Extremely Rare Form of Impac on Bilateral Kissing Molars: Report of a Case and Review of the Literature

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Extremely Rare Form of Impac on Bilateral Kissing Molars: Report of a Case and Review of the Literature


Tamer Zerener, Gurkan Rasit Bayar, Hasan Ayberk Altug, and Serkan Kiran


Gulhane Military Medical Academy, Department of Oral and Maxillofacial Surgery, 06010 Ankara, Turkey


): 鄭凱駿 (intern L 組)

報告日期: 2016/07/11 內文:

Introduc on

1. The permanent teeth can be affected by erup on problems.

No.1: mandibular and maxillary third molars No.2: maxillary canines

No.3: central incisors,

No.4: mandibular and maxillary second premolars

No.5: second molars (rarely, about 0.03–0.04% of all impacted teeth) 2. Kissing molars (KMs) or rose e forma on is an extremely rare condi on of

impacted molars contac ng occlusal surfaces in a single follicular space and their roots poin ng in opposite direc ons. It consists exactly in a full impacted of permanent molars which occurs only in the lower jaw.

3. Van Hoofer presented the first descrip on of this dental pathological condi on in 1973, Robinson et al. coined the specific term “kissing molars” in 1991.

4. In some cases kissing molars can be seen, but occurrence of bilateral kissing molars is extremely rare phenomenon in the dental literature and the e ology of this phenomenon is s ll unknown. At the present me, about thirty cases have been reported in the scien fic literature

Case Report

1. A 38-year-old female pa ent complained of swelling at the right lower side of the angulus of mandible. / Medically, without any previously known allergic reac on, and she was not taking any medica on.

2. Intraoral examina on:

Expansion of buccal cor cal plate and a palpable so swelling over the residual alveolar ridge bone in the second and third molars region of lower mandible.


3. X-ray finding:

(1) Bilateral impac on of the lower second and third molars in each side of the angulus region of the mandible.

(2) In each side of the mandible, the impacted teeth (the second and third molars) had their occlusal surfaces contac ng each other in a single follicular space.

4. Treatment plan: Surgical removal of the kissing molars.

5. Surgical Opera on:

(1) Medicated preopera vely with 40 mg prednisolone for controlling the postopera ve complica ons.

(2) Regional and infiltra on anesthesia blocking the inferior alveolar, buccal, and lingual nerves.

(3) The kissing molars were approached with the help of a ves bular incision.

(4) Mucoperiosteal flap was removed.

(5) Then, osteotomy was performed to expose the impacted kissing molars.


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(7) A er removal of the third molar, second molar was removed by the same approach.

(8) Following removal of kissing molars, the socket was rinsed with saline solu on and residual follicular ssue was removed

(9) Finally, the opera onal region was sutured by interrupted s tches using 3/0 silk suture.

(10) A er 3 months from the first opera on, the same surgical

interven on procedure was performed to the other side of the mandible


(11) Following the surgical opera ons, for controlling postopera ve pain and infec on, 1000 mg amoxicillin and 550 mg naproxen sodium were prescribed to the pa ent for a week.

(12) Swelling decreased gradually in the follow-up period a er surgery. The sutures were removed seven days a er the opera ons. The pa ent was kept on a so diet for about two months. A er that, recovery period was

uneven ul.


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1. Kissing molars:

(1) A form of impac on that is very rarely reported in dental literature.

(2) The term of kissing molars or rose e forma on was first described in 1973.

(3) It refers to mandibular second and third molars which have occlusal surfaces containing each other in an enlarged single follicular space and roots poin ng in opposite direc ons.

(4) The dis nc on between unusual impac on and kissing molars is unclear and the e ology of this phenomenon remains to be unknown

2. Mucopolysaccharidosis (MPS):

(1) Bilateral kissing molars may be related to mucopolysaccharidosis (MPS).

However, it has not been cleared yet.

(2) It is a group of inherited metabolic disorders and an enzyme abnormality accumula on of mucopolysaccharides in different ssues of the body.

(3) Cawson reported a pa ent affected with MPS and suggested that MPS could be a possible e ological factor for occurrence of kissing molars.

(4) Also, Nakamura et al. reported Bilateral kissing molars in their 2 out of 4 pa ents with MPS.


3. The decision for extrac on of asymptoma c kissing molars represents surgical dilemma.

◎Complica ons of extrac on:

∙ Mandibular fractures during the surgery or postopera vely

∙ Damage to the inferior alveolar nerve (0.5 to 5%) and lingual nerve (0.2 to 2%)

∙ Dry socket

∙ Osteomyeli s

∙ TMJ disorders

◎Complica ons of maintenance of kissing molars:

∙ Pericoroni s

∙ Local pain

∙ Cys c changes

∙ Root resorp on of adjacent teeth.

4. Panoramic radiography is considered as the gold standard in most cases. CT scans must be used for evalua on of proximity of inferior alveolar nerve channel.

Utmost care must be taken to avoid lingual nerve injury.

5. Kissing molars can be seen in unilateral or bilateral forms. However, most of them are in unilateral form.


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1. The phenomenon of this issue has not been well described yet. Few treatment op ons were described in the literature.

2. This phenomenon can be sign of various medical condi ons that may require further inves ga on.



題號 題目

1 下列各圖中,何者在「Pell and Gregory classifica on」的分類裡面,屬 於「class II posi on B」的埋伏齒情形?”


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答案(B) 出處:

Contemporary Oral and Maxillofacial Surgery, Sixth Edi on / p.150-153

題號 題目

2 下列關於拔除阻生齒的敘述,何者有誤

(A) 在下顎骨還未完全發育完成前發現有阻生齒的情形,應盡早拔除 阻生齒,以防後患。

(B) 若在同一台手術中需拔除上顎及下顎的阻生齒,通常優先拔除上 顎,再拔下顎

(C) 拔除阻生齒的術後併發症包括,嘴唇麻痺、疼痛、腫脹、瘀血、


(D) 再拔除智齒的術後飲食方面,在術後數天內要切記不要用吸管進 食,並以軟、冷食物為宜,多喝水。

答案(A) 出處:

Contemporary Oral and Maxillofacial Surgery, Sixth Edi on / p.169-171




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