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National Journal of Maxillofacial Surgery
 
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Table of Contents
CASE REPORT
Year : 2014  |  Volume : 5  |  Issue : 2  |  Page : 192-194  

An unusual case of compound odontome associated with maxillary impacted central incisor


1 Department of Pedodontics and Preventive Dentistry, Career Post Graduate Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh, India
2 Department of Conservative Dentistry and Endodontics, Saraswati Dental College and Hospital, Dr. Ram Manohar Lohia Avadh University, Lucknow, Uttar Pradesh, India
3 Department of Oral Pathology and Microbiology, King George's Dental College, King George's Medical University, Lucknow, Uttar Pradesh, India

Date of Web Publication10-Apr-2015

Correspondence Address:
Nadia Khan
Department of Pedodontics and Preventive Dentistry, Career Post Graduate Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-5950.154834

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   Abstract 

Odontomas are the most common type of odontogenic tumor occurring within the jaws and are frequently associated with the retained deciduous teeth interfering with the eruption of permanent teeth. Compound odontomas are usually diagnosed in the anterior portion of the jaws and resemble tooth-like structure. These are usually asymptomatic. Complex odontomas are normally diagnosed in the posterior part of the jaws and consist of a disorganized mass with no morphologic resemblance to a tooth. The present case report of a 16-year-old female is a typical case of compound odontoma in the maxillary anterior region associated with retained deciduous incisor, which also resulted in failure of eruption of the permanent maxillary right central incisor. An intraoral periapical radiograph revealed the presence of a radio-opaque tooth-like structure in the apical region of retained deciduous incisor and an impacted permanent right central incisor whose path of eruption was impeded by the structure. Treatment included the surgical removal of the lesion followed by orthodontic extrusion of the impacted incisor. Follow-up was done for one 1 year and no recurrence was seen.

Keywords: Complex odontoma, impacted teeth, odontoma, orthodontic extrusion


How to cite this article:
Khan N, Shrivastava N, Shrivastava TV, Samadi FM. An unusual case of compound odontome associated with maxillary impacted central incisor. Natl J Maxillofac Surg 2014;5:192-4

How to cite this URL:
Khan N, Shrivastava N, Shrivastava TV, Samadi FM. An unusual case of compound odontome associated with maxillary impacted central incisor. Natl J Maxillofac Surg [serial online] 2014 [cited 2021 May 9];5:192-4. Available from: https://www.njms.in/text.asp?2014/5/2/192/154834


   Introduction Top


Odontomas are defined as "a benign odontogenic tumor composed of odontogenic epithelium and odontogenic ectomesenchyme with dental hard tissue formation" by the World Health Organization. [1] They are lesions of children and young adults, and are diagnosed most frequently at 10-19 years of age. [2] Paul Broca was the first person to use the term "odontoma" in 1867. Odontomas have been classified into two main types - compound and complex. Compound odontomas are usually diagnosed in the anterior portion of the jaws and resemble tooth-like structure. These are usually asymptomatic. Local trauma and infections are the most common etiologic factors. Odontomas are usually discovered during routine radiography, but may cause difficulty in identification due to lack of calcification. [3] Odontomas are usually managed by conservative surgical excision. Prognosis after treatment is very favorable, with rare chances of recurrence. [4],[5]


   Case Report Top


A 16-year-old female patient reported with the chief complaint of apparent delay of the exfoliation of the upper right deciduous tooth. The clinical history did not reveal any systemic pathology associated with it. Intraoral examination revealed the presence of retained right maxillary deciduous central incisor (51), the absence of the corresponding tooth, i.e. right maxillary permanent central incisor (11), with the contralateral tooth already erupted. An intraoral periapical radiograph was obtained, which revealed the presence of a radio-opaque tooth-like structure in the apical region of 51 and an impacted permanent right maxillary central incisor whose path of eruption was impeded by the radio-opaque structure [Figure 1]a-c.
Figure 1: (a) Pre-operative frontal view. (b) Pre-operative intraoral view. (c) Pre-operative radiograph. (d) Flap raised during surgery and exposed odontome along with orthodontic brackets in place. (e) Excised specimen. (f) Surgical site after removal of odontome

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A complete blood investigation was carried out before performing the surgical procedure. Surgical excision of the odontoma was done under local anesthesia. A full-thickness mucoperiosteal flap from the right maxillary permanent canine to the left maxillary permanent canine was reflected [Figure 1]d. The layer of bone overlying the calcified mass was removed and the calcified tooth-like structure was excised [Figure 1]e and f without disturbing the underlying impacted right maxillary permanent central incisor and was sent for histopathologic examinations. In order to ensure that no denticles remained, a thorough curettage was performed in the area and radiographs were taken before the closure of the flap [Figure 2]a. After hemostasis was achieved, the area was irrigated with normal saline and the lingual button was bonded onto the labial surface of the impacted right maxillary permanent central incisor and ligature wire was tightly secured to it; the mucoperiosteal flap was then sutured back in the position. After flap closure, the ligature wire was tightly secured to the arch wire in order to apply traction forces [Figure 2]b and c. The healing was uneventful and the sutures were removed on the 7 th day after surgery. Follow-up examinations were done after 1 week, 3 months, and 6 months and, subsequently, ligature wire was tightened [Figure 2]e, f and [Figure 3]a, 3b. After 6 months, a minor surgery was attempted to reposition the flap apically to the right permanent central incisor [Figure 3]c and d.
Figure 2: (a) Post-operative radiograph. (b) Bonded lingual button with ligature wire. (c) Twisted ligature wire secured to archwire. (d) Histological section of specimen showing enamel, dentin and pulp. (e) One week follow-up photograph. (f) One week follow-up radiograph

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Figure 3: (a) Three months follow-up radiograph. (b) Six months follow-up radiograph. (c) Apically positioned flap raised at 6 months to maintain adequate width of the attached gingiva. (d) Right maxillary permanent central incisor in occlusion

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   Discussion Top


Odontomas are the most common odontogenic tumor of the jaws. They are usually diagnosed in the second decade of life with no gender predilection. They are frequently asymptomatic and are associated with retained deciduous teeth resulting in delayed eruption of permanent tooth. [6] Compound odontomas are more common than complex odontomas. [6] Compound odontomas most commonly appear in the anterior region of the jaws. [7] Odontomas may sometimes be associated with pain and swelling, suppuration, bony expansion, and displacement of teeth. In some cases, odontomas may lead to root resorption and paresthesia. The case described in the study was diagnosed provisionally as odontoma on the basis of clinical signs and radiographic findings. Radiological findings are variable and depend upon the amount of enamel and dentin present in the lesion; hence, the lesion which is radiolucent in early stages may become radiodense at later stages, making clinical judgement difficult. Differential diagnosis must be established with ameloblastic fibroma and ameloblastic fibroodontoma. [3] Odontoma can also manifest a part of some syndromes such as Gardner syndrome, Hermann syndrome and basal cell nevus syndrome. [2] Odontomas are easily enucleated, [8] so conservative surgical excision was planned. The tissue was sent for histopathologic analysis and was confirmed as compound odontoma [Figure 2]d. Histologically, odontoma comprised varying amounts of enamel, pulp tissue, enamel organ and cementum. Clinical diagnosis of compound odontomas is easy compared to that of complex odontomas. The rate of correct clinical diagnosis of odontomas has been reported to be 84%. [2] Recurrence rates of odontomas are very low. In the present case once the diagnosis of impaction was done, the treatment was immediately started in order to minimize the negative effect on the occlusion, such as the inclination of the adjacent teeth towards the edentulous space. Since the spontaneous eruption of permanent maxillary central incisor was not anticipated, orthodontic extrusion was done as described and attempted in previous studies. [9],[10] Surgical exposure of the crown of the retained tooth was done to receive a bonded orthodontic traction device. The advantage of this technique is that it makes it easy to visualize the movement of the retained tooth and facilitates the eruption. The patient was motivated and taught to maintain oral hygiene as the periodontal health of the tractioned teeth may have worsened in case of negligence.


   Conclusion Top


The early diagnosis and management of odontomas is important because these are a major category of odontogenic tumors occurring within the jaws. The present study demonstrated successful management of a typical case of compound odontoma, utilizing orthodontic maneuver, which resulted in esthetic rehabilitation of the patient. Routine radiographs are of utmost importance in cases of delayed eruption as early diagnosis may avoid some possible complications.

 
   References Top

1.
Praetorius F, Piatelli A. Odontoma. In: Barnes L, Eveson JW, Reichart P, Sidransky D, editors. WHO Classification of Tumours. Pathology and Genetics: Head and Neck Tumours. 5 th ed. Lyon: IARC Press; 2005. p. 310.  Back to cited text no. 1
    
2.
Soluk Tekkesin M, Pehlivan S, Olgac V, Aksakallý N, Alatli C. Clinical and histopathological investigation of odontomas: Review of the literature and presentation of 160 cases. J Oral Maxillofac Surg 2012;70:1358-61.  Back to cited text no. 2
    
3.
Shafer WG, Hine MK, Levy BM. Cysts and tumours of the jaws. In: Shafer WG, Hine MK, Levy BM, Tomich CE, editors. A Textbook of Oral Pathology. 4 th ed. Philadelphia: WB Saunders Company; 1997. p. 308-11.  Back to cited text no. 3
    
4.
White SC, Pharoah MJ. Benign tumours of the jaws. In: White SC, Pharoah MJ, editors. Oral Radiology: Principles and Interpretation. 5 th ed. Missouri: Mosby; 2004. p. 424-8.  Back to cited text no. 4
    
5.
Cawson RA, Odell EW. Odontogenic tumours and tumour like lesions of the jaws. In: Essentials of Oral Pathology and Oral Medicine. 6 th ed. Edinburgh: Churchill Livingstone; 1998. p. 117-31.  Back to cited text no. 5
    
6.
Hidalgo-Sánchez O, Leco-Berrocal MI, Martínez-González JM. Meta-analysis of the epidemiology and clinical manifestations of odontomas. Med Oral Patol Oral Cir Bucal 2008;13:E730-4.  Back to cited text no. 6
    
7.
de Oliveira BH, Campos V, Marçal S. Compound odontoma-Diagnosis and treatment: Three case reports. Pediatr Dent 2001;23:151-7.  Back to cited text no. 7
    
8.
Kaban LB, Troulis MJ. Dentoalveolar surgery. In: Kaban LB, Troulis MJ, editors. Pediatric Oral and Maxillofacial Surgery. Philadelphia: Saunders; 2004. p. 140.  Back to cited text no. 8
    
9.
Kamakura S, Matsui K, Katou F, Shirai N, Kochi S, Motegi K. Surgical and orthodontic management of compound odontoma without removal of the impacted permanent tooth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002;94:540-2.  Back to cited text no. 9
    
10.
Sreedharan S, Krishnan IS. Compound odontoma associated with impacted maxillary incisors. J Indian Soc Pedod Prev Dent 2012;30:275-8.  Back to cited text no. 10
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    Figures

  [Figure 1], [Figure 2], [Figure 3]


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