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Odontoma

Odontomas are developmental tumors that arise from the dental tissue. They are benign and can be classified into compound and complex. Usually, they occur at a young age and are asymptomatic.


Presentation

Odontomas are hamartomas that most frequently occur in children and young people, with a higher incidence in the second decade of life. They are not, however, limited to this age group. Odontomas in themselves are rare tumors, with cases comprising only 0.1% of the general population, but make up a large proportion of odontogenic tumors [1]. In fact, they are the most common masses of odontogenic origin to occur in the oral cavity.

They consist of dental tissue that is both mesenchymal and epithelial in origin and may contain any of components of teeth, that is, pulp, dentin, enamel or cementum. It is unclear in the literature whether the tumors have a male or female predilection, however, some authors claim that odontomas have a marginal female preponderance [2].

Odontomas are usually small and asymptomatic, although generally, they can disrupt the eruption of neighboring teeth. Symptomatic odontomas typically present with displaced teeth, pain, swelling and a disruption of the bony architecture of the jaw [3]. The latter is especially common with odontomas that present as a large mass, prone to complications such as bone expansion and impaction [4] [5]. Patients may have other dental problems simultaneously.

Odontomas are often classified into two types: compound and complex. They can occur both in the maxilla or mandible, although the former is the more common location [2] [6]. Compound odontomas are small, organized structures that resemble a cluster of teeth [7]. They tend to occur in the anterior part of the maxilla. In contrast, complex odontomas are poorly differentiated structures that contain cementum, dentin, and enamel. These tend to develop in the posterior maxilla. Odontomas can occasionally occur in soft tissue (gums) [8].

There are a number of risk factors for the development of odontomas, and these include trauma, infections, inherited conditions like Gardner and Hermann's syndromes, genetic mutations, and the abnormal proliferation of a type of neural crest cells (odontoblasts) that are found in the pulp [6].

Asymptomatic
  • Odontomas are the most common type of odontogenic tumor and are generally asymptomatic.[ncbi.nlm.nih.gov]
  • Around 28% of all AFs were small and asymptomatic, and 72% exhibited moderate-to-severe bone expansion. There are 2 variants of AF: neoplastic and hamartomatous.[ncbi.nlm.nih.gov]
  • Diagnosis at an asymptomatic stage is uncommon when the history is not suggestive. We describe a rare case where a foreign object was misdiagnosed as an odontoma in a patient with an alveolar cleft.[ncbi.nlm.nih.gov]
  • Usually, they occur at a young age and are asymptomatic. Odontomas are hamartomas that most frequently occur in children and young people, with a higher incidence in the second decade of life. They are not, however, limited to this age group.[symptoma.com]
  • They are usually asymptomatic and are diagnosed on routine radiological examination .The eruption and infection of odontoma are uncommon. Till now, only 20 cases of erupted odontoma are reported in the literature.[ncbi.nlm.nih.gov]
Recurrent Sinusitis
  • We describe the case of a 76-year-old man who presented with symptoms of chronic nasal obstruction and recurrent sinusitis of many years' duration.[ncbi.nlm.nih.gov]
Aspiration
  • Aspiration performed during surgery was negative for blood and other exudates. No recurrence has occurred during a follow-up period of 11 months.[ncbi.nlm.nih.gov]
Malocclusion
  • Odontomas are familiar entities but their eruption into the oral cavity is an extraordinary occurrence, which may be associated with pain, infection, malocclusion, etc. Not many cases of erupted odontomas have been reported in the literature.[ncbi.nlm.nih.gov]
  • In patients with skeletal malocclusion and odontoma, the prioritization of treatment is ofgreat importance. Ifsurgical removal of odontoma is postponed, the probability of adjacent teeth impaction increases.[ncbi.nlm.nih.gov]
Eruptions
  • Odontomas, benign tumors that develop in the jaw, rarely erupt into the oral cavity. We report an erupted odontoma which delayed eruption of the first molar.[ncbi.nlm.nih.gov]
  • This occurs when tooth eruption does not occur within a normal time frame, the tooth is not present in the dental arch, and there is no potential for eruption due to the presence of a completely formed root or when the homologous tooth has been erupted[ncbi.nlm.nih.gov]
  • Odontomas are familiar entities but their eruption into the oral cavity is an extraordinary occurrence, which may be associated with pain, infection, malocclusion, etc. Not many cases of erupted odontomas have been reported in the literature.[ncbi.nlm.nih.gov]
  • CONCLUSION: Compound odontomas rarely erupt into the mouth. The presented case is the 13 th case of erupted compound odontoma reported in the literature. The treatment of choice is surgical removal of the odontoma.[ncbi.nlm.nih.gov]
  • Most odontomas are asymptomatic and are discovered during routine radiographic investigations and can cause disturbances in the eruption of the teeth, most commonly delayed eruption or deflection.[ncbi.nlm.nih.gov]
Fracture
  • A two-stage surgical treatment was chosen; first, removing most part of the lesion and preserving the second molar, decreasing the risk of a pathological mandibular fracture. A maxillo-mandibular fixation for a period of 4 weeks was used.[ncbi.nlm.nih.gov]
  • Almost all pediatric fractures must be managed with closed reduction as much as possible.[ncbi.nlm.nih.gov]
  • Immediate postoperative inter-maxillary fixation was performed to prevent pathological fractures for a period of 3 weeks. In an 8-month follow-up, no untoward complications were noticed.[ncbi.nlm.nih.gov]
  • The developmental deviations that occur in a tooth bud in the line of a jaw fracture range from agenesis to hamartomatous proliferation.[ncbi.nlm.nih.gov]
  • Contents Management of Salivary Gland Disorders 396 ranaffement of Temooromandibular loint Disorders 427 Orthognathic Surgery 464 Orofacial Clefts 493 Orofacial Neuropathy 515 Basic Principles in Management of Patients With Maxillofacial Injuries 545 Fractures[books.google.com]
Facial Scar
  • A conservative intraoral enucleation was used to avoid facial scarring and preserve mandibular continuity and function. The huge bony defect healed completely without a bone graft or further intervention.[ncbi.nlm.nih.gov]

Workup

There are two standard methods of diagnosis of odontomas, and these include radiographic imaging, as well as histological analysis of the sample tissue. Often, odontomas are discovered incidentally, during routine radiographs [2] [6].

Typical radiographic features are dependent on the type and stage of a particular tumor. Initially, tumors may be radiolucent, with the inclusion of small calcifications. They progress to being entirely radiodense, with a persisting radiolucent rim. Compound odontomas may show denticles, which appear in different shapes and sizes and resemble teeth, within a well-demarcated, septate, radiolucent mass [9].

Complex odontomas have no recognizable structures and are a mixture of dense material within a lucent margin [3] [10]. Dentigerous cysts may also be visualized, although their occurrence is rare.

Treatment

  • The treatment protocol involved surgical intervention followed by sequential traction of the 3 impacted teeth. The patient's smile dramatically improved after orthodontic treatment. Good posterior occlusion was achieved.[ncbi.nlm.nih.gov]
  • Only rarely the treatment of this lesion in association with an impacted tooth has been reported.[ncbi.nlm.nih.gov]
  • The treatment was considered a success, since both health and aesthetics of the smile were recovered.[ncbi.nlm.nih.gov]
  • This case demonstrates the value of the tridimensional computed tomography in treatment planning prior to any definitive surgery.[ncbi.nlm.nih.gov]
  • The patient was referred for orthodontic treatment and a Hyrax appliance was fitted. The patient has been followed for 12 months. CBCT is an important auxiliary tool, aiding in both correct diagnosis and accurate treatment planning.[ncbi.nlm.nih.gov]

Prognosis

  • Therefore, the treatment and prognosis differs for these two histologically similar neoplasms.[ncbi.nlm.nih.gov]
  • The diagnosis, complications, treatment, and prognosis of this entity will be discussed.[ncbi.nlm.nih.gov]
  • The analysis of the described cases showed that early diagnosis and early removal of the odontoma are essential in improving the prognosis of the involved teeth. Early treatment allows the impacted tooth to re-start the physiological eruption.[ncbi.nlm.nih.gov]
  • Treatment of choice has been surgical removal of the lesion, and prognosis is usually favorable because of its benign characteristics and rare recurrence.[ncbi.nlm.nih.gov]
  • Regular follow-up period is crucial to evaluate the prognosis of these teeth.[ncbi.nlm.nih.gov]

Etiology

  • The etiology of odontoma is unknown, although several theories have been proposed. This article describes a case of a large infected complex odontoma in the residual mandibular ridge, resulting in considerable mandibular expansion.[ncbi.nlm.nih.gov]
  • The exact etiology of odontomes is still not known. Most odontomes are asymptomatic and are discovered during routine radiographic investigations.[ncbi.nlm.nih.gov]
  • These are commonly found in tooth-bearing regions, although the etiology remains unknown. There are no previous reports of an established line of immortalized human odontoma cells.[ncbi.nlm.nih.gov]
  • Most common odontogenic tumour - considered to be a hamartoma. [2] Etiology unknown. [3] Typically first two decades of life. Classification: [2] Compound odontoma - tooth-like structure. Complex odontoma - disorganized mass of odontogenic tissues.[librepathology.org]

Epidemiology

  • Epidemiology [ edit ] Odontomas are thought to be the second most frequent type of odontogenic tumor worldwide (after ameloblastoma ), accounting for about 20% of all cases within this relatively uncommon tumor category which shows large geographic variations[en.wikipedia.org]
  • Each entity is extensively discussed with information on clinicopathological, epidemiological, immunophenotypic and genetic aspects of these diseases. This book is in the series commonly referred to as the "Blue Book" series. Contributors: :Dr.[books.google.com]
  • A clinical–histological and retrospective epidemiological study of 46 cases. Med Oral, 5 (2000), pp. 367-372 [15] M. Hisatomi, J. Asaumi, H. Konouchi, Y. Honda, T. Wakasa, K. Kishi.[elsevier.pt]
  • […] ameloblastic fibro-odontomas as developing odontomas rather than a distinct tumor ( IARC: WHO Classification of Head and Neck Tumours, 4th Edition, 2017 ) Terminology Compound odontoma Complex odontoma Ameloblastic fibro-odontoma Peripheral odontoma Epidemiology[pathologyoutlines.com]
Sex distribution
Age distribution

Pathophysiology

  • […] common odontogenic tumor Usually diagnosed during the first two decades of life No sex predilection Sites Can occur in any tooth bearing area Compound odontoma usually occurs in anterior maxilla Complex odontoma usually occurs in posterior mandible Pathophysiology[pathologyoutlines.com]

Prevention

  • The purpose of this study is to report the case of a complex odontoma in a child impacting a permanent molar and preventing its eruption.[ncbi.nlm.nih.gov]
  • Early intervention is advisable to prevent these odontogenic lesions from eventually deforming the jaw and displacing adjacent teeth.[ncbi.nlm.nih.gov]
  • Immediate postoperative inter-maxillary fixation was performed to prevent pathological fractures for a period of 3 weeks. In an 8-month follow-up, no untoward complications were noticed.[ncbi.nlm.nih.gov]
  • Early diagnosis of odontomas in primary dentition is crucial in order to prevent later complications, such as impaction or failure of eruption of teeth.[ncbi.nlm.nih.gov]
  • These findings underline the value of the panoramic radiograph in preventive dentistry in younger patients.[ncbi.nlm.nih.gov]

References

Article

  1. Yeung KH, Cheung RC, Tsang MM. Compound odontoma associated with an unerupted and dilacerated maxillary primary central incisor in a young patient. Int J Paediatr Dent. 2003;13(3):208-212.
  2. Nelson LB, Thompson DRL. Compound odontoma. Head Neck Pathol. 2010;4(4):290-291.
  3. Soluk Tekkesin M, Pehlivan S, Olgac V, Aksakallı N, Alatli C. Clinical and histopathological investigation of odontomas: review of the literature and presentation of 160 cases. J Oral Maxillofac Surg. 2012;70(6):1358-1361.
  4. Serra-Serra G, Berini-Aytés L, Gay-Escoda C. Erupted odontomas: a report of three cases and review of the literature. Med Oral Patol Oral Cir Bucal. 2009;14(6):E299-303.
  5. Vengal M, Arora H, Ghosh S. Large erupting complex odontoma: a case report. J Can Dent Assoc. 2007;73(2):169-173.
  6. Oz YG, Tosun G, Kiziloğlu D, Durmuş E, Şener Y. An unusual association of odontomas with primary teeth. Eur J Dent. 2007;1(1): 45–49.
  7. Junquera L, de Vincente JC, Roig P, Olay S, Rodriguez-Recio O. Intraosseous odontoma erupted into the oral cavity: an unusual pathology. Med Oral Patol Oral Cir Bucal. 2005;10(3):248-251.
  8. Otsuka Y, Mitomi T, Tomizawa M, Noda T. A review of clinical features in 13 cases of impacted primary teeth. Int J Paediatr Dent. 2001;11(1):57-63.
  9. Amado CS, Gargallo AJ, Berini AL, Gay EC. Review of 61 cases of odontoma. Presentation of an erupted complex odontoma. Med Oral. 2003;8(5):366–373.
  10. An SY, An CH, Choi KS. Odontoma: a retrospective study of 73 cases. Imaging Sci Dent. 2012;42(2):77–81.

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Last updated: 2019-07-11 22:45