CLINICIAN’S CORNER

Maxillary tooth transposition: Correct or accept?

Roberto Ciarlantinia and Birte Melsenb
Recanati, Italy, and Aarhus, Denmark

Among dentitional anomalies, tooth transposition is considered the most difficult to manage clinically.
Uncorrected, the results are often both functionally and esthetically unsatisfactory. Acceptance of the
malpositions and alignment is nevertheless the predominating treatment strategy in case reports in the
literature. Our aims in this article were to present a literature survey on the prevalence and the etiology and
to discuss the cost-benefit considerations influencing the treatment strategy and the decision whether to
accept or correct. An additional aim was to discuss the treatment of 12 patients who had maxillary
transpositions— 8 with maxillary canine and first premolar, and 4 with maxillary canine and lateral incisor—9
of whom were corrected within normal treatment times. A segmented appliance allowed for the differentiation
between active and passive units of the appliance and for the delivery of a specific and necessary line of
action of the force. Two patients were treated with extractions, 1 because of periodontal problems and the
other because of crowding; in 1 patient, the transposition was accepted because the alignment had been
started by another dentist. (Am J Orthod Dentofacial Orthop 2007;132:385-94)

and Peck11 collected 201 published cases of maxillary

T
he prevalence of tooth transposition has been
described based on epidemiologic studies of
various populations. In a sample of 800 Scottish
orthodontic patients, transposition was found in 0.38%.1
This was similar to the figure of 0.4% reported for a
population in India studied by Chattopadhyay and Srini-
vas.2 In another study, Yilmaz et al3 also found that
0.38% of a Turkish population had tooth transposition.
Among 384 Swedish school children, the prevalence
was reported to be 0.26% by Thilander and Jacobsson,4
whereas Ruprecht et al5 found transposition in only
0.13% of Saudi Arabian dental patients. A higher
prevalence, 0.51%, was reported in an African popula-
tion comprising contemporary subjects and skeletons
from 100 BC and AD 1350.6 In a study of Native
Americans, 1.8% had transposed maxillary canine and
first premolar (Mx.C.P1).7
Transpositions can, according to some authors,3,8
affect both sexes equally, whereas others reported that
they are more frequent in females,9-12 and some even
found the prevalence higher among males.2,13 Although
transposition can appear in both the maxilla and the
mandible, the Mx.C.P1 transposition is the most fre-
quently described, followed by transposition of the max-
illary lateral incisor with the canine (Mx.C.I2).8,11,14 Peck
a
Private practice, Recanati, Italy.
b
Professor and head, Department of Orthodontics, University of Aarhus,
Aarhus, Denmark.
Reprint requests to: Birte Melsen, Department of Orthodontics, University of
Aarhus, Vennelyst Boulevard 9, DK-8000 Aarhus C, Denmark; e-mail,
orthodpt@odont.au.dk.
Submitted, April 2005; revised and accepted, April 2007.
0889-5406/$32.00
Copyright © 2007 by the American Association of Orthodontists.
doi:10.1016/j.ajodo.2007.04.011
transpositions and found that 71% could be classified as
Mx.C.P1 and 20% as Mx.C.I2.
Unilateral transpositions are found more often than
bilateral transpositions, and the left side is more fre-
quently involved than the right.15,16 In the mandible,
transposition is reported to involve the canine and
incisors only.17,18 Transpositions have, to our knowl-
edge, not been reported in the deciduous dentition.
Mx.C.P1 transposition is always a result of dis-
placement and ectopic eruption of the maxillary canine,
but a genetic influence on its development has been
supported by the elevated frequencies of associated
dental anomalies, such as incisor impaction; absence of
at least 1 permanent tooth; missing, small (Fig 1, B). or
peg-shaped (Fig 1, J) maxillary lateral incisors; in-
creased incidence of bilateral occurrence in families;
and significant differences between male and female
prevalence.2,10,16,19-25 Mx.C.I2 transposition is, on the
other hand, frequently caused by trauma to the decid-
uous dentition resulting in drift of the permanent tooth
bud.11 However, genetic influence on Mx.C.I2 transpo-
sition cannot be totally excluded.11 Local pathologic
processes, such as tumors (Fig 1, F and I) and cysts,
retained deciduous canines, lack of deciduous canine
root resorption, and supernumerary teeth (Fig 1, E)
might also be responsible for the displacement of a
canine, causing deflection lingually or labially or, if
mesially displaced, transposition with the lateral incisor
or, if distally displaced, transposition with the first
premolar.15
Clinical management of transposed teeth comprises
the following treatment options.26
385
386 Ciarlantini and Melsen American Journal of Orthodontics and Dentofacial Orthopedics
September 2007

Fig 1. Pretreatment and posttreatment radiographs of 12 patients treated for transposition. Patients
are listed by letter; images labeled 1 are pretreatment, and those labeled 2 are posttreatment.
American Journal of Orthodontics and Dentofacial Orthopedics
Volume 132, Number 3
1. Interceptive treatment: if detected early enough, at
the age of 6 to 8 years, extraction of deciduous
teeth, guiding the eruption of the transposed tooth
into the normal position, while the space is main-
tained by a lingual arch or a palatal bar. Usually,
this approach is possible only if the teeth are tilted
so that the roots are near the desired position; this
clinical situation is also called pseudotransposition.
2. Alignment of teeth in their transposed positions
followed by reshaping their incisal or occlusal
surfaces and using composite materials for restor-
ative camouflage.
3. Extraction of 1 or both transposed teeth followed by
orthodontic correction. This strategy has been rec-
ommended when other factors such as crowding
and caries indicate extraction.
4. Orthodontic tooth movement to the correct intra-
arch position.16
Among the Mx.C.P1 and Mx.C.I2 cases described
in the literature (Table I), the choice of treatment has
often been 2 or 3, because the correction was consid-
ered both difficult and long.8,11,13,16,22,23,27-44 Treat-
ment times ranged from 18 to 49 months.
Several factors should be considered when making
the treatment plan.
1. Dental morphology. The dental morphology is of
the utmost importance when a transposition must be
maintained, because reshaping the teeth is neces-
sary for an illusion of correct position.
2. Occlusal considerations. The underlying malocclu-
sion, morphological and functional, and the possi-
bility of obtaining a symmetrical canine-guided
group function influence the choice of treatment.26
If substituting the canine with the first premolar is
considered, the roots of the maxillary first premolar
must have morphology that allows for the necessary
rotation without generating fenestrations corre-
sponding to the buccal root.
3. Facial esthetics. Facial prognathism is also impor-
tant when extraction is considered an alternative.
4. Stage of development and position of the root
apices. The buccolingual width of the alveolar bone
is often not sufficient to support 2 adjacent teeth
moving in different directions, especially when
they are fully erupted. Compression and friction
during correction can cause iatrogenic damage to
teeth (eg, root resorption) and periodontal tissues
(eg, clefting and recession of gingival tissue).
5. Treatment time. Treatment time for either correc-
tion or acceptance must be considered from a
cost-benefit point of view.26
Ciarlantini and Melsen 387
The literature on transposition is more focused on
epidemiology. Treatment is dealt with mainly in reports
of 1 case or a few cases in addition to a review of the
latter.
Our purposes were to demonstrate the treatment of
12 patients with maxillary transposition and to present
the rationale behind the treatment approach.
MATERIAL AND METHODS
All patients included in this report had transposi-
tions in the maxilla, 8 with Mx.C.P1 and 4 with
Mx.C.I2 (Fig 1).
The patients’ ages ranged from 10 years 2 months
to 14 years, except for one who was 52 years old. There
was equal distribution between the right and left sides,
and, in 9 patients, the canine was vestibular to the other
teeth. All patients had a Class I molar relationship
except 2 with a Class II subdivision. Treatment times
varied from 12 to 30 months, with an average of 19
months (Table II). All patients received a fixed retainer
except 2 in whom a removable Hawley retainer was
used (Fig 1, A and I).
RESULTS
Correction was attempted in 9 patients. Full correc-
tion with no crossover of the roots was obtained in 7
patients (Fig 1). Correction of the transposition but
without complete root paralleling was seen in 2 patients
(Fig 1, B and D). In 3 patients, a different approach was
chosen (Table II). Alignment of the teeth in the trans-
posed position was chosen for the patient in Figure 1, F.
That patient had been treated by another orthodontist
for a long time, and the canines were almost aligned.
Esthetically, it was acceptable because there was great
similarity between the buccal morphology of the canine
and the premolar. Functionally, it was possible to
obtain group function after grinding the lingual cusp of
the premolar. A premolar was extracted in the adult
patient in Figure 1, H, for periodontal reasons. The
canine was localized lingually to the premolar, and
there was a deep pocket between the vestibular side of
the maxillary canine and the palatal side of the first
premolar. This could not be treated because it would be
impossible for the patient to maintain good hygiene and
a healthy periodontium between these 2 adjacent teeth
during orthodontic treatment. It was decided to extract
the periodontically affected premolar, which was later
replaced by prosthodontic treatment. In patient L, with
Mx.C.I2 transposition with a Class II molar relationship
on the left side, the involved lateral incisor was ex-
tracted. The roots of the involved teeth were already
almost completely aligned in the transposed order.
Correction of the transposition would be a long treat-
388 Ciarlantini and Melsen American Journal of Orthodontics and Dentofacial Orthopedics
September 2007

Table I. Survey of literature on transposition

Age Right, left, Vestibular, Treatment time Treatment
Author Year n (y, mo) Type bilateral palatal (mo) option Comments

Maxillary transpositions
Payne23 1969 1 11, 9 MxCP1 R V 33 Transposition
1 MxCP1 B V 16 Transposition
Newman22 1977 1 MxCP1 R Interceptive All relatives
1 MxCP1 R V Transposition
1 MxCP1 L V Transposition
1 MxCP1 L V Transposition
1 MxCP1 R V Prosthetics
Shapira et al45 1980 2 MxCP1 L 5 alignment
4 MxCP1 R 3 extractions
1 MxCI2 L 1 tranplantation
2 MxCI2 R Correction
Laptook and Silling33 1983 1 12 MxCP1 B V 1 correction, 1
alignment
1 15 MxCI2 L V Correction Pseudotransposition
Shapira et al8 1989 1 17 MxCP1 B V Transposition
1 11, 5 MxCP1 R V Transposition
1 13 MxCP1 R V Extraction
Shapira et al41 1989 1 12, 5 MxCI2 R V 36 Correction
Bassigny27 1990 1 MxCI2 R V Correction
1 MxCP1 R V Extraction
Pajoni and Saade36 1990 1 11, 5 MxCP1 L V 30 Extraction
1 12, 5 MxCP1 L V 18 Transposition
Parker37 1990 1 13 MxCP1 B V 20 Transposition
Shanmuhasuntharam 1990 1 20 MxCM1 L V Extraction
and Thong40
Lanteri et al32 1991 1 13 MxCP1 L Transposition
1 12 MxCP1 L V Transposition
1 13 MxCP1 L V Transposition
Zuccati44 1994 1 27 MxCI2 B P Correction Pseudotransposition
Peck and Peck11 1995 1 12, 5 MxCP1 B V 24 Transposition
1 11, 3 MxCP1 R V Extraction
1 11, 5 MxCP1 R V Correction failed
1 12, 2 MxCP1 L V 35 Interceptive
Wasserstein et al43 1997 1 12, 5 MxCI2 L P 26 Correction
Rabie and Wong38 1999 1 13 MxCI1 B V Extraction
Swinnen et al42 1999 1 8, 3 MxCI2 L P 29 Extraction
Maia34 2000 1 10, 10 MxCI2 L V 49 Extraction
Laino et al30 2001 1 10 MxCP1 R V 32 Correction
Miyawaki et al35 2001 1 10 MxCI2 L V 25 Transposition
Shapira and Kuftinec16 2001 1 12 MxCI2 R V 45 Correction
Bocchieri and Braga28 2002 1 10, 7 MxCP1 B V 34 Correction
Demir et al29 2002 1 22 MxCP1 R V 20 Transposition
Langlade31 2002 1 10 MxCP1 B V Correction
1 12 MxCP1 R V Correction
Sato et al39 2002 1 12 MxCP1 B V Extraction
Mandibular
transpositions
Shapira et al46 1978 1 11 MdCI2 B V Transposition
Shapira et al45 1980 2 MdCI2 B Transposition
Shapira et al47 1982 2 8-13 MdCI2 B 5 interceptive
4 MdCI2 R 1 extraction
1 MdCI2 L 1 alignment
Laptook and Silling33 1983 1 12 MdCI2 L V Correction
Lieberman et al48 1983 1 10 y MdCI2 R Interceptive
Shapira et al49 1983 2 12-15 MdCI2 R V Extraction
2 MdCI2 B V Transposition
1 MdCI2 L V Transposition
American Journal of Orthodontics and Dentofacial Orthopedics Ciarlantini and Melsen 389
Volume 132, Number 3

Table I. continued
Right,
Age left, Vestibular, Treatment time Treatment
Author Year n (y, mo) Type bilateral palatal (mo) option Comments

Shapira et al8 1989 1 14 MdCI2 L V Transposition

1 11 MdCI2 R V Extraction
Yaillen50 1989 1 8, 8 MdCI2 R V 28 Interceptive
Bassigny27 1990 1 MdCI2 L Interceptive
1 MdCI2 R V Interceptive
1 MdCI2 L V Interceptive Periodontal graft
Pajoni and Saade36 1990 1 9 MdCI2 L 48 Extraction
Parker et al37 1990 1 10, 1 MdCI2 L V 22 Interceptive
1 14, 9 MdCI2 L V 20 Transposition
Brezniak et al51 1993 1 19 MdCI2 V Transposition Periodontal graft

MdC12, mandibular transposition between canine and lateral incisor.

Table II. Survey of patients treated

Age Right, left, Vestibular, Treatment time Treatment
Patient Sex (y, mo) Type bilateral palatal (mo) option Comments

A F 11, 1 MxCP1 R V 18 Correction Case report 1

B F 11, 4 MxCP1 R V 16 Correction
C F 12, 4 MxCP1 L V 26 Correction
D F 10, 5 MxCP1 R V 16 Correction
E M 11, 7 MxCP1 L P 20 Correction
F M 14 MxCP1 B V 20 Alignment
G M 11, 5 MxCP1 R V 22 Correction
H M 52 MxCP1 R P 12 Extraction
I F 11, 8 MxCI2 L V 26 Correction Case report 2
J F 10, 11 MxCI2 R P 20 Correction
K M 13, 10 MxCI2 L V 30 Correction
L M 10, 2 MxCI2 L V 26 Extraction

F, Female; M, male.

ment without predictable success because of the
crowded maxillary incisors. The fact that the crown of
the canine was small and easy to reshape as a lateral
also supported this treatment option. The treatment
approach was thereafter the same as for patients with
agenesis of 1 lateral incisor.
In the remaining 9 patients, the transposition was
corrected by goal-oriented mechanics, in which the
appliance was activated to generate the desirable line of
action of the force with respect to the transposed teeth.
This could be executed only by using segmented
appliances that allow for the differentiation between the
active and the passive units. The passive unit was
consolidated by a transpalatal arch. The active part of
the appliance was a segment with a configuration that
allowed for the generation of the correct line of action
of the force in all 3 planes of space. The appliances
used to correct the 2 types of transposition are
illustrated in the examples of Mx.C.P1 and Mx.C.I2
below.
Case report, patient A: Mx.C.P1 and treatment
option 4
A girl, aged 11.1 years, had a canine buccally
transposed between teeth 14 and 15 (Table II; Figs 1, A,
and 2). Her maxillary deciduous right canine was still
not mobile, and the left one had been shed a long time
ago. Clinical examination showed a convex profile. The
upper dental midline was shifted 1 mm to the right, and
the patient had a Class I molar relationship on both
sides. There was mild crowding in the mandibular arch.
The intraoral radiographs showed that the apex of the
maxillary right canine was vestibular and distal to the
first premolar. The first premolar was distally tipped
and the apex was in the canine region (Fig 1, A1). No
local factors could account for the transposition of the
canine. Correction of the transposition was chosen as
the treatment objective, because the canine was not yet
fully erupted and the apices of the 2 transposed teeth
were not close; thus, the risk of root resorption was
390 Ciarlantini and Melsen American Journal of Orthodontics and Dentofacial Orthopedics
September 2007

Fig 2. Patient A. A, Pretreatment intraoral photograph. B, Rectangular loop for buccal and forward
displacement of canine. Vertical level of canine was maintained while sagittal correction was
performed. C, Schematic of cantilever and force system. D, Treatment progress after 8 months.
Sagittal displacement of canine has been performed, and eruption can begin while uprighting of
premolar root continues. E, Schematic of appliance used for eruption of canine and uprighting of
premolar root. F, After 12 months of treatment. G and H, Finishing after 16 months of treatment.
I, Posttreatment intraoral photograph. J–M, X-ray series from pretreatment to posttreatment.

considered limited (Fig 2, A and B). An alternative
would have been to let the canine erupt distal to the
premolar. This would, considering the morphology of
the crowns of both teeth, have been both esthetically
and periodontally unsatisfactory. Extraction was not
considered because the patient had a Class I molar
relationship on both sides.
Treatment started with placement of a transpalatal
arch for maximum anchorage and 2 individually con-
figured rectangular loops of 0.017 ⫻ 0.025-in beta-
titanium alloy as the active unit. Both loops extended
from the double tube on the molar band. One loop was
first placed to displace the canine mesially, keeping the
vertical level (Fig 2, C). Once this movement had
started, the second loop was placed to upright the
premolar simultaneously with the continued mesial
movement of the canine (Fig 2, D). After sagittal
correction that lasted for 8 months, the loop used for
mesial displacement was activated for eruption and
lingual movement of the canine (Fig 2, E and F). At the
end of treatment, a 0.017 ⫻ 0.025-in nickel-titanium
wire was placed for minor finishing (Fig 2, G and H).
The fixed appliances were removed after 18 months
(Fig 2, I). The intraoral radiographs confirmed the
American Journal of Orthodontics and Dentofacial Orthopedics
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correction (Fig 2, J-M). A Hawley retainer was used in
the maxillary arch for retention. A posttreatment radio-
graph (Fig 1, A2) indicated that the canine root was not
correctly inclined, this was probably due to the ineffi-
ciency of the removable retainer, since the photo taken
3 months earlier (Fig 2, M) showed satisfactory root
position and no root or periodontal damage.
Case report, patient I: Mx.C.I2 and treatment
option 4
A girl, aged 11.8 years, had a maxillary left canine
transposed between the central and lateral incisors
(Table II; Figs 1, I, and 3). She had lost her maxillary
left deciduous canine several months previously, and
her mother was concerned because the canine did not
erupt. The clinical examination showed a 2-mm mid-
line shift to the left of the maxillary arch, a Class II
molar relationship on the right side, and a Class I molar
relationship on the left. The intraoral x-rays showed
transposition with the maxillary left canine erupting
between the lateral and central incisors (Fig 1, I). A
possible etiology in this patient could be an odontoma
in the region of tooth 22 that had been surgically
removed at the age of 7 years. At the same time, a
frenulectomy had been performed. Correction was
chosen as the treatment goal, because the canine had
favorable inclination, and this would facilitate correc-
tion of the midline.
As an alternative, extraction of the lateral incisor
and maintenance of the distal molar relationship could
have been done. This would, however, have led to an
esthetic compromise, because the morphology and the
dimension of the canine were not similar to the lateral
incisor. Extraction of the canine was a high price for the
patient and would have called for mesial displacement
of all posterior teeth of that side, with no shortening of
the treatment time.
Treatment started with placement of a transpalatal
arch activated in the first order for distal movement of
tooth 16. Class II traction was applied on the other side
to counteract mesial movement of tooth 26 as a side
effect of the asymmetrical activation of the transpalatal
arch. After 8 months, the molar relationship was
corrected and the transposed canine was surgically
exposed, and a 0.016 ⫻ 0.022-in beta-titanium alloy
archwire extending from tooth 16 across the midline to
the transposed canine was placed. The wire was placed
into the brackets of all teeth from 16 to 21, bypassing
tooth 22, and ending in an extension apically in the
canine region. During the first phase of treatment, a
power arm was added to the exposed canine, and the
first activation was to displace the canine distally while
maintaining the vertical level with a force passing close
Ciarlantini and Melsen 391
to the center of resistance (Fig 3, C). During the next
phase, the power arm was removed, and the extension
was shortened and activated for vestibular movement of
the canine (Fig 3, B and D). The appliance was
constructed so that the distal displacement of the canine
was counteracted by midline correction (Fig 3, A).
After 18 months of treatment, the canine had passed
above the lateral incisor and was brought down to the
level of the dental arch. The distal movement was
continued with a 100-cN nickel-titanium coil spring,
and a cantilever made of 0.016 ⫻ 0.022-in beta-
titanium alloy was used for uprighting and rotation of
the lateral incisor (Fig 3, E and F). In relation to the
next phase of treatment, buccal root torque was added
to the lateral incisor. This was done with a wire placed
into the bracket of the lateral only and tied to a heavy
stainless steel wire extending from molar to molar (Fig
3, G and H). Simultaneously, the mandibular arch was
levelled, and the mandibular canine was slightly in-
truded to improve the canine guidance. During the
finishing phase, a torque arch was applied to generate
buccal root torque to the maxillary incisors, and an
0.018-in beta-titanium alloy round wire welded to a
0.017 ⫻ 0.025-in beta-titanium alloy arch and activated
90° was applied to obtain palatal root torque on the
maxillary left canine (Fig 3, I). At the end of treatment,
a continuous arch was applied for the generation of
second- and third-order correction of tooth 22. The
fixed appliance was removed after 26 months, and a
removable Hawley retainer was used for retention.
All treatment objectives were obtained. No root
resorption was found on the final radiographs, the
inclinations of the roots were corrected (Fig 1, I2), and
the level of attached gingiva of teeth 22 and 23 was
maintained. Esthetically, the result was optimal (Fig 3,
J and K). The duration of the treatment was within the
normal range.
DISCUSSION
In this article, we report on the treatment of 12
consecutive patients with transposition in the maxilla.
The radiographic images are shown in Figure 1. It
appears that all patients, except patient K, had total
transposition, and that patients I and J had favorable
root inclination. In 9 patients, correction was per-
formed. Based on the literature, the treatment approach
most frequently recommended has been acceptance or
extraction of 1 tooth involved in the transposition
(Table I). Correction was considered impossible by
some authors. Sandham and Harvie1 stated that correc-
tion of transposition at a later stage would be impossi-
ble orthodontically, and tooth sequence must be ac-
cepted. Peck and Peck11 also suggested correcting only
392 Ciarlantini and Melsen American Journal of Orthodontics and Dentofacial Orthopedics
September 2007

Fig 3. Patient I. A and B, Intraoral photographs at start of treatment. C and D, Appliance design. At
first stage (C), cantilever was tied to power arm in canine bracket; force was close to center of
resistance. In second stage (D), power arm was removed, and cantilever was applied for buccal and
distal displacement of canine. E and F, Cantilever applied for rotation and uprighting of lateral
incisor. G and H, Torque arch delivering buccal torque to lateral incisor. I, Torque arch delivering
buccal torque to maxillary front teeth and bypassing canine. Lingual root torque was delivered
simultaneously to canine by beta-titanium alloy arch to which perpendicular extension was welded.
Extension was placed in vertical tube of canine and activated 90° by placing main arch into auxiliary
molar tubes. J and K, Posttreatment photographs (radiographs shown in Fig 1, I).

pseudotranspositions and maintaining the transposed
tooth order in all types of true transposition. They
indicated that attempts to restore the natural tooth order
would usually lead to prolonged orthodontic treatment
with less than adequate results due to the difficulties of
root movement. Weeks and Power26 also discussed the
drawbacks related to correction and described the
interventions necessary to obtain an acceptable com-
promise without correction of the transposition. Cor-
rection of the teeth to their normal position was
reported by some authors,28,30,31,33 all of whom used
segmented or partially segmented appliances and took
American Journal of Orthodontics and Dentofacial Orthopedics
Volume 132, Number 3
great care to avoid contact between the teeth when the
passage was performed. Shapira and Kuftinec8 stated
that the correction is complex and can be damaging to
both the teeth and the supporting structures, and pre-
sented the pros and cons of both alignment and correc-
tion.
The long distance the roots must be displaced might
be a risk for root resorption. Among the patients treated
in this report, the radiographs of patients B, F, J, and K
exhibited significant root shortening. In B and F,
pronounced root resorption was seen on the first pre-
molar. However, the pretreatment images showed that
this was already present at the start of treatment. One of
the 2 premolars (patient F) had 2 roots for which reason
the performed treatment would still be the preferred
approach because it would be difficult to have this
premolar mimic a canine. In patient J, the morphology
of both teeth— cone shape—might predict an increased
risk of resorption. The resorption in neither patient J
nor patient K could be considered crucial for the
long-term prognosis of these teeth (Fig 1).
Apart from patient H, who had periodontal disease,
none of the patients had periodontal damage after
treatment.
Correction requires tooth displacements that are
fully controlled in 3 planes of space. It has been
suggested to start treatment with palatal displacement
of the premolar or the incisor before moving the canine
into its normal position. The treatment would be fin-
ished with buccal movement of the palatally displaced
teeth.31 In these patients, an attempt was made to
correct the mesiodistal discrepancy while the canine
was still in a high position and not fully erupted so that
the eruption could be guided after the mesiodistal
correction. Only segmented appliances allow the appli-
cation of well-defined and frictionless biomechanical
force systems for highly controlled tooth movement;
cantilevers and various types of loops can be designed
according to the laws of equilibrium. The results are
highly predictable, and undesirable side effects (round-
tripping, iatrogenic damage) can be minimized and
easily monitored.30 The low load-deflection rate and
wide range of activation of nickel-titanium springs and
beta-titanium alloy wires enable them to maintain high
constancy of both force and moments during orthodon-
tic therapy without the need for frequent reactivations
and appliance adjustments. This treatment strategy
resulted in clinically satisfactory corrections when this
was attempted, and the treatment results were obtained
within the time frame of normal orthodontic treatment.
However, in the treatment results on the intraoral
radiographs (Fig 1), it can be seen that, in patients A, B,
and D, total paralleling of the roots was not obtained. In
Ciarlantini and Melsen 393
patient A, it seemed that there had been relapse because
the x-ray taken at appliance removal showed parallel
roots. The Hawley retainer was obviously unable to
maintain the result. In patient B, the root resorption
seemed to be active, and the treatment was finished
when the clinical result was satisfactory. Patient D had
a hygiene problem during treatment, and considering
the caries risk, finishing was recommended when the
clinical result was acceptable.
CONCLUSIONS
Corrections of total transpositions of M.C.P1 and
Mx.C.12 with appliances especially designed to deliver
the correct force system were demonstrated. The treat-
ments were carried out within a normal time frame, but
costs in terms of root shortening were observed in 2
patients; in 2 others, paralleling of the roots was
unsatisfactory after treatment. Although we demon-
strated that transposed teeth can be brought into their
correct positions, it was advantageous to treat the
patients when the canine was still not fully erupted.
When the teeth involved in the transposition are fully
erupted and completely or almost completely aligned in
the transposed position, a satisfactory result can be
obtained by maintaining the transposition, and correc-
tion, even if possible, would not always be advisable
from a cost-benefit point of view.
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1. Sandham A, Harvie H. Ectopic eruption of the maxillary canine
resulting in transposition with adjacent teeth. Tandlaegebladet
1985;89:9-11.
2. Chattopadhyay A, Srinivas K. Transposition of teeth and genetic
etiology. Angle Orthod 1996;66:147-52.
3. Yilmaz H, Turkkahraman H, Sayin M. Prevalence of tooth
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