PMC4072348_01
Pretreatment records (a-d) intraoral photographs of the patient showing missing right and fractured left maxillary central Incisors, spaced mandibular anteriors and retained deciduous right mandibular canine (e) orthopantomogram revealing retained deciduous right mandibular canine and transmigrated permanent right mandibular canine (f) lateral cephalogram
JOS-1-23-g001.jpg
PMC4072348_01_JOS-1-23-g001.jpg
F1
She had Angle's class II division 1 subdivision right malocclusion with fractured upper left central incisor (Ellis and Davey's Class II #), and missing upper right central incisor [Figure 1a-d]. On orthopantomogram examination we observed the lower right canine to be in position of mesioangular impaction (more towards horizontal) below the apices of lower left central and lateral incisor (type 2 of Mupparapu pattern of transmigration) [Figure 1e].
Preadjusted orthodontic appliance (Roth prescription - 0.022" x 0.028" slot) was bonded to maxillary and mandibular arches except on the deciduous mandibular right canine as it had to be extracted later on (a) frontal photograph to show composite buildup of left maxillary central incisor to enhance the aesthetics as well as to facilitate bracket placement (b) maxillary occlusal photograph showing space loss for right central incisor (c) mandibular occlusal photograph showing spacing between anterior teeth (d) lower occlusogram showing consolidation of anterior spacing at the lower right canine region
JOS-1-23-g002.jpg
PMC4072348_01_JOS-1-23-g002.jpg
F2
It also facilitates accurate positioning of bracket on the tooth [Figure 2a]. Pre-adjusted orthodontic appliance (Roth prescription 0.022"x0.028"slot) was bonded to the maxillary and mandibular teeth except the deciduous mandibular right canine [Figure 2a-d].
(a) NiTi open coil spring was compressed between left central incisor andright lateral incisor to regain the space for prosthetic replacement of right central incisor (b) intraoral mandibular occlusal photograph during treatment, the angulation of anterior teeth was corrected (c) mandibular arch was debonded before autotransplantation of mandibular right canine to facilitate maintenance of proper oral hygiene following surgery
JOS-1-23-g003.jpg
PMC4072348_01_JOS-1-23-g003.jpg
F3
The faulty angulations of adjacent teeth were corrected simultaneously with the creation of required space for fixed prosthesis of upper right central incisor [Figure 3a].
Intraoral photographs during surgery (a) full thickness flap was reflected (b) exposed right mandibular canine, that has been transmigrated to left side (c) primary canine was extracted
JOS-1-23-g004.jpg
PMC4072348_01_JOS-1-23-g004.jpg
F4
Incision was made at the level of the mucogingival junction and full thickness flap was reflected carefully by securing the mental nerve and, there was adequate clearance between the apex of the crown and mental foramina [Figure 4a]. Lower right canine was extracted via a labial approach from the left side but adequate amount of local anesthetic was administered on right side as the tooth maintains its nervous innervations on the side that the germ was formed [Figure 4b]. The primary canine was extracted simultaneously to avoid second dose of local anesthesia and recipient site was prepared by using sterile stainless steel burs with proper irrigation of saline to avoid heat generation at the surgical site [Figure 4c].
Intraoral photographs during surgery (a) recipient site preparation (b) permanent canine was transplanted at the recipient site (c) mucoperiosteal flap sutured (d) IOPA X-ray 2 weeks after the replantation
JOS-1-23-g005.jpg
PMC4072348_01_JOS-1-23-g005.jpg
F5
Silk 4/0 suture was used to close soft tissue flap [Figure 5a-d].
Post treatment records: (a-e) Intraoral photographs of the patient showing fixed prosthesis for missing right maxillary central incisor (f) panoramic radiograph revealing transplanted right mandibular canine as well as fixed prosthesis of maxillary arch (g) lower occlusogram, showing well aligned mandibular ach
JOS-1-23-g006.jpg
PMC4072348_01_JOS-1-23-g006.jpg
F6
Periapical radiolucency related to the replanted canine may be related to the socket preparation during the replantation procedure [Figure 6a-g].
(a) At 1 year of follow up for transplanted tooth intraoral periapical radiograph shows a small radiolucency at the distal side of the apical 1/3 of root surface (b) Denta Scan of the mandible (Cross section) (c) axial section of the mandible at the apical 1/3 of the root
JOS-1-23-g007.jpg
PMC4072348_01_JOS-1-23-g007.jpg
F7
At 1 year of follow up of transplanted tooth, the periodontal condition was good with no gingival recession but a small radiolucency (localized external root resorption) was observed at the distal side of the apical zone of the root surface in the panoramic radiograph and axial section of CT scan [Figure 7a-c].