Complex Odontome A Case Report

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SRM University Journal of Dental Sciences
Volume 2, Issue 1, January - March 2011
Case Report
Complex odontome - A case report

Senthil Kumar K1, Rangeeth BN2, Priyaa Rangeeth3, Dinesh Kumar T4
1
Department of Oral and Maxillofacial Surgery

Department of Pedodontics and Preventive Dentistry,
3
Department of Prosthodontics, Thai Moogambigai Dental College, Mogappair, Chennai
4
Department of Oral & Maxillofacial Pathology, SRM Dental College, Ramapuram, Chennai
2
Address for correspondence

Dr. K Senthil Kumar
Department of Oral and Maxillofacial Surgery,
Thai Moogambigai Dental College,
Golden George Nagar,
Mogappair, Chennai
Tel No: +91-98846-34754
Email id: [email protected]
Abstract
Odontomas are hamartomatous growths of enamel, dentin,
cementum and pulp tissue. A case of a complex odontoma
associated with the permanent dentition is discussed. The
odontoma was present in relation to the roots of the second
premolar and the first molar. Even though asymptomatic
considering the literature reviewed we considered it best to
surgically remove the odontoma.
Keywords: C omplex odontoma, hamartomatous
malformation, radiopaque jaw lesion
Introduction
Odontogenic tumors (OT) are lesions that derive from the
tooth-producing tissues or their remnants that remain
entrapped either within the jawbones or into the adjacent soft
tissues1. The World Health Organization histological typing of
odontogenic tumors classifies odontoma under benign tumors
containing odontogenic epithelium with odontogenic
ectomesenchyme, with or without dental hard tissue
formation. Ameloblastic fibro-odontoma, compound and
complex odontoma are entities under this category2. In
general, radiological features show that odontomas manifest
as a dense radio-opaque lesion surrounded by a thin
radiolucent halo corresponding to the connective tissue
capsule 3, 4.
In the complex odontoma, radio-opacity is not specific rather;
a disorganized, irregular single or multiple mass was
identified. Microscopic features show 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 cement5,6. Tooth
impaction or malpositioning, malformation, reabsorption and
devitalization of the adjacent teeth have been associated with
70% of odontomas7. In contrast to compound odontoma most
of the complex odontomas are detected in the mandibular first
and second molar area8.
There are certain syndromes, such as Gardner syndrome and

some other in which odontomas, particularly when multiple,
may be one of the earlier manifestations of the genetic
disorders and their identification allow an early diagnosis and
may improve its prognosis favoring an early and proper
management of the more severe manifestations of such
syndromes9, 10.
Herein we present a case of multiple complex odontoma
occurring in the lingual aspect of the mandibular premolar in
a non-syndromic patient.
Case Report
A 16-year-old female patient reported to the outpatient unit
with the chief complaint of irregularly placed dentition. The
patient had undergone fixed orthodontic therapy a few years
early for which the first premolars were extracted in all
quadrants. We had suggested a panoramic view [Figure 1],
which revealed impacted mandibular right second molar and
radio-opacities in relation to roots of left mandibular second
premolar and mesial root of first permanent molar. The
patient was not aware of the presence of the lesion and was
asymptomatic.
Considering the history given by the patient and the
radiological findings a provisional diagnosis of odontoma
was given. The patient was suggested extraction of the
65
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Complex odontome- A case report
Senthil Kumar K et al
impacted permanent molar and removal of the jaw lesions.

Considering the complexity in removal of the lesions the
procedure was done under general anesthesia. The oral cavity
was mopped with betadine prior to procedure and first the
area of the odontoma [Figure 2] was isolated. Crevicular
incision was done lingually and a mucoperiosteal flap was
raised following which the bone around the area of lesion was
removed and the lesion was exposed [Figure 3].
The lesions were removed and the area curetted to ensure
there were no remnants of the lesions. Two lesions were
removed which were hard in consistency and colour like that
of natural teeth [Figure 4]. Histopathology of the lesions
[Figure 5] revealed pulpal tissue underlying predentin and
mature dentin, following which a definitive diagnosis of
Complex Odontoma was arrived at.
Figure 3: Complex odontoma exposed
Figure 4: Two excised specimens sent for histopathology

Figure 1: Panaromic radograph showing the complex
odontoma and impacted mandibular molar
Figure 2: Intra oral view of surgical site mopped with

betadine
66
Figure 5: Histopathology revealing pulpal tissue

underlying predentin and mature dentin
Streamdent, 2(1), 2011
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Complex odontome- A case report
Senthil Kumar K et al
Discussion
The term odontoma was coined by Paul Broca and defined it
as a tumor formed by overgrowth or transitory of complete
dental tissue11. Studies have found that males are more likely
to be diagnosed with odontomas than females. They are
mostly seen in the 11 to 20 age group, Caucasians
predominating and the maxilla being more frequently
affected. Most of the clinical diagnoses were correct and
majority were compound odontomas12.
4.
5.
6.
The odontoma composed of disorganized normal dental
tissues may contain stem cell populations with unique ability
to regenerate different tooth components. An odontoma that
contains multiple well-formed miniature teeth is referred to as
a compound odontoma while one with heterogeneous mixture
of irregular tooth-like structures such as enamel, dentin,
cementum, pulp tissue and odontogenic epithelium is referred
to as a complex odontoma13. Even though odontoma is
considered asymptomatic lesion those that erupt into the oral
cavity can give rise to moderately serious conditions
particularly in the presence of overinfection of the lesion14.
Pouyat et al proposed the hypothesis of a direct relationship
between the ameloblastic odontoma and the complex
odontoma, which represents the advanced stage of the first
tumour. Thus, the odontoma can be considered an evolutive
tumour. This hypothesis had been illustrated by a case report,
which was associated with confusion concerning the
histology15.
7.
8.
9.
10.
11.
The presence of the complex odontoma was possible by the
aid of panoramic radiograph, which we had advised with
respect to the chief complaint of irregularly placed teeth. The
planning for surgical removal was complicated by the
location of the odontoma on the lingual side of the premolar.
Considering the location and complexity of surgery, we had
advised the procedure under general anesthesia that included
removal of the impacted mandibular second molar in the right
side. The patient underwent an uneventful recovery and has
been suggested further orthodontic therapy.
References
1.
2.
3.
Broca P. Recherches sur un nuveau grupe des tumeurs

dsignes sous le nom d'odontomes. Gaz Hebd Sci
Med. 1868;5:70.
Kramer IRH, Pindborg JJ, Shear M. The WHO
Histological typing of odontogenic tumours. A
commentary on the second edition.
Cancer1992;70:2988-94.
Owens BM, Schuman NJ, Mincer HH, Turner JE,
Streamdent, 2(1), 2011
12.
13.
14.
15.
Oliver FM. Dental odontomas: a retrospective study of

104 cases. J Clin Pediatr Dent 1997; 21: 2614.
Miki Y, Oda Y, Iwaya N et al. Clinicopathological
studies of odontoma in 47 patients. J Oral Sci 1999; 41:
1736.
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;2: 3402.
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.
Sikes JW Jr, Ghali GE, Troulis MJ. Expansile
intraosseous lesion of the maxilla. J Oral Maxillofac
Surg 2000; 58: 1395-400.
Stuart C White, Michael J Paroah. Mixed Tumors (Of
O dontogenic Epithelium and O dontogenic
Ectomesenchyme). In: Stuart C White, Michael J
Paroah eds. Oral Radiology: Principles and
Interpretation. 5th Ed. St Louis, Missouri: Elsevier;
2006; 424-28.
Schmidseder R, Hausamen JE. Multiple odontogenic
tumors and other anomalies. An autosomal dominantly
inherited syndrome. Oral Surg Oral Med Oral Pathol.
1975 Feb;39:249-58.
Wijn MA, Keller JJ, Giardiello FM, Brand HS. Oral and
maxillofacial manifestations of familial adenomatous
polyposis. Oral Dis. 2007 Jul;13:360-5.
Broca P. Recherches sur un nuveau grupe des tumeurs
dsignes sous le nom d'odontomes. Gaz Hebd Sci Med.
1868;5:70.
Owens BM, Schuman NJ, Mincer HH, Turner JE, Oliver
FM. Dental odontomas: a retrospective study of 104
cases. J Clin Pediatr Dent. 1997 Spring;21:261-4.
Sapp JP, Eversole LR, Wysocki GP. Contemporary oral
and maxillofacial pathology. Mosby, St. Louis, Mo.
2004.
Gabriel Serra-Serra 1, Leonardo Berini-Ayts 2, Cosme
Gay-Escoda Erupted odontomas: A report of three cases
and review of the literature Med Oral Patol Oral Cir
Bucal. 2009 Jun 1;14:E299-303.
Pouyat X, Ballon G, Jobard P. Should an odontoma be
considered as a developing tumor? Rev Stomatol Chir
Maxillofac. 1985;86:224-8.
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[Downloadedfreefromhttp://www.srmjrds.inonMonday,November24,2014,IP:1.39.61.

SRM University Journal of Dental Sciences

Volume 2, Issue 1, January - March 2011

Complex odontome - A case report

Department of Oral and Maxillofacial Surgery

Address for correspondence

There are certain syndromes, such as Gardner syndrome and

Complex odontome- A case report

impacted permanent molar and removal of the jaw lesions.

Figure 3: Complex odontoma exposed

Figure 4: Two excised specimens sent for histopathology

Figure 2: Intra oral view of surgical site mopped with

Figure 5: Histopathology revealing pulpal tissue

Streamdent, 2(1), 2011

Complex odontome- A case report

Broca P. Recherches sur un nuveau grupe des tumeurs

Streamdent, 2(1), 2011

Oliver FM. Dental odontomas: a retrospective study of

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