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CASE REPORT |
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| Year : 2012 | Volume
: 30
| Issue : 3 | Page : 275-278 |
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Compound odontoma associated with impacted maxillary incisors
S Sreedharan, IS Krishnan
Department of Pedodontics, Government Dental College, Trivandrum, Kerala, India
| Date of Web Publication | 21-Dec-2012 |
Correspondence Address:
S Sreedharan
Room No. 401, Department of Pedodontics, Government Dental College, Trivandrum, Kerala
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0970-4388.105025
 Abstract | | |
Odontomas are considered to be the most common odontogenic tumors of the oral cavity. Some authors consider it as malformations rather than true neoplasms. The exact etiology of odontomes is still not known. Most odontomes are asymptomatic and are discovered during routine radiographic investigations. Odontomes generally cause disturbances in the eruption of the teeth, most commonly delayed eruption or deflection. The present report describes the surgical management of a case of compound odontoma in a 10-year-old boy who presented with a complaint of swelling in the maxillary right anterior region and retained deciduous incisors. The related literature is also being reviewed in this article.
Keywords: Compound odontoma, delayed tooth eruption, odontoma, retained deciduous teeth
How to cite this article:
Sreedharan S, Krishnan I S. Compound odontoma associated with impacted maxillary incisors. J Indian Soc Pedod Prev Dent 2012;30:275-8 |
| Introduction | |  |
Odontomas constitute the most common variety of odontogenic tumors resulting from growth of completely differentiated epithelial and mesenchymal cells. [1],[2] They are formed of enamel and dentin but can also contain variable amounts of cementum and pulp tissue. [3],[4] The etiology of odontoma is still unclear. [1] Local traumas or infections may cause odontomas. [1],[5] Radiographically, odontomas appear as dense radio-opaque lesions with prominent external margins surrounded by a thin radiolucent zone. [6],[7]
Management consists of excision. Prognosis after treatment is very favorable, with scant relapse. [1],[3],[6],[7],[8]
An unusual case of a compound odontoma in the maxilla is presented with clinical, radiographic, and microscopic findings. The odontomas consisting of multiple denticles were surgically removed and microscopic examination showed a lot of crown-like structures in a very irregular form, some of which were fused to each other at their apical parts.
| Case Report | | |
A 10-year-old boy reported to the Department of Pedodontics at Government Dental College, Trivandrum with a chief complaint of swelling in the right maxillary anterior region [Figure 1] and was present since 1 year. The swelling had increased considerably in size. Family and past medical history were non-contributory. | Figure 1: Swelling over the right maxillary anterior region. Retained 51, 52 can be seen
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Clinical examination revealed retained deciduous maxillary right incisors. A swelling was noticed over the buccal gingiva extending from the mesial margin of the canine to the labial frenum. The swelling had no associated symptoms.
Radiographic examination revealed multiple dense radio-opaque structures contained in a radiolucent cavity surrounded by a corticated border in relation to the apices of the deciduous maxillary right incisors [Figure 2]a and b. | Figure 2: (a) Intra-oral peri-apical radiograph showing dense radiopaque structures in relation to 51 and 52. (b) Occlusal radiograph showing the complete extent of the lesion
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Coronal and axial sections of computed tomography revealed a well-demarcated hyperdense lesion, located at the level of the apices of deciduous incisors [Figure 3]. The permanent incisors were displaced with only a small rim of bone present between the nasal cavity and central incisor. A provisional diagnosis of odontome was given. | Figure 3: Computed tomography showing a well-demarcated hyperdense lesion
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Routine blood investigations were carried out and the patient was posted for surgery. The retained teeth were extracted and a full thickness mucoperiosteal flap was reflected. A window was prepared over the buccal cortical bone in relation to the swelling. Numerous small denticles, about 50 in number, were removed. The denticles were contained in a capsule which was removed using a curette [Figure 4]. | Figure 4: About 50 denticles were removed along with the lining capsule. Some presented as tooth-like structures whereas others were calcified tissues with no resemblance to teeth
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The unerupted permanent maxillary central incisor could be seen at the apical portion of the cystic cavity. The displaced lateral incisor was also visible [Figure 5]a and b. | Figure 5: (a) Permanent central incisor displaced to the apical extent of the cavity. (b) Permanent lateral incisor displaced laterally
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Since the root formations of both these teeth were not completed, the teeth were let to erupt on their own [Figure 2]. To ensure that no denticles remained, radiographs were taken [Figure 6]. | Figure 6: Intra-oral, peri-apical, and occlusal radiograph confirming removal of all the denticles
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After hemostasis, the area was irrigated with saline and the mucoperiosteal flap was sutured back [Figure 7]. Healing was uneventful and sutures were removed on the seventh post-operative day. | Figure 7: Hemostasis achieved and mucoperiosteal flap sutured back in place
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Histopathological diagnosis was compatible with compound odontoma. The soft tissue lining was suggestive of the dental follicle.
The teeth were surgically exposed at a later date and brackets were bonded on to the teeth [Figure 8] and [Figure 9]. Currently, the treatment is underway and the teeth are being extruded and aligned orthodontically [Figure 10]. The final alignment of the teeth will be completed after the eruption of the canine teeth. | Figure 8: Eighth month post-operative intra-oral, peri-apical, and occlusal radiograph showing progressive root formation
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 | Figure 9: Brackets bonded at a later stage to facilitate orthodontic extrusion of the teeth
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| Discussion | | |
The term "odontoma" was coined by Paul Broca in 1867. Odontomas are relatively common, asymptomatic odontogenic lesions, rarely diagnosed before the second decade of life. The most frequent clinical signs are delayed eruption, persistence of the temporal tooth, and the presence of a tumor. [2],[3],[8] In severe cases, infection or regional adenopathies may be observed. [2],[3],[4]
Odontomas are accepted as developmental anomalies rather than true neoplasms. [3],[5],[9] Compound odontomas appear more frequently than complex odontomas. [2],[4] Majority of odontomas located in the anterior region of the maxilla are compound, whereas those located in the posterior areas, especially in the mandible, are complex. [3],[4]
The World Health Organization classifies odontomas from the histopathological perspective as: (a) Complex odontomas in which the dental tissues are well formed but exhibit a more or less disorderly arrangement and (b) composite odontomas in which the dental tissues are normal, but their size and conformation are altered - giving rise to multiple small tooth-like structures called denticles. [2]
Differential diagnosis must be established with ameloblastic fibroma, ameloblastic fibroodontoma, and odonto ameloblastoma. [1],[2] Odontomas can also manifest as part of syndromes, like basal cell nevus syndrome, Gardner syndrome, familial colonic adenomatosis, Tangier disease, or Hermann syndrome. [2]
The case described in this report was initially diagnosed as compound odontoma based on the radiographic findings. [3],[4],[8] This diagnosis was later confirmed by histopathological examination of the lesion. The lesion was found on the anterior region of the maxilla, which, according to many researchers, is the most common location. [1],[2],[4],[6] In our case, the lesion produced a swelling of the cortical bone and this contributed to the discovery of the lesion. In 70% of odontomas, the neighboring teeth undergo pathologic alterations such as devitalization, malformation, aplasia, malposition, and delayed eruption. [10] They may also undergo cystic transformation. [2] In this case, the right maxillary incisors were displaced and this hampered the normal exfoliation of the deciduous teeth.
Ideally, odontomas should be removed when the permanent teeth adjacent to the lesion exhibit about one half of their root development because this ensures safety of the normal permanent teeth and prevents interference with their eruption. Kaban states that odontomas are easily enucleated. [11]
| Conclusion | | |
Variations in the normal eruption of teeth is a common finding, but significant deviations from established norms should alert the clinician to further investigate the patient's health and development. Clinical experience and dental literature suggest that an individualized radiographic examination should be performed for any pediatric patient who presents with clinical evidence of delayed permanent tooth eruption or temporary tooth displacement or retained deciduous teeth with or without a history of previous dental trauma. Early diagnosis facilitates the clinician to adopt a simpler and less complex approach of treatment and ensures better prognosis for the condition. Inspite of the low frequency of this lesion and the fact that most cases are surgically removed and heal uneventfully, there must be a close follow-up, because there have been reports of association with carcinoma, adenomatoid tumor, and ameloblastoma.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10]
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