Clinical management of impacted and transmigrated lower canines

Abstract Objectives Impacted, in particular transmigrated lower canines are rare. If they transmigrate, the most common treatment is extraction. Alternatively, the native tooth can be preserved; however, the management and decision making is complex. We developed a decision making flowchart (DMFC) with surgical strategies for the management of impacted lower canines. Materials and Methods We investigated 56 patients with impacted lower canines, of which 16 were transmigrated. We used a preliminary version of the DMFC for the development of treatment plans to decide which strategy can be applied for these complex cases. After removal of associated pathologies - for experimental tooth preserving therapies - we used mini-screws as transient skeletal anchorage devices (TADs). The TADs allowed a closed surgical approach for impacted and transmigrated lower canine eruption. For autotransplantation we used a dummy tooth for socket preparation to keep the grafts time without blood supply at a minimum. Results After surgical exposure and TAD insertion orthodontic treatment was performed in four patients. One patient was selected for successful autotransplantation. Nine patients had the transmigrated canines surgically removed. The remaining patients opted for “leave and observe”. Based on the satisfactory long-term results with orthodontic treatment and autotransplantation, as well as published reports, the finally suggested flow chart lists key aspects of the treatment plan, i.e. 1) associated pathology, 2) patient age, 3) compliance, and 4) root tip position. Conclusions TAD-assisted orthodontic treatment and autotransplantation of impacted lower canines are tooth preserving alternatives to extraction. The developed flow chart assists the complex treatment planning of impacted/transmigrated lower canines.