title: Clinical Management of Impacted and Transmigrated Lower Canines.
abstract: OBJECTIVE
  Impacted, in particular transmigrated, lower canines are rare. If they transmigrate, then the most common treatment is extraction. Alternatively, the native tooth can be preserved; however, management is complex. This report describes a decision-making flowchart (DMFC) with surgical strategies for the management of impacted lower canines.
  
  
  METHODS
  Fifty-six patients had impacted lower canines, of which 16 were transmigrated. A preliminary version of the DMFC was used for the development of treatment plans to decide which strategy to apply to these complex cases. After removal of associated pathologies (for experimental tooth-preserving therapies), miniscrews were used as transient skeletal anchorage devices (TADs). The TADs allowed a closed surgical approach for impacted and transmigrated lower canine eruption. For autotransplantation, a dummy tooth was used for socket preparation to minimize the period of no blood supply to the graft.
  
  
  RESULTS
  After surgical exposure and TAD insertion, orthodontic treatment was performed in 4 patients. One patient was selected for successful autotransplantation. Nine patients had the transmigrated canines surgically removed. The remaining patients opted for "leave and observe." Based on the satisfactory long-term results with orthodontic treatment and autotransplantation and on published reports, the resulting DMFC presents key aspects of the treatment plan, namely 1) associated pathology, 2) patient age, 3) compliance, and 4) root tip position.
  
  
  CONCLUSIONS
  TAD-assisted orthodontic treatment and autotransplantation of impacted lower canines are tooth-preserving alternatives to extraction. The developed DMFC assists the complex treatment planning of impacted and transmigrated lower canines.
authors.affiliation: Orthodontist, Department of Craniomaxillofacial and Oral Surgery, Medical University of Vienna, Vienna, Austria. Electronic address: klaus.sinko@meduniwien.ac.at.
authors.forename: Klaus
authors.initials: K
authors.lastname: Sinko
authors.affiliation: Associated Professor, Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.
authors.forename: Stefan
authors.initials: S
authors.lastname: Nemec
authors.affiliation: Maxillofacial Surgeon, Department of Craniomaxillofacial and Oral Surgery, Medical University of Vienna, Vienna, Austria.
authors.forename: Rudolf
authors.initials: R
authors.lastname: Seemann
authors.affiliation: Vice Head, Maxillofacial Surgeon, Department of Craniomaxillofacial and Oral Surgery, Medical University of Vienna, Vienna, Austria.
authors.forename: Christina
authors.initials: C
authors.lastname: Eder-Czembirek
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D000066491:Clinical Decision-Making / Q000379:methods*; D003481:Cuspid / Q000000981:diagnostic imaging / Q000601:surgery* / Q000637:transplantation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019647:Oral Surgical Procedures / Q000379:methods*; D009971:Orthodontics, Corrective / Q000379:methods; D010347:Patient Care Planning; D014079:Tooth Eruption, Ectopic / Q000000981:diagnostic imaging / Q000601:surgery*; D014095:Tooth, Impacted / Q000000981:diagnostic imaging / Q000601:surgery*; D014182:Transplantation, Autologous; D055815:Young Adult