Treatment of a deep impacted and transmigrated mandibular canine of type 2 using a mini-implant and gradual change of traction direction

Transmigration of a permanent mandibular canine is considered, in most cases, to be an untreatable dental malposition. However, various indicators can be drawn from the study of these two case reports to determine the proper approach in this situation: the impaction and transmigration diagnosis causes and the severity of transmigration; that is, the distance between the apex of the transmigrated canine and the lower border of the mandible, the length of its root, the volume of its crown and the amount of the tooth beyond the mandibular midline, lack of a priori ankylosis, and the patient's age, patience, and willingness. If orthodontic traction is chosen, the following parameters need to be considered: detailed surgical exposure; location and design of the attachment on the crown of the transmigrated canine; the means linking the attachment and the traction-force means, which remain intra-tissue; skeletal anchorage; and vector of force traction, ensuring that the mandibular first premolar and the permanent mandibular incisors remain free from the orthodontic appliance during the initial stages of treatment. The proper decision on whether to extract or to expose and tract the affected tooth is discussed through the presentation of two cases of a permanent mandibular transmigrated canine of type 2. Two female patients are presented, one at the age of 23 years and 2 months, and the other at the age of 11 years and 6 months, successfully and unsuccessfully treated, respectively.