|Year : 2015 | Volume
| Issue : 2 | Page : 72-73
A Tale of Impacted Molars: Rare Case Report
D Deepa, Chandni Gupta
Department of Periodontology, Subharti Dental College and Hospital, Meerut, Uttar Pradesh, India
|Date of Web Publication||17-Dec-2015|
Department of Periodontology, Subharti Dental College and Hospital, NH-58, Delhi-Haridwar Bypass Road, Meerut - 250 005, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
"Kissing" or "rosetting" of molars is a rare phenomenon which refers to contacting occlusal surfaces of impacted permanent mandibular second, third, and very rarely, a fourth molar. Kissing molars may occur alone or accompanied by other disorders such as mucopolysaccharidosis. Early surgical intervention is essential as this condition could cause serious complications, including the formation of pathologies such as dentigerous cyst or destruction of the adjacent bone. Here, we report a rare case of unilateral impaction of molars with occlusal surfaces facing each other in the lower jaw.
Keywords: Dentigerous cyst, impacted molars, kissing molars, unilateral
|How to cite this article:|
Deepa D, Gupta C. A Tale of Impacted Molars: Rare Case Report. Indian J Oral Health Res 2015;1:72-3
| Introduction|| |
An impacted tooth is the one that fails to erupt and will not eventually assume its anatomical arch relationship beyond the chronological eruption date. This may be caused by a physical barrier or ectopic positioning of a tooth. In cases, where the second and third mandibular molars are unerupted, with occlusal surface contacting each other in a single follicular space, with the roots in opposing direction are called "kissing molar" (KM) or "rosette formation."  Van Hoff was the first to describe "KMs" in an intellectually challenged, 31-year-old man in 1973. Disturbance in tooth position could be linked with a condition such as mucopolysaccharidosis (MPS), where multiple "resetting" of molars may either as a disease component or an isolated feature as surmised by Nakamura in 1991. , The MPS are a rare group of inherited disorders of connective tissue metabolism of which the condition most familiar is Hurler's syndrome known to be associated with excessive mucopolysacharide excretion. Biochemical investigations for MPS involve urinary glycosaminoglycans levels including hyaluronic acid, chondroitin-4-sulfate, heparin sulfate, keratin sulfate, and proteoglycans.
Though some cases of inverted teeth have been reported in the literature, majority of them were located in the maxilla, or erupted in the nasal cavity or the maxillary sinus. In the mandible also, few cases of inverted teeth have been reported but most of them were third molars.  The incidence of kissing between third and fourth molar is quite rare, such involvement between second and third molar is relatively more common.  KM may be easily diagnosed through radiographic examination. Such conditions require surgical intervention and if ignored could lead to serious complications such as internal or external resorption, pericoronitis, dentigerous cyst or tumors. This case report documents a case of unilateral impaction of the left mandibular second molar and third molar with occlusal surfaces facing each other.
| Case Report|| |
A male patient aged 25 years presented to the department of periodontology for a check-up and oral prophylaxis. The patient was systemically healthy. On clinical examination, oral hygiene status was good with mild gingivitis. Hard tissue and soft tissue examination of oral cavity further revealed that second molar on left mandibular arch was missing. Orthopantomograph was advised to the patient to confirm whether the tooth was impacted or congenitally missing. On radiographic examination, it was observed that the second and third molars were impacted with the occlusal surfaces facing each other in the same follicular space in the left lower jaw [Figure 1]. Patient's medical and family history ruled out the possibility of any hereditary etiology. Finding of resetting of molars, in this case, was an isolated feature and not linked with MPS. Hence, biochemical investigations to rule out the association with this disease were not required. The patient was asymptomatic. The need for surgical intervention was discussed with the patient. The patient is under observation. The patient was asymptomatic and also a frequent traveler. Patient desires to get the treatment done after few months.
|Figure 1: Orthopantomograph showing impacted kissing molars (second and third molar) in the left mandibular jaw region|
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| Discussion|| |
Many theories explaining altered tooth position (delayed/noneruption/impaction) have been suggested, but exact etiology is yet to be determined. Impaction is classified based on its position in relation to adjacent teeth such as mesioangular, distoangular, vertical, horizontal, or inverted. Rarely, an interesting pattern of impaction is observed called "KMs." However, previous studies conclude that KMs have association with MPC, dentigerous cyst, or other syndromes. In the literature, there are controversies regarding the difference between unusual impaction and rosetting of molars. It has been suggested that the absence of a contact between the two impacted molars discounts them from being classified as KM. ,
The literature advocates odontectomy as a decisive form of treatment, even for this unusual impaction. The decision of removal of lower third molar (impacted) in usual position is a surgical challenge. The KM are in the same situation with higher risk of complication; such as mandible fracture during surgery or postoperatory, dry socket and damage to the alveolar nerve.  In order to reduce or prevent these complications, prior surgical planning to manage such unusual condition is necessary.
| Conclusion|| |
The majority of anomalies are coincidental finding, and KMs is one such condition and also highlights the signs of various medical conditions which may require further investigation. Limited options of treatment are available, either surgical intervention or combination of orthodontic and surgical intervention. However, if more information is provided with new cases better treatment planning could be done to treat such accidental findings.
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