A multidisciplinary approach for treating congenitally transposed canines: a clinical report


Jahangiri, L.; Luu, L.; Estafan, D.

Journal of Prosthetic Dentistry 95(6): 413-416

2006


A multidisciplinary approach is generally required in the treatment of patients who present with missing and malpositioned teeth to achieve an esthetic and functional outcome. Treatment of a patient with congenitally transposed canines, missing central incisors, and peg-shaped lateral incisors using a multidisciplinary approach is presented.

A
multidisciplinary
approach
for
treating
congenitally
transposed
canines:
A
clinical
report
Leila
Jahangiri,
BDS,
DMD,
MMSc,a
Long
Luu,
BS,
BA,
DDS,
b
and
Denise
Estafan,
DMD,
MSC
New
York
University
College
of
Dentistry,
New
York,
NY
A
multidisciplinary
approach
is
generally
required
in
the
treatment
of
patients
who
present
with
missing
and
malpositioned
teeth
to
achieve
an
esthetic
and
functional
outcome.
Treatment
of
a
patient
with
con-
genitally
transposed
canines,
missing
central
incisors,
and
peg-shaped
lateral
incisors
using
a
multidisci-
plinary
approach
is
presented.
(J
Prosthet
Dent
2006;95:413-6.)
T
ransposition
is
a
form
of
ectopic
eruption
in
which
there
is
a
positional
substitution
of
2
permanent
teeth,
typically
within
the
same
quadrant.'
The
term
complete
transposition
is
used
for
situations
in
which
both
the
crown
and
the
root
of
the
tooth
are
transposed,
as
compared
to
partial
transposition,
in
which
the
root
remains
in
the
normal
position.
2
Maxillary
canines
have
been
reported
as
the
teeth
most
commonly
in-
volved,
with
a
prevalence
of
0.14%
to
0.51%,
3-8
with
uni-
lateral
transpositions
being
more
common,
particularly
affecting
the
left
side.
The
etiology
of
transposed
teeth
has
been
attributed
to
genetic
factors
related
to
the
position
of
developing
dental
lamina,
or
trauma
to
the
deciduous
teeth
and/or
retained
deciduous
canines,
6
'
7
with
women
more
often
affected
than
men.'
Transposi-
tion
often
presents
in
combination
with
other
dental
anomalies,
such
as
peg-shaped
lateral
incisors
or
hypo-
dontia.
8
The
treatment
of
these
patients
frequently
re-
quires
multidisciplinary
treatment
planning
to
achieve
a
long-term
esthetic
and
functional
result.
2
'
9-16
This
clinical
report
describes
the
restorative
management
of
a
patient
with
canines
bilaterally
transposed
into
the
cen-
tral
incisor
region,
missing
central
incisors,
and
bilater-
ally
peg-shaped
lateral
incisors.
CLINICAL
REPORT
A
14-year-old
boy
was
referred
to
the
New
York
University
College
of
Dentistry
with
a
chief
complaint
of
poor
esthetics
and
poor
speech.
The
patient
was
in
good
general
health,
and
the
medical
and
dental
history
indicated
no
contraindications
to
dental
treatment.
Initial
intraoral
and
radiographic
examinations
revealed
maxillary
canines
bilaterally
transposed
into
the
position
of
central
incisors,
missing
central
incisors,
peg-shaped
lateral
incisors,
and
blunted/shortened
root
morphol-
ogy
of
maxillary
anterior
teeth
(Fig.
1).
Evaluation
of
the
midline
was
determined
to
be
coincident
with
the
facial
midline
and
perpendicular
to
the
occlusal
plane,
'Assistant
Professor
and
Chair,
Louis
Blatterfein
Department
of
Prosthodontics.
b
Resident
in
Orthodontics.
`Associate
Professor,
Department
of
General
Dentistry
and
Manage-
ment
Sciences.
L
Fig.
1.
Panoramic
radiograph
at
initial
presentation.
I
Fig.
2.
Preoperative
frontal
view
showing
transposed
canines
and
diastema.
with
horizontal
and
vertical
overlaps
of
4
mm
and
1
mm,
respectively.
Space
analysis
indicated
an
asym-
metrical
ovoid
maxillary
arch
with
4
mm
of
excess
spac-
ing
and
a
mandibular
arch
with
a
symmetrical
U-shaped
form
with
10
nun
of
space
deficiency.
Assessment
of
the
occlusion
showed
Class
II
molar
malocdusion
17
with
the
presence
of
anterior
open
articulation
and
transposi-
tion
of
canines,
which
affected
the
phonetics
on
F-V
as-
sessment.
Phonetic
assessment
of
the
"s"
sound
showed
acquired
"s"
sound
deficiency
due
to
excessive
space
JUNE
2006
THE
JOURNAL
OF
PROSTHETIC
DENTISTRY
413
THE
JOURNAL
OF
PROSTHETIC
DENTISTRY
JAHANGIRI,
LUU,
AND
ESTAFAN
r4
,
N^4
4
0.
4
"
F
air
Fig.
3.
Maxillary
(top)
and
mandibular
(bottom)
preoperative
occlusal
views.
caused
by
diastema
and
open
articulation.
Smile
analysis
showed
transposed
canines,
bilaterally
missing
central
incisors,
and
peg-shaped
lateral
incisors,
in
addition
to
a
lack
of
any
tooth
structure
display
upon
smiling.
Treatment
options
for
congenitally
transposed
and
missing
teeth
were
either
to
create
space
for
the
replace-
ment
of
missing
teeth,
or
to
eliminate
space
and
restor-
atively
correct
tooth
anatomy
of
the
transposed
and
malformed
teeth
to
provide
acceptable
esthetics.
9
Although
implant-supported
prostheses
may
be
consid-
ered
as
a
treatment
alternative
when
the
treatment
re-
quires
the
creation
of
spaces
for
the
missing
teeth,
their
use
is
controversial
when
facial
growth
may
not
be
complete.
13
'
14
However,
if
the
treatment
plan
calls
for
space
creation
and
the
replacement
of
missing
teeth
with
dental
implants,
the
adolescent
patient
can
be
pro-
visionally
treated
with
a
fiber-reinforced
fixed
partial
denture
until
the
growth
is
completed
and
implants
are
placed.
In
this
patient,
a
hand—wrist
radiograph
indi-
cated
that
skeletal
growth
was
not
complete;
therefore,
the
option
of
opening
spaces
for
placement
and
restora-
tion
with
implants
was
not
considered.
18
Radiographic
examination
revealed
shortened
root
morphology
of
the
maxillary
left
first
premolar,
and
Fig.
4.
Preoperative
right
(A)
and
left
(B)
lateral
views
depict-
ing
vertical
and
horizontal
overlaps.
bilaterally
of
the
lateral
incisors
(Fig.
1).
Therefore,
cre-
ating
the
spaces
for
fabrication
of
fixed
partial
dentures
supported
by
these
teeth
was
deemed
inappropriate.
9
The
patient
and
parent
consented
to
a
combined
ortho-
dontic
and
prosthodontic
approach
in
which
orthodon-
tic
treatment
goals
included
correction
of
crowding
in
the
mandibular
arch,
closing
maxillary
arch
spaces
with
orthodontic
alignment
of
canines
in
the
ideally
aligned
position
of
maxillary
central
incisors,
and
reduction
of
the
horizontal
overlap
(Figs.
2,
3,
and
4),
followed
by
prosthetic
correction
of
the
malformed
teeth.
The
orthodontic
treatment
included
the
extraction
of
the
mandibular
second
premolars
and
application
of
an
edgewise
appliance
banding
(Snap-Fit
First
Molar
Bands;
GAC
Intl
Inc,
Bohemia,
NY)
to
the
maxillary
first
molars
and
bracket
attachments
(OmniArch
Appliances;
GAC
Intl
Inc)
to
the
remaining
maxillary
dentition,
bonded
using
a
resin
luting
agent
(Transbond
XT
Adhesive;
3M
Unitek,
Monrova,
Calif).
To
achieve
the
goals
of
correcting
the
malocclusion
and
aligning
the
teeth,
treatment
began
using
a
0.016-inch
nickel
titanium
round
leveling
wire
working
up
to
a
0.016
X
0.022-inch
stainless
steel
rectangular
finishing
wire
(Permachrome
Resilient
OrthoForm;
3M
Unitek,
and
414
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JAHANGIRI,
LUU,
AND
ESTAFAN
THE
JOURNAL
OF
PROSTHETIC
DENTISTRY
:7""•••11111111110
41mNit
4000
01111111111111W"
Fig.
5.
Assessment
of
orthodontics
progress
using
waxing
Fig.
6.
Postorthodontic
treatment
waxing.
guide.
r
a
Fig.
7.
Buccal
view
of
porcelain
veneer
preparations.
brackets,
OmniArch
Appliances; GAC
Intl
Inc).
The
progress
of
orthodontic
alignment
of
anterior
teeth
was
measured
using
a
waxing
guide
(Golden
Proportions
Waxing
Guides;
Panadent
Corp,
Grand
Terrace,
Calif)
19
(Fig.
5).
This
guide
indicated
when
the
orthodontic
treatment
achieved
ideal
spacing
of
the
residual
teeth
so
that
ideal
tooth
anatomy
and
pro-
portions
could
be
achieved
with
a
diagnostic
waxing
(Fig.
6)
and
be
approved
by
the
patient
and
parents.
To
assess
the
esthetics
and
phonetics,
the
diagnostic
waxings
were
duplicated
in
ADA
type
III
stone
(Microstone;
Whip
Mix
Corp,
Louisville,
Ky)
and
a
0.02-inch
vacuum-formed
matrix
(Thermo-forming
material;
Henry
Schein,
Melville,
NY)
was
fabricated.
Intraorally,
the
maxillary
vacuum-formed
matrix
was
filled
with
a
sufficient
amount
of
composite
resin
(PermaFlo;
Ultradent
Products
Inc,
South
Jordan,
Utah)
which
was
placed
onto
lubricated
(Vaseline;
Unilever,
Greenwich,
Conn),
unprepared
teeth.
The
composite
resin
was
light
polymerized
for
30
seconds
(Coe
Lunar
TA
curing
light;
GC
America
Inc,
Alsip,
Fig.
8.
Buccal
view
of
porcelain
veneer
after
cementation.
Ill);
the
vacuum-formed
matrix
was
then
removed
and
esthetics
and
phonetics
were
assessed
20'21
The
maxillary
canines,
lateral
incisors,
and
first
premolars
were
pre-
pared
for
bonded
labial
veneers
and
the
vacuum-formed
matrix
was
used
to
evaluate
the
preparation
reduction
(Fig.
7).22,23
Definitive
impressions
were
made
using
an
elastomeric
impression
material
(medium
body
Reprosil;
Dentsply
Caulk,
Milford,
Del),
and
interim
restorations
were
fabricated
using
a
composite
resin
(Vitalescence;
Ultradent)
applied
with
the
previously
fabricated
vacuum-formed
matrix.
Specifically,
the
teeth
were
spot-etched
and
the
splinted
resin
interim
veneers
were
bonded
(Calibra
Esthetic
Resin
Cement;
Dentsply
Caulk)
to
the
prepared
teeth.
The
diagnostic
waxing
was
used
as
a
guide
for
the
technician
in
the
fabrication
of
the
definitive
restorations.
Casts
made
from
these
pro-
visional
restorations
were
mounted
in
maximum
inter-
cuspation
in
a
semi-adjustable
articulator
(Panadent
PSH
Articulator;
Panadent
Corp),
and
lateral
interoc-
clusal
records
were
used
to
set
the
condylar
angles.
24
'
25
Definitive
ceramic
veneers
were
fabricated
(Empress
II;
JUNE
2006
415
THE
JOURNAL
OF
PROSTHETIC
DENTISTRY
JAHANGIRI,
LUU,
AND
ESTAFAN
Ivoclar
Vivadent,
Schaan,
Liechtenstein)
and
cemented
using
composite
resin
cement
(Calibra
Esthetic
Resin
Cement;
Dentsply
Caulk)
according
to
the
manufac-
turer's
recommendations
(Fig.
8).
To
prevent
ortho-
dontic
relapse,
it
was
essential
that
the
patient
continue
to
wear
a
removable
retainer
appliance
for
a
period
of
8
months.
At
the
18-month
follow-up
the
patient's
occlu-
sion
was
stable,
oral
hygiene
was
adequate,
and
the
pa-
tient
was
satisfied
with
the
esthetic
results.
SUMMARY
Treatment
of
an
adolescent
patient
with
transposed
canines,
missing
central
incisors,
and
peg-shaped
lateral
incisors
was
described
in
which
a
multidisciplinary
treat-
ment
approach
was
selected
to
achieve
optimal
esthetics
and
function.
REFERENCES
1.
Shapira
Y,
Kuftinec
MM.
Maxillary
tooth
transpositions:
characteristic
features
and
accompanying
dental
anomalies.
Am
J
Orthod
Dentofacial
Orthop
2001;119:127-34.
2.
Shapira
Y,
Kuftinec
MM.
A
unique
treatment
approach
for
maxillary
canine-lateral
incisor
transposition.
Am
J
Orthod
Dentofacial
Orthop
2001;119:540-5.
3.
Demir
A,
Basciftci
FA,
Gelgor
1E,
Karaman
Al.
Maxillary
canine
transpo-
sition.
J
Clin
Orthod
2002;36:35-7.
4.
Ruprecht
A,
Batniji
S,
El-Neweihi
E.
The
incidence
of
transposition
of
teeth
in
dental
patients.
J
Pedod
1985;9:244-9.
5.
Joshi
MR,
Bhatt
NA.
Canine
transposition.
Oral
Surg
Oral
Med
Oral
Pathol
1971;31:49-54.
6.
Peck
L,
Peck
S,
Attia
Y.
Maxillary
canine-first
premolar
transposition,
associated
dental
anomalies
and
genetic
basis.
Angle
Orthod
1993;63:
99-109.
7.
Chattopadhyay
A,
Srinivas
K.
Transposition
of
teeth
and
genetic
etiology.
Angle
Orthod
1996;66:147-52.
8.
Gholston
LR,
Williams
PR.
Bilateral
transposition
of
maxillary
canines
and
lateral
incisors:
a
rare
condition.
ASDC
J
Dent
Child
1984;51:58-63.
9.
Chaushu
S,
Becker
A,
Zalkind
M.
Prosthetic
considerations
in
the
restora-
tion
of
orthodontically
treated
maxillary
lateral
incisors
to
replace
missing
central
incisors:
a
clinical
report.
J
Prosthet
Dent
2001;85:335-41.
10.
Beznos
C.
An
alternative
approach
to
replacement
of
a
congenitally
missing
maxillary
central
incisor:
a
case
report.
Quintessence
Int
1996;27:759-62.
11.
Kokich
VG,
Nappen
DL,
Shapiro
PA.
Gingival
contour
and
clinical
crown
length:
their
effect
on
the
esthetic
appearance
of
maxillary
anterior
teeth.
Am
J
Orthod
1984;86:89-94.
12.
Rabie
AB,
Wong
RW.
Bilateral
transposition
of
maxillary
canines
to
the
incisor
region.
J
Clin
Orthod
1999;33:651-5.
13.
Oesterle
Li,
Cronin
RJ
Jr,
Ranly
DM.
Maxillary
implants
and
the
growing
patient.
Int
J
Oral
Maxillofac
Implants
1993;8:377-87.
14.
Cronin
RJ
Jr,
Oesterle
U.
Implant
use
in
growing
patients.
Treatment
plan-
ning
concerns.
Dent
Clin
North
Am
1998;42:1-34.
15.
Sarver
DM,
Ackerman
MB.
Dynamic
smile
visualization
and
quantifica-
tion:
part
1.
Evolution
of
the
concept
and
dynamic
records
for
smile
capture.
Am
J
Orthod
Dentofacial
Orthop
2003;124:4-12.
16.
Sarver
DM,
Ackerman
MB.
Dynamic
smile
visualization
and
quantifica-
tion:
part
2.
Smile
analysis
and
treatment
strategies.
Am
J
Orthod
Dento-
facial
Orthop
2003;124:116-27.
17.
Proffit
WR,
Fields
FIW.
Contemporary
orthodontics.
3rd
ed.
St.
Louis:
Elsevier;
1999.
p.
2-3.
18.
Fishman
LS.
Radiographic
evaluation
of
skeletal
maturation.
A
clinically
oriented
method
based
on
hand-wrist
fi
I
ms.
Angle
Orthod
1982;52:88-112.
19.
Ricketts
RM.
The
golden
divider.
J
Clin
Orthod
1981;15:752-9.
20.
Fayz
F,
Eslami
A,
Graser
GN.
Use
of
anterior
teeth
measurements
in
deter-
mining
occlusal
vertical
dimension.
J
Prosthet
Dent
1987;58:317-22.
21.
Pound
E.
Let
/S/
be
your
guide.
J
Prosthet
Dent
1977;38:482-9.
22.
Preston
JD.
A
systematic
approach
to
the
control
of
esthetic
form.
J
Pros-
thet
Dent
1976;35:393-402.
23.
Magne
P,
Belser
UC.
Novel
porcelain
laminate
preparation
approach
driven
by
a
diagnostic
mock-up.
J
Esthet
Restor
Dent
2004;16:7-16.
24.
Azarmehr
P,
Yarmand
MA.
The
use
of
lateral
interocclusal
records
in
semi-
adjustable
articulators.
J
Prosthet
Dent
1973;29:330-3.
25.
Curtis
DA.
A
comparison
of
lateral
interocclusal
records
to
pantographic
tracings.
J
Prosthet
Dent
1989;62:23-7.
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©
2006
by
The
Editorial
Council
of
The
Journal
of
Prosthetic
Dentistry.
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