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All rights reserved IDA, W.B., Vol - 37, No.-1, March 2021 1
MANAGEMENT OF COMPOUND ODONTOMA :
A CASE REPORT
Dr. Rajib Sikdar*, Dr. Supreet Shirolkar*, Dr. Avik Narayan Chatterjee**
Dr. Raju Biswas**, Dr. Soumen Pal***, Dr. Subir Sarkar****
*Post graduate trainee, 2nd Year,
**Post graduate trainee, 3rd Year
***Assistant Professor
****Professor and Head of Department
Department of Pedodontics and Preventive Dentistry
Dr. R. Ahmed Dental College & Hospital, Kolkata
Dr. Rajib Sikdar
Post Graduate Trainee, 2nd Year
Department of Pedodontics and Preventive Dentistry
Dr. R. Ahmed Dental College & Hospital, Kolkata
e-mail id :rajibmanutd@gmail.com
CORRESPONDING AUTHOR
Odontoma is a developmental odontogenic
t u m or a r i si n g f r o m c om pl e t el y
differentiated ameloblast and odontoblast
forming epithelial and mesenchymal cells.
Odontomas are asymptomatic tumor which
is classified into three different groups.
Routine radiographic examination often
revealed their presence in the jaw and
surgical removal being it's main mode of
treatment. Compound odontoma is most
common and may cause hindrance in the
eruption of permanent teeth. This paper
describes a case of a compound odontoma in
anterior maxilla of a 10 year old child.
KEY WORDS
INTRODUCTION
Odontoma a developmental hamartomas
1
malformation arising from the odontogenic tissue.
It is derived from the completely differentiated
odontogenic epithelial and mesenchymal cells from
which ameloblasts and odontoblasts developed. But
variable amounts of enamel and dentin were laid
down in an abnormal pattern because the
organization of odontogenic cells failed to reach the
2
normal pattern of morphodifferntiation. Paul Broca
3
in 1867 coined the term “Odontoma”. It is an
asymp t o m a t ic, n o n-aggr e s s i v e t u m o r o f
odontogenic origin which shows no gender
predilection. Generally odontomas are discovered
during routine radiographic examination during
4
investigation of missing permanent teeth in the jaw.
Sometimes, if odontoma is large, it may cause facial
5
asymmetry. Gabell, James & Payne in 1914
classified odontoma according to their origin: a)
Epithelial b) Composite (Epithelial & Mesodermal)
3
and C) Connective tissue type. Most commonly
6
used classification given by WHO in 2005 :-
1) Complex :- It is a conglomerate solid mass of
enamel and dentin, with no anatomic resemblance
with a tooth, surrounded by a narrow radiolucent
zone.
2) Compound :- Multiple tooth like radio-opaque
structures of varying size and shape surround by a
radiolucent zone.
3) Ameloblastic Fibro-odontoma :- A tumor with
the general features of an ameloblastic fibroma but it
also contains enamel and dentin.
This case report summarizes a case of
compound odontoma in anterior maxilla in a 10 year
old child with impacted permanent incisors reported
in the department of Pedodontics and Preventive
dentistry of Dr. R. Ahmed dental college & Hospital.
CASE REPORT
A 10 years old male child reported to Dept. Of
Pedodontics And Preventive Dentistry of Dr. R.
Ahmed Dental College & Hospital with chief
complain of unerupted permanent teeth in the upper
ABSTRACT
ABOUT THE AUTHORS
CASE REPORT
Odontoma, Compound Odontoma,
Impaction
2 IDA, W.B., Vol - 37, No.-1, March 2021 All rights reserved
anterior region. In clinical examination it was found
that 51,52 is still retained in the oral cavity (Fig :1).
No swelling or tenderness was present on percussion.
21& 22 erupted in its place in the oral cavity within 7
years of age. As a routine radiographic examination
(Orthopantamogram) revealed presence of multiple
small radio-opaque tooth like structure present
between primary incisors (51 &52) and permanent
incisors (11 & 12). Presence of this radio-opaque
mass eventually blocking the eruption of permanent
incisors. Root of the incisors also not completely
formed.
Presence of small tooth-like structure in the
anterior maxillary region blocking the path of
eruption of permanent incisors (11 & 12) suggestive
of compound odontoma. So, provisional diagnosis of
compound odontoma was concluded and extraction
of deciduous incisors and surgical removal of
odontomas was planned. Further investigation of
CBCT of face with 3D reconstruction was done to
confirm the diagnosis and routine blood test was done
before surgery(Fig :2 & 3).
After surgery 10 tooth like structures, most likely
compound odontoma, were removed and sent for his
to patholgical analysis. Wound was closed with 3-0
silk suture and follow-up was done after 7 days( Fig :
4, 5 & 6 ). Histopathological analysis confirmed the
provisional diagnosis of compound odontoma (Fig :
7).
Fig 1
Fig 2 Fig 3
Fig 4 Fig 5
Fig 6 Fig 7
All rights reserved IDA, W.B., Vol - 37, No.-1, March 2021 3
DISCUSSION
Odontoma is one of the most common
odontogenic tumor co mp ri si ng 22% of all
7
odontogenic tumor. Compound odontoma is
2
generally found in maxillary anterior region and
8
complex odontoma in mandibular posterior region.
Odontoma can be found in any age but most
commonly discovered in first two decades of life.4
Among all odontomas, 67% found in maxilla and
33% in mandible with right side of the jaw being more
2
common than left.
Odontomas are generally asymptomatic tumor,
remain unnoticed until it is accidentally found during
4
routine radiographic investigation . But most of the
time odontoma can lead to malpositioning, deviation
of path of eruption, delayed eruption or impaction of
7
adjacent permanent tooth. Etiology of odontoma is
not clear but hereditary, odontoblastic hyperactivity,
various syndromes like Gardner's syndrome or signal
difficulty of genetic control of tooth formation may
7,8
be the reason. Odontomas have very high success
rate after surgery with very little probability of
recurrence. It is very unusual that odontomas became
symptomatic and very rarely delayed diagnosis of
odontoma can lead to tooth loss, cystic changes, bone
9
expansion etc.
Line of treatment of odontoma comprises of early
diagnosis by radiographic examination during
evaluation of unerupted or delayed erupted
permanent tooth followed by surgical removal of
odontoma. After removal of odontoma, we generally
wait for 3 months for eruption of impacted permanent
tooth. If tooth fails to erupt surgical exposure of
impacted tooth with or without orthodontic traction is
required. During surgery proximity to the adjacent
important structure should be kept in mind to prevent
10
injury.
CONCLUSION
Odontoma are asymptomatic, non-aggressive,
odontogenic d ev el opmental tumor ro ut inely
discovered during radiographic investigation of
unerupted permanent tooth. After radiographic and
clinical examination, surgical removal of odontoma
leads to good prognosis and eventual eruption of
impacted tooth.
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