tooth was situated horizontally below the root apices of anterior teeth and first premolar [Figure 1]. The treatment consisted of surgical removal of maxillary canine and autotransplantation.
Figure 1: Preoperative cone beam computed tomography

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Bilateral greater palatine nerve block was given with buccal infiltration on the left side (2% lignocaine with 1:80,000 epinephrine), a crevicular incision was taken from the right central incisor to the second premolar on the left side, a full thickness mucoperiosteal flap was reflected, and canine was exposed with round burs.

Initially, the permanent canine was luxated, and then the new alveolus was prepared as completely as possible to a slightly wider socket. The over-retained primary canine was carefully luxated and extracted. Socket preparation was done at the region of 23. The permanent canine was extracted in one piece [Figure 2], and the surgical area was irrigated with saline solution. Recipient alveolar site was inadequate; the transplant was kept in a dressing with physiological saline while adjusting the new alveolar site. Palatal flap closure was done with absorbable suture and then extracted permanent canine was placed in the socket with slight subocclusion without bony contact [Figure 3] and stabilized with composite resin bonding. Postoperative period was uneventful. Follow-up revealed good healing and stabilization in arch [Figure 4].
Figure 2: Preoperative intraoperative canine

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Figure 3: Autotransplanted canine

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Figure 4: Postoperative orthopantomogram

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  Discussion Top


Impacted maxillary canines are the most frequently impacted teeth after the third molars, with a prevalence ranging from approximately 1% to 3%. [1],[2] More commonly observed in females. [3],[4] Although alignment of maxillary canines play an important role in maintaining esthetics and function of dentition, they are more difficult and time-consuming to treat. Moreover, resorption of neighboring incisors, as well as cystic degeneration can be seen because of location and variable inclination of impacted maxillary canine. [5]

The treatment options for impacted canines are no treatment, surgical intervention, removal, transplantation, prosthetic or restorative treatment, or surgical exposure with or without orthodontic traction to align the malpositioned tooth. Autotransplantation is a valuable alternative to the extraction of impacted teeth, where surgical exposure and subsequent orthodontic realignment are difficult or impossible due to unfavorable impaction position. Moreover, its prognosis is dependent on a number of factors such as preservation of periodontal ligament, degree of root development, surgical technique, patient's age, endodontic treatment, time and type of splinting, and storage medium.

As the result in this case, atraumatic removal of donor tooth during operation is prerequisite to an optimal clinical result. Due to a high possibility of pulp necrosis, endodontic treatment of fully developed transplanted teeth should be undertaken. In complex case, autotransplantation can save time and less expensive than orthodontic forced eruption. Recipient socket should be prepared to a size that is slightly larger than the root of the donor tooth, and can be prepared with open or close procedure depends on root size of donor tooth and buccolingual width at transplantation site.

An autotransplantation provides not only a biological replacement of tooth which has potential to induce alveolar bone growth but also supports proprioceptive function by maintaining a normal PDL. An autotransplanted tooth has potential to erupt with neighboring teeth during continued facial growth. Autotransplanted tooth maintains a normal interdental papilla and shows desired movement with orthodontic treatment. [6],[7]


  Conclusion Top


Autotransplantation is an alternative for replacing missing teeth. Success rate is approximately similar to implants, with proper technique applied.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Richardson G, Russell KA. A review of impacted permanent maxillary cuspids - Diagnosis and prevention. J Can Dent Assoc 2000;66:497-501.  Back to cited text no. 1
    
2.
Chaushu S, Chaushu G, Becker A. The use of panoramic radiographs to localize displaced maxillary canines. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;88:511-6.  Back to cited text no. 2
    
3.
Walker L, Enciso R, Mah J. Three-dimensional localization of maxillary canines with cone-beam computed tomography. Am J Orthod Dentofacial Orthop 2005;128:418-23.  Back to cited text no. 3
    
4.
Mason C, Papadakou P, Roberts GJ. The radiographic localization of impacted maxillary canines: A comparison of methods. Eur J Orthod 2001;23:25-34.  Back to cited text no. 4
    
5.
Ericson S, Kurol PJ. Resorption of incisors after ectopic eruption of maxillary canines: A CT study. Angle Orthod 2000;70:415-23.  Back to cited text no. 5
    
6.
Kim E, Jung JY, Cha IH, Kum KY, Lee SJ. Evaluation of the prognosis and causes of failure in 182 cases of autogenous tooth transplantation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005;100:112-9.  Back to cited text no. 6
    
7.
Zachrisson BU, Stenvik A, Haanaes HR. Management of missing maxillary anterior teeth with emphasis on autotransplantation. Am J Orthod Dentofacial Orthop 2004;126:284-8.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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Abstract
Introduction
Case Report
Discussion
Conclusion
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