Case #4 Diagnoses: Complex Odontoma
Figure 8. Panoramic Image of a Complex Odontoma.
Figure 9. Periapical and Occlusal Images of an Odontoma.
Demographics: Can be seen more commonly in children and young adults.
Odontomas are the most common benign odontogenic tumor (Figures 8 and 9). Abnormal proliferation of cells of the enamel organ, they give rise from the odontogenic epithelium and mesenchyme that produce enamel and dentin. There are two types of odontomas: compound and complex. A compound tumor represents multiple toothlike structures, where a complex odontoma has irregularly shaped masses of enamel (amorphous) showing no anatomic resemblance to a tooth. The tumor consists of multiple hard tissues, e.g., enamel, dentin, and cementum. If miniature teeth can be recognized in the lesion, it is called compound odontoma. If not then it’s called a complex odontoma, like this case. The complex odontoma is the most common odontogenic tumor in relation to tooth eruption. Compound odontomas occur in the canine and incisor region, found more often in the maxilla than mandible, and occur in children on average 14.8 years of age. Complex odontoma tumors occur in the posterior jaws in children 20.3 years of age on average. In one research study, 48% of cases involving unerupted teeth were diagnosed as odontomas, where 28% of unerupted teeth were dentigerous cysts.1-4
Clinical Notes: Usually asymptomatic and slow-growing. Found during a radiographic examination when a tooth has not erupted and possible retention of deciduous teeth. An encapsulated tumor, it rarely destroys alveolar bone or resorbs adjacent tooth roots. The dental team should inquire about the concurrent presence of dysphagia or a family history of dysphagia.3
Differential Diagnoses: An odontoma associated with a dentigerous cyst is rare. Another rare diagnosis is the amelobastic odontoma, e.g., odontoameleoblastoma. Although similar in age range and clinical location to the odontoma, the neoplastic tumor has a clinically aggressive growth.3-4
Treatment: Except for rare, large, complex lesions like this case, odontomas do not require treatment unless they block tooth eruption. If surgical removal, enucleation of the surrounding epithelial tissue including mucoperiosteal flap to expose the tumor, curettage, and if needed overlying bone is removed via highspeed handpiece. The tumor should be submitted for histopathologic evaluation. Large lesions would require adding bone to fill the defect. Postoperative clinical and radiographic observation should continue.1-4,10