Journal of Orofacial Sciences

: 2014  |  Volume : 6  |  Issue : 2  |  Page : 122--124

Mandibular canine-lateral incisor and maxillary bilateral canine-premolar transposition: Report of two cases

Deepa Dhruvakumar, Vidhi Munjal, Saras Mediratta 
 Department of Periodontology, Subharti Dental College and Hospital, Meerut, Uttar Pradesh, India

Correspondence Address:
Deepa Dhruvakumar
Department of Periodontology, Subharti Dental College and Hospital, Meerut - 250 005, Uttar Pradesh


Tooth transposition is a rare developmental anomaly in which the adjacent teeth switch/swap their positions and may create problems both esthetically and functionally. The maxillary permanent canine is the tooth most frequently involved, which is often transposed with the first premolar followed by transposition between the maxillary permanent canine and maxillary lateral incisor. This paper reports two cases of tooth transposition, one in mandibular arch involving the right lateral incisor and canine; and the other bilateral transposition in maxillary arch involving the first premolars and canine. It also focuses on the etiology and the prevalence of this interesting phenomenon called transposition.

How to cite this article:
Dhruvakumar D, Munjal V, Mediratta S. Mandibular canine-lateral incisor and maxillary bilateral canine-premolar transposition: Report of two cases .J Orofac Sci 2014;6:122-124

How to cite this URL:
Dhruvakumar D, Munjal V, Mediratta S. Mandibular canine-lateral incisor and maxillary bilateral canine-premolar transposition: Report of two cases . J Orofac Sci [serial online] 2014 [cited 2020 Oct 27 ];6:122-124
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Tooth transposition is defined as the positional interchange of two neighboring teeth and especially of their roots, or the development or eruption of a tooth in a position normally occupied by a non-neighboring tooth. Therefore, tooth transposition is a peculiar type of ectopic eruption in which the order and sequencing of teeth are changed in the dental arch. [1] It is reported that transposition of maxillary teeth occurs approximately one of three hundred orthodontic patients and that transposition between the canine and first premolar appears most often (70%) in maxillary dentition, followed by one between canine and lateral incisor (20%). Unilateral transpositions are found more often than bilateral transpositions and show left side dominance. [2]

This article presents the rare occurrence of unilateral complete transposition of mandibular right canine with lateral incisor and in another case bilateral transposition of maxillary canine with maxillary first premolar.


Case 1

A male patient aged 20 years reported to the outpatient department of Periodontology for routine checkup. There was no significant family history or medical history. No history of tongue thrusting or lip biting reported. On intra-oral examination, the mandibular right lateral incisor was present in place of mandibular right canine and canine in place of lateral incisor [Figure 1]. Overjet and overbite was normal. There was no other abnormality present in the oral cavity. Intra-oral periapical radiograph and orthopantamograph (OPG) further confirmed this entity with no other associated abnormality in the maxillary or mandibular arches [Figure 2] and [Figure 3].{Figure 1}{Figure 2}{Figure 3}

Case 2

A male patient aged 32 years reported for regular check-up and oral prophylaxis. Intra-oral examination revealed swapped positions between maxillary first premolar and canine on both right and the left sides [Figure 4], [Figure 5], [Figure 6]. Remaining teeth in all the other quadrants were at normal location with normal morphology, overjet and overbite. Both medical and family histories were non-contributory. This patient too did not give any history of tongue thrusting or nail biting or lip biting habit.{Figure 4}{Figure 5}{Figure 6}

Since both the patients were asymptomatic, only scaling and polishing were performed. Treatment options including esthetic recontouring were explained.


Unilateral transposition and particularly left side is more commonly involved than bilateral transposition. The term complete transposition is used when both the crown and the entire root structure of the involved teeth are found parallel in their transposed position and an incomplete transposition, if the transposition is of the crown, but not the root apex. [3]

Five types of tooth transposition observed in the maxillary jaw were classified by Peck and Peck according to the teeth involved.

Canine-first premolar (Mx.C.P1); Canine-Lateral incisor (Mx.C.I2);Canine to first molar position (Mx.C.M1);Lateral incisor-Central incisor (Mx.I2.I1);Canine to central incisor position (Mx.C.I1). [4]

Theories such as a role of genetics, trauma and interchange of the position of the developing tooth buds, lack of deciduous canine root resorption, early loss of primary teeth, and prolonged retention of primary teeth have been proposed to explain the phenomenon. A genetic origin, however, is reported as the main etiologic factor. [5]

The hypothesis of a genetic cause for transposition is due to a disturbance in the order of developing tooth follicles. Genes play an important role in patterning the dentition. Expression of homeobox-containing transcription factors pattern, the presumptive dental axis prior to dental initiation and manipulation of these domains can result in the transformation of tooth type. However, no mutations have been identified in any subjects demonstrating transposition. Mutations in several homeobox genes cause selective tooth agenesis rather than transposition, almost certainly because of the important reiterative role these genes play during the later stages of odontogenesis. Within a purely genetic model, the canine tooth might be more commonly transposed because it lies at the boundary between the developing incisor and premolar fields of development, a region that is possibly more susceptible to particular thresholds of gene activity for normal pattern to occur. Mx.C.P1 transposition is currently considered a tooth position anomaly caused by genetic factors, and presents a multifactorial inheritance pattern. Peck et al., used canine malposition as a model to suggest a molecular basis for this condition. [6],[7]

However, the canine tooth has a long path of eruption and theoretically more susceptible to deflection during its long eruptive descent, hence is frequently associated with transposition. Opinions differ as to the relative contribution of genetics and environment in this eruptive process. Certainly in non-syndromic forms of cleft lip and palate, both genetic mutations and environmental factors seem to play a role in defining thresholds of susceptibility within affected individuals. [8]

Lateral incisor-canine transpositions are seen less often in the mandible than in the maxilla. Although many have speculated about the cause of transposition, it was recently determined as this transposition results from genetic influences in a multifactorial inheritance model. In the mandible, after early loss of a first deciduous molar, the lateral permanent incisor deflects from its normal path of eruption and migrates distally along the lingual side of the lateral deciduous incisor and canine to erupt above the developing first premolar. Therefore, transposition in the mandible is a result of distal migration of the lateral incisor. [9],[10]

As reported by Peck, EM Miel was the first to describe the maxillary canine-first premolar transposition in detail in 1817. Since then, this anomaly has been the most often reported transposition. The tooth transposition is also seen associated with other dental anomalies such as peg-shaped lateral incisor and congenitally missing teeth. [11]


Early diagnosis of transpositions helps in correction with less chance of injuries to the surrounding tissues. This is possible with periodic clinical examination and complete radiographic analysis. Both function and esthetics restoration in patients with tooth transposition depends on the treatment design and cooperation of the patient.


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