Kissing Molars: A Report of Three Cases and Literature Review

Abstract

We found a mean age at diagnosis of 29.1 years. Six patients had bilateral kissing molars, while kissing molars were located unilaterally in sixteen patients: on the right side in four patients, on the left side in three patients, and the affected side is not mentioned in the remaining nine unilateral cases. The second and third molars were affected in seventeen patients, while in four patients the third and fourth molars were involved, and in one case the first and second molar were affected. Five cases were asymptomatic. Treatment included conservative management in two cases and surgical removal in seventeen patients. In the three remaining patients no data concerning their management were provided. Conclusions: While the etiopathogenesis of kissing molars is yet to be elucidated, it seems that developmental disorders of the jaw that cause bone resorption by expansion of the follicular cyst associated with impaction of the first, second, third or fourth molars, seems to be the most appropriate explanation for the condition. Surgical management must be planned according to the location and position of the kissing molars, along with an assessment of possible morbidity associated with the surgery.

Expanding torque possibilities: A skeletally anchored torqued cantilever for uprighting “kissing molars”

“…1,2 However, "kissing molars" (KMs) describe an unusual type of tooth impaction in which 2 mandibular molars are severely tipped and impacted with their occlusal surfaces positioned crown-to-crown and the roots pointing in opposite directions. [3][4][5][6][7][8] Gulses et al 9 proposed a radiographic classification of KMs into Class I, Class II, or Class III categories depending on the location of the teeth involved. If the impactions are between the first and second molars, they are classified as Class I KMs; between the second and third molars, Class II KMs; and between the third and fourth mandibular molars, Class III KMs.…”

“…KMs should be treated if they cause adverse symptoms, are associated with cystic pathology, or because they have a high risk of caries, periodontal complications, or progressive bone loss. 5,9 Orthodontic mechanics for uprighting KMs have not been reported. Surgical treatment involving extraction of 1 or both KMs is the most common protocol.…”

“…Radiographically, the right first and second molars were severely tipped toward each other so that their occlusal surfaces were contacting crown to crown, whereas the roots pointed in opposite directions, in a typical KM impaction position (Fig 2). [4][5][6][7] The second molar was the most severely tipped, with a vertically inverted position and over 90 of long axis rotation in relation to the adjacent unaffected teeth (Fig 2). The unerupted surfaces of the KMs presented an enlarged pericoronal space that communicated with the oral cavity, allowing food debris impaction, bacterial contamination, and chronic infection with acute episodes, leading to bone loss (Figs 1 and 2).…”

“…This difficult access for dental cleaning probably led to the development of a deep carious lesion in the first molar (Fig 2). 5 The patient's parents reported a history of a cystic lesion related to the KMs, which had been surgically treated 3 years previously. Since the patient had no history of metabolic diseases, trauma, or fracture involving the KM area, the cystic formation may have contributed to the displacement of the adjacent teeth to the KM position.…”

“…Since the patient had no history of metabolic diseases, trauma, or fracture involving the KM area, the cystic formation may have contributed to the displacement of the adjacent teeth to the KM position. 4,5,7,9,11,[13][14][15] The premolar relationships showed a half cusp Class II malocclusion (Fig 1). Distal tipping of the first molar, associated with mesial tipping of the second molar, caused arch-length shortening in the KM area.…”