Compound Odontoma: A Case Report

Case Report
Compound Odontoma: A Case Report
Kiran Raj1, Sowmya B Shetty2, Amrutha Joy3, Reshmi N Shetty1, Madhusudan Kaikure4
Reader, Department of Pedodontics and Preventive Dentistry, A. J. Institute of Dental Sciences, Mangalore, Karnataka, India, 2Professor,
Department of Pedodontics and Preventive Dentistry, A. J. Institute of Dental Sciences, Mangalore, Karnataka, India, 3Post-graduate Student,
Department of Pedodontics and Preventive Dentistry, A. J. Institute of Dental Sciences, Mangalore, Karnataka, India, 4Assistant Professor,
Department of Pedodontics and Preventive Dentistry, A. J. Institute of Dental Sciences, Mangalore, Karnataka, India
1
ABSTRACT
Odontomas are hamartomas of aborted tooth formation. They are coming under the classification of benign calcified odontogenic
tumors. These odontogenic tumors are composed of enamel, dentine, cementum, and pulp tissue. Odontomas are classified into
complex and compound odontomas. They commonly occur in permanent dentition. Odontomas are usually diagnosed during
the routine radiographic examination. Sometimes these tumors are associated with delayed tooth eruption, impaction, or primary
tooth retention. Compound odontomas are usually present in the anterior region of the upper maxilla. This odontogenic tumor is
treated by surgical removal of the lesion. Here we report a case of compound odontoma in a 9-year-old girl that has caused the
delayed eruption of left permanent central incisor.
Keywords: Compound odontoma, Odontogenic tumor, Odontomas, Retained primary teeth, Unerupted incisor
Corresponding Author: Dr Amrutha Joy, Department of Pedodontics and Preventive Dentistry, A. J. Institue of Dental Sciences, Kuntikana,
Mangalore - 575 004, Karnataka, India. Phone: +91 9663940534. E-mail: [email protected]
INTRODUCTION
Odontomas are benign tumors of odontogenic origin
combining mesenchymal and epithelial elements. 1
Odontomas constitute about 22% of all odontogenic
tumors. They are more common in females. The term
odontoma was first coined by Paul Broca (1866). He
defined odontomas as a tumor formed by an overgrowth
of complete dental tissues. They occur mostly in the first
decades of life. Odontomas usually seen in permanent
dentition, but it is reported with primary dentition also.2,3
Histologically, odontomas are composed of enamel,
dentine, cementum and, in some cases, pulp tissue.
Clinically, odontomas are asymptomatic lesions often
associated with alterations in tooth eruption. The
diagnosis is made on routine radiological studies, or
on evaluating the cause of delayed tooth eruption.1
Compound odontomas usually not associated with bony
expansion, but complex odontomas can cause marked
bony expansion.2
Compound odontomas are usually seen in the anterior
region of the maxilla, over the crowns of unerupted
teeth or between the roots of erupted teeth. Complex
odontomas are mostly seen in the mandibular posterior
region. The presence of odontomas are also reported
in areas like maxillary sinuses, pituitary region,
subcondylar region, ramus of the mandible middle
ear, and midpalatal region. However, these are rare
cases. The lesions are unilocular that contain multiple
radio-opaque miniature tooth-like structures known as
denticles.1,2
Gravey et al. classified compound odontomas as:
1. Denticulo type: Composed of two or more separated
denticles having crown and root, dental hard tissue
resembling that of the tooth.
2. Particulate type: Composed of two or more separate
masses or particles, bearing no resemblance to the
tooth.
3. Denticulo-particulate type: In this both denticles and
particles are present together.2
The treatment of choice is surgical removal of the lesion
in all cases, followed by the histopathological study
to confirm the diagnosis.3 Removal of the lesion and
curettage of enveloping soft tissue should be done to
prevent cystic degeneration.4
Ideally odontomas should be removed when the
permanent teeth adjacent to the lesion shows about the
one-half of its root development so that the tooth eruption
will not be disturbed. Kaban reported that odontomas
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Compound Odontoma: A Case Report
are easily enucleated and adjacent teeth that may have
been displaced by the lesion are seldom harmed by
the excision because they are usually separated from
the lesion by a septum of bone.5 The early diagnosis of
odontomas will reduce the chance of development of
malocclusion and pathological changes in that region.6
Here we report a case of compound odontomas in a
9-year-old girl that has caused the delayed eruption of
left permanent central incisor.
CASE REPORT
A 9-year-old female patient came to the Department of
Pediatric Dentistry, A J Institute of Dental Sciences with
the complaint of unerupted central incisor in the upper
region. The patient was medically fit.
Intraoral examination revealed retained primary incisor.
The labial gingiva in relation to left central incisor
showed bulging which is hard in consistency. The size
of the lesion was about 2-3 mm (Figure 1).
Raj, et al.
shift technique). The radio-opaque mass moved to the
opposite side which confirmed its labial position.
Removal of odontoma had done by the surgical procedure
under local anesthesia. Full thickness mucoperiosteal
flap was raised from right primary canine to left primary
canine. The vertical releasing incision avoided for the
esthetic reason. Since the bone covering was thin, there
was no need for cutting bone. The thin superficial layer
of bone was removed using curette. The lesion was
containing nine teeth like small structures (Figures 3
and 4). All of the hard tissue removed and the cavity
was curetted. The sharp bony edges removed using bone
rontger and smoothened with a bone file.
Intraoral periapical radiograph was taken to make sure
complete removal of the lesion immediately after the
procedure. Sutures placed. The specimen had sent for
histopathological examination.
Patient was recalled after 1 week and 1 month after the
procedure (Figures 5 and 6).
Based on history and clinical examination, the
provisional diagnosis was a supernumerary tooth.
Differential diagnosis includes odontoma, adenomatoid
odontogenic tumor, and calcified epithelial odontogenic
tumor.
Intraoral periapical radiograph revealed a well-defined
multiple radio-opaque mass similar to the density of
dental tissue. It had been placed between the roots of
left primary central and lateral incisors. Developing
permanent central incisor was seen apical to the radioopaque mass (Figure 2).
Another radiograph was taken by shifting the X-ray tube
to more left side to know the position of odontoma (tube
Figure 2: Pre-operative intraoral periapical radiograph with tube shift technique
Figure 1: Pre-operative intraoral clinical view
Figure 3: Intra-operative surgical view
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Raj, et al.
Compound Odontoma: A Case Report
DISCUSSION
Odontoma is the most common type of odontogenic
tumor, and some authors called it as hamartoma, not a
true tumor.4
Hitchin suggested that odontomas inherited through
a mutant gene or interference, possibly postnatal, with
genetic control of tooth development. In humans, there
is a tendency for the lamina between the tooth germs to
disintegrate into clumps of cells. The persistence of the
lamina may be an important factor in the etiology of
complex or compound odontomas, and either of these
may occur instead of a tooth.4
Figure 4: Nine mineralized structures removed from the lesion
Odontomas have been associated with trauma during
primary dentition, inflammatory and infectious
processes, hereditary anomalies (Gardner syndrome and
Hermann syndrome), and odontoblasts hyperactivity,
and alterations in the genetic components are responsible
for controlling dental development.4
According to the classification of WHO (2005), two types
of odontomas can be found: Complex odontomas and
compound odontomas.1 In complex odontomas, dental
tissues are arranged in a disorderly pattern. In compound
odontomas, they are arranged more orderly.4 Complex
odontomas are less common than the compound
odontoma in the ratio 1:2.7
Figure 5: Postoperative clinical view after 1 week
Clinically odontomas are either complex or compound,
and classified as follows:
• Intraosseous: These odontomas occur inside the bone
and may erupt into the oral cavity.
• Extraosseous or Peripheral: Odontomas occurring in
the soft tissue covering the tooth bearing portions of
the jaws.8
About 70% of the unerupted tooth have been reported to
erupt spontaneously after removal of obstruction.9 The
same was seen in this case also.
Figure 6: Post-operative intraoral periapical radiograph after 1 week
The histopathologic report shows definite arrangements
of dentinal tubules, dentin tissue with the presence of
intertubular dentine. Pulp tissue components were
also present. These features with radiographic features
confirmed the diagnosis as compound odontoma.
Some authors recommended the exposure of the
unerupted tooth at the time of surgery and placement of
bonded attachment and ligature/e-chain for orthodontic
traction, to facilitate rapid eruption. This approach may
result in a poor gingival margin, inadequate gingival
tissue attachment, and a discrepancy of the gingival
level between the exposed tooth and its neighboring
teeth.6 In this case, only one-third of root formation
was completed, so left undisturbed for the normal
physiologic eruption of the tooth.
In our case, vertical releasing incision and bone cutting
using micro motor was avoided to facilitate better
healing and for reducing post-operative trauma.
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Compound Odontoma: A Case Report
CONCLUSION
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Arch Clin Exp Surg 2014;3:47-51.
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report. J Orofac Res 2012;2:56-60.
9. Tanki JZ, Naqash TA, Gupta A, Singh R, Jamwal A. Impacted
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4.
It is very common for children to present with a
difference in eruption pattern of maxillary incisors.
Because of esthetic reasons, this patient came for
treatment. Early removal of the lesion will enhance the
eruption. Usually, odontomas does not recur, but close
monitoring is necessary in young children till permanent
teeth erupt into normal occlusion.
1.
Raj, et al.
How to cite this article: Raj K, Shetty SB, Joy A, Shetty RN, Kaikure M.
Compound Odontoma: A Case Report. Int J Adv Health Sci 2015;1(12):10-13.
Source of Support: Nil, Conflict of Interest: None declared.
International Journal of Advanced Health Sciences • Vol 1 Issue 12 • April 2015