Teeth transpositions by almuzian

1. Mohammed Almuzian, University of Glasgow, 2014 Page 1
Transpositions
Definition
 True transposition a transposed toothis the positional interchange of 2
adjacent teeth or erupting into a position of non-adjacent tooth . In complete
transposition, both the crowns and the entire root structures of the involved
teeth are found parallel in their transposed positions
 Pseudo-transpositionoccurs when the crowns of adjacent teeth have changed
in positional location but the roots have not (roots remain in the normal tooth
order). In incomplete transposition (also called “pseudo”or “partial”) the
crowns may be transposed while the root apices remain in their normal
positions. Alternatively, the crowns may be in the correctorder while the root
apices are transposed. Thus, the 2 involved teeth overlap and their long axes
cross each other. In addition, the crowns and roots of the 2 involved teeth may
completely superimpose each other on normally projected radiographs
Aetiology
1. Genetic
2. Environmental
 Retention of primary teeth
 Trauma
Classification,
Three parts code:Favot et al., 1986
1. First part: jaw of occurrence
2. Secondpart: transposed tooth
3. Third part: site of transposition
e.g. Mx.C.P1 = transposition of maxillary canine to first premolar position

2. Mohammed Almuzian, University of Glasgow, 2014 Page 2
Prevalence
Peck andPeck 1995
1. less than 0.5-1% in general population
2. Mor common in female
3. More common in LHS
4. 88% cases are unilateral
5. more common in max (76%)
6. most common transpositions in decreasing order of occurrence in the maxilla:
 Mx.C.P1 Incidence: 71%
 Mx.C.12 Incidence: 20%
 Mx.C.M1
 Mx.12.Il
 Mx.C.I1
7. most common transposition in mandible: Mand C.12
8. Mx.C.P1 and Mx.C.12 more common in females, rest more common in males
often associated with other dental anomalies Ely et al., 2006
Treatment options, Shapira 2005
1. Interceptive treatment: if detected early enough, at the age of 6 to 8 years,
extraction of deciduous teeth, guiding the eruption of the transposed tooth into
the normal position, while the spaceis maintained by a lingual arch or a palatal
bar. Usually, this approachis possible with pseudo-transposition.
2. Correct transposition.
3. Accept transposition followed by reshaping their incisal or occlusal surfaces and
using composite materials for restorative camouflage.
4. Extraction of 1 or both transposed teeth followed by orthodontic correction.
This strategy has been recommended when other factors such as crowding and
caries indicate extraction.

3. Mohammed Almuzian, University of Glasgow, 2014 Page 3
5. There are a number of interesting case reports using a modified Nance to bring
premolar or lateral incisor more palatal so that the canine can slide over to the
correct position using push coil. When the canine is correct, the premolar or
lateral is again pushed back into line of arch in correctarch position.
Severalfactors should be consideredwhen making the treatment plan.
1. Facial aesthetics.
2. Intra and inter-arch relationship
3. Type of transposition.
4. Toothshape and morphology.
5. Clinical condition of the teeth
6. Amount of bone and attached gingivae available that might permit correction of
transposition
7. Others
Intraosseous migration
1. Prevelance 0.5% (Kumar 2012)
2. More in female than male
3. More unilateral than bilateral
4. More commonly left canine migrate to right (2;1)
5. migration occurs in Mand and effects second premolar and canine
6. however, recent literature reported an unusual transmigration of a palatally
impacted 3 across midpalatal suture to the oppositeside (to the other side of the
maxillary bone)
7. Treatment options proposed fortransmigrated mandibular canines are surgical
removal, transplantation, surgical exposure with orthodontic alignment or
leaving them in situ with periodic radiographic follow-up. If the decision is
extraction, it should be kept in mind that, although the teeth have transmigrated
to the other side of the midline, they still maintain their nerve supply from the
originating side

4. Mohammed Almuzian, University of Glasgow, 2014 Page 4
8. Peck et al and Shapira mention it occurmore in female and has some genetic
Aetiology:
 Genetic,
 Trauma,
 Cyst,
 Premature loss of canine,
 Hypodontia,
 Proclination of the lower incisors,
 Increased axial inclination of the unerupted canine more than 50 degree,
 An enlarged symphyseal cross-sectionalarea of the chin may be favourable
conditions for transmigration.
Classificationaccording to Mupparapu’s classification