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 Table of Contents  
CASE REPORT
Year : 2022  |  Volume : 7  |  Issue : 1  |  Page : 73-76

Surgical management of complex odontoma associated with impacted tooth: A case report and review of literature


Department of Periodontics and Community Dental Sciences, College of Dentistry, King Khalid University, Abha, Saudi Arabia

Date of Submission09-Jan-2022
Date of Decision18-Jan-2022
Date of Acceptance22-Jan-2022
Date of Web Publication27-Jul-2022

Correspondence Address:
Dr. Manea Mousa AlAhmari
Department of Periodontics and Community Dental Sciences, College of Dentistry, King Khalid University, Abha
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/KKUJHS.KKUJHS_6_22

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  Abstract 

Odontomas are a type of mixed odontogenic tumor made up of mineralized ectomesenchymal tissue. Odontomas are divided into two categories by the World Health Organization: complex and compound. They are commonly observed in regular radiography tests and can be caused by a variety of factors. They are, however, rarely linked to impacted teeth. Through a clinical case report, this study attempts to highlight the clinical and histological aspects of this rare dental tumor. In the present case report, a 28-year old male patient visited with a complaint of impacted anterior tooth and swelling. After a thorough clinical and radiological examination, it was decided to excise the growth by curettage. On histological investigation, the tissue was diagnosed with complex odontoma. One-year follow-up of the case revealed excellent healing with no sign of recurrence.

Keywords: Curettage, hamartoma, impacted tooth, odontoma, tooth-like structure


How to cite this article:
AlAhmari MM. Surgical management of complex odontoma associated with impacted tooth: A case report and review of literature. King Khalid Univ J Health Sci 2022;7:73-6

How to cite this URL:
AlAhmari MM. Surgical management of complex odontoma associated with impacted tooth: A case report and review of literature. King Khalid Univ J Health Sci [serial online] 2022 [cited 2022 Nov 28];7:73-6. Available from: https://www.kkujhs.org/text.asp?2022/7/1/73/352525


  Introduction Top


In 1867, Paul Broca referred to the “tumor caused by the proliferation or transitory of full dental tissue” and named them “odontoma.” The “World Health Organization” did not identify a grouping of two forms of odontomas until 1992. The “compound odontomas” and the “complex odontomas” are malformations representing the dental tissues named “denticles” that are placed in an organized and unorganized manner, respectively. Combinations of these two are called “mixed odontomas.”[1]

Compound odontomas are the most common type,[2] with the maxillary incisors and canines being the most common location, followed by the posterior and anterior mandibular areas. The second and third mandibular molars are more commonly affected by complex odontomas. Children are more likely to develop these hamartomatous lesions, with no gender differences.[3] Clinically, both subtypes' growth is often gradual and painless, and it is frequently linked to changes in the primary or permanent teeth.[4]

Routine radiographic examinations (orthopantomogram and intraoral periapical radiograph) to determine the cause of delayed tooth eruption frequently reveal these abnormalities. Odontomas are usually unilocular on radiographs and have several radiopaque, called denticles that are tooth like. Sometimes, they may be seen as a solid radiopaque mass encircled by a radiotransparent thin ring. Lesions are most commonly found between the roots of erupted teeth or between the deciduous and permanent dentition.[3] Odontomas are made up of a variety of tooth tissue formations, comprising cement, dentin, enamel, and occasionally pulpal tissues, and their diagnosis is validated by histological testing.

For odontomas, traditional surgery is the preferred method of treatment. For the treatment of cutaneous and mucosal diseases, lasers can be used successfully,[5] and it is known that the erbium-doped yttrium aluminum garnet (Er: YAG) laser, with a wavelength of 2940 nm, has appropriate qualities for treating hard tissue due to its characteristic wavelength, which is highly absorbed by water.[6] These can successfully ablate bone even though no heat is emitting that may harm nearby structures.[7]

In 1983, Eriksson et al. proposed that when the rotary instrumentation bone surgery was done, the temperature of the tissue should not increase over 47°C for more than a minute to avoid lasting damage to the cell. Because photothermal interaction is the primary form of ablative laser-tissue contact, the notion of possible thermal injury may also be imagined for laser use. These harmful effects can be reduced by utilizing a pulsed emission laser and using cooling methods such as water and air spray. Er: YAG laser, which operates at 20 Hz, an average power of 5.0 Watts, is also said to have strong cutting capacity for dental hard tissue without generating carbonization, as well as significant antibacterial activity.[8] The goal of our study was to assess the effectiveness of conventional surgery in managing odontomas. This was achieved by assessing the recurrence and the clinical results.


  Case Report Top


A 28-year-old male subject presented to the dental clinic complaining of missing anterior teeth. At the intraoral clinical examination, a localized swelling over the alveolar mucosa of the right central incisor region was reported [Figure 1]. The nature of the swelling was hard, nonfluctuant, and nontender. The impacted right central incisor was noted on a panoramic radiograph closely associated with masses that were diagnosed as a radiopaque mass having a lucent halo and associated bone thickening (cortical). The cone-beam computed tomography images revealed a 1.2 cm × 1.3 cm × 1.2 cm hyperdense mass interspersed with areas of hypodensity [Figure 2]a and [Figure 2]b.
Figure 1: Preoperative picture of the affected area

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Figure 2: (a) Cone-beam computed tomography image of the anterior maxillary region showing radiopaque mass in lateral view and (b) same mass in cross-sectional view

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Following a thorough diagnosis, the decision was made to remove the lesion. An intraoral technique was used to perform traditional surgery. The surgical procedure comprised administration of local anesthesia (2% lidocaine, with adrenaline 1:80000), followed by raising a mucoperiosteal flap, executing an osteotomy to disclose the lesion, and resecting the odontoma with curettage of the surrounding tissues [Figure 3]. The cavity was filled with equine cortical and spongy bone (“Bioteck, Vicenza, Italy, Osteoxenon® granules”) to avoid the formation of significant bone defect during healing phase. Interrupted sutures were used to close the flap in its original position by using 3-0 polytetrafluoroethylene suture material, needle 3/8 “Gore-tex®.” To confirm the diagnosis, the excised tissue was sent for histopathological examination [Figure 4]a.
Figure 3: Intraoperative picture of the affected area

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Figure 4: (a) Gross specimen picture and (b) histopathological picture

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The histological specimen [Figure 4]b validated the clinical findings of complex odontomas, with globules of cementum-like material and tooth-like dentin as the major component that were randomly formed hard tissues, although enamel was also present.

Postsurgery, comprehensive treatment plan was explained to the patient that consisted of orthodontic extrusion of the impacted central incisor and space gain in the area of the right central incisor because space loss has occurred due to long-term edentulous space.


  Discussion Top


The occurrence of the odontogenic tumor varied across the continents.[9],[10] However, we might speculate that geographic variation may play a role in the differences identified in these studies because odontoma is underdiagnosed in some countries due to a lack of clinical signs, the slow growth of some tumors, and even the patient's neglect in not seeking treatment.[11],[12] As in the presented case, it took more than 2 years for the patient to undergo a biopsy and receive a histological confirmation of complex odontomas after the growth was first discovered. As a result, many instances are misdocumented or never sent for histological examination.

We can see the predominance of odontomas among odontogenic tumors in the Brazilian population, with 29.9%–9.7% compound odontoma and 15.3% complex odontoma.[13] Several odontomas involving the entire jaw, on the other hand, are quite uncommon.[14] This is a rare occurrence of a complex odontoma with significant harm in the clinical case in question, which was presumably caused by the impaction of the lower third molar.

The majority of individuals with odontogenic tumors (about 86%) have been diagnosed for more than 20 years and have no preference for sex of the subjects.[15] Complex odontomas are more abundant in the right posterior areas of the jaw, which is consistent with earlier research.[16] Many cases are detected during a regular radiographic evaluation because it is frequently an asymptomatic growth. Complex odontomas include distinct radiographic features, such as the presence of calcified structures, akin to a radiopaque mass, rather than a tooth, as in the compound odontoma, which is surrounded by a radiolucent area. Complementing conventional radiographs, computed tomography reveals more features of the interior structure that are not visible on conventional radiography, allowing us to display in three dimensions, and it is very useful in diagnosis and surgical planning.[17],[18]

The presence of impacted teeth has been linked to the development of pathological circumstances of this odontogenic tumor. As a result, removing this dental growth in the presence of a complication requires well-defined criteria.[19] Infection, cysts, tumors, and loss of the teeth and adjacent bone are all signs that it is time to get rid of it. It is highly rare for malignancies to grow in the presence of impacted teeth. One-year clinical and radiographic follow-up of the case revealed excellent healing with no sign of recurrence [Figure 5]a and [Figure 5]b.
Figure 5: Postoperative images (a) clinical (b) radiographic

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  Conclusion Top


The clinical, radiological, and histomorphological observations, as well as the studies required to arrive at a diagnosis, are highlighted in this case report. The treatment detailed here, when paired with histological research, confirms that the established treatment strategy is the best option. Disparities in routine tooth eruption are typical, but major departures from accepted standards should prompt the clinician to look into the patient's health and growth further. Early diagnosis allows the practitioner to take a more straightforward approach to treatment, resulting in a better prognosis.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
López-Areal L, Silvestre Donat F, Gil Lozano J. Compound odontoma erupting in the mouth: 4-year follow-up of a clinical case. J Oral Pathol Med 1992;21:285-8.  Back to cited text no. 1
    
2.
Tomizawa M, Otsuka Y, Noda T. Clinical observations of odontomas in Japanese children: 39 cases including one recurrent case. Int J Paediatr Dent 2005;15:37-43.  Back to cited text no. 2
    
3.
Soluk Tekkesin M, Pehlivan S, Olgac V, Aksakallı N, Alatli C. Clinical and histopathological investigation of odontomas: Review of the literature and presentation of 160 cases. J Oral Maxillofac Surg 2012;70:1358-61.  Back to cited text no. 3
    
4.
Litonjua LA, Suresh L, Valderrama LS, Neiders ME. Erupted complex odontoma: A case report and literature review. Gen Dent 2004;52:248-51.  Back to cited text no. 4
    
5.
Angiero F, Parma L, Crippa R, Benedicenti S. Diode laser (808 nm) applied to oral soft tissue lesions: A retrospective study to assess histopathological diagnosis and evaluate physical damage. Lasers Med Sci 2012;27:383-8.  Back to cited text no. 5
    
6.
Sullivan J, Pileggi R, Varella C. Evaluation of root-end resections performed by Er, Cr: YSGG laser with and without placement of a root-end filling material. Int J Dent 2009;2009:798786.  Back to cited text no. 6
    
7.
Rizoiu IM, Eversole LR, Kimmel AI. Effects of an erbium, chromium: Yttrium, scandium, gallium, garnet laser on mucocutanous soft tissues. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996;82:386-95.  Back to cited text no. 7
    
8.
Eriksson AR, Albrektsson T. Temperature threshold levels for heat-induced bone tissue injury: A vital-microscopic study in the rabbit. J Prosthet Dent 1983;50:101-7.  Back to cited text no. 8
    
9.
Luo HY, Li TJ. Odontogenic tumors: A study of 1309 cases in a Chinese population. Oral Oncol 2009;45:706-11.  Back to cited text no. 9
    
10.
Osterne RL, Brito RG, Alves AP, Cavalcante RB, Sousa FB. Odontogenic tumors: A 5-year retrospective study in a Brazilian population and analysis of 3406 cases reported in the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;111:474-81.  Back to cited text no. 10
    
11.
Mehra P, Singh H. Complex composite odontoma associated with impacted tooth: A case report. N Y State Dent J 2007;73:38-40.  Back to cited text no. 11
    
12.
Tawfik MA, Zyada MM. Odontogenic tumors in Dakahlia, Egypt: Analysis of 82 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109:e67-73.  Back to cited text no. 12
    
13.
Fernandes AM, Duarte EC, Pimenta FJ, Souza LN, Santos VR, Mesquita RA, et al. Odontogenic tumors: A study of 340 cases in a Brazilian population. J Oral Pathol Med 2005;34:583-7.  Back to cited text no. 13
    
14.
da Costa CT, Torriani DD, Torriani MA, da Silva RB. Central incisor impacted by an odontoma. J Contemp Dent Pract 2008;9:122-8.  Back to cited text no. 14
    
15.
Sriram G, Shetty RP. Odontogenic tumors: A study of 250 cases in an Indian teaching hospital. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;105:e14-21.  Back to cited text no. 15
    
16.
Ochsenius G, Ortega A, Godoy L, Peñafiel C, Escobar E. Odontogenic tumors in Chile: A study of 362 cases. J Oral Pathol Med 2002;31:415-20.  Back to cited text no. 16
    
17.
Marques YM, Botelho TD, Xavier FC, Rangel AL, Rege IC, Mantesso A. Importance of cone beam computed tomography for diagnosis of calcifying cystic odontogenic tumour associated to odontoma. Report of a case. Med Oral Patol Oral Cir Bucal 2010;15:e490-3.  Back to cited text no. 17
    
18.
Gurgel CV, Lourenço Neto N, Kobayashi TY, Garib DG, da Silva SM, Machado MA, et al. Management of a permanent tooth after trauma to deciduous predecessor: An evaluation by cone-beam computed tomography. Dent Traumatol 2011;27:408-12.  Back to cited text no. 18
    
19.
Werkmeister R, Fillies T, Joos U, Smolka K. Relationship between lower wisdom tooth position and cyst development, deep abscess formation and mandibular angle fracture. J Craniomaxillofac Surg 2005;33:164-8.  Back to cited text no. 19
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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