|Year : 2013 | Volume
| Issue : 2 | Page : 83-85
Erupted compound odontoma: Report of a rare case
Lakshmi Kavitha Nadendla
Senior Lecturer, Department of Oral Medicine and Maxillofacial Radiology, Kamineni Institute of Dental Sciences, Sreepuram, Narketpally, Nalgonda District, Andhra Pradesh, India
|Date of Web Publication||21-Oct-2013|
Lakshmi Kavitha Nadendla
Department of Oral Medicine and Maxillofacial Radiology, Kamineni Institute of Dental Sciences, Sreepuram, Narketpally, Nalgonda District, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
Odontomas are the most common type of odontogenic tumors and are generally asymptomatic. They are usually discovered on routine radiographic examination. Frequently it may interfere with the eruption of the teeth. Eruption of odontoma into the oral cavity is very rare. We report a case of an asymptomatic erupted compound odontoma in an 18-year-old female patient, situated between right mandibular canine and lingually placed right lateral incisor, causing crowding of lower anterior teeth, along with a brief review of the literature.
Keywords: Denticles, dense radioopacity, eruption, homogenous, odontoma, odontoma compound, radiolucent halo
|How to cite this article:|
Nadendla LK. Erupted compound odontoma: Report of a rare case. J Oral Maxillofac Radiol 2013;1:83-5
| Introduction|| |
Odontomas are the most common odontogenic tumors of the jaws and characterized by their slow growth and non-aggressive behavior. They are mixed tumors, consisting of both epithelial and mesenchymal cells, that present a complete dental tissue differentiation (enamel, dentin, cementum and pulp). , According to World Health Organization classification, odontomas are classified as complex odontoma and compound odontomas. A malformation in which all dental tissues are formed, but occurring in less orderly pattern is complex odontoma. A malformation in which all dental tissues are arranged in a more orderly pattern than complex odontoma is compound odontoma.  Clinically, these are asymptomatic lesions often associated to alterations in permanent or temporary tooth eruption. The diagnosis is usually established on occasion of routine radiological studies (panoramic and/or intraoral X-rays), or on evaluating the cause of delayed tooth eruption. 
Odontomas erupting into the oral cavity are extremely uncommon, the first case being reported in English literature in 1980 by Rumel et.al.  The mechanism of odontoma eruption appears to be different from tooth eruption because of lack of the periodontal ligament in odontoma.Therefore, the force required to move the odontoma is not linked to the contractility of fibroblasts, as is the case for the teeth. Although there is no root formation in odontoma, its increasing size may lead to the sequestration of the overlying bone and, hence, occlusal movement or eruption. An increase in size of the odontoma over time produces a force sufficient to cause bone resorption.  Another reason for odontoma eruption could be the bony remodeling of the jaws. 
However the mechanism behind eruption times remains uncertain as some odontomas erupt at a young age and others at an older age.  Eruption of odontomas are most often seen in older people. Thus, it is likely that resorption of the edentulous part of the alveolar process plays a role, but it is also possible that reactive growth of the capsule contributes to this phenomenon.  Eruption at a young age is possible through bone remodeling that might have resulted from the presence of dental follicles.  We are reporting a case of an asymptomatic erupted compound odontoma in an 18 year young female along with a brief review.
| Case Report|| |
An 18-year-old female presented with a chief complaint of presence of extra teeth in relation to right side of the lower arch since 2 years. On examination, along with the normal compliment of teeth, multiple yellowish white teeth like structures were present on the lingual aspect in the fourth quadrant, between the lower right canine and lower right lingually placed lateral incisor [Figure 1]. On palpation, the teeth like structures were asymptomatic, hard and calcified and measured around 5-6 mm in diameter. These calcified structures resembled multiple small teeth and they were non-mobile. There was no erythema, inflammation, ulceration or pain on surrounding mucosa.
|Figure 1: Intraoral view showing erupted compound odontoma between right lateral incisor and canine|
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An intraoral periapical radiograph was advised to determine the exact extent of the lesion as well as its relation to surrounding structures [Figure 2]. It showed multiple radiopaque small teeth like structures between right lateral incisor and canine and was not associated with any impacted teeth. They were well defined with smooth periphery, and the internal structure was densely radiopaque with a small radio lucent halo and appearing like a number of denticles or tooth like structures. These denticles displaced the disto-inferior aspect of the lateral incisor and mesio-inferior aspect of the canine, which led to mild crowding of lower anterior teeth. The location of the lesion can be determined clinically as it is lingually present.
|Figure 2: Intraoral periapical radiograph showing multiple dense radiopaque teeth like structures (denticles) with a small radiolucent halo inside the radiopacity|
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Based on clinical and radiographic findings, a diagnosis of erupted compound odontoma was determined. The odontoma was extracted under local anesthesia and it showed no resemblance to normal series of teeth. It consists four small teeth like structures (denticles), with small rudimentary roots [Figure 3]. The specimen was subjected to histopatholgical examination, which confirmed the diagnosis of compound odontoma [Figure 4]. Patient was referred to orthodontics department for further management of crowding teeth.
|Figure 3: An extracted specimen of erupted compound odontoma consisting of four small teeth like structures with rudimentary roots|
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|Figure 4: Histopathology picture showing decalcifi ed dentin, pulp and pulp stones in an irregular matrix of enamel on ×20|
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| Discussion|| |
Odontomas are the most common type of odontogenic tumor and they constitute 22% of all odontogenic tumors of the jaws.  Some authors prefer to refer it as hamartoma, not a true tumor. Paul Brocain 1867 first used the term "odontome."  The etiology of odontoma has been attributed to various pathological conditions like local trauma, inflammatory and or infectious processes, hereditary anomalies (Gardner's syndrome, Hermann's syndrome). Odontoblastic hyperactivity and alterations in genetic component is responsible for controlling dental development. Persistence of a portion of lamina may be an important factor in the etiology of a compound odontoma. 
These are usually asymptomatic lesions, and in most cases they are associated to alterations in permanent or temporary tooth eruption.  Eruption of odontomas is infrequent in the literature. Pain and swelling are the most common symptoms when odontomas erupt, followed by malocclusion.  Recurrent infection following the eruption into the oral cavity has been reported.  Our patient was asymptomatic, there was no pain, swelling or erythema in surrounding mucosa except for lower anterior crowding and the right lateral incisor is positioned lingually, causing malocclusion due to eruption of odontoma. Compound odontomas are more commonly found in the anterior maxilla while complex odontomas tend to favor the posterior mandible.  In our case, the erupted compound odontoma was present in the mandible, which is a rare occurrence.
Radiographically, odontoma presents as a well-defined radiopacity situated in bone but with a density that is greater than bone and equal to or greater than that of a tooth. It contains foci of variable density. It is present with a radiolucent halo, typically surrounded by a thin sclerotic line, surrounding the radiopacity. Radiolucent zone is the connective tissue capsule of a normal tooth follicle. Thin sclerotic line resembles the corticated border seen in a normal tooth crypt. Developmental stages can be identified based on radiologic features and the degree of calcification of the lesion at the time of diagnosis.  First stage is characterized by radiolucency due to the absence of dental tissue calcification, the second or intermediate stage shows partial calcification and the third or classically radiopaque stage exhibits pre-dominant tissue calcification with the surrounding radiolucent halo described above.  Management of choice is surgical removal of the lesion in all cases.
This case needs to be differentiated from supplemental and supernumerary teeth. Supplemental tooth is the one that resembles a normal tooth both morphologically and histologically and is located adjacent to the normal tooth; whereas a supernumerary tooth is a tooth like structure of variable size and shape. However histologically, it represents the normal organization of the tooth structure, such as enamel, dentin, pulp and cementum including the periodontal ligament. 
In conclusion, this paper describes a rare case of asymptomatic erupted compound odontoma causing only mild crowding of anterior teeth. Most often such cases are diagnosed as supplemental or supernumerary tooth or vice versa and need to be differentiated.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]