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ONE OF THE TUMORS OF ODONTOGENIC EPITHELIUMThis group of tumors is composed of proliferating odontogenicepithelium in a cellular ectomesenchyme resembling the dental papilla.
Odontomas are composed of all mature components ofdental hard and soft tissue: enamel, dentin, and pulptissue. Because of their limited slow growth and well-differentiation, they are generally considered torepresent hamartomas rather than true neoplasmDEFINITION
CLINICAL FEATURES•They are the most common odontogenic tumors• and they interfere with eruption of permanent teeth.• They begin to develop as normal dentition start to•develop and cease when the teeth development ends.• There is no sex predilection.•Theyoccur in young age group, with the average age beingsecond decade of life.
CLINICAL FEATURES• They are usually asymptomatic and are discovered during routine radiographic examination when there is delayed eruption of permanent tooth. Location: Somewhat more common in the maxilla. The compound type is more often in the anterior maxilla while the complex type occurs more often in the posterior regions of either jaw.
TWO TYPES OF ODONTOMAS ARERECOGNIZED Complex Compound
COMPOUND ODONTOMAIt is a collection of small radiopaque masses,some or all may be tooth-like structures“denticles”.It tends to occur in 62% in the anterior region ofthe maxilla and usually associated with the crownof an unerupted canine. It is formed by exuberantgrowth of the dental lamina or into a number ofsmall enamel organs by proliferation of theenamel organ.
COMPLEX ODONTOMA It is composed of haphazardly arranged dental hard and soft tissue. It has no resemblance to a normal tooth. It tends to occur in 70% in the posterior region of the mandible. There might be a missing tooth if it arises from a normal tooth follice.
RADIOGRAPHIC FEATURESEarly lesions are radiolucent with smooth, well-defined contours.Later a well-defined radiopaque appearance develops.Most odontomas are small and do not exceed the size of a normal tooth in the region.However, large ones do occur and these may cause expansion of the jaw.Most odontomas are asymptomatic and as a result are discovered upon routine radiographic examination.
RADIOGRAPHIC FEATURES*Odontomas may block the eruption of a permanent tooth and in these cases are often discovered when “searching for” the “missing” tooth radiographically.*They can be associated with impacted, malposition, malformation, and displacement of adjacent teeth.
COMPLEX ODONTOMA RADIOGRAPHICLLY Common lesions that persist through life Usually detected in adolescence most commonly in mandibular molars not painful, or swelling radiographically "sunburst radiopacities, thin uniform radiolucent rim similar description as osteosarcoma, but assoc w/ tooth, clear of bony borders
• large radioopaque lesion• well encapsulated w/ radioiolucent border
COMPOUND ODONTOMA RADIOGRAPHICLLY *Most common odontogenic tumor *Appears as a cluster of multiple abortive teeth *Often prevents normal tooth eruption *Radiographically multiple tiny toothlike structures are contained within a fine radiolucent rim *Do not recur after excision *thus discovered during adolescence Histology of compound odontomas approaches normal tooth strcture. Gross clinical examination usually is sufficient for diagnosis.
3 small radioopaque lesion w/ radiolucent rim
DIFFERENTIAL DIAGNOSISCompound odontomas can be detected easily due to their tooth-like appearance. Complex odontomas can be differentiated from cemento-ossifying fibromas due to their propensity to be associated with crown of unerupted molar and they are more radiopaque than cement-ossifying fibromas. They can also develop at much younger age than cemento-ossifying fibromas.
DIFFERENTIAL DIAGNOSIS A dense bony island can be included in the differential. However, the presence of a soft tissue capsule is very useful in differentiation. Periapical cemental dysplasia may resemble complex odontomas but usually they are multiple, surrounded by sclerotic borders and centered around apices of teeth, whereas odontomas are commonly found occlusal or overlapping the involved teeth.
TREATMENT Odontomas are treated by simple local excision and the prognosis is excellent They don’t recur and are not invasive.
Case ReportsHISTORY:A 28-YEAR-OLD FEMALE WAS REFERRED FOR ACONE BEAM CT SCAN FOR EVALUATION OF LEFTMANDIBULAR CANINE/PREMOLAR AREA FORPATHOLOGY.FINDINGS:THERE IS A WELL-DEFINED MIXED DENSITYLESION BETWEEN ROOTS OF TEETH #20-21. THELESION IS SURROUNDS BY RADIOLUCENT BANDAND RADIOPAQUE CORTEX GIVING IT A TARGETAPPEARANCE. THE HETEROGENEOUS DENSITYWITHIN THE LESION HAS TOOTH LIKEAPPEARANCE AND DENSITY. IT MEASURESAPPROXIMATELY 12 MM AT ITS GREATESTDIMENSION. THERE IS DISPLACEMENT OF ROOTSOF #20 AND #21. THERE ARE NO SIGNS OF ROOTRESORPTION. THE LESION IS IN CLOSE PROXIMITYTO THE MENTAL FORAMEN. THE MANDIBULARCANAL IS LOCATED INFERIOR AND BUCCAL TO THELESION.