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 Table of Contents  
CASE REPORT
Year : 2021  |  Volume : 11  |  Issue : 2  |  Page : 114-117

Management of complex odontome in the mandibular premolar region


Department of Pedodontics and Preventive Dentistry, Dr. R. Ahmed Dental College and Hospital, Kolkata, West Bengal, India

Date of Submission19-May-2021
Date of Acceptance21-May-2021
Date of Web Publication11-Feb-2022

Correspondence Address:
Dr. Avik Narayan Chatterjee
114 A.J.C. Bose Road, Kolkata - 700 014, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijohs.ijohs_11_21

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  Abstract 


Odontomes are the most common odontogenic tumor of the jaws and generally asymptomatic. Odontomes are basically classified into two types, complex odontomes, and compound odontomes. Various theories or etiological factors are been quoted for the occurrence of odontomes. The sole management depends on the early diagnosis, histopathological examination, and excision of these tissues. This article aims to present a case report on complex odontome in the mandibular premolar region in a 13-year-old male child.

Keywords: Complex odontome, mandibular premolar region, management


How to cite this article:
Chatterjee AN, Gayen K, Biswas R, Sikdar R, Pal S, Sarkar S. Management of complex odontome in the mandibular premolar region. Int J Oral Health Sci 2021;11:114-7

How to cite this URL:
Chatterjee AN, Gayen K, Biswas R, Sikdar R, Pal S, Sarkar S. Management of complex odontome in the mandibular premolar region. Int J Oral Health Sci [serial online] 2021 [cited 2022 May 23];11:114-7. Available from: https://www.ijohsjournal.org/text.asp?2021/11/2/114/337493




  Introduction Top


In the field of medicine and dentistry, the term odontome refers to any tumor or tumor-like lesions such as neoplastic cysts arising from tooth forming tissues.[1] Odontomes are the most common benign odontogenic tumors of epithelial and mesenchymal origin and are hamartomas of aborted tooth formation which account for 22% of the odontogenic tumors.[2],[3] The growth of completely differentiated epithelial and mesenchymal cells that give rise to ameloblasts and odontoblasts results in the formation of these tumors. These cells result in the formation of variable amounts of enamel, dentin, and pulpal tissue of the odontoma.[4] Enamel and dentin are usually laid down in aberrant pattern since the organization of odontogenic cells fail to reach the normal state of morph differentiation.[5] Hence, is considered as developmental anomalies rather than true neoplasm. Odontomes majorly comprise enamel and dentin, but a variable amount of cementum and pulp tissue can also be found.[6] The classification approved at the Editorial and Consensus Conference held in Lyon, France (WHO/IRAC) in July 2003 has placed odontome under tumors of containing odontogenic epithelium with odontogenic ectomesenchyme with or without dental hard tissue formation.[7]

The term “odontoma” was first coined by Paul Broca in 1866, who defined the term as tumor formed by the overgrowth of complete dental tissue.[8] When the structure formed by deposition of odontogenic tissue resembles the anatomic structure of normal tooth, it is referred to as compound odontome, whereas in complex odontome there is a deposition of simple irregular mass occurring in irregular pattern. Compound odontome is more common than complex odontome.[9] The incidence of compound odontome varies between 9% and 37%, while that of complex odontome varies between 5% and 30%.[10] Compound odontomes are more prevalent in the anterior segment of the jaws (61%), whereas the posterior segment of the jaws shows more occurrence of complex odontomes (34%). Both types of odontomes occur more commonly on the right side than on the left, (compound 62%, comple × 68%).[5] Specifically, compound composite odontome is more prevalent in the incisor cuspid region of the upper jaw and the complex composite odontome is more common in premolar-molar segment of the mandible.[1] However, odontomes have been reported in rare occasions in other locations such as the maxillary sinus,[11] mandibular ramus,[12] subcondylar region,[13] mental foramen,[11] mid palate[14], and the middle ear.[15] Odontomes have been found to be more common in the permanent dentition than primary dentition[16] with more or less equivalent gender predilection.[17]

Odontomes have an unknown etiology, but some are of the opinion that it may be due to localized trauma or infection.[5] Odontomes generally are asymptomatic with a slow growth pattern and usually do not exceed the size of a tooth but may cause cortical expansion of the bone if it is large in size.[6]

This article presents a case report and management of complex odontome in a 12-year-old male child on the left side of the mandible.


  Case Report Top


A 13-year-old male child reported to the Department of Pediatric and Preventive Dentistry with the chief complaint of swelling on the left side of the mandible in the premolar region for the past 3 months [Figure 1]. As reported by the parents, the swelling did not increase in size but the discomfort of the patient had successively increased in due course of time.
Figure 1: Pre-operative photograph

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On intraoral examination, it was found that a swelling was present in the left side of the mandible with respect to an erupting second premolar. The region was palpated and the swelling was found to be firm and hard in nature. No teeth were carious, and the oral hygiene was good.

An intraoral periapical radiograph of the mandibular left second premolar region along with a mandibular occlusal radiograph was advised to the patient to facilitate diagnosis. The periapical radiograph showed a dense radiopaque mass present without complete root formation of the second premolar in the left side of the mandible and the occlusal radiograph showed expansion of the cortical bone buccally. A cone-beam computed tomography (CBCT) of the region was advised to further determine the extent of the lesion in the mesiodistal and buccolingual aspects. It showed similar findings and the CBCT showed that the radiopaque mass was present with respect to the incompletely formed root of the second premolar which was discrete and not fused with the mandible with proper margins [Figure 2]. A provisional diagnosis of complex odontome was considered, and the management included surgical resection of the mass.
Figure 2: Cone-beam computed tomography showing the lesion

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Blood reports which included complete blood count, prtothrombin time, activated partial thromboplastin time, international normalized ratio, blood glucose for fasting and postprandial and reverse transcription-polymerase chain reaction test for SARS CoV2 was advised. All the reports were conducive for performing the surgery.

An inferior alveolar nerve block was given on the left side, and a trapezoidal flap was raised extending from the first molar to the canine on the left side of the mandible. The calcified mass along with the incompletely formed second premolar was resected and the site was irrigated normal saline and betadine solution. Sutures were given in the area with 3-0 silk sutures and the resected sample was sent for histopathological examination [Figure 3].
Figure 3: Odontome visible after flap retraction and sutures given after odontome removal

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Histological examination showed mixture of dental tissues such as dentin and cementum-like areas arranged in a haphazard manner along with inclusions of pulp tissue was present. There were also irregularly arranged fibrocollagenous tissue, with the cellular fibrous matrix containing fibroblasts and portions of odontogenic epithelium. These features were suggestive of complex odontome [Figure 4].
Figure 4: The odontome and its associated histological examination

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  Discussion Top


Odontomes are composed of enamel, dentin, cementum, and other tooth forming tissues and are the most common benign odontogenic tumor.[18] Odontomes have an unknown etiology[5] but may be due to some pathological conditions such as localized trauma, inflammatory and infectious diseases, dental lamina remnants such as cell rests of Serres or hereditary anomalies such as Gardener's syndrome, Hermanns syndrome, odontoblastic hyperactivity, and alterations in the genetic component responsible for controlling dental development.[19] However, some authors such as Hitchin opined that odontomes may be inherited or due to a mutagene or interference, possibly postnatal, with the genetic control of tooth development.[20]

Odontomes are mostly detected during the first two decades of life which happens most commonly between 11 and 15 years of age, but they may be found at any point of time.[6] Odontomes are mostly associated with unerupted teeth leading to its impaction. The most frequently impacted teeth by odontomes are the canines, followed by upper central incisors and third molars.[5] Usually, these tumor remains inside the bone or are intraosseous, but occasionally they may erupt into the oral cavity.[12]

Radiographically complex odontomes present as irregular mass of calcified tissue surrounded by a thin radiolucent area with smooth periphery while the compound type presents as teeth-like calcified structures in the center of a well-defined radiolucent lesion. Histologically complex odontomes present as conglomerates without orientation of dentin, enamel, enamel matrix, cementum, and areas of the pulp tissue. The capsule of connective tissue surrounding an odontome bears resemblance with the follicle that covers a normal tooth.[5] Similar findings were found in this case also. The treatment of odontomes involves complete surgical removal of the lesion with the least chances of recurrence.[5]

The most common classification for odontome–complex and compound has been described earlier. The WHO classification of odontome is as follows:[21]

  1. Ameloblastic fibro-odontome: Consists of varying amounts of calcified dental tissue and dental papilla-like tissue, the latter component resembling fibroma. The ameloblastic fibro-odontome is considered as an immature precursor of complex odontome
  2. Odonto-ameloblastoma: Its a very rare neoplasm which resembles an ameloblastoma both structurally and clinically but contains enamel and dentine
  3. Complex odontome: When the calcified dental tissues are simply arranged in an irregular mass bearing no morphologic similarity to rudimentary teeth
  4. Compound odontome: Composed of all odontogenic tissues in an orderly pattern that results in many teeth-like structures but without morphologic resemblance to normal teeth.[21]


Depending on the site of occurrence the differential diagnosis for lesions such as odontomes include calcifying epithelial odontogenic tumors, adenomatoid odontogenic tumors, supernumerary teeth, or benign osteoblastoma.[22]

In the present case also the radiographic findings were similar to those found in case of complex odontome depending on which it was decided to undergo surgical removal of the lesion and histological examination confirmed the diagnosis.


  Conclusion Top


Although odontomes are frequently encountered complex odontomes are relatively rare. Timely excision of complex odontomes should be done; else it may lead to fracture of the expanded cortical bone.

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

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kharbanda OP, Saimbi CS, Kharbanda R. Odontome: A case report. J Indian Dent Assoc 1986;58:269-71.  Back to cited text no. 1
    
2.
Bhaskar SN. Odontogenic tumors of jaws. In: Synopsis of Oral Pathology. 7th ed. United States: Elsevier Mosby Year Book; 1986. p. 292-303.  Back to cited text no. 2
    
3.
Budnick SD. Compound and complex odontomas. Oral Surg Oral Med Oral Pathol 1976;42:501-6.  Back to cited text no. 3
    
4.
Bimstein E. Root dilaceration and stunting in two unerupted primary incisors. ASDC J Dent Child 1978;45:223-5.  Back to cited text no. 4
    
5.
Shafer WG, Hine MK, Levy BM. Cysts and tumours of odontogenic origin. In: Rajendran R, Sivapathasundharam B, editors. A Textbook of Oral Pathology. 6th ed. Delhi: Elsevier; 2009. p. 254-309.  Back to cited text no. 5
    
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Neville BW, Damm DD, Allen CM, Bouquot JE. Oral and Maxillofacial Pathology. Philadelphia, PA: Saunders; 1995. p. 531-3.  Back to cited text no. 6
    
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Imran A, Jayanthi P, Tanveer S, Gobu SC. Classification ofodontogenic cysts and tumors antecedents. J Oral Maxillofac Pathol 2016;20:26971.  Back to cited text no. 7
[PUBMED]  [Full text]  
8.
Broca P, Des Tumeurs TV, Asselin P. France; 1866.  Back to cited text no. 8
    
9.
Katz RW. An analysis of compound and complex odontomas. ASDC J Dent Child 1989;56:445-9.  Back to cited text no. 9
    
10.
Philipsen HP, Reichart PA, Praetorius F. Mixed odontogenic tumors and odontomas. Considerations on interrelationship. Review of literature and presentation of 134 new cases of odontomas. Oral Oncol 1997;33:86-7.  Back to cited text no. 10
    
11.
Clayman GL, Marentette LJ. Complex odontoma of the maxillarysinus with a complete dentition. Otolaryngol Head Neck Surg 1989;101:581-3.  Back to cited text no. 11
    
12.
Lopez-Areal L, Donat FS, Lozano JG. Compoundodontoma erupting in the mouth: 4-year follow-up of a clinical case. J Oral Pathol Med 1992;21:285-8.  Back to cited text no. 12
    
13.
Shteryer A, Taicher S, Marmary T. Odontoma in the subcondylar region. Br J Oral Surg 1979;17:161-5.  Back to cited text no. 13
    
14.
Hunsuck EE. A midpalatal compound odontoma in an infant. Oral Surg Oral Med Oral Pathol 1970;29:353-5.  Back to cited text no. 14
    
15.
Bellucci RJ, Zizmor J, Goodwin RE. Odontoma of the middle Ear: A case presentation. Arch Otolaryngol 1975;101:571-3.  Back to cited text no. 15
    
16.
Brunetto AR, Turley PK, Brunetto AP, Regattieri LR, Nicolau GV. Impaction of a primary maxillary canine by an odontoma: Surgical and orthodontic management. Pediatr Dent 1991;13:301-2.  Back to cited text no. 16
    
17.
Avsever H, Kurt H, Suer TB, Ozturk HP, Piskin B. The prevalence, anatomic locations and characteristics of the odontomas using panoramic radiographs. J Oral Maxillofac Radiol 2015;3:49-53.  Back to cited text no. 17
  [Full text]  
18.
Cuesta SA, Albiol JG, Aytés LB, Escoda CG. Review of 61 cases of odontoma. Presentation of an erupted complex odontoma. Med Oral 2003;8:366-73.  Back to cited text no. 18
    
19.
Shekar S, Roopa SR, Gunasheela B, Supriya N. Erupted compound odontome. J Oral Maxillofac Pathol 2009;13:47-50.  Back to cited text no. 19
[PUBMED]  [Full text]  
20.
Hitchin AD. The aetiology of the calcified composite odontomes. Br Dent J 1971;130:475-82.  Back to cited text no. 20
    
21.
Pindborg JJ, Kramer IR, Torloni H. Histological typing of odontogenic tumors, jaw cysts and allied lesions. In: International Histological Classification of Tumors. Geneva: World Health Organization; 1970. p. 29-30.  Back to cited text no. 21
    
22.
Idalgo-Sánchez O, Leco-Berrocal MI, Martínez-González JM. Metaanalysis of the epidemiology and clinical manifestations of odontomas. Med Oral Patol Oral Cir Bucal 2008;13:E730-4.  Back to cited text no. 22
    


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



 

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