CASE PRESENTATION

1. Complex Odontome associated
with Maxillary Impacted
Permanent Central Incisor: A
Case Report
Raghavendra M Shetty, Sangamesh Halawar, Hanumanth Reddy, Sujata Rath,
Sunaina Shetty, Anushka Deoghare
Presented by:-
Khushboo Sinhmar
M.D.S. 2ND YEAR

2. CONTENTS
• INTRODUCTION
• CLINICAL FEATURES
• ETIOLOGY
• CASE REPORT
• INTRA ORAL EXAMINATION
• RADIOGRAPHIC FINDINGS
• TREATMENT
• HISTOPATHOLOGICAL EXAMINATIONDISCUSSION
• CONCLUSION
• REFERENCE

3. INTRODUCTION
• ODONTOMA
• The term odontome was coined by Paul Broca in 1867
• Odontomas by definition alone refers to any tumor of
odontogenic origin. This is because odontomas result from the
growth of completely differentiated epithelial and mesenchymal
cells that give rise to ameloblasts and odontoblasts.

4. • TYPES:-
Acc to WHO classification Odontomes can be divided into three
types:
1)- Complex Odontome
2)- Compound Odontome
3)- Ameloblastic fibro Odontome

5. Compound odontome: Composed of all odontogenic tissues in
an orderly pattern that results in many teeth like structures, but
without morphologic resemblance to normal teeth.

6. • Compound odontome was classified as acc to Gravey et al
• Denticulo type : Composed of two or more of tissues separate
denticles, having crown and root, dental hard tissues
resembling to that of tooth
• Particulate type :Composed of two or more separate masses or
particles, bearing no resemblance to tooth, consists of hard
dental tissues
• Denticulo-particulate type: In this type, denticles and particles
are present together

8. • Complex odontome: When the calcified dental tissues are
simply arranged in an irregular mass bearing no morphologic
similarity to rudimentary teeth.

9. • Ameloblastic fibro-odontome:
Consists of varying amounts of calcified dental tissue and
dental papilla-like tissue, the later component resembling an
ameloblastic fibroma. The ameloblastic fibro-odontome is
considered as an immature precursor of complex odontome.

10. 2)- On the basis of their developmental origin in 1914, Gabell,
James and Payne grouped odontome into three types:
• a. Epithelial
• b. Composite (epithelial and mesodermal) and
• c. Connective tissue.
3) According to their position within the jaws:
• 1) Intra osseous
• 2) Extra osseous

11. 4) According to Thoma and Goldman (1946):
• Germinated composite odontomes
• Compound composite odontomes
• Complex composite odontomes
• Dilated odontomes
• Cystic odontomes

12. CLINICAL FEATURES
1) SHAPE-
Compound Odontome is regularly shaped solitary or multiple
denticles
Complesx odontome amorphous conglomeration of dental tissues
2) APPEARANCE-
Compound Odontome Bizzare peg shaped teeth show anatomic
resemblance
Complesx odontome- an irregular mass

13. 3) COMPOSITION- Both compound and complex tumours are
formed of enamel dentin , also have variable amounts of
cementum and pulpal tissue
4) INCIDENCE:- Compound odontomes – 9-37%
Complex odontome- 5-30%
5) age- both complex and compound found in yoinger patients
with mean age 14 to 20 years

14. 6) SIGNS AND SYMPTOMS
• Asymptomatic, although occasionally signs and symptoms
relating to their presence do occur
• These generally consist of
– Unerupted or impacted teeth,
– Impacted tooth,
– Retained deciduous teeth,
– Swelling and evidence of infection,
– Displacement of teeth and malocclusion.
• Compound odontomes seldom cause bony expansion but
complex odontome often cause slight or even marked bony
expansion.

15. ETIOLOGY
• Local trauma
In 1979, Shteyer, Taicher and Marmary reported a case of
odontome occurring at the subcondylar region associated
with a sinus tract linking to the third molar region. They
deduced that the missing third molar had migrated to the
subcondylar region followed by the occurrence of trauma
or infection which led to the development of the odontome.
• Inflammatory and/or infectious processes,
• cell rests of serres (dental lamina remnants)

16. • due to hereditary anomalies (Gardner’s syndrome, Hermanns
syndrome)
• Alterations in the genetic component responsible for
controlling dental development.

17. • Hitchin suggested that odontomes are inherited or are
due to a mutagene or interference, possibly postnatal, with
the genetic control of tooth development.

18. CASE REPORT
-12 years old female patient
-Chief complaints- Missing tooth in the upper front region of the
jaw
-Past, family and medical history- not relevant
-General physical examination- not significant

19. Intra oral examination
• Permanent dentition with unerupted left maxillary permanent
central incisor
• Inspection- swelling on the labial side of unerupted tooth
• Palpation- firm nodule of 2 cm in diameter

21. RADIOGRAPHIC FINDINGS
• Intraoral periapical and panoramic radiographs
revealed that radiopaque structures were present
obstructing the eruption of left maxillary permanent
central incisor.
• On basis of clinical and radiographic findings, case
was provisionally diagnosed as odontome

24. • Surgical removal of the odontome under local anesthesia.
• Full thickness mucoperiosteal flap was reflected from the
labial surface of right maxillary permanent lateral incisor to
left maxillary permanent canine.
• Layer of bone overlying the mass was removed and the
calcified masses were exposed
TREATMENT

26. • Four to five calcified irregular masses were removed without
disturbing the underlying tooth

27. • Curettage was done and the area was irrigated with povidineiodine
solution and normal saline (0.9%).
• Unerupted left maxillary permanent central incisor was located

28. • After hemostasis, begg’s bracket with a twisted ligature wire in a hook
form tied to it was bonded on the labial surface of the impacted incisor.
• The flap was repositioned and sutured, keeping the ligature wire hook
suspended in the oral cavity making sure the occlusion was not disturbed

29. HISTOPATHOLOGICAL
EXAMINATION
• Microscopically, hematoxylin and eosin-stained
(H&E) section showed structures exhibiting an
irregular arrangement of dentin, mesenchymal tissue
resembling pulp and a small area of cementum-like
material

31. POSTOP PANORMIC RADIOGRAPHY

32. DISCUSSION
• In clinical setting, dentists often encounter the problem of
tooth impaction, which has been defined as a situation where a
tooth fails to erupt into a normal functional position by the
expected times
• The treatment for odontomes in both primary and permanent
dentition is their surgical removal.

33. • If odontomes are extirpated early without disturbing the
underlying tooth germ, the eruption of the impacted teeth can
then be expected spontaneously or after orthodontic traction
• However, underlying impacted teeth are sometimes extracted
in association with the removal of odontomas

34. • In this case, the overlying odontomes were surgically removed
and the impacted central incisor has been kept under
observation to monitor its eruption.
• If the root of the impacted tooth is still developing, the tooth
may erupt normally; but, once the root apex has closed, the
tooth has lost its potential to erupt.

35. Conclusion
• Radiographic examination of all pediatric patients that present
clinical evidence of delayed permanent tooth eruption or
temporary tooth displacement, with or without history of
previous dental trauma should be performed.
• Early diagnosis of odontomes allows adoption of a less
complex and less expensive treatment and ensures normal
eruption pattern of permanent teeth which may otherwise get
impacted.

36. REFERENCES
1) Shetty RM, Halawar S, Reddy H, Rath S, Shetty S, Deoghare
A. Complex Odontome associated with Maxillary Impacted
Permanent Central Incisor: A Case Report. Int J Clin Pediatr
Dent 2013;6(1):58-61
2) V Satish, Maganur C Prabhadevi, Rajesh Sharma Odontome:
A Brief Overview International Journal of Clinical Pediatric
Dentistry, September-December 2011;4(3):177-185
3) Shteryer A, Taicher S, Marmary T. Odontoma in the
subcondylar region. Br J Oral Surg 1979 Nov;17(2):161-165.