J Oral Maxillofac Surg

70:1358-1361, 2012

Clinical and Histopathological

Investigation of Odontomas: Review of
the Literature and Presentation of
160 Cases
Merva Soluk Tekkesin, DDS, PhD,* Sevim Pehlivan, DDS,†
Vakur Olgac, DDS, PhD,‡ Nihan Aksakallı, DDS, PhD,§ and
Canan Alatlı, DDS, PhD储

Purpose: The purpose of the present study was to evaluate the clinical and histopathologic aspects of
different types of odontomas.
Materials and Methods: 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.
Results: Odontomas were classified histopathologically as complex, compound, or mixed. Of all investi-
gated 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.
Conclusions: 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.
© 2012 American Association of Oral and Maxillofacial Surgeons
J Oral Maxillofac Surg 70:1358-1361, 2012

The World Health Organization classifies odontomas as

a benign odontogenic tumor composed of odontogenic
epithelium and odontogenic ectomesenchyme with
dental hard tissue formation.1 Odontomas are the most
common odontogenic tumors. They are lesions of chil-
dren and young adults, especially in the second decade
*Research Assistant, Department of Tumor Pathology, Institute of
of life. There is no significant gender predilection.2
Oncology, Istanbul University, Istanbul, Turkey. Histologically, 2 main types of odontomas are recog-
†Corlu Oral and Dental Health Center, Corlu, Turkey. nized: complex and compound. Compound odontomas
‡Associated Professor, Department of Tumor Pathology, Institute consist of many separate, small, toothlike structures and
of Oncology, Istanbul University, Istanbul, Turkey. usually form in the anterior part of the jaws and may
§Assistant Professor, Department of Tumor Pathology, Institute give rise to a painless swelling. Complex odontomas
of Oncology, Istanbul University, Istanbul, Turkey. tend to appear in the posterior part of the jaws and
储Professor, Departments of Tumor Pathology and Oncological consist of a disorganized mass of hard and soft dental
Cytology, Institute of Oncology, Istanbul University, Istanbul, tissues with no morphologic resemblance to a tooth.3
Turkey. There have also been complex odontoma cases involv-
Address correspondence and reprint requests to Dr Soluk-Tek- ing the maxillary sinus reported in the literature.4,5
kesin: Institute of Oncology, Department of Tumor Pathology, Clinically, 3 types of odontomas are recognized in
Istanbul University, Floor 3 Capa 34093, Istanbul, Turkey; e-mail: the literature: intraosseous, extraosseous (soft tissue),
[email protected] and erupted.6 Radiologically, the appearances vary
© 2012 American Association of Oral and Maxillofacial Surgeons from radiolucent to radiodense, depending on the
0278-2391/12/7006-0$36.00/0 presence of dentin and enamel in the lesion. Com-
doi:10.1016/j.joms.2011.05.024 pound odontomas typically appear as separate,

1358
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SOLUK TEKKESIN ET AL 1359

Table 1. DISTRIBUTION OF AGE AND GENDER

Age (yrs)
Gender 0–9 10–19 20–29 30–39 40–49 50–59 60–69 ⬎70 Total

Female 3 26 24 12 4 7 3 1 80
Male 4 25 20 16 3 8 3 1 80
Total 7 51 44 28 7 15 6 2 160
Soluk Tekkesin et al. Investigation of Odontomas. J Oral Maxillofac Surg 2012.

densely calcified bodies in a single focus, whereas ameloblastic fibroma, dentinoblastoma, odontogenic tu-
complex odontomas appear as an irregular amor- mor, or radicular cyst.
phous radiopaque mass when calcification is com- Histopathologic diagnosis was compared with clin-
plete. These may appear radiolucent during the early ical and microscopic features: analysis of the presence
stages of tumor development.2,7 of symptoms and histopathologic findings, tumor
The pathogenesis is not clear, but trauma during found with a buried tooth, missing tooth, malformed
primary dentition, heredity, and genetic mutations are tooth/fusion, adhesion to a root, erupted, paresthesia,
accepted possible etiologic factors.8 Odontomas can follicle, odontogenic cyst, odontogenic epithelium,
also manifest as part of some syndromes: Gardner ameloblastic epithelium, odontogenic mesenchyme,
syndrome, Hermann syndrome, familial colonic ade- ghost cells, cementicle, ameloblastic odonto-fibroma/
nomatosis, and basal cell nevus syndrome.8,9 fibroma, infection, or inflammation. To determine the
Odontomas should be removed by conservative localization of odontomas, the upper and lower jaws
surgery because they have very low growth potential were divided into anatomic regions: maxillary ante-
and enucleation or surgical excision is curative. Re- rior, premolar, and molar and mandibular anterior,
currence is unusual. premolar, and molar.
The present study was designed to present the This was a retrospective study and thus exempt
epidemiologic features of odontomas in Istanbul and from approval by the local institutional review board.
discuss findings from the literature. All data analysis and graphs were performed using
Microsoft Office Excel 2007 (Microsoft, Redmond,
Materials and Methods WA).

Biopsies sent for diagnosis to the Oncology Insti-

tute, Department of Tumor Pathology, Istanbul Uni-
Results
versity from 1971 through 2010 were investigated.
Among 40,999 oral cases, 160 odontomas were de- In total, 40,999 oral cases were received from 1971
tected, and these tumors were compared by age of through 2010. Of all oral specimens, 160 odontomas
patient, gender of patient, localization, histopatho- were diagnosed (0.4%). Of the patients with these
logic type, clinical diagnosis, and clinical and micro- odontomas, 80 were male (50%) and 80 were female
scopic features. (50%). Table 1 summarizes the data for odontomas by
Odontomas were classified histopathologically as age and gender. Patients’ ages ranged from 3 to 81
complex, compound, or mixed and divided into 10 years (mean age, 27.9 years). At diagnosis, patients
groups according to clinical diagnosis: odontoma, me- most frequently were 10 to 19 years of age. The
siodens/fusion, calcified mass/tooth root, osteoid osteo- distribution of age groups according to diagnosis is
ma/osteoma/torus, cementum tumors, ameloblastomas, presented in Table 2.

Table 2. DISTRIBUTION OF AGE GROUPS ACCORDING TO HISTOPATHOLOGIC TYPE

Age (yrs)
Diagnosis 0–9 10–19 20–29 30–39 40–49 50–59 60–69 ⬎70 Total

Complex 1 28 31 19 5 10 4 2 99
Compound 5 20 13 9 2 5 2 0 57
Mix 1 3 0 0 0 0 0 0 4
Total 7 (4.4%) 51 (31.9%) 44 (27.5%) 28 (17.5%) 7 (4.4%) 15 (9.4%) 6 (3.7%) 2 (1.2%) 160
Soluk Tekkesin et al. Investigation of Odontomas. J Oral Maxillofac Surg 2012.

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1360 INVESTIGATION OF ODONTOMAS

Table 3. DISTRIBUTION OF 160 ODONTOMAS ACCORDING TO ANATOMIC SITE

Maxilla Mandible
Diagnosis No. of Cases Anterior Premolar Molar Anterior Premolar Molar

Complex 99 12 3 10 6 6 62
Compound 57 19 6 2 17 5 8
Mix 4 3 0 0 0 0 1
Total 160 (100%) 34 (21.3%) 9 (5.6%) 12 (7.5%) 23 (14.4%) 11 (6.9%) 71 (44.3%)
Soluk Tekkesin et al. Investigation of Odontomas. J Oral Maxillofac Surg 2012.

In general, the mandible (105 cases, 65.6%) was were complex odontomas (Table 2), similar to reports
more commonly involved than the maxilla (55 cases, by Amado et al17 and Hisatomi et al.18
34.3%) with all odontomas. Complex odontomas Complex odontomas were found most frequently
were found most frequently in the mandibular poste- in the posterior mandibular region. Compound odon-
rior region (62 cases); compound odontomas and tomas were found to show a slight preference for the
mixed odontomas were found most commonly in the anterior part of the maxilla, as in reports by Ochse-
anterior maxillary region (19 cases). Table 3 summa- nius et al,13 Mosqueda-Taylor et al,15 and Philipsen et
rizes the localization of odontomas according to his- al.19
topathologic type. One hundred thirty-four of 160 histopathologically
Of the 160 odontoma cases, 158 were sent with a diagnosed odontoma cases were also diagnosed as
different clinical diagnosis to the department, odontoma by clinical examination and panoramic
whereas only 2 cases were not diagnosed clinically. film. The incidence of a correct clinical diagnosis of
One hundred thirty-four of 160 cases were diagnosed odontoma was 83.75%. The percentages of correct
clinically as odontoma. clinical diagnosis of both types of odontomas were
Seventeen different features were found according
to radiologic, histopathologic, or clinical features ob-
served during surgery in 77 cases of odontoma. A Table 4. PREDOMINANT CLINICAL AND
differentiation of these features according to odon- MICROSCOPIC FEATURES
toma type is presented in Table 4.
Features Complex Compound Mixed Total

Retention of 7 5 1 13
Discussion permanent
Odontomas are classified as benign mixed odonto- teeth
Agenesis of 0 1 0 1
genic tumors in the World Health Organization clas- permanent
sification, but are thought to be developmental anom- teeth
alies rather than benign neoplasms.3,10,11 However, Malformed teeth/ 4 0 0 4
several studies have examined large series of these fusion
tumors, and odontomas have been identified as the Attached to teeth 5 0 0 5
Root resorption 0 1 0 1
most frequent odontogenic tumor.12-15 An odontoma Erupted 1 0 1 2
incidence of 21% was found and was the second most Paresthesia 2 0 0 2
common tumor in a previous study on odontogenic Follicle 7 5 1 13
tumors.16 This is much lower than rates in series from Odontogenic cyst 7 5 0 12
the United States14 and Canada.12 Odontogenic 12 7 1 20
epithelium
In the present study, odontomas were histopatho- Ameloblastic 4 2 0 6
logically classified as complex, compound, or mixed. epithelium
Complex odontomas accounted for 61.8%, com- Odontogenic 2 4 0 6
pound odontomas accounted for 35.6%, and mixed mesenchyme
odontomas accounted for 2.5% of all investigated Ghost cell 4 4 2 10
Cementicle 3 3 0 6
cases. The incidence of odontomas was found to be Areas similar to 3 2 0 5
equal (50%) in male and female patients, in accord ameloblastic
with results of some studies.15,17 The mean age at fibroma
diagnosis was 27.9 years. Odontomas were found Inflammation 7 1 0 8
most frequently at 10 to 19 years of age. Compound Soluk Tekkesin et al. Investigation of Odontomas. J Oral Maxil-
odontomas were diagnosed at a younger age than lofac Surg 2012.

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SOLUK TEKKESIN ET AL 1361

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