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Table of Contents
CASE REPORT
Year : 2019  |  Volume : 7  |  Issue : 3  |  Page : 77-80

Erupted compound odontoma: A rare case report and review


1 Department of Oral Medicine and Radiology, Vokkaligara Sangha Dental College and Hospital, Bengaluru, Karnataka, India
2 Department of Pedodontics, Vokkaligara Sangha Dental College and Hospital, Bengaluru, Karnataka, India
3 Department of Orthodontics, Vokkaligara Sangha Dental College and Hospital, Bengaluru, Karnataka, India

Date of Submission15-Oct-2019
Date of Acceptance16-Oct-2019
Date of Web Publication19-Nov-2019

Correspondence Address:
Dr. Dilip Kumar Kasavanhalli Honnegowda
Department of Oral Medicine and Radiology, Vokkaligara Sangha Dental College and Hospital, Bengaluru, Karnataka.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/INJO.INJO_34_19

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  Abstract 

Odontomas are benign tumors containing various component tissues of the teeth. They usually remain asymptomatic and are diagnosed on routine radiographs. Clinically, they are often associated with delayed eruption or impaction of permanent teeth and retained primary teeth. A case of erupted compound odontoma in association with an impacted maxillary permanent right canine in a 32-year-old female patient was reported. Erupted odontoma is a rare entity to occur, making it an interesting case for reporting.

Keywords: Complex odontoma, compound odontoma, erupted compound odontoma, erupted odontoma, hamartoma, odontoma


How to cite this article:
Kasavanhalli Honnegowda DK, Lakavanahalli Ranganna V, Yadnalli Chandregowda K, Krishna G, Kumar N. Erupted compound odontoma: A rare case report and review. Int J Oral Care Res 2019;7:77-80

How to cite this URL:
Kasavanhalli Honnegowda DK, Lakavanahalli Ranganna V, Yadnalli Chandregowda K, Krishna G, Kumar N. Erupted compound odontoma: A rare case report and review. Int J Oral Care Res [serial online] 2019 [cited 2019 Dec 12];7:77-80. Available from: http://www.ijocr.org/text.asp?2019/7/3/77/271308




  Introduction Top


Odontomas are mixed odontogenic tumors where both the epithelial and mesenchymal components undergo functional differentiation and form enamel and dentin.[1] They are considered as a hamartomatous lesions rather than true neoplasms.[2] The first person to use the term “odontoma” was Paul Broca in 1867, and he defined the term odontoma as “tumors formed by the overgrowth of transitory or complete dental tissues.”[3] In 2005, World Health Organization classified odontomas into the following two types, which are commonly used till today[4]:

  1. Complex odontoma: A malformation in which all the dental tissues are well formed but occurring in a less orderly pattern due to which the lesion will not appear like tooth.


  2. Compound odontoma: A malformation in which all the dental tissues are arranged in a more orderly pattern than in the complex odontoma, such that the lesion consists of many toothlike structures.


On the basis of the position, whether present in bone or in soft tissue, they are classified into the following two types:[3]

  1. The intraosseous odontomas occur inside the bone and may erupt into the oral cavity (erupted odontoma).


  2. The extraosseous or peripheral odontomas are odontomas occurring in the soft tissue covering the tooth-bearing portions of the jaws, having a tendency to exfoliate and are very rare.


Odontomas can also be subclassified based on the radiographic appearance alone into the following two types:[5]

  1. Compound odontomas appear as a collection of small teeth leaving few entities in the radiographic differential diagnosis except, perhaps, a supernumerary tooth.


  2. Complex odontomas appear as a radiodense mass of hard tissues, which may result in a broader differential diagnosis.


Erupted compound odontome is a rare occurrence. Compound odontomas are more commonly found in the anterior maxilla, whereas complex odontomas are more common in the mandible. Odontomas are generally small; however, they may occasionally grow large, resulting in bone expansion.[3]


  Case Report Top


A 32-year-old female patient presented with the chief complaint of pain in the right upper back tooth since 4–5 days. Pain was insidious in onset, intermittent, mild to moderate, localized, aggravated while having food, and relieved after some time. No history of swelling or of medications was reported. On examination, she was moderately built and moderately nourished. During lymph node examination, the right submandibular lymph node was found to be palpable, measuring around 0.5 × 1cm in diameter, soft in consistency, and not fixed. On intraoral examination, a swelling was observed in the upper right labial mucosa between 12 and 14, measuring around 1 × 1.2cm in diameter with diffuse borders. No surface changes were evident, on palpation inspectory findings are confirmed, non-tender, firm in consistency with poorly defined borders. Lower anterior gingiva was inflamed with bleeding on probing. On hard tissue examination, teeth present were 11, 12, 14, 15, 16, 17, 21, 22, 23, 24, 25, 27, 28, 31, 32, 33, 34, 35, 36, 37, 38, 41, 42, 43, 44, 45, 47, and 48, and carious teeth were 36, 38, 45, 47, 48, 11, and 21. Grossly decayed teeth in relation to (i.r.t) 15, root stumps i.r.t 26, supernumerary teeth between 45 and 46, and cusp tip was observed between 11 and 12 on the palatal aspect. Small tooth cusp-like structure was observed between 12 and 14 at the place of canine region [Figure 1]. As per the chief complaint and clinical examination, a provisional diagnosis of chronic irreversible pulpitis i.r.t 15 was made. intra oral periapical radiograph showed multiple impacted toothlike radiopaque structures between 12 and 14 along with impacted canine [Figure 2]. Ortho pantamograph revealed an irregular multiple small teethlike radiopacities in the alveolar bone between 12 and 14. Impacted supplementary teeth were observed between 33, 34 and 43, 44 [Figure 3]. Considering both clinical and radiographic examination, the radiopacities presented in the upper right anterior teeth region were diagnosed as erupted compound odontoma. After educating the patient about the condition, the lesion was surgically excised [Figure 4] and [Figure 5].
Figure 1: Intraoral picture showing erupted odontoma

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Figure 2: IOPAR showing multiple toothlike structures

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Figure 3: OPG showing multiple toothlike structures with impacted canine

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Figure 4: Surgical removal of odontome

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Figure 5: Enucleated specimen

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  Discussion Top


The odontomas are benign tumors containing all the various component tissues of the teeth. They are the most common odontogenic tumors constituting 22% of all odontogenic tumors of the jaws. Odontomas can occur in any age-groups but are most commonly reported in the second decade of life.

The percentages of occurrence of combined odontomas are around 67% and 33% in maxilla and in mandible, respectively. In the aforementioned case, erupted compound odontoma was observed in the anterior maxilla at the canine region.[5]

The compound odontomas have a predilection toward anterior maxilla (61%), whereas complex odontomas have a predilection for the posterior jaws (59%), most commonly mandible.[5]

Interestingly, both types of odontomas occur more frequently on the right side of the jaw than those on the left, compound odontoma (approximately 62%) and complex odontoma (around 68%) are reported on the right side. In our case also, it was present on the right side.[5]

The review of literature till 2011 revealed that only 21 cases of erupted odontomas have been reported, among which 10 cases were compound odontomas and 11 cases corresponded to complex odontomas.[6] The case discussed here is of 22nd erupted odontoma, and this becomes the 11th case of erupted compound odontoma to be reported in the English literature.

Etiology

The etiology of the odontomas is unknown. However, it has been suggested that trauma and infection at the place of the lesion can offer ideal conditions for its appearance.[7] Another cause may be due to extraneous odontogenic epithelial cells. When these extraneous odontogenic epithelial cells divide into several particles, they may develop individually to become numerous, closely positioned malformed teeth or toothlike structure. When the buds develop without such uncommon division and consists of haphazard conglomerates of dental tissues, they may develop into complex odontome.[3],[4]

Genes associated with odontomas are amelogenins, keratins, collagens type III and IV, vimentin, fibronectin, osteonectin, and osteocalcin. On the basis of the research conducted by Ji-Youn et al.,[8]LHX8 gene expression in alveolar bone might play an important role in odontoma formation.

As odontomas are observed in hereditary anomalies such as Gardner syndrome and Hermann syndrome, alteration of the genetic components might be responsible for odontoma formation. Hitchin suggested that the odontomas are inherited through a mutant gene or interference, possibly postnatal, with genetic control of tooth development.[9]

Clinical features

Erupted odontomas are commonly asymptomatic and are rarely diagnosed at early age groups. They frequently lead to impaction or delayed eruption of permanent teeth. In general, they are asymptomatic, have slow growth, and seldom exceed the size of a tooth, but when they are large, they can cause expansion of the cortical bone, and their eruption into the mouth may give rise to pain, inflammation, and infection, or sometimes, they remain asymptomatic. In some cases, facial asymmetry, halitosis, malocclusions, and recurrent infections were also recorded.[1],[4] In this case, the patient was asymptomatic with missing canine in the right maxilla with cortical bone expansion on the buccal side.

Radiographic features

  • Periphery: The lesions may be well defined and may be smooth or irregular. These lesions have cortical borders, and immediately inside and adjacent to cortical border is a soft tissue capsule.


  • Internal structure: Contents of lesions are largely radiopaque. Compound odontomas have a number of teethlike structures or denticles that look like a calcified tissue.


  • Effects on surrounding structures: The lesions interfere with the normal eruption of teeth. Most odontomas (70%) are associated with abnormalities such as malpositioning, diastema, aplasia, malformation, and devitalization of adjacent teeth. Large complex odontomes may cause expansion of the jaw with the maintenance of cortical boundary.[4],[10]


  • Syndromes associated with odontomas are Gardner syndrome, basal cell nevus syndrome, familial colonic adenomatosis, Tangier disease, and Hermann syndrome.

    Treatment

    Treatment for an odontoma is complete removal with any associated soft tissues. Recurrences do not occur. Orthodontic treatment may be indicated to correct any malocclusion.[1],[11]


      Conclusion Top


    Dental literature supports that an individualized radiographic examination of any patient that presents clinical evidence of delayed permanent tooth eruption or temporary tooth displacement with or without a history of previous dental trauma should be performed. Early diagnosis of odontomas allows adaptation of a less complex and less expensive treatment and ensures better prognosis. Odontomas rarely erupt into the mouth and tend to be associated to impacted teeth. Despite their benign nature, their eruption into the oral cavity can give rise to pain, inflammation, and infection. The treatment of choice is surgical removal of the odontoma. In the case of odontomas associated to impacted teeth, the tooth should be preserved in wait for spontaneous eruption, or alternatively, fenestration followed by orthodontic traction should be considered.

    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.
    Prabhakar C, Haldavnekar S, Hegde S. Compound-complex odontoma—An important clinical entity. J Int Oral Health 2012;4:49.  Back to cited text no. 1
        
    2.
    Iwamoto O, Harada H, Kusukawa J, Kameyama T. Multiple odontomas of the mandible: A case report. J Oral Maxillofac Surg 1999;57:338-41.  Back to cited text no. 2
        
    3.
    Shekar S, Rao RS, Gunasheela B, Supriya N. Erupted compound odontome. J Oral Maxillofac Pathol 2009;13:47-50.  Back to cited text no. 3
    [PUBMED]  [Full text]  
    4.
    Serra-Serra G, Berini-Aytés L, Gay-Escoda C. Erupted odontomas: A report of three cases and review of the literature. Med Oral Patol Oral Cir Bucal 2009;14:E299-303.  Back to cited text no. 4
        
    5.
    Zoremchhingi, Joseph T, Varma B, Mungara J. A compound composite odontoma associated with unerupted permanent incisor: A case report. J Indian Soc Pedod Prev Dent 2004;22:114-7.  Back to cited text no. 5
        
    6.
    Avinash Tejasvi ML, Balaji BB. Erupted compound odontomas: A case report. J Dent Res Dent Clin Dent Prospects 2011; 5:33-6.  Back to cited text no. 6
        
    7.
    Amailuk P, Grubor D. Erupted compound odontoma: Case report of a 15-year-old Sudanese boy with a history of traditional dental mutilation. Br Dent J 2008;204:11-4.  Back to cited text no. 7
        
    8.
    Kim JY, Jeon SH, Pak JY, Suh JD, Choung PH. Comparative study of LHX8 expression between odontoma and dental tissue-derived stem cells. J Oral Pathol Med 2011;40:250-6.  Back to cited text no. 8
        
    9.
    Hitchin AD.The aetiology of the calcified composite odontomes. Br Dent J 1971;10:475-82.  Back to cited text no. 9
        
    10.
    Amado CS, Gargallo AJ, Berini AL, Gay EC. Review of 61 cases of odontoma: Presentation of an erupted complex odontoma. Med Oral 2003;8:366-73.  Back to cited text no. 10
        
    11.
    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. 11
        


        Figures

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



     

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