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National Journal of Maxillofacial Surgery
 
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CASE REPORT
Year : 2010  |  Volume : 1  |  Issue : 1  |  Page : 67-70 Table of Contents     

A rare case of odontome in a 65-year-old lady


Department of OMFS, Kothiwal Dental College and Research Centre, Moradabad, India

Date of Web Publication9-Sep-2010

Correspondence Address:
Gokkulakrishnan
Department of OMFS, Kothiwal Dental College and Research Centre, Moradabad
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-5950.69163

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   Abstract 

Odontomes are considered to be hamartomas rather than a true neoplasm. They are comparatively common odontogenic tumors, and may lead to interference with eruption of associated tooth. Compound odontomes are commonly seen in young adults, but if they occur in children they are usually associated with permanent dentition and prevent eruption of the associated tooth. We hereby report a case of large compound odontome in the mandibular body region of a 65-year-old woman. Because of difficulty in denture fabrication and associated pain on mastication, surgical removal of the lesion was done.

Keywords: Compound odontome, odontome, rare case


How to cite this article:
Gokkulakrishnan, Singh S, Singh M, Singh KT. A rare case of odontome in a 65-year-old lady. Natl J Maxillofac Surg 2010;1:67-70

How to cite this URL:
Gokkulakrishnan, Singh S, Singh M, Singh KT. A rare case of odontome in a 65-year-old lady. Natl J Maxillofac Surg [serial online] 2010 [cited 2020 Dec 6];1:67-70. Available from: https://www.njms.in/text.asp?2010/1/1/67/69163


   Introduction Top


The term odontome, in true sense, refers to any tumor of odontogenic origin. [1] It is a growth in which both epithelial and ectomesenchymal cells exhibit complete or incomplete differentiation of tooth formation. It may be soft, calcified or mixed tissues distributed in numerous combinations and different patterns. Odontomas are hamartomas composed of various dental tissues, i.e., enamel, dentin, cementum and sometimes pulp. They are slow-growing, benign tumors showing nonaggressive behavior. They can be classified as complex, when the calcified tissue presents as an irregular mass composed mainly of mature tubular dentin, and compound, if there is superficial anatomic similarity to even rudimentary teeth. [2] Complex odontomas are less common than the compound variety, the ratio being 1:2. [3] Eruption of an odontoma in the oral cavity is rare. We report a case of compound odontome, in which apparent eruption had occurred in the area of the right mandibular body region of an otherwise edentulous patient.


   Case Report Top


A 65-year-old female reported to our department with the chief complaint of pain in the right lower back teeth (premolar) region. She also complained of pain during mastication and experienced difficulty in denture fabrication, as there was a tooth like structure, which was preventing the fabrication of the denture by impingement and causing pain. On examination, a diffuse smooth swelling was found in the right mandibular body area with an impacted tooth like structure [Figure 1], which was tender on palpation. Expansion of both the buccal and lingual cortices was observed and the area was firm and nontender. The mouth opening was within normal limits. Orthopantomogram (OPG) revealed a radiopaque mass in the right mandibular premolar area measuring 10 Χ 15 mm with well-defined borders and a radiolucent lining in the body region of the mandible associated with an impacted tooth [Figure 2]. The lesion was provisionally diagnosed as an odontome. Surgery was planned under local anesthesia after routine hematological investigations. A crestal incision was given and mucoperiosteal flap was retracted [Figure 3], the lesion was exposed [Figure 4] and was taken out after sectioning [Figure 5]. Wound was closed with 3-0 silk after achieving hemostasis. The excised lesion was reassembled [Figure 6], which revealed a bony mass with a tooth like structure. A provisional diagnosis of compound odontome was made. Post operatively, antibiotic and analgesic were prescribed and the post operative period was uneventful. Histopathologic examination of the excised mass confirmed the diagnosis of compound composite odontome.
Figure 1: Pre operative picture; arrow points the lesion

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Figure 2: OPG revealing the lesion

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Figure 3: Intra operative picture revealing the tooth like structure

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Figure 4: Intra operative - entire lesion

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Figure 5: Excised lesion

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Figure 6: Excised lesion (reassembled)

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   Discussion Top


The term odontoma was coined by Paul Broca in 1867. He defined the term as tumors formed by the overgrowth of transitory of complete dental tissues. [4] The odontoma is the most common odontogenic tumor in maxilla, and investigators reported the incidence to be 22-67% of all odontogenic maxillary neoplasms. [5],[6]

Clinically, odontomas [7] are either complex or compound, which can be further classified as follows.

Intraosseous: These odontomas occur inside the boneand may erupt (erupted odontoma) into oral cavity. Till date, 12 cases of the erupted variety have been described in the literature.

Extraosseous or peripheral: These odontomas occur in the soft tissue in the tooth-bearing areas of the jaws. Our case was similar to the intraosseous type.

Most compound odontomes are found in the maxillary anterior area, whereas complex odontomas are commonly found in the posterior mandible. [1],[5],[6] An increased prevalence of these tumors is observed in children and adolescents, with little significance in relation to patient sex. However, in our case, the patient was a 65-year-old female who was otherwise edentulous. In most children, these tumors are associated with tooth eruption disturbances such as delayed eruption of the primary and permanent teeth or overretained primary teeth. [8]

These lesions are normally diagnosed by routine radiological investigations, by second and third decades of life.

Several hypotheses propose etiologic factors. Some odontomas are associated with a history of trauma during primary dentition, inflammatory and infectious processes, hereditary (Gardner's syndrome, Hermann's syndrome), odontoblastic hyperactivity and alterations of the genetic components responsible for controlling tooth development. [6],[9]

In general, radiological features show that odontomas manifest as a dense radiopaque lesion surrounded b a thin radiolucent halo corresponding to the connective capsule. [8] In our case, we found a radiopaque mass measuring approximately 1.5 cm Χ 1.5 cm, which was surrounded by a thin radiolucent halo.

The mechanism of odontome eruption appears to be different from tooth eruption because of the lack of the periodontal ligament in odontome. Therefore, the force required for the eruption of odontomas is not linked to the contractility of fibroblasts, as is the case for teeth. Although there is no root formation in odontome, its increasing size may lead to the sequestration of the overlying bone and, hence, leads to eruption. The increase in size of the odontoma over time produces a force sufficient to cause bone resorption. [10] Three developmental stages can be identified based on the radiological features and degree of calcification of the lesion at the time of diagnosis. The first stage is characterized by radio transparency due to the absence of dental tissue calcification.

The second or intermediate stage presents partial calcification, and the third or classically radiopaque stage exhibits significant calcification surrounded by a radiolucent halo. [11]

The treatment of choice is surgical excision followed by histopathologic study to confirm the diagnosis of odontoma. Histologically, the compound odontoma often is seen to have normal appearing enamel, dentin, cementum and pulp. [12],[13] Microscopic features show that the denticles of compound odontomas comprise a central core, similar to pulp tissue, surrounded by primary dentin and covered with partially demineralized enamel and primary cementum. [14],[15]

In our case, histopathologically we noticed the presence of uniformly arranged normal appearing enamel with underlying dentin and cementum covering the majority of the area. The enamel was brownish yellow in color with prominence of incremental lines of Retzius. Underneath the scalloped Dentino-enamel Junction (DEJ) was primary and secondary dentin with significant evidence of pulp space. The hard tissues were arranged in a uniform pattern depicting tooth like structures. Ideally, the recommended treatment is removal of the lesion in toto. However, in our case, as the patient was old and edentulous, considering the size of the lesion, we removed it by sectioning.


   Conclusion Top


Odontomas are benign tumors frequently seen in the oral cavity, are usually asymptomatic and are diagnosed as incidental findings on routine radiological studies. Odontomas usually cause delayed eruption. If no signs or symptoms appear, the lesions go undetected and can remain as such for many years without clinical manifestations. Ideally, the recommended treatment is removal of the lesion in toto; however, in our case, as the patient was old and edentulous, considering the size of the lesion, we removed it by sectioning.

 
   References Top

1.Neville BW, Damm DD, Allen CM, Bouquot JF. Odontogenic cysts and tumors. Oral and maxillofacial pathology. 2nd ed. Philadelphia (PA): WB Saunders; 2002. p. 631-2.  Back to cited text no. 1      
2.Mupparapu M, Singer SR, Rinaggio J. Complex odontoma of unusual size involving the maxillary sinus: Report of a case and review of CT and histopathologic features. Quintessence Int 2004;35:641-5.  Back to cited text no. 2  [PUBMED]    
3.Cohen DM, Bhattacharyya I. Ameloblastic fibroma, ameloblastic fibroodontoma, and odontoma. Oral Maxillofac Surg Clin North Am 2004;16:375-84.  Back to cited text no. 3  [PUBMED]    
4.Batra Puneet, Gupta Shweta, Rajan Kumar, Duggal Ritu, Hariparkash. Odontomes: Diagnosis and treatment: A case report. Journal of Pierre Fauchard Academy. 2003;19:73-6.   Back to cited text no. 4      
5.Owens BM, Schuman NJ, Mincer HH, Turner JE, Oliver FM. Dental odontomas: A retrospective study of 104 cases. J Clin Pediatr Dent 1997;21:261-4.  Back to cited text no. 5  [PUBMED]    
6.Miki Y, Oda Y, Iwaya N, Hirota M, Yamada N, Aisaki K, et al. Clinicopathological studies of odontoma in 47 patients. J Oral Sci 1999;41:173-6.  Back to cited text no. 6  [PUBMED]    
7.Junquera L, de Vincente JC, Roig P, Olay S, Rodriguez-Recio O. Intraosseous odontomas erupted into the oral cavity: An unusual pathology. Med Oral Patol Oral Cir Bucal 2005;10:248-51.  Back to cited text no. 7      
8.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.  Back to cited text no. 8  [PUBMED]  [FULLTEXT]  
9.Kaugars GE, Miller ME, Abbey LM. Odontomas. Oral Surg Oral Med Oral Pathol 1989;67:172-6.   Back to cited text no. 9  [PUBMED]    
10.Vengal M, Arora H, Ghosh S, Pai KM. Large erupting complex odontoma: A case report. J Can Dent Assoc 2007;73:169-73.  Back to cited text no. 10  [PUBMED]  [FULLTEXT]  
11.Giunta JL, Kaplan MA. Peripheral, soft tissue odontomas. Two case reports. Oral Surg Oral Med Oral Pathol 1990;69:406-11.  Back to cited text no. 11  [PUBMED]    
12.Regezi JA, Scuibba JJ. Oral pathology- Clinical pathologic correlation. 3 rd ed. Philadelphia: WB Saunders Co.; 1999. p. 350-1.  Back to cited text no. 12      
13.Haring JI. Case #7. Compound odontoma. RDH 1990;10:10, 12.  Back to cited text no. 13  [PUBMED]    
14.Piattelli A, Trisi P. Morphodifferentiation and histodifferentiation of the dental hard tissues in compound odontoma: A study of undemineralized material. J Oral Pathol Med 1992;21:340-2.  Back to cited text no. 14  [PUBMED]    
15.Sapp JP, Gardner DG. An ultrastructural study of the calcifications in calcifying odontogenic cysts and odontomas. Oral Surg Oral Med Oral Pathol 1977;44:754-66.  Back to cited text no. 15  [PUBMED]    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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