23 May 2022

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Kissing molars: report of three cases

Authors: Octavian Fiore, Carla Cinquegrana, Elisabetta Vignudelli, Giuseppe Corinaldesi

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The definition of “kissing molars (KMs)” refers to a condition in which two or more permanent mandibular impacted molars are in tight contact with the respective occlusal surfaces inside the same follicle and the roots are oriented in the opposite directions.  The aim of the present work is to describe the diagnosis and the treatment of three KMs cases (found in two patients) both classifiable as III class according to Gulses.

MATERIALS AND METHODS

Patient 1 - Case 1
14-year-old female patient who arrived to the attention of the Department of Oral and Maxillo-Facial Surgery of the University of Bologna, after been diagnosed of inclusion of multiple dental elements. Based on the radiological examination the element were classified as III class, “true-KMs”, according to Gulses. Considering the location of the germs of the elements 38 and 39 and their impossibility for proper fisiological eruption, the extraction of both elements in general anesthesia was planned.

Patient 2 - Cases 2 and 3
41-year-old female patient who arrived to the attention of the Department of Oral and Maxillo-Facial Surgery of the University of Bologna, after the diagnoses of inclusion of multiple dental elements. The patient reported, in the previ- ous 6 years, cyclic episodes of partial dysesthesia responsive to antiinflammatory therapy. Based on the radiologi- cal examination the element 38 and 39 were classified as III class, “true-KMs”, according to Gulses and the elements 48 and 49 were classified as “pseudo-KMs”. Considering the location of the germs, the radiological examination and the symptomatology, the surgical extraction was performed in general anesthe- sia of the “true-KMs” 38 and 39 elements. Considering the absence of symptomatology and bleeding distal to element 47, annual follow-up of “pseudo-KMs” 48 and 49 was planned. 

RESULTS
The condition of KMs is quite rare and until 2016 only thirty cases were reported. Several theories are reported in the literature on the etiopathogenetic mechanisms of this condition: the unusual position of the dental germ, the presence of a fourth molar and the bone resorption due to a cystic formation are some of them. Further, according to a number of authors, the rare possi- bility of bilaterality KMs could be related to syndromic patients.

CONCLUSIONS
The kissing molar phenomenon is part of the dental inclusion chapter, however, an unclear etiopathogenesis is still reported in literature. It would be interesting to better understand this condition, also considering the possible role of the fourth molar in the embryological phase.

CLINICAL SIGNIFICANCE
The majority of KMs cases are asymptomatic and rarely are associated with facial pain. Usually they are impacted elements oc- casionally diagnosed during radiological examination. The elective treatment plan, when patient does not have contraindica- tions to oral surgery, is surgical extraction.