|Year : 2021 | Volume
| Issue : 2 | Page : 138-140
A rare case of compound odontoma associated with unerupted mandibular primary canine
Tanzeem Ahmed, Nikhil Kaushal
Kaushal Dental Care Centre, New Delhi, India
|Date of Submission||19-Aug-2020|
|Date of Acceptance||24-Nov-2020|
|Date of Web Publication||22-Mar-2021|
P3D Hanuman Temple Complex Pocket 1, Trimulgherry, Secunderabad - 500 015, Telangana
Source of Support: None, Conflict of Interest: None
Odontomas are the most common odontogenic tumors. They are considered to be hamartomas rather than neoplasms and are composed of enamel, dentin, cementum, and pulp tissue. These lesions are considered benign; however, they often cause disturbances in eruption of the associated tooth. Early diagnosis and removal of an odontoma associated with a primary tooth are essential to prevent any further disturbance in the dental arch. Odontomas occur more frequently in the permanent dentition and are very rarely associated with the primary teeth. This report presents a rare case of compound odontoma associated with unerupted primary canine and its management. The adoption of a conservative surgical approach is advisable, in order to preserve the dental tissues and achieve optimal tissue healing.
Keywords: Compound odontome, conservative management, primary teeth
|How to cite this article:|
Ahmed T, Kaushal N. A rare case of compound odontoma associated with unerupted mandibular primary canine. Indian J Dent Sci 2021;13:138-40
|How to cite this URL:|
Ahmed T, Kaushal N. A rare case of compound odontoma associated with unerupted mandibular primary canine. Indian J Dent Sci [serial online] 2021 [cited 2021 Apr 17];13:138-40. Available from: http://www.ijds.in/text.asp?2021/13/2/138/311679
| Introduction|| |
Odontomas are benign odontogenic tumors of epithelial and mesenchymal origin. They are a hamartomatous malformation of functional ameloblasts and odontoblasts comprising enamel, dentin, cementum, and pulpal tissues in variable proportions and different degrees of development., The World Health Organization has classified odontomas as follows: (a) complex odontomas, in which the dental tissues are arranged in a disorderly pattern, and (b) compound odontomas, in which the dental tissues show anatomic similarity to normal teeth, but their size and conformation are altered, giving rise to multiple small tooth-like structures called denticles. The incidence of compound odontome ranges between 9% and 37% and the complex odontome between 5% and 30%. The etiology is unknown, however, it has been suggested that it may develop due to trauma, inflammation, infections, odontoblastic hyperactivity, alterations in the genetic component responsible for controlling dental development, or hereditary anomalies such as Gardner's syndrome and Hermann's syndrome. Odontomes are usually asymptomatic and are commonly diagnosed during routine radiographic examination. However, sometimes it may lead to unerupted/impacted teeth, delayed eruption, retained deciduous teeth, swelling, or infection., On a radiograph, compound odontoma appears as radiopaque malformed tooth-like structures within a radiolucent halo. A complex odontoma shows an irregularly shaped oval radiopacity with no similarity to dental structures surrounded by a well-defined thin radiolucent zone.
Odontomas occur more commonly in permanent dentition, and most of them are detected in the first two decades of life. Budnick reported a slight predilection for the occurrence in males (59%). Of all the odontomas combined, 67% occurred in the maxilla with a marked predisposition for the anterior maxillary region (61%). There are a very few reported cases of odontomas in association with primary teeth in the literature.,
| Case Report|| |
An 8-year-old boy reported to the dental clinic with the chief complaint of missing teeth in the lower right back tooth region since birth. During clinical examination, it was found that the patient had a missing mandibular right primary canine and lateral incisor. An intraoral swelling was observed in that region which was hard on palpation. Periapical radiograph of the region of missing tooth showed multiple radiopaque tooth-like structures associated with an unerupted primary canine. A panoramic radiograph and a cone-beam computed tomography (CBCT) were advised to find the extent of the lesion with respect to the adjacent structures. They confirmed the presence of a well-corticated lesion with a radiolucent border encapsulating tooth-like nodular masses. The lesion was causing deviation of the path of eruption of the mandibular right permanent canine [Figure 1]. A provisional diagnosis of compound odontome was made and surgical removal of the odontome was planned to prevent further complications in the eruption of the permanent canine.
|Figure 1: (a) Preoperative intraoral photograph, (b) Intraoral periapical showing impacted 83 along with multiple radiopaque structures, (c) Orthopantomogram, (d) Cone-beam computed tomography showing multiple tooth-like radiopaque structures and the extent of the lesion|
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Surgery was done under local anesthesia. Buccal mucoperiosteal flap was raised and bone over the odontome was removed with a bur under copious saline irrigation. Extraction of 84 was done to improve the accessibility to the lesion. Surgical excision of the odontoma was performed and 14 calcified small tooth-like structures were removed along with the unerupted primary canine [Figure 2]a, [Figure 2]b, [Figure 2]c. The excised specimen was sent for histopathological examination. Under high magnification, dentinal tubule-like appearance was observed in the decalcified hard tissue specimen and the central area showed predentin along with odontoblasts lining the inner surface. The histopathological features along with the clinical and radiographic findings confirmed the diagnosis of compound odontome. An immediate postoperative radiograph was taken to confirm the complete removal of the odontome [Figure 2]d. The surgical wound was closed with 3-0 black silk suture. The patient was recalled after 7 days for removal of suture. Postoperative healing was uneventful. A fixed lingual arch space maintainer was given for maintaining space for the eruption of the canine and the first premolar, and the patient was followed up every 3 months to assess the eruption of the permanent teeth. The 12-month recall revealed the mandibular right permanent canine and first premolar close to eruption [Figure 2]e, [Figure 2]f, [Figure 2]g.
|Figure 2: (a) Buccal mucoperiosteal flap raised, (b and c) Excision of the odontome along with 85 and impacted 83, (d) Immediate postoperative intraoral periapical, (e) 1-month follow-up photograph, (f) Cementation of lingual arch space maintainer, (g) 12-month follow-up intraoral periapical showing 43 and 44 close to eruption|
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| Discussion|| |
Odontoma was first described by Broca in 1866, and since then, they have been reported by several authors and identified as the most common odontogenic tumors. Buchner et al. reported the incidence of odontoma to be as high as 75.9% in all odontogenic tumors. In 2002, Ochsenius et al. analyzed a sample of 362 odontogenic tumors in which odontomas represented 44.7%. These tumors may cause the impaction of teeth and expansion of bony cortical plate, as was seen in this case. Early diagnosis plays an important role in preventing craniofacial and tooth developmental problems. Surgical removal has been suggested to be the best therapeutic option according to several authors since the odontoma may interfere with eruption of the permanent tooth, displace the adjacent teeth, or give rise to a dentigerous cyst. The prognosis after treatment is favorable, and recurrence is found to be rare.,
According to the literature, the optimal management of the impacted tooth should allow its conservation and spontaneous eruption into the oral cavity. However, impacted teeth are frequently reported to be extracted along with the odontoma. In the present case, the primary canine was surrounded by the odontome and was also causing deviation in the path of eruption of permanent canine. Therefore, the impacted primary canine was removed along with the compound odontoma in order to allow the normal eruption of the permanent tooth.
A careful evaluation with the panoramic radiograph and CBCT helps to localize the lesion accurately to have a conservative approach to the site of the odontome avoiding the removal of excessive bone and preventing tissue defects. A histological evaluation is necessary to confirm the diagnosis.
| Conclusion|| |
The presence of odontoma in association with the impacted primary teeth needs an early diagnosis and early treatment. A careful clinical and radiographic evaluation is essential to diagnose and treat each clinical case. The adoption of a conservative surgical approach is advisable, in order to preserve the dental tissues and achieve optimal tissue healing. A follow-up to evaluate the eruption of the succedaneous teeth is mandatory.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]