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 Table of Contents  
CASE REPORT
Year : 2014  |  Volume : 42  |  Issue : 3  |  Page : 115-117

An unusual case of erupted compound odontoma: What happens when it erupts?


1 Department of Oral Medicine and Radiology, Yenepoya Dental College, Yenepoya University, Mangalore, Karnataka, Egypt
2 Department of Oral Pathology, Yenepoya Dental College, Yenepoya University, Mangalore, Karnataka, Egypt

Date of Submission11-Apr-2014
Date of Acceptance09-May-2014
Date of Web Publication29-Oct-2014

Correspondence Address:
Prasanna Kumar Rao
MD, Department of Oral Medicine and Radiology, Yenepoya Dental College, Yenepoya University, Nithyananda Nagar, Deralakatte, Mangalore - 575 018, Karnataka
Egypt
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DOI: 10.4103/1110-1415.143570

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  Abstract 

Odontomas are benign odontogenic tumors of epithelial and mesenchymal origin. They are considered as hamartomas rather than true neoplasms. They are asymptomatic, slow growing, nonaggressive and are composed of dental tissues. They are commonly associated with tooth eruption disturbances and are discovered on routine radiographic examination. Erupted odontomas are rare entities in the oral cavity. Here, we report an unusual case of erupted odontoma.

Keywords: Benign odontogenic tumor, compound odontoma, hamartoma


How to cite this article:
Rao PK, Chatra L, Shenai P, Veena K M, Prabhu RV, Kushraj T, Shetty P, Prabhu V. An unusual case of erupted compound odontoma: What happens when it erupts?. Tanta Med J 2014;42:115-7

How to cite this URL:
Rao PK, Chatra L, Shenai P, Veena K M, Prabhu RV, Kushraj T, Shetty P, Prabhu V. An unusual case of erupted compound odontoma: What happens when it erupts?. Tanta Med J [serial online] 2014 [cited 2020 Nov 29];42:115-7. Available from: http://www.tdj.eg.net/text.asp?2014/42/3/115/143570


  Introduction Top


Odontomes are slow-growing hamartomas with unknown etiology [1]. They are benign odontogenic tumors of epithelial and mesenchymal origin [2]. The WHO classified odontomas into four types [Table 1] [3],[4]. These odontomas constitute around 22% of all odontogenic tumors of the jaws [5]. Around 10% of all odontogenic tumors of the jaws are compound odontomas. The incidence of compound odontoma is between 9 and 37% and complex odontomas between 5 and 30% [3].
Table 1: WHO classification [3,4]

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Erupted odontomas in the oral cavity are extremely rare. Usually, they are associated with tooth eruption disturbances. Since 1980, only 20 cases of erupted odontoma have been reported [4],[6]. Here, we describe an unusual case of erupted odontoma in the mandibular anterior region in a 25-year-old female patient.


  Case report Top


A 25-year-old medically fit female patient reported to the dental clinic with the complaint of the presence of a small hard mass in the mandibular anterior region. The mass was noticed 3 months back. Intraoral examination revealed a small mobile whitish oval-shaped hard structure in a lingual aspect of the mandibular anterior region at the level of the attached gingiva [Figure 1]. An intraoral periapical radiograph showed a well-defined radioopaque mass similar in density to the dental tissue. It was at the level of the middle third of the root surface of the mandibular left second incisor tooth [Figure 2]. On the basis of history and clinical and radiographic examinations, a diagnosis of erupted compound odontoma was made. It was removed under local anesthesia. Histopathological examination showed an organized mass of dental tissues, which confirmed the clinical diagnosis of compound odontoma [Figure 3] and [Figure 4].
Figure 1:

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Figure 2:

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Figure 3:

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Figure 4:

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  Discussion Top


The term odontoma was first described by Paul Broca in 1867. He defined the term as a tumor formed by the overgrowth or transitory of complete dental tissue [7]. In 1914, these benign tumors were grouped according to their developmental origin as epithelial, composite and epithelial and mesodermal. Later in 1946, the classification of odontoma was formulated by Thoma and Goldman [Table 2]. Odontoma by definition refers to any tumor of odontogenic origin. Rumel et al. reported a first case of odontoma in 1980 [8],[9],[10].
Table 2: The Thoma and Goldman classification [3,9]

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The etiology may be local trauma, inflammatory and infectious processes and hereditary anomalies such as Gardner's syndrome and Hermann's syndrome. Odontoblastic hyperactivity and alterations in the genetic components are also responsible for controlling dental development. Persistence of a portion of the lamina plays an important role in formation of complex or compound odontoma [11].

It is classified as compound and complex types: The compound type is more in the maxillary anterior region and the complex type is more in the mandibular posterior region [12]. Depending on their position within the jaws, they are classified as intraosseous (erupted odontoma), extraosseous or peripheral odontoma [11],[13]. Intraosseous odontomas occur inside the bone and may eventually erupt in the oral cavity. Peripheral odontomas arise in the extraosseous soft tissues and have a tendency to exfoliate [13],[14]. A new type known as a hybrid odontome has also been reported by some authors [15]. There is no sex prediction and it can occur at any age, but the mean age of occurrence is the second or the third decade of life [16]. The present case consisted of an erupted compound type of odontoma in the mandibular anterior region in a 25-year-old female patient, which is a very rare entity.

Because of the lack of root length and periodontal ligaments, eruption mechanisms of these odontomas are different from that of normal tooth eruptions. Its increasing size over a period of time will lead to resorption of the overlying bone, alveolar bone remodeling in young adults or reactive growth of the surrounding capsule in elderly patients, resulting in occlusal movement or eruption of odontomas [10].

Usually, odontomas are asymptomatic, slow growing and nonaggressive; exposure of these benign tumors sometimes causes pain, swelling, inflammation of the adjacent soft tissues or infection associated with suppuration, tongue irritation, facial asymmetry, halitosis and malocclusion [10]. In the reported case, the patient was complaining of tongue irritation and pain due to eruption of odontoma on the mandibular lingual aspect.

Radiographically, three developmental stages can be identified. In the first stage, it is radiolucent because of the absence of dental tissue calcification; later, it shows partial calcification in the second or the intermediate stage; and finally, in the third stage, it shows predominant tissue calcification that is fully radioopaque [6]. Advanced radiographic techniques such as high-magnification microradiographs show the finest dentinal tubules in detail. Low-magnification radiography shows structural differences clearly [3]. The present case consisted of a well-defined radioopaque mass that was in the third stage and similar in density to the dental tissue.

The treatment of choice is surgical removal and curettage because of the very low rate of recurrence, followed by histological examination to confirm the diagnosis.


  Conclusion Top


Odontoma is usually associated with tooth eruption disturbances and is discovered incidentally on routine radiographic examination. A proper clinical and radiographic examination should be performed for patients who have clinical evidence of delayed eruption, missing tooth or erupted malformed tooth with or without a history of trauma to rule out the presence of odontoma. They erupt very rarely in the oral cavity, which is undesirable for the appearance when it erupts labially and causes irritation to the tongue when it erupts in the lingual aspect. Hence, surgical removal followed by histopathological examination is necessary to confirm the diagnosis, and the patient should be on regular follow-up.


  Acknowledgements Top


Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Gnepp D. Diagnostic surgical pathology of head and neck. Philadelphia: WB Saunders Co.; 2001.  Back to cited text no. 1
    
2.
Ragalli CC, Ferreria JL, Blasco F. Large erupting complex odontoma. Int J Oral Maxillofac Surg 2000; 29:373-374.  Back to cited text no. 2
    
3.
Sathish V, Prabhadevi MC, Sharma R. Odontome: a brief overview. Int J Clin Pediatr Dent 2011;4:177-185.  Back to cited text no. 3
    
4.
Amailuk P, Grubor D. Erupted compound odontoma: case report of a 15-year-old Sudanese boy with a history of traditional dental mutilation. Br Dent J 2008; 204:11-14.  Back to cited text no. 4
    
5.
Amado CS, Gargallo AJ, Berini AL, Gay EC. Review of 61 cases of odontoma: presentation of an erupted complex odontoma. Med Oral 2003; 8:366-373.  Back to cited text no. 5
    
6.
Tejasvi AML, Babu BB. Erupted compound odontomas: a case report. J Dent Res Dent Clin Dent Prospect 2011; 5:33-36.  Back to cited text no. 6
    
7.
Batra P, Gupta S, Rajan K, Duggal R, Prakash H. Odontomes-diagnosis and treatment: a 4 case report. J Pierre Fauchard Acad 2003; 19:73-76.  Back to cited text no. 7
    
8.
Rumel A, de Freitas A, Birman EG, Tannous LA, Chacon PT, Borkas S. Erupted complex odontoma: report of a case. Dentomaxillofac Radiol 1980; 9:5-9.  Back to cited text no. 8
[PUBMED]    
9.
Sudarshan R, Annigeri RG, Vijayabala GS. Periapical complex odontome - a rare case report. Int J Adv Biotechnol Res 2012; 3:610-614.  Back to cited text no. 9
    
10.
Serra-Serra G, Berini-Aytes L, Gay-Escoda C. Erupted odontomas: a report of three cases and review of the literature. Med Oral Patol Oral Cir Bucal 2009; 14:E299-E303.  Back to cited text no. 10
    
11.
Vengal M, Arora H, Ghosh S, Pai KM. Large erupting complex odontoma: a case report. J Can Dent Assoc 2007; 73:169-171.  Back to cited text no. 11
    
12.
Litonjua L, Suresh L, Valderrama L, Neiders M. Erupted complex odontoma: a case report and literature review. Gen Dent 2004; 52:248-251.  Back to cited text no. 12
    
13.
Shekar SE, Rao RS, Gunasheela B, Supriya N. Erupted compound odontome. J Oral Maxillofac Pathol 2009; 13:47-50.  Back to cited text no. 13
[PUBMED]  Medknow Journal  
14.
Junquera L, De Vincente JC, Roig P, Olay S, Rodriguez-Relio O. Intraosseous odontoma erupted in to the oral cavity: an unusual pathology. Med Oral Pathol Oral Cir Bucal 2005; 10:248-251.  Back to cited text no. 14
    
15.
Singh S, Singh M, Singh I, Kandelwal D. Compound composite odontome associated with an unerupted deciduous incisors a rarity. J Indian Soc Prev Dent 2005; 9:146-150.  Back to cited text no. 15
    
16.
Nisha D, Rishabh K, Ashwarya T, Sukriti M, Gupta SD. An unusual case of erupted composite complex odontoma. J Dent Sci Res 2011; 2:1-5.  Back to cited text no. 16
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1], [Table 2]



 

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