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Odontoma, managment

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  • 1. By : Ahmed Al-Asmari
  • 2. Treatment
    • Enucleation
    • Orthodontic Traction
  • 3. Enucleation :
    • This technique involves complete removal of the Odontoma sac and healing of the wound by primary intention. This is the most satisfactory method of treatment of an Odontoma. The surgical procedure for treatment of an Odontoma with enucleation includes the following steps:  
  • 4. CONT...
    • 1.  Reflection of a mucoperiosteal flap.
    •  
    • 2.  Removal of bone and exposure of part of the Odontoma.
    •  
    • 3.  Enucleation of the Odontomaic sac.
    •  
    • 4.  Care of the wound and suturing.
  • 5. CONT...
    • After taking a radiograph to determine the exact localization and size of the lesion, a trapezoidal flap is created, whose extent must ensure adequate access and visualization of the surgical field.
  • 6.  
  • 7. CONT...
    • After reflection of the mucoperiosteum , the bone covering the lesion is evaluated, which, as mentioned above, may be normal, thinned, or completely destroyed.
  • 8.  
  • 9. CONT...
    • In normal bone , a round bur is used to remove a portion of the buccal cortical plate covering the Odontoma, and, depending on its extent, a rongeur may be used to enlarge the osseous window created .
  • 10.  
  • 11.  
  • 12. CONT...
    • If the bony wall is thinned or perforated , it is removed peripherally with a rongeur, until it reaches compact bone.
  • 13. Cont...
    • A curette is used for enucleation of small Odontomas , while for larger Odontomas , the broad end of a periosteal elevator is preferred, which is placed inside the cavity pressing gently between the Odontomaic wall and bone, while the Odontoma is carefully grasped with forceps.
  • 14. Cont...
    • After removal of the Odontoma, a curette is used to inspect the cavity for the presence of remnants of the Odontoma, and copious irrigation with saline solution and suturing of the flap follow.
  • 15.  
  • 16. Orthodontic Traction :
    • the impacted permanent tooth showed a fully formed root resulting in little spontaneous eruption potential , it was decided that an orthodontic device would have to be placed in order to guide the impacted tooth into its position .
  • 17. Cont...
    • So, at the time of the surgery, a bracket was bonded to the labial surface of the crown. After healing of the soft tissues, traction of the unerupted maxillary right central incisor was initiated .
  • 18.  
  • 19.  
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  • 21.  
  • 22.  
  • 23.  
  • 24.  
  • 25. REFERENCE:
    • 1- Michael Miloro, PETERSON'S PRINCIPLES OF ORAL AND MAXILLOFACIAL SURGERY, Second Edition, chapter: 30, p: 590-591.
    • 2- F. D. Fragiskos, Oral Surgery, first edition , chapter: 12 p: 301-302
    • 3- Branca et al, Compound odontoma -diagnosis and treatment: three case reports,2001