INTRODUCTION
Tooth impaction is a pathological process in which the tooth does not erupt into its functional position due to physical or genetic factors.1 The most commonly affected teeth are the mandibular third molars having a prevalence of between 16% to 68% while the least common are the mandibular second molars whose prevalence is a mere 0% to 2.3%.2-4 The ‘kissing molar’ (occlusal surfaces contacting each other with their roots pointed in opposite directions) relationship of these teeth is extraordinarily sparse with only eleven cases of bilateral pathology having been reported to date.5,6 The etiopathogenesis of this condition unknown, however, some authors implicate arch length deficiency and metabolic diseases in an attempt to explain the finding.5,7,8
Abnormal root morphology of the maxillary premolars, although uncommon, have been reported previously in literature involving relatively rare cases such as presence of a third root of the first maxillary premolar and a two-rooted second maxillary premolar in about 25% of cases.9,10 There are scarce reports on the occurrence of a three-rooted second maxillary premolar whose incidence was reported to be 0.3% to 2% with no reports so far on a bilateral occurrence of this phenomenon.11,12
We hereby report a unique combination of two rare dental findings in the same individual which could pose future treatment challenges: bilateral kissing molar impactions and bilateral three-rooted second maxillary premolars. In addition, we discuss the relationship of the molar apices to the mandibular neurovascular bundle and to the inferior border of mandible, its surgical implications and the endodontic considerations of a three-rooted second maxillary premolar.