Odontomas are hamartomas of odontogenic origin characterized by abnormal enamel and dentine formation, primarily affecting permanent dentition. They can be classified into compound and complex types based on their morphological features, and while generally asymptomatic, they may cause tooth displacement or other dental issues. Early diagnosis and surgical removal are crucial for effective management to avoid complications associated with these lesions.

2. ODONTOMA
• This is a hamartoma of odontogenic origin in which both epithelial and
mesenchymal cells exhibit complete differentiation with enamel and dentine
laid down in abnormal position.
• The term odontome was coined by Paul Broca in 1867

3.  It may result from the extraneous buds of odontogenic epithelial cells from the
lamina dura, from any of the three dental tissues, enamel, dentine or cementum.
 The cause may be trauma, infection or genetic transmission or due to hereditary
anomalies (Gardner’s syndrome, Hermanns syndrome)
ETIOLOGY

4. • Second and third decades of life
• commonly occur in permanent dentition
• 22% of all odontogenic tumors of the jaws.
• 10% of all odontogenic tumors of the jaws are compound odontomas.
• Compound odontome : 9 and 37%
• Complex odontome :5 and 30%.
EPIDEMIOLOGY

5. • The anterior segment of the jaws: compound composite (61%)
• The posterior segment of the jaws: complex composite (34%)
• Occur more frequently on the right side of the jaw than on the left
• The compound composite odontoma most frequently occurred in incisor cuspid region of the
upper jaw in contrast to the complex odontome which were commonly found in molar and
premolar region of the mandible.
• Compound is twice as common than complex.

6. SIGNS AND SYMPTOMS
* Asymptomatic
* These generally consist of unerupted or impacted teeth, retained deciduous teeth, swelling
and evidence of infection.
* Compound odontomas seldom cause bony expansion but complex odontomes often cause
slight or even marked bony expansion.
* The presence of odontomas may lead to malpositioning or displacement of adjacent teeth,
aplasia, malformation and devitalization of adjacent teeth

7. CLASSIFICATION
Four lesions containing enamel and dentine of normal appearance are defined in the
WHO classification. They are as follows:
1. Ameloblastic fibro-odontome
2. Odonto-ameloblastoma
3. Complex odontome
4. Compound odontome

8. On the basis of gross, radiographic and microscopic features, two types of
odontoma are recognized:
a. Compound
b. Complex

9. 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.

10. According to their position within the jaws:
a. Intraosseous (erupted odontoma): They occur inside the bone and may erupt into
the oral cavity.
b. Extraosseous or peripheral odontomas: These are odontomas occurring in the
soft tissue covering the tooth bearing portions of the jaws, having a tendency to
exfoliate.

11. According to Thoma and Goldman:
• Germinated composite odontomas: two or more, more or less well-developed teeth fused
together
• Compound composite odontomas: made up of more or less rudimentary teeth
• Complex composite odontomas: calcified structure, which bears no great resemblance to
the normal anatomical arrangement of dental tissues
• Dilated odontomas: the crown or root part of tooth shows marked enlargement
• Cystic odontomas: an odontome that is normally encapsulated by fibrous connective

12. Z Gorlin et al eliminated the term composite as redundant and classified odontomas as
either complex or compound.
There are essentially two types of odontome:
• Complex composite odontome
• Compound composite odontome

13. A. Ectodermal origin
• Enameloma (enamel pearl, enamel nodule)
B. Mesodermal origin
• Dentinoma
• Cementoma
C. Mixed
• Complex composite odontoma
• Compound composite odontoma- multiple well formed teeth
• Compound complex odontoma
• Geminated odontoma
• Dilated odontoma with dens in dente.

14. COMPOUND ODONTOME
Definition: Malformation in which all dental tissues are represented in a more orderly
pattern than in the complex odontome represented, so that the lesion consists of many tooth-
like structures.
Shape : Regularly shaped, solitary or multiple small denticles. The compound odontoma is
usually between 1-3 cm in diameter in size
Appearance : Bizarre peg shaped teeth show anatomic resemblance to normal teeth.

15. Classification 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.

16. Radiographic features:
 Shows a number of teeth like structures or denticles that look like deformed teeth, mostly in
the region of the canine.
 Each tooth like structure has radiopaque with a dark line surrounding it
 The radiopaque mass is surrounded by a radiolucent line that separates the pericoronal space
of the unerupted teeth.

17. Definition: Malformation in which all dental tissues are represented, individual tissues
being mainly well formed cut occurring in more or less disorderly pattern
Shape : Amorphous conglomeration of dental tissues
Appearance : An irregular mass
COMPLEX ODONTOME

18. • This appears as a dense radiopaque object, density greater than that of bone
and equivalent to that of teeth.
• It is associated with unerupted teeth.
Radiographic features:

19. Cystic odontoma
 It shows a solid mass of the odontoma but without any associated unerupted tooth.
 There is a dark shadow of the cystic cavity and has well-defined corticated
margins except in the cases of infection.

20. Cystic compound odontoma
• There is an area of bone destruction which appears as a dark shadow having well defined
margins lined by a thin white layer of cortical border.
• Within the cystic cavity there are numerous white radiopacities which vary in size and
shape.
• In some cases there are small amorphous granular densities scattered through out the
cavity and in some cases there are small denticles with enamel caps or without distinction
of the compound mass.

21. Dilated odontoma
Has a single calcified structure with more radiolucent central portion that has an
overall form of a doughnut.

22. Early diagnosis of odontomas helps us to:
1. Adopt a less complex and less expensive treatment
2. Ensures better prognosis
3. Avoid relapse of the lesion
4. Avoid displacement or devitalization of adjacent tooth.

23. TREATMENT
The treatment of choice is surgical removal of the lesion because it contains various tooth
formulations that can predispose to cystic change, interfere with eruption of permanent
teeth and cause considerable destruction of bone.

24. ADENOMATOID ODONTOGENIC TUMOUR
 Adenomatoid odontogenic tumor (AOT)
was first described by Steensland in 1905
 Adenomatoid Odontogenic Hamartoma
was first introduced in 2006 by Vargas et
al

25. SYNONYMS
• Adenoameloblastoma
• Ameloblastic Adenomatoid Tumor
• Adamantinoma
• Epithelioma Adamantinum
• Teratomatous Odontoma

26.  The AOT is a benign, non-neoplastic (hamartomatous) lesion with a slow but
progressive growth.
 Philipsen and Birn (1971), defined it as an odontogenic epithelial tumor with an
inductive effect on the odontogenic mesenchyme. The nature of the lesion is
uncertain and it may be hamartomatous rather than truly neoplastic.
DEFINITION

27. CLASSIFICATION
Based on the location it can be classified as:
❍ Follicular
❍ Extra follicular
❍ Peripheral

28.  The 2nd and 3rd decades of life
 The anterior part of the maxilla especially in the canine areas
 The lesion usually presents as asymptomatic swelling which is slowly growing and
often associated with an unerupted tooth.
 Adenomatoid odontogenic tumors are relatively small. They seldom exceed 3 cm in
greatest diameter
CLINICAL FEATURES

29. AOT may be seen in one of two stages of development:
(I) the early radiolucent stage, with histologic evidence of calcification only
(II)the mature stage, characterized by calcification within the lesion.

30. • AOT is well encapsulated by a fibrous capsule.
• Tumor shows various-sized solid nodules of cuboidal or spindle-shaped odontogenic
epithelium with minimal stroma.
• Within these nodules, there are characteristic rosette- or duct like spaces that are the
most characteristic features of AOT
HISTOPATHOLOGICAL FEATURES

31. RADIOLOGIC FEATURES
 The size of the lesion ranges from 1.5 to 3 cm.
 There is often a well-corticated non-scalloped outer margin, and sometimes it may be
very thick; this feature may be absent in parts of the lesion.
 The expanded cortex may appear thick and firm or thin and yielding.
 Fine snowflake calcifications are often present in the radiolucent lesion

32. MANAGEMENT
The AOT is readily enucleated

33. SQUAMOUS ODONTOGENIC TUMOUR
 Squamous odontogenic tumor first was reported in 1975 by Pullon and associates.
 Squamous odontogenic tumor is a rare benign epithelial odontogenic tumor
consisting of islands of well differentiated squamous epithelium in a fibrous
stroma.

34. • Mean age of 38 years
• The male to female ratio is 1.8:1
• Squamous odontogenic tumors mostly arise intraosseously around the alveolar processes
between the roots of vital erupted teeth.
• Possible indicator of the underlying tumor: mobility of the teeth, swelling of the alveolar
process, and moderate pain
• SOTs occurring in the maxilla seem to be more aggressive than those in the mandible
CLINICAL FEATURES

35. • squamous odontogenic tumors consist of islands of terminally differentiated squamous
epithelium.
• There is no peripheral palisading or cytological atypia.
HISTOPATHOLOGICAL FEATURES

36. • The central variant of SOT shows a well-defined unilocular
and triangular radiolucency between the roots of adjacent teeth
• The peripheral variant of SOT may reveal some
"saucerization" of the underlying bone which is explained as a
pressure phenomenon rather than a result of neoplastic
infiltration.
RADIOGRAPHIC FEATURES

37. Conservative surgical excision
MANAGEMENT

38. AMELOBLASTIC FIBRO-ODONTOMA
Ameloblastic fibro-odontoma (AFO) is a quite rare, mixed
odontogenic tumour
AFO is a benign, slow growing, expansile epithelial
odontogenic tumor with odontogenic mesenchyme.

39. • The lesions are usually diagnosed during the first and second decades of life
• It occurs with equal frequency in the maxilla and the mandible and with equal
frequency in males and females
• It may inhibit tooth eruption or displace involved teeth although teeth in the
affected area are vital
CLINICAL FEATURES

40. The lesion is composed of strands, cords, and islands of odontogenic epithelium
embedded in a cell-rich primitive ectomesenchyme, resembling the dental papilla.
HISTOPATHOLOGICAL FEATURES

41. Well-defined, radiolucent area containing various amounts of radiopaque material
of irregular size and form
RADIOLOGIC FEATURES

42. DIFFERENTIAL DIAGNOSIS
Complex odontoma

43. HAMARTOMAS OF OSSEOUS TISSUES

44. TORI

45. 45
• These are benign, developmental bony growths that are
commonly observed in the oral cavity.
• Latin word torus : “to stand out” / “lump”
SYNONYMS:
• Exostosis of oral cavity
• Buccal exostosis.
INTRODUCTION

46. • More common and are specific to the midline hard palate and anterolateral lingual
mandible.
• Similar lesions involving the buccal aspect of the maxilla or mandible are called
exostoses.
• These areas are covered by keratinized or nonkeratinized mucosa, depending on the
anatomic location.

47. Torus maxillaris externus is a sessile nodule of bone signifies one or multiple unilateral
or bilateral hyperostoses arising from the alveolar portion of the maxilla, usually in the
molar region
Torus mandibularis is a bony protruberance located on the lingual aspect of the mandible
(commonly between the canine and premolar areas).
Torus palatinus is a benign thickening of normal cortical and medullary bone on the oral
surface of the hard palate.
DEFINITION

49. 49
ETIOLOGY:
• Mild nasal septum pressures, which form palatal torus
• The torquing action of the arch of the mandible, which form
mandibular torus
• Lateral pressures from the roots of the underlying teeth, which
form buccal exostosis
• Bruxism (tooth grinding) forms the torus, which is more common
in early adult life

50. 50
Reichart’s modification of Haugen's classification:
Grade I – Tori up to 3 mm in their largest dimension
Grade II – Tori up to 6 mm in their largest dimension
Grade III – Tori above 6 mm belong to this group

51. 51
Maxillary Tori can be categorized by their appearance
1.Flat tori - Arising as a broad base and a smooth surface, are located on the
midline of the palate and extend symmetrically to either side.
2.Spindle tori - Have a ridge located at their midline.
3.Nodular tori - Have multiple bony growths that each have their own base.
4.Lobular tori - Have multiple bony growths with a common base.

52. 52
Mandibular Tori can be categorized as:
• Unilateral solitary
• Bilateral solitary
• Unilateral multiple
• Bilateral multiple
• Bilateral combined

53. 53
CLINICAL PRESENTATION
• They are usually asymptomatic and discovered incidentally but
when tori continues growth become large and interfere with
tongue mobility and speech, and the thin mucosa
• The growth of tori is very slow and may stop spontaneously

54. 54
RADIOGRAPHIC FINDINGS
• Appear as well-defined radiopacities superimposed on the roots of
the teeth.
• Palatal tori may not be appreciated in periapical radiographs.
• Occlusal radiographs may show a faint radiopaque shadow over the
midpalatal region
• Mandibular tori are readily visualized as radiopaque areas projecting
from the lingual cortical plate on mandibular occlusal radiographs

55. 55
DIFFERENTIAL DIAGNOSIS
Osteoma
Fibrous Dysplasia
Paget’s Disease

56. Management :
• No management is required unless tori pose a
functional problem
• Surgical Excision

57. • The mucosa over torus is ulcerated
• Speech interference.
• Prosthodontic reconstruction.
• Patient with poor oral hygiene around the lower posterior teeth.
• Cancer phobia.
• Traumatic ulceration from mastication
• Disturbances involving masticatory apparatus
• Esthetic reasons
INDICATIONS FOR SURGICAL REMOVAL:

58. FIBROUS DYSPLASIA

59. 59
• It is a benign developmental disorder, where normal bone is
substituted by fibrous tissue with abnormal mineralization
also called as a dysplastic process of transformed
osteogenesis.
INTRODUCTION

60. ETIOLOGY AND PATHOGENESIS
• It is caused by a mutation in the G
protein alpha- subunit (Gs- alpha)
gene, which disrupts guanosine
triphosphatase function, resulting in
an increase in cyclic adenosine
monophosphate levels, which excite
endocrine receptors.

61. 61
CLINICAL FEATURES:
FD may manifest as:
1. The monostotic form; a single bone lesion
2. The polyostotic form; multiple bone lesions:
 Craniofacial Fibrous Dysplasia
 Jaffe–lichtenstein Type
 Mccune–albright Syndrome
Monostotic form is at least six times more common than polyostotic form

62. Monostotic form
• Asymptomatic bone swelling with buccolingual and inferior cortical bone expansion
• Obliteration of the maxillary sinus
• Root and tooth displacement
• Root resorption
• Dislocation of inferior mandibular canal

63. 63
POLYOSTOTIC FORM
• Hormonal abnormalities
• Early puberty
• Skin pigmentation

64. 64
 equally in male and female patients
 maxilla slightly more often than the mandible.
 the most frequent sites-
* In the mandible: molar, premolar, and canine areas,
the ramus and the symphysis.
* In the maxilla: the molar-premolar region with the
maxillary sinus being frequently involved. FD may
extend into the floor of the orbit, the zygomatic
process, and backward toward the base of the skull

65. 65
• The lesion forms a painless expansion of the jawbone, which
grows slowly over the years and then stops.
• The expansion is usually fusiform (low plateau) rather than
nodular or dome shaped and is firm, smoothly contoured, and
covered with normal mucosa.
• Teeth in the region remain firm and are not displaced.
ORAL MANIFESTATION

66. 66
RADIOGRAPHIC FEATURES
Early lesions of FD :
* Usually an elongated rather than spherical
radiolucency.
* Margins are ragged and poorly defined,
merging imperceptibly into normal bone.
* These lesions are usually situated deep within
the jawbone rather than superficially in the
alveolus .

67. 67
LATE STAGES
* The maturing changes that produce the ground-glass
appearance may commence at the periphery of the lesion.
* Gross displacement of the mandibular canal is frequently
associated with FD of the mandible

68. 68
• Waters’ view of maxillary lesions frequently shows a radiodense
area that largely obliterates the maxillary sinus and involves the
zygoma and lower rim of the orbit.
• Most common manifestation of fibrous dysplasia in the skull is the
thickening of the occiput and base of skull.
• Involved dentition shows narrowing of the periodontal ligament
space with an ill-defined lamina dura that blends with the abnormal
bone.

69. • Grossly, the tissue is calcified, firm, gritty or granular.
• The characteristic microscopic features of fibrous
dysplasia comprises a fibrous stroma in which
spicules of woven bone are found.
• The woven bone is present in the form of irregular
shaped trabeculae which can be resembled to Chinese
script writing
HISTOPATHOLOGIC FEATURES

70. • The disease tends to stabilize and essentially stops growing when skeletal maturation is
reached.
• Small lesions, particularly in mandible can be removed by complete resection.
• Cosmetic deformity, with associated psychological problems or functional deformity
may require surgical intervention
MANAGEMENT