International J. of Healthcare & Biomedical Research, Volume: 1, Issue: 4, July 2013, Pages 325-330

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Case Report: Dental science

“Case Report of a compound composite odontome with an impacted maxillary canine” 1Dr. Deepa Das , 2Dr. Gopal Sharma, 3Dr. Jaya Mukherjee , 4Dr. Bhagyashri Purandare

1Associate Professor, Dept of Oral medicine and Radiology, YMT Dental College and Hospital 2 Head of Department, Oral Medicine and Radiology, YMT Dental College and Hospital 3Postgraduate studies, Dept of Oral medicine and Radiology, YMT Dental College and Hospital 4Postgraduate studies, Dept of Oral medicine and Radiology, YMT Dental College and Hospital

Institute: YMT Dental College and Hospital, kharghar, Navi Mumbai, Maharashtra, India

Corresponding author: Dr Jaya Mukherjee , Email id :drjaya_mukherjee@yahoo.co.in

ABSTRACT:

Odontomas are the most common type of odontogenic tumours and are generally asymptomatic. Frequently they interfere

with the eruption of the teeth. This is the case report of a compound composite odontoma in a 15 years old girl, which

resulted in failure of eruption of the permanent maxillary left canine while the contra lateral tooth had erupted. A calcified

mass was seen in the radiograph and was provisionally diagnosed as a compound composite odontoma following which the

odontoma was enucleated along with disimpaction of the left maxillary canine.

Keywords: odontomas, calcified, disimpaction, enucleation

INTRODUCTION

Odontomas are the most common of odontogenic

tumors of the jaws. They are mixed tumors,

consisting of both epithelial and mesenchymal

cells, that present a complete dental tissue

differentiation (enamel, dentin, cementum, and

pulp).1,2

These tumours are basically formed of

enamel and dentin but they can also have variable

amounts of cementum and pulp tissue. It was in

1867 that Paul Broca first used the term

“Odontoma.” Broca defined the term as “tumors

formed by the overgrowth of transitory or complete

dental tissues”. 3Odontomas are further sub-

classified based upon their gross and radiographic

features into compound (small tooth like structures)

or complex (a conglomeration of dentin, enamel

and cementum)4.In 1974, Shafer, Hine and Levy

described odontomes as tumors of odontogenic

origin but their current views support that an

odontome is now widely accepted by most

authorities as a hamartoma.5

CASE PRESENTATION

A 15 years old female patient reported to the

Department of Oral Medicine and Radiology, YMT

Dental College and Hospital, Kharghar with a chief

complaint of unerupted upper left front tooth, while

the contra lateral tooth had already erupted.

Medical and family histories were non-

contributory. No history of trauma to the face or

mouth was reported. Clinical examination revealed

no facial asymmetry extra orally on inspection. On

palpation, there was no swelling or tenderness

present. Intraorally, unerupted 23 without any

swelling or inflammation of the overlying mucosa

was noticed (Fig. 1&2).On palpation intra orally,

slight tenderness was reported by the patient in the

upper left vestibule above the missing tooth (23).

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Figure 1 Figure2

INVESTIGATIONS

The intraoral periapical (Fig. 3), Occlusal (Fig 4 )

and panoramic radiographs (Fig. 5) revealed the

presence of a radiopaque mass in 23 region

obstructing its eruption. Clark’s radiographic

technique revealed the presence of two radiopaque

masses ,one in the palatal region (impacted upper

left maxillary canine ) of the upper left central and

lateral incisors and the other (calcified mass)

buccal to it.

Figure 3 Figure 4 The radiograph showed the presence of impacted maxillary left canine and a radiopaque mass consisting of

tooth like structures.

Figure 5 : On the basis of clinical and radiographic findings, it was provisionally diagnosed as a compound

composite odontoma.

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TREATMENT

Under local anaesthesia, surgical removal was

done. A mucoperiosteal flap on the palatal surface

(Fig 6) from the right permanent central incisor to

left permanent second molar was raised. The layer

of bone overlying the palatal surface from 11 to 23

was removed and the crown of the canine was

exposed. (Fig 7).

Figure 6 Figure 7

The bone was further removed to expose the root of

the impacted canine and it was removed. (Fig 8). A

window was then created in the bone from the

labial aspect between 22 and 24 to gain access to

the calcified mass. (Fig 9) This mass was excised

completely and submitted for histopathological

evaluation.(Fig 10)

Figure 8 Figure 9

OUTCOME AND FOLLOW-UP :The histopathological report confirmed the specimen to be compound

composite odontoma . The patient was kept under observation and followed up for 6 months. The healing was

uneventful.

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Figure 10

Figure 11

After 6 months complete healing was seen and patient was advised for replacement of missing teeth and referred

to the concerned department.(Fig 12)

Figure 12

DISCUSSION

The most common clinical presentation for an

odontoma is the association with impacted or

retained primary teeth.6The case presentation

described above was in accordance with the

finding. They can be discovered at any age, and in

any location of the dental arch. The mean age of

detection on an average is 14.8 years, with the

prevalent age being the second decade of life.

There is a slight predilection for occurrence in

males (59%) compared to females (41%). The

compound odontome is known to occur more

commonly in the maxilla (67%) as compared to the

mandible (33%), with a marked predilection for the

anterior maxillary region (61%).7,8,9

The etiology of

odontoma is unknown. It has been suggested that

local trauma or infection may lead to production of

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such lesion. It may also be caused due to a mutant

gene or interference or by traumatic interference.

10,11

In 1946, Thoma and Goldman gave a classification

which is as follows.

• Geminated composite odontomes: Two or

more, more or less well-developed teeth

fused together.

• Compound composite odontomes: Made

up of more or less rudimentary teeth.

• Complex composite odontomes: Calcified

structure bearing no great resemblance to

the normal anatomical arrangement of

dental tissues.

• Dilated odontomes: The crown or root part

of tooth shows marked enlargement.

• Cystic odontomes: An odontome that is

normally encapsulated by fibrous

connective tissue in a cyst or in the wall of

a cyst.

According to World Health Organization (WHO)

classification, odontomes can be divided into three

groups.

• Complex odontome: When the calcified

dental tissues are simply arranged in an

irregular mass bearing no morphologic

similarity to rudimentary teeth.

• Compound odontome: Composed of all

odontogenic tissues in an orderly pattern,

which result in many teeth-like structures,

but without morphologic resemblance to

normal teeth.

• Ameloblastic fibro-odontome: Consists of

varying amounts of calcified dental tissue

and dental papilla-like tissue, the later

component resembling an ameloblastic

fibroma. The ameloblastic fibro-odontome

is considered as an immature precursor of

complex odontoma.

A new type known as hybrid odontome is also

reported by some authors.12

The radiographic

findings of odontomas depend on their stage of

development and degree of mineralization. The

first stage is characterized by radiolucency due to

lack of calcification. Partial calcification is

observed in the intermediate stage, while in the

third stage the lesion usually appears as radiopaque

masses surrounded by radiolucent areas

corresponding to the connective tissue

histologically.13,14

Histopathologically, odontomas

are normal appearing enamel or enamel matrix,

dentin, pulp tissue and cementum, which may

exhibit a normal relation to one another.15

Compound odontomas are formed by tooth-like

structures which resemble pulp tissue in the central

portion surrounded by a dentin shell and partially

covered by enamel. Complex odontomas are

conglomerates without orientation of dentin,

enamel; enamel matrix, cementum and areas of

pulp tissue. Odontomas are treated by conservative

surgical removal and there is little probability of

recurrence. 16

Timely detection and surgical

enucleation of odontoma followed by curettage is

recommended to prevent complications such as

tooth loss, cystic changes, bone expansion and

delayed eruption of permanent teeth.17

Surgical

excision of odontoma and its surrounding soft

tissue is recommended as the treatment of choice

because of the possibility of its cystic degeneration.

The lack of recurrence indicates that conservative

excision is adequate18

REFERENCES

1. Philipsen HP, Reichart PA, Praetorius F. Mixed odontogenic tumours and odontomas. Considerations

on interrelationship. Review of the literature and presentation of 134 new cases of odontomas. Oral

Oncol. 1997;33:86–99.

International J. of Healthcare & Biomedical Research, Volume: 1, Issue: 4, July 2013, Pages 325-330

330

www.ijhbr.com

2. Amado Cuesta S, Gargallo Albiol J, Berini Aytés L, Gay Escoda C. Review of 61 cases of

odontoma.Presentation of an erupted complex odontoma. Med Oral. 2003;8:366–73.

3. Batra P, Duggal R, Kharbanda OP, Parkash H. Orthodontic treatment of impacted anterior teeth due to

odontomas: A report of two cases. J Clin Pediatr Dent. 2004;28:289–94.

4. Bordini J, Jr, Contar CM, Sarot JR, Fernandes A, Machado MA. Multiple compound odontomas in the

jaw: case report and analysis of the literature. J Oral Maxillofac Surg. 2008;66(12):2617–2620. doi:

10.1016/j.joms.2007.08.027

5. Shafer GW, Hine MK, Levy BM. A textbook of oral pathology (3rd ed). Philadelphia: WB Saunders

1974;276

6. Yassin OM . Delayed eruption of maxillary primary cuspid associated with compound odontoma . J

Clin Pediatr Dent 1999 ; 23 : 147 – 9

7. Owens BM, Sachuman NJ, Mineer H, Turner JE, Oliver FM. Dental odontomas: A retrospective study

of 104 cases. Clin Pediat Dent. 1997;21:261–4.

8. Shafer, Hine, Levy . Shafer's Textbook of Oral Pathology. In: Rajendran R, Sivapathasundharam B,

editors. Cysts and tumors of odontogenic origin. 5th ed. New Delhi: Elsevier; 2006. pp. 404–7.

9. Syed MR, Meghana SM, Ahmedmujib BR. Bilateral complex odontomas in mandible. J Oral

Maxillofac Pathol. 2006;10:89–91.

10. Levy SH. Cysts and Tumours of the Jaws. In a Textbook of Oral Pathology. 4 th ed. United States: W.

B .Saunders Company; 2003.

11. Owens HM, Schuman NJ. Dental odontomas: A retrospective study of 104 cases. Int J Clin Pediatr

Dent 1997;21:261-4.

12. Natl J Maxillofac Surg. 2010 Jul-Dec; 1(2): 157–160. Vibha Singh, Satish Dhasmana,1 Shabad

Mohammad, and Nimisha Singh

13. Tomizawa M, Otsuka Y, Noda T. Clinical observations of odontomas in Japanese children: 39 cases

including one recurrent case. Int J Paediatr Dent. 2005;15:37–43.

14. Kodali RM, Venkat Suresh B, Ramanjaneya Raju P, Vora SK. An unusual complex odontoma. J

Maxillofac Oral Surg. 2010;9:314–317.

15. . Lopez-Areal L, Silvestre Donat F, Gil Lozano J. Compound odontomas erupting in the mouth: 4-year

follow-up of a clinical case. J Oral Pathol Med 1992;21:285

16. Areal-Lopez L, Silvestre DF, Gil LJ. Compound odontoma erupting in the mouth: Four years follow-up

of a clinical case. J Oral Path 1992;21:285-88

17. John J B, John R R, Punithavathy I, Elango ICompound Odontoma Associated with Maxillary Primary

Tooth –A Case Report. Journal of Indian academy of dental specialists 2010;1:49-51

18. Kaugars GE, Miller ME, Abbey LM . Odontomas . Oral Surg Oral Med OralPathol 1989 ; 67 : 172 – 6

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Date of submission: 30 May 2013

Date of provisional acceptance: 11 June 2013

Date of Final acceptance: 28 June 2013

Date of Publication: 03 July 2013

Source of support: Nil; Conflict of Interest: Nil