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Odontoma-Associated Tooth Impaction: Accurate Diagnosis With Simple Methods? Case Report and Literature Review
Abstract and Figures
Odontomas account for the largest fraction of odontogenic tumors and are frequent causes of tooth impaction. A case of a 13-year-old female patient with an odontoma-associated impaction of a mandibular molar is presented with a review of the literature. Preoperative planning involved simple and convenient methods such as clinical examination and panoramic radiography, which led to a diagnosis of complex odontoma and warranted surgical removal. The clinical diagnosis was confirmed histologically. Multidisciplinary consultation may enable the clinician to find the accurate diagnosis and appropriate therapy based on the clinical and radiographic appearance. Modern radiologic methods such as cone-beam computed tomography or computed tomography should be applied only for special cases, to decrease radiation.
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... Ectodermal and mesenchymal cells are seen at various stages of differentiation which separates a compound odontoma with complex odontoma based upon the histologic development of their contents [4]. enucleation and curettage is the main line of treatment for a complex odontoma associated with an impacted tooth which involves careful evaluation of the adjacent vital structures both clinically and radiographically. ...
Odontomas are the most common type of odontogenic tumor composed of dental tissues such as enamel, dentin, pulp and sometimes cementum. They are benign, slow growing, asymptomatic and may be diagnosed during routine clinical intraoral examination or on radiographic examination. They may sometimes interfere with the eruption of an associated tooth or may erupt in the oral cavity causing malposition of the tooth. Present case report is a case of complex odontoma in the posterior region of the mandible erupted in the place of 2 nd molar.
... 16 Compound and complex odontomas are two different types of odontomas that can be distinguished by the level of their histologic development, and, consequently, the level of development of their mineralized content. 59 Compound odontoma is represented by numerous tooth-like structures that are detected in the tooth-bearing areas of the jaws, mainly in the anterior maxilla. Complex odontoma is characterized as an amorphous calcification with dysplastic dentin covered by enamel, occurring in tooth-bearing areas, frequently in the posterior mandible. ...
Great attention has been given to the study of radiolucent periapical lesions to avert possible misdiagnosis of apical periodontitis associated with certain radiolucent non-endodontic lesions. However, there are a significant number of radiopaque lesions found in the periapical region, which could be equally relevant to endodontic practice. The diagnosis and management of these radiopaque/hyperdense lesions could be challenging to the endodontist. These bone alterations could be neoplastic, dysplastic or of metabolic origin. In the context of the more widespread use of cone-beam CT, a detailed review of radiopaque inflammatory and non-inflammatory lesions is timely and may aid clinicians perform a differential diagnosis of these lesions. Distinguishing between inflammatory and non-inflammatory lesions simplifies diagnosis and consequently aids in choosing the correct therapeutic regimen. This review discusses the literature regarding the clinical, radiographic, histological and management aspects of radiopaque/hyperdense lesions, and illustrates the differential diagnoses of these lesions.
... Multidisciplinary consultation may enable the clinician to find the accurate diagnosis and appropriate therapy based on the clinical and radiographic appearance. Modern radiologic methods such as cone-beam computed tomography or computed tomography should be applied only for special cases, to decrease radiation.136 ...
Endodontic practice may be affected by periapical radiopaque/ hyperdense lesions. Oral medicine specialists and endodontists may have trouble diagnosing and treating radiopaque lesions. Inflammatory, non-inflammatory, neoplastic, dysplastic, metastatic or metabolic bone changes may occur. With the increased use of cone-beam CT, a detailed review of radiopaque lesions may help clinicians differentiate these lesions. Differentiating inflammatory, non-inflammatory and neoplastic disorders simplifies diagnosis and helps choose the best treatment. Aim: The aim of this review was to investigate the periapical radiopaque/hyperdense lesions. An extensive review of the literature was carried through. The literature search was conducted using MEDLINE (National Library of Medicine)-PubMed, Web of Science and Google scholar without restrictions concerning the date of publication. The inclusion criterion was that the article should be written in English, whereas the exclusion criterion was the opposite. This literature review covers radiopaque/hyperdense lesion differential diagnoses, clinical, radiographic, histological, and management issues. The effectiveness of root canal therapy is measured by the absence of pain, the absence or reduction of periapical lesions, and the restoration of tooth function. In endodontic practice, the diagnosis of periapical lesions is difficult because many of these lesions can mimic endodontic lesions, even when derived from different sources. For the diagnosis of periapical lesions in this scenario, a comprehensive clinical examination, in conjunction with clinical and radiographic aspects of the disease, is essential. The oral medicine specialist and endodontist must know how to diagnose radiopaque periapical lesions. Knowing how to differentiate between inflammatory, non-inflammatory, neoplastic and metabolic lesions expedites diagnosis and ensures the selection of the appropriate treatment.
Odontomas are the odontogenic tumour which are benign whose origin is from epithelial and mesenchymal cells. These have a high incidence rate and are widely acknowledged as hamartomas. Odontomas are mainly made up of enamel and dentin, with differing amounts of cementum and pulp. The aetiology is not known yet, the hypothesized causes are: local trauma, infection, inheritance and genetic mutation. Most of these lesions are not symptomatic and are frequently diagnosed on routine radiographs. They are divided histologically into complex and compound odontomas.
These are generally diagnosed in the posterior region of the mandible and resemble haphazardly arranged tooth‑like structure. Here, we report the case of a patient who is 21 years of age with a complex odontoma-related impaction of permanent maxillary right central incisor which was managed by surgical excision through palatal approach.
À la convergence de l’odontologie pédiatrique, de l’orthodontie et de la chirurgie orale la prise en charge des dents incluses est multidisciplinaire et nécessitera fréquemment le recours à un examen CBCT afin d’évaluer les options thérapeutiques (désinclusion chirurgico-orthodontique, avulsion, réimplantation, abstention), les atteintes des dents adjacentes, les voies d’abord chirurgicales et risques anatomiques associés dès lors que les limites des examens 2D sont atteintes.
Par une large iconographie clinique nous aborderons les différentes étiologies des inclusions ainsi qu’une méthodologie simple d’analyse des volumes CBCT permettant au clinicien d’exploiter pleinement tous les éléments pouvant être mis en évidence sur ce type d’examen.
Introduction
Odontoma is the most commonly diagnosed odontogenic tumor of the oral cavity. The objective of the present study was to assess the demographic variables, patterns, diagnostic features, and management issues of odontomas treated at several European departments of maxillofacial and oral surgery.
Materials and methods
This study was conducted at 8 European departments of oral surgery between January 1, 2004, and December 31, 2018. Only patients with odontomas were included. The following data were recorded for each patient: gender, age, comorbidities, site, size of odontomas, radiographic features, type of odontoma, treatment of odontomas, treatment of associated teeth, complications, and recurrence.
Results
A total of 127 patients (70 male and 57 female patients) with odontomas were included. The mean age was 22 years; 71 odontomas were found in the mandible, whereas 56 in the maxilla.
In the mandible, the most frequently involved subsite was the parasymphysis, while in the maxilla, the most common subsite was the upper incisor region. The mean size of included odontomas was 15.3 mm. On the whole, 62 complex odontomas, 50 compound odontomas, and 15 mixed-type odontomas were observed. Complete excision of the odontomas was performed in 121 patients. In 24 patients, the extraction of deciduous teeth was performed, and in 43 patients, one or more permanent teeth were removed. Finally, in 9 patients, a partial excision of the odontoma was performed. Recurrence was observed in 4 cases out of 127 patients.
Conclusions
Dental practitioners should be aware of the distinct clinical and radiographic features of odontoma in order to perform an appropriate and early diagnosis. Conventional radiography, such as panoramic radiograph, is often sufficient technique for a diagnosis after clinical suspicion or for an incidental diagnosis to prevent later complications, such as impaction or failure of eruption of teeth.
Odontomas are benign odontogenic tumors formed from epithelial and mesenchymal cells. They are mostly associated with disorders of tooth eruption, causing impaction and/or delayed tooth eruption, and are an accidental finding on routine radiological examination. The aim of this paper is to present current findings in the etiology and treatment of odontomas, as well as the clinical and radiographic features, describing a case that is rarely found in the literature. A case of multiple complex odontoma in the mandible of an 11-year-old boy is presented, causing impaction of the first permanent right molar, 46. The treatment consisted of surgical enucleation of the multiple complex odontoma with preservation of the impacted tooth, monitoring clinically and radiologically its spontaneous eruption followed by final orthodontic alignment. Odontomas are not an everyday part of clinical practice and given that they are most commonly associated with permanent tooth impaction, it is extremely important to have knowledge of their clinical and radiological features. Early diagnostics and appropriate treatment result in better diagnosis, thus increasing the possibility of preserving the impacted teeth.
Background:
Odontomas are the most frequent odontogenic tumors in the oral cavity and can result in failure of eruption of permanent teeth or be associated with impacted teeth.
Material and methods:
The present study evaluated the prevalence of complex and compound odontomas in non-syndromic patients prior to the onset of orthodontic treatment. Panoramic radiographs of 4,267 non-syndromic patients were evaluated; 22 cases were included being 54.5% complex and 45.4% compound odontomas.
Results:
The sample was composed predominantly by White males with mean age of 14.5 years. Complex odontomas were commonly found in the maxilla (83.3%) while compound type was mostly located on mandible (60%), presenting a significant association (P=0.027). Moreover, odontomas were significantly associated with impacted teeth (P<0.0001). The most frequently odontoma-associated impacted teeth were lower canines, followed by upper central incisors and upper canines, while impacted teeth with no odontoma were predominantly upper canines, lower second premolars and upper second premolars. Compound and complex odontomas showed mean size of 10.5 and 7.25 mm, respectively, presenting significant association between lesion size and odontoma type (P=0.021).
Conclusions:
Odontomas affected mainly White male patients with mean age of 14.5 years, being the complex type commonly found in the maxilla and the compound type mostly located on mandible. Furthermore, odontomas were significantly associated with impacted teeth, affecting mainly lower canines. Early diagnosis and correct treatment are essential to avoid any complications, such as prolonged retention of primary teeth and delayed eruption of permanent teeth. Key words:Odontoma, odontogenic tumors, dental anomalies.
Odontomas represent the most common type of odontogenic jaw tumors among patients younger than 20 years of age. Clinically, they are often associated with eruption failure of adjacent permanent teeth, and are classified as compound and complex. The aim of the present retrospective study was to present the characteristics, treatment approach and outcome of odontomas in Greek children, over a ten-year period. Twenty six patients, 2 to 14 years of age (mean 9.3 years), with odontomas treated during the years 1999-2008 at the Department of Oral & Maxillofacial Surgery of a Children's Hospital, were included in the study. Data from patients' files were retrieved and they were recalled for review. Odontomas were equally distributed in the maxilla and mandible and 42.3% of them were located in the anterior maxilla. Of the odontomas, 80.7% were related to disturbances in tooth eruption. Bone expansion was observed in 65.3% of the cases. All odontomas were surgically removed, and related impacted permanent teeth were either left to erupt spontaneously, orthodontically guided into occlusion or were removed. Orthodontic intervention appeared to be necessary in older children, while in younger children spontaneous eruption was frequent. In the present study, odontomas were associated with unerupted or impacted teeth. Radiographic examination was essential to verify the presence of the tumor and early removal prevented tooth eruption failure and disturbances in a majority of the cases.
Gardner's syndrome (GS) is a hereditary autosomal dominant disease of the colon that presents with extra-colonic manifestations such as osteomas, skin lesions and dental abnormalities. Osteomas are commonly found in the skull, jaws and the paranasal sinuses. We present a family of four sisters affected with GS with a wide range of anomalies. The role of Cone beam computed tomography (CBCT) in the early detection and evaluation of osteomas and dental anomalies with precise assessment of their relationship to adjacent anatomic structures is described here in detail. The careful interpretation of CBCT may be of a great value in surgical and orthodontic treatment planning in the presence of jaw lesions. Management of dental problems in GS may be challenging due to the presence of odontomas and increased bone density. A multidisciplinary approach in the management of GS can achieve the best treatment results.
A case of compound composite odontome is reported. The classification and aetiology of odontomes is briefly discussed.
The borderline between hamartoma and neoplasia is indistinct, as demonstrated by the compound odontome, the complex odontome, the ameloblastic fibro-odontome, the ameloblastic fibroma and ameloblastic odontosarcoma. All can present with similar clinical findings and similar radiographic findings; thus histological examination of all specimens is recommended.
Diagnosis and treatment of a case of complex odontome of the mandible is presented, together with a discussion of the condition.
The purpose of the present study was to evaluate the clinical and histopathologic aspects of different types of odontomas.
One hundred sixty odontoma cases sent to the Institute of Oncology, Department of Tumor Pathology, Istanbul University from 1971 through 2010 were investigated. These tumors were compared by age of patient, gender of patient, localization, histopathologic type, clinical diagnosis, and clinical and microscopic features.
Odontomas were classified histopathologically as complex, compound, or mixed. Of all investigated cases, 99 were complex, 57 were compound, and 4 were mixed odontomas. The mean age at diagnosis was 27.9 years, and odontomas were diagnosed most frequently at 10 to 19 years of age.
From the perspective of community health, the presence of odontomas within the jaws is important because these constitute 21% to 67% of all odontogenic tumors. The present study showed 2 interesting findings that differed from previous studies. These are the lower incidence rate of odontomas within the category of odontogenic tumors and the higher incidence of complex odontomas over compound odontomas.
Odontomas are mixed odontogenic tumors of the jaws with both epithelial and mesenchymal origins. These tumors usually are small and at times are disregarded; however, there are times when dentists will need to remove such tumors (for example, when they are symptomatic, when they enlarge or impede tooth eruption, when orthodontic treatment is required, or when they are associated with teeth that require removal, such as impacted third molars). Although odontomas are not uncommon and are familiar to practitioners, postsurgical complications may result if dentists are not aware of the potential pitfalls associated with the surgical removal of large maxillary odontomas. This article reports a typical case of a complex odontoma and addresses points and pitfalls concerning surgery to remove maxillary complex odontomas.
The term "primary failure of eruption" (PFE) refers to the complete or partial failure of a primary non-ankylosed tooth to erupt due to a disturbance of the eruption mechanism. Up to now, the molecular basis for this failure was unknown.
Four families were studied in whom at least two members were affected by non-syndromic PFE as part of a clinical and molecular genetics study. Radiological diagnostics (OPTs) were carried out in all patients and their unaffected relatives (control group). The genetic analysis included a genomewide linkage analysis followed by direct DNA sequencing of positional candidate genes.
Starting from the index patients, we were able to reconstruct pedigrees over two and/or three generations in the families that indicated an autosomal-dominant mode of inheritance of non-syndromic PFE. Fifteen patients were diagnosed with PFE. Gender distribution was nearly equal (7 female, 8 male). Molecular genetic analysis of the PTHR1 gene revealed three distinct heterozygous mutations (c.1050-3C>G; c.543+1G>A; c.463G>T). Unaffected persons exhibited no mutations.
Knowledge of the genetic causes of non-syndromic PFE can now be used for the differential diagnosis of eruption failure. It permits affected family members to be identified early and may lead to new treatment possibilities in the long term. The genetically-verified diagnosis of "primary failure of eruption" can protect patients and orthodontists from years of futile treatment, because orthodontic treatment alone does not lead to success. Moreover, it has a negative influence on unaffected teeth and areas of the jaw.
As a group, odontomas are the most common odontogenic neoplasms. This case report illustrates the benefits of cone beam computed tomography, in terms of treatment planning and surgical technique, to localize a large maxillary odontoma and accurately establish its relationship with the maxillary sinus and molar.
Medical radiation from CT should be kept as low as reasonably achievable (ALARA), particularly in young patients.
To examine radiation dose from head CT in children in a trauma center (TC) and a regional children's hospital (RCH).
A random sample of 240 children (0-3, 4-9, 10-14 years of age) from the TC were compared with a similar cohort from the RCH. All children had undergone at least one head CT scan without contrast enhancement; data from PACS and Department of Radiology Information System were used to estimate normalized effective dose (ED). Lifetime attributable risk of cancer incidence was estimated using the Biologic Effects of Ionizing Radiation (BEIR) VII report.
The mean normalized ED was significantly higher in the youngest children at the TC (2.74 mSv in those aged 0-3 years vs. 2.23 mSv in those aged 10-14 years; P<0.001) and at the RCH (2.44 mSv in those aged 0-3 years vs. 1.71 mSv in those aged 10-14 years; P<0.001). Each decreasing year of age was independently associated with a 0.06 mSv higher mean normalized ED (P<0.001). After adjusting for the age difference between the institutions, the mean normalized ED was 0.44 mSv lower at the RCH than at the TC across all ages (95% CI 0.31-0.58, P<0.001). A higher lifetime attributable risk of cancer was associated with younger age.
The radiation dose from head CT in children as defined by the normalized ED was highest in the youngest children and varied significantly between institutions in this bi-institutional study.