|Year : 2015 | Volume
| Issue : 1 | Page : 52-56
Tooth transposition: Report of three cases and literature review
NB Nagaveni1, NB Radhika2, Aditya Kumar3, Meghna Bajaj1, P Poornima1
1 Department of Pedodontics and Preventive Dentistry, College of Dental Sciences, Davangere, Karnataka, India
2 Department of Orthodontics, Ideas Dental College, Gwalior, Madhya Pradesh, India
3 General Dental Practitioner, Ghaziabad, Uttar Pradesh, India
|Date of Web Publication||4-Jun-2015|
Dr. N B Nagaveni
Department of Pedodontics and Preventive Dentistry, College of Dental Sciences, Davangere - 577 004, Karnataka
Source of Support: None, Conflict of Interest: None
Tooth transposition is a relatively rare developmental anomaly of the teeth characterized by a positional interchange of a permanent tooth leading to distortion in the alignment of the affected segment, a midline shift, and malocclusion of the teeth. In the general population, the prevalence of this anomaly has been reported to be below 1% in most investigations. This condition is frequently observed in the maxillary arch and most commonly involves the canine tooth. Investigations in three Indian patients revealed different variants of tooth transpositions all occurring in the maxilla. The present article reports these different cases of transpositions associated with other dental anomalies.
Keywords: Canine, dental anomalies, transposition
|How to cite this article:|
Nagaveni N B, Radhika N B, Kumar A, Bajaj M, Poornima P. Tooth transposition: Report of three cases and literature review. Niger J Exp Clin Biosci 2015;3:52-6
|How to cite this URL:|
Nagaveni N B, Radhika N B, Kumar A, Bajaj M, Poornima P. Tooth transposition: Report of three cases and literature review. Niger J Exp Clin Biosci [serial online] 2015 [cited 2020 Jan 27];3:52-6. Available from: http://www.njecbonline.org/text.asp?2015/3/1/52/158168
| Introduction|| |
Tooth transposition is rarely encountered and is an interesting dental phenomenon related to a disturbance of the eruption of teeth and the resultant abnormal occlusal relationships. Peck et al., defined this condition as the positional interchange of two adjacent teeth particularly of the roots or the development or eruption of a tooth in a position occupied normally by a non-adjacent tooth. It is identified as "complete (true) transposition" when the crowns and the roots of the involved teeth exchange places in the dental arch and "incomplete (pseudo transposition)" when the crowns are transposed, but the roots remain in their normal positions. 
Although this anomaly has been investigated in various populations across the globe, only one Indian study has been reported in 1996 with a prevalence of only 0.4%.  Subsequently, there is documentation of only single cases. , The aim of the present article is to report three different variations of transposition cases diagnosed in patients of Indian origin and to evaluate their clinical features with the existing literature.
| Case Reports|| |
Three cases of transposition observed in three non-syndromic healthy patients over a period of 2 years from 2008 to 2010 were investigated. Information was obtained from clinical records, intra-oral photographs, and radiographs of the patients. Transposition was diagnosed according to the definition by Peck et al., and confirmed both clinically and radiographically. Panoramic radiographs were used to confirm the presence of a true transposition, involving both the crown and root of the affected teeth. Patient's age, gender, location, laterality, and side; main complaints at presentation and history of dental trauma; and presence of other dental anomalies was investigated. The classification (Peck and Peck's classification  ) [Table 1] and type of tooth transposition was also recorded for each subject. Associated other congenital dental anomalies were ascertained from both the panoramic radiographs and clinical records.
The ages of patients reported here ranged from 10 year four months to 14 years. The first patient was a boy and other two were girls. Two patients had transpositions involving the canine and premolar tooth (case no. 1 and 3) with one case involving the central incisor (case no. 2). All three transpositions were complete type and occurred in maxilla. All three patients had tooth transposition on one side only (right side). Each patient exhibited different transpositions like maxillary canine-first premolar (Mx.C.P1) [Figure 1] and [Figure 2], maxillary central-lateral incisor (Mx.I1.I2) [Figure 3] and [Figure 4] and maxillary canine - first premolar (Mx.C.P1) [Figure 5] and [Figure 6]. Associated congenital anomalies were detected in all cases like supernumerary teeth, root dilacerations, and retained deciduous tooth [Table 2].
|Figure 1: Clinical picture showing transposition of maxillary right canine-first premolar (arrows)|
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|Figure 2: Periapical radiograph showing transposed canine with first premolar|
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|Figure 3: Intra-oral photograph showing maxillary right central — lateral incisor transposition (arrows)|
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|Figure 4: Orthopantamograph showing transposed teeth (arrows). Also see supernumerary teeth and root dilaceration in 11|
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|Figure 6: Orthopantamograph showing maxillary canine transposition (arrow). Root dilaceration in 15, retained 53, 63 and impaction of 23 are also present|
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| Discussion|| |
Tooth transposition is a peculiar type of ectopic eruption in which each ectopic tooth changes the normal order of the tooth sequence within the same dental arch. To date, there have been few investigations of transpositions in different ethnic groups. The prevalence of transpositions has been reported as 0.14-0.38% in Nigeria, , 0.41% in India,  0.13-0.64% in Greece, , 0.09% in Germany,  0.13% in Saudi Arabia,  and 0.27-0.33% in Turkish , populations. All these figures suggest that tooth transposition might be considered a rare phenomenon.
Transposition can be detected quite easily even by means of clinical examination and palpation of the area of the roots of the corresponding teeth. For confirmatory diagnosis, a radiographic survey by means of panoramic or intraoral periapical radiographs is of more useful. The age of the patient is very important during diagnosis as tooth transposition cannot be securely diagnosed in individuals aged younger than 7 years.  There seem to be no significant difference in the prevalence of tooth transposition between males and females. However, contrast observations have been found in the literature. Some studies , reported that transpositions were more commonly observed in males while some reported the opposite finding. ,, Although some of these authors proposed a hypothesis that gender-related genes may be responsible for tooth transposition but this is yet to be confirmed. Chattopadhyay and Srinivas  stated that higher female predilection might be associated with higher number of females seeking orthodontic treatment. This is in agreement ,, with this study where a higher male prevalence was observed and in contrast with other studies , where females were more frequently identified.
Transposition can affect either the maxillary or mandibular dentition but has been reported more commonly in the maxilla than mandible. The high bone density of the mandible might be responsible for a prohibition of the phenomenon of tooth transposition, and thus the higher incidence of maxillary occurrence.  In all three cases, transposition occurred in the maxilla coinciding with the reported literature. ,,,
It was observed from various studies ,, that the unilateral occurrence of tooth transposition is more frequent than the bilateral. In all three cases reported here, transposition occurred unilaterally and this is in agreement with previous studies. ,, The localization of tooth transposition on either theleft or right quadrant with a predilection for the maxilla or mandible has been identified in previous studies. ,,, In contrast, previous studies ,,,, identified that most of the maxillary transpositions were found on the left side and all of the mandibular transpositions on the right side. However, this present case report identified all three transpositions on the right.
Tooth transpositions most frequently involve the canine tooth, which may be transposed with either the first premolar or the lateral incisor. ,,, Shapira and Kuftinec  explained this high incidence with the canine's longest period of development and longest path of eruption. Similarly, in this case report, canines were involved. Transpositions that do not involve the canine teeth, such as the central and lateral incisor transpositions, are extremely rare. In one patient, maxillary lateral incisor was transposed with central incisor thereby being a rare case.
Among the five Peck and Peck's  classification of tooth transpositions, maxillary canine-first premolar transposition is the most commonly seen transposition reported with prevalence of 0.135-0.51%. ,, Celikoglu et al., and Yilmaz et al., reported 57.9% and 0.9% prevalence of maxillary canine-lateral incisor transposition, respectively. Our two patients exhibited maxillary central incisor- lateral incisor transposition (Mx.I1.I2) and maxillary canine-first premolar transposition (Mx.C.P1). Although the phenomenom of transposition has been identified previously in the literature, its exact etiology is still obscure and an area of controversy. Several theories have been proposed to account for this condition and includes the interchange of developing tooth buds, migration of a tooth during eruption, heredity, the presence of retained primary teeth, and mechanical interferences. , Bone pathology, such as cyst formation and odontomas may also cause displacement and transposition of the tooth.  Early loss of incisors and trauma to the deciduous teeth has also been suggested as possible etiologic factors. Many types of transposition have been associated with factors that have a genetic basis including female predilection, unilateral left-side dominance, hypodontia, retained primary teeth, and peg-shaped maxillary lateral incisor teeth I. It has been suggested based on research ,, that the fundamental etiology for dental transposition may be genetic and within a model of multifactorial inheritance. However, in a study on transposition by Yilmaz et al., a previous history of trauma was observed to be more frequent (50%) in maxillary canines than in the central incisor. Though a history of trauma was observed in one of the cases selected, it is unlikely to be an etiologic factor in the development of transposition as the trauma occurred in a non-transposition area.
Association of dental anomalies has been reported more frequently in transposition cases than in a normal population. ,,, Various anomalies reported with tooth transpositions are peg-shaped lateral incisors, retained deciduous canines, rotations and malpositions, dilacerations, supernumerary teeth, impacted teeth, and hypodontia. Our transposition cases also showed associated anomalies to include supernumerary teeth, root dilacerations, and retained primary canines, which is in agreement to the existing literature. ,,
Peck et al., found 37% of tooth agenesis in transposition cases, whereas, Yilmaz et al.,  and Chattopadhyay and Srinivas  found tooth agenesis (either one or two teeth) in transpositions cases to be 33.3% and 40%, respectively. They also found a higher frequency of missing teeth in maxillary canine-lateral incisor cases. Other Indian studies  reported a higher frequency of peg-shaped lateral incisors in the maxillary canine-premolar transpositions (67%) and maxillary canine-lateral incisor transpositions (71%). However, Shapira and Kuftinec  stated that only one patient (1/65) had peg-shaped lateral incisors in their study. (Our report showed the presence of a supplemental lateral incisor in the maxillary lateral incisor-central incisor transposition case (case no. 2). A morphological and radiographical examination diagnosed the transposed tooth which appeared similar to the supplemental lateral incisor in this study. Other studies have also used these methods in differentiating these teeth. ,,, Eruption of mesiodens in the midline may have been an etiologic factor in the distal and labial displacement of the central incisor resulting in the transposition of the lateral incisor.
Yilmaz et al., showed that in 60% of maxillary canine-first premolar transpositions, root dilacerations were observed in premolars and laterals. This high frequency suggests that root dilacerations of the adjacent teeth may be a potential etiological factor of canine-premolar transpositions. The same finding was observed in our canine-second premolar transposition case where the transposed premolar had a dilacerated root. This was also observed in the central incisor which was transposed with the lateral incisor. ,,,
Two Turkish studies , recorded supernumerary teeth in 4.8% and 5.3% of their cases. Our two transposed cases also showed supernumerary teeth coinciding with these findings. In one case, two supernumerary teeth were located in the midline of maxilla, and in other patient, one mesiodens and one supplemental lateral incisor were present.
Deciduous canines have more often been reported to be over retained in majority of the transposition cases. ,,, Some reports , stated that if the roots of primary canines were not resorbed, then migration of permanent canines to the incisor, second premolar or first molar area might occur. However, Peck et al., suggested, a retained primary canine is a consequence of the anomaly not its cause. Yilmaz et al., found retained primary canines in 60% of maxillary canine-first premolar and in 22.2% of maxillary canine-lateral incisor transpositions. Our canine-premolar transposition case also showed a similar finding. Impaction of contra lateral canine was also observed in the same patient. This indicates that retained primary canines in both quadrants might be a possible etiologic factor for transposition and impaction of permanent canines but this cannot be justified.
| Conclusion|| |
Tooth transposition manifests in various forms and may represent a condition of multifactorial etiology. Early diagnosis and detection by clinicians of a developing transposition is very important to prevent subsequent malocclusion and its attendant consequences.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
[Table 1], [Table 2]