Excisions of 4 Unerupted Canines in the Mentonian Region of the Mandible: “Kisses Teeth”

Background and Aim: An impacted tooth, despite full development, remains enclosed within bone tissue, often encased by both bone and mucous tissue, failing to erupt at the expected time. This paper aims to present a clinical case involving an impacted tooth in the mandibular symphyseal (mentonian) region, along with the clinical and surgical management of this case.
Method: A 14-year-old female patient of African descent sought the Oral and Maxillofacial Surgery and Traumatology Service at the Federal University of Pernambuco with complaints of discomfort in the chin area. An imaging-based evaluation was initiated, revealing symptoms associated with two impacted canine teeth and two supernumerary teeth that radiographically resembled canines. These impacted teeth were surrounded by a radiolucent image resembling a dentigerous cyst, situated in an unusual "kissing teeth" configuration. During the patient's medical history, she reported the absence of bilateral lower canines, as well as the absence of traumatic incidents or premature loss of deciduous teeth in the affected region. The surgical procedure involved incisions in both the right and left parasympyseal regions of the mandible, followed by mucoperiosteal flap dissection and osteotomies. The surgical approach aimed to access the lesion and impacted teeth. Uppermost elements on the right side were delicately removed with the assistance of Seldin elevators, followed by the meticulous management of the left side to avoid injury to adjacent roots. The lesion surrounding the impacted teeth was gently excised via curettage to preserve the integrity of the inferior alveolar nerve vascular bundle. The excised lesion was sent for histopathological examination at the Oral Histopathology Laboratory of the Federal University of Pernambuco. The surgical procedure continued with cavity cleansing, bone contouring, flap repositioning, and suturing using separate 5.0 mononylon stitches.
Results: The patient experienced an uneventful postoperative recovery, displaying no signs of inflammation. A one-year follow-up with a facial (panoramic) radiograph showed evident bone tissue healing in the region while preserving the apices of the inferior teeth. Clinically, the patient's tissues remained intact, and all dental elements exhibited pulp vitality.
Conclusion: This case underscores a rare scenario where lower canines were impacted alongside supernumerary teeth, all enclosed within a single dentigerous cyst. Given the lower incidence rates of impacted canines in the mentonian region, as opposed to impacted upper canines, this case holds significance for surgical, pathological, and radiological professionals, emphasizing the importance of accurate diagnosis in such unique clinical presentations.