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CASE REPORT
Year : 2014  |  Volume : 2  |  Issue : 3  |  Page : 88-91

A rare case of bilateral complex odontomas: Clinical, radiological and histopathological findings


1 Departments of Dentomaxillofacial Radiology, Faculty of Dentistry, Ataturk University, Erzurum, Turkey
2 Departments of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ataturk University, Erzurum, Turkey
3 Department of Pathology, Faculty of Medicine, Ataturk University, Erzurum, Turkey

Date of Web Publication14-Nov-2014

Correspondence Address:
Ozkan Miloglu
Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Ataturk University, 25240, Erzurum
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2321-3841.144681

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  Abstract 

Odontoma is the most common odontogenic tumor that is radiographically and histologically characterized by the production of mature enamel, dentin, cementum and pulp tissue. It grows slowly and has nonaggressive behavior. This case report presents clinical, radiological and pathological findings of bilateral complex odontoma that is rarely in literature in a 30-year-old female patient.

Keywords: Bilateral, cone beam computed tomography, odontoma


How to cite this article:
Miloglu O, Yalcin E, Dagistan S, Bayrakdar IS, Calik M, Ertas U. A rare case of bilateral complex odontomas: Clinical, radiological and histopathological findings . J Oral Maxillofac Radiol 2014;2:88-91

How to cite this URL:
Miloglu O, Yalcin E, Dagistan S, Bayrakdar IS, Calik M, Ertas U. A rare case of bilateral complex odontomas: Clinical, radiological and histopathological findings . J Oral Maxillofac Radiol [serial online] 2014 [cited 2019 Nov 13];2:88-91. Available from: http://www.joomr.org/text.asp?2014/2/3/88/144681


  Introduction Top


Odontoma is most common odontogenic tumor that is radiographically and histologically characterized by the production of mature enamel, dentin, cementum and pulp tissue. The World Health Organization classifies odontomas as a benign odontogenic mixt tumor consists of odontogenic epithelium and odontogenic ectomesenchyme with dental hard tissue formation. [1],[2] Odontomas are best known as a hamartomatous benign tumors rather than true neoplasms due to slow growth and well differentiated tooth tissue. They are generally asymptomatic and are usually discovered on routine radiographic examinations. [3],[4],[5] The present report shows bilateral complex odontoma that is rarely in the literature and cone beam computed tomography (CBCT) is the important imaging method to evaluate this type masses for management and treatment planning.


  Case Report Top


A 30-year-old female patient referred to Department of Oral Diagnosis and Dento-Maxillofacial Radiology at the Ataturk University in Turkey because of the tooth pain and missing tooth. The patient gave history that she has not any systemic diseases. Extraoral examination revealed no obvious facial asymmetry. Mouth opening was adequate. Intraorally, the patient was examined and found out teeth that have deep caries, half-embedded second molar tooth in the right region and missing second molar tooth in the left mandibular region on routine clinical examination. To understanding cause of complaints, we took routine radiography including periapical radiography and orthopantomography after intra-oral routine clinical examination. A panoramic radiograph revealed bilateral well defined radiopaque masses with radiolucent borders that not resemble teeth are associated with impacted teeth were seen at the posterior region of mandibular [Figure 1]. Then we decided CBCT examination to analyze this case as three dimensions. CBCT images that were taken from the patient were analyzed by two radiologists. Bilateral well defined radiopaque masses associated with second molar teeth have seen on the panoramic images that were created by CBCT imaging software. We have seen radiopaque masses in right and left posterior mandibular regions on axial sequences. It has been seen slightly buccal-lingual expansion and cortical thinning in the right mandibular posterior region on the coronal sequences. It could be not seen buccal-lingual expansion and cortical thinning in the right mandibular posterior region. This mass in the left posterior region of the mandibula lead to be impacted second molar tooth and the mass in the right posterior region of the mandibula lead to be half-impacted second molar tooth. These masses lead to change course of mandibular canal inferiorly [Figure 2] and [Figure 3]. After assessment on CBCT, we referred to the patient Department of Oral Surgery as bilateral complex odontoma. These lesions were removed with surgical excision by oral surgeon and after extraction these lesions [Figure 4]a and b were sent to Department of the Pathology to be investigated. Histopathologic examination revealed a complex odontoma [Figure 5]a-d. The patient was followed-up. Panoramic radiography was taken after 6 months. Significant bone regeneration was observed in the regions of the lesions without signs of recurrence.
Figure 1: Panoramic radiograph showing the bilateral radiopaque structures with bilateral impacted mandibular second molars

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Figure 2: Cone beam computed tomography images of the lesion on the right side. (a) Axial, (b) coronal, (c) sagittal and (d) three-dimensional images clearly show borders of the lesion and its relationship with cortical bone.

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Figure 3: Cone beam computed tomography images of the lesion on the left side. (a) Axial, (b) coronal, (c) sagittal and (d) three-dimensional images clearly show borders of the lesion and its relationship with cortical bone.

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Figure 4: (a and b) Bilateral extracted tissues

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Figure 5: (a) Photomicograph shows pulpal tissue adjacent to predentin and mature dentin. The relationship is similar to that of normal teeth (H and E, ×200), (b) the inner soft and reticular connective tissue was covered by stratified epithelium resembling odontoblasts (H and E, ×200), (c) microscopic examination showed a structure consisting of dentine and connective tissue resembling a pulp tissue (H and E, ×100) and (d) the inner soft and reticular connective tissue was covered by stratified epithelium resembling odontoblasts (H and E, ×200)

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  Discussion Top


Odontomas are the most frequent benign odontogenic tumor that is nonaggressive, slow growing, expanding and routinely asymptomatic in the oral cavity and accounts for 22-67% of all odontogenic tumours. They occur particularly in second and third decades of life and diagnose on routine radiological examination. They show no sex predilection. The present case was diagnosed on routine examination. [1],[2],[3],[4],[5] The patient is in third decade of life and female. These lesions removed from the patient show slow growing in terms of clinical features and radiological appearances.

Clinically, three types of odontomas are recognized in the literature: Intraosseous (central), extraosseous (peripheral or soft tissue), and erupted odontoma. Intraosseous odontoma occurs in the bone and may erupt into the oral cavity. When it erupts into the oral cavity, it was called erupted odontoma. Extraosseous odontoma occurs in the soft tissue covering the tooth-bearing part of the jaws. Peripheral odontoma is rare and having a tendency to exfoliate. [2],[6] The present case is intraosseous odontoma.

Histologically odontomas are separated into three groups, according to World Health Organization classification.

  • Complex odontoma; when the calcified dental tissues are simply arranged in an irregular mass bearing no morphological similarity to rudimentary teeth.
  • Compound odontoma: Composed of all odontogenic tissues in an orderly pattern, which result in many teeth-like structures, but without morphological resemblance to normal teeth.
  • Ameloblastic fibro-odontoma: Consists of varying amounts of calcified dental tissue and dental papilla-like tissue, the later component resembling an ameloblastic fibroma.


The ameloblastic fibro-odontoma is considered as an immature precursor of complex odontoma. A new variant called as hybrid odontomas are quoted in few published literatures. [6],[7] The present case is complex odontoma that is bilateral and rarely in the literature.

Radiographically, odontomas are divided into two types in terms of the degrees of morphological similarity to mature teeth as complex and compound odontoma. The contents of the odontomas are largely radiopaque surrounded by a lucent zone and have a well defined cortical border. Compound odontomas have tooth-like structures as known denticles. The degree of radiopacity is equivalent or exceeds that of adjacent tooth structure and it may change in from one part to another part. The morphology of compound odontoma is similar to a developing tooth or unerupted tooth. Their sizes are generally about same as a small tooth and are most commonly located in the anterior tooth-bearing areas. Complex odontoma shows a well circumscribed radiopaque mass and occasionally it may be surrounded by a narrow radiolucent zone. They are often found posterior region of mandibula and have greater growth potential. They may reach considerable size that causes deformity of jaws. The lesions are often detected because of abnormal tooth eruption or absence of eruption of teeth. Compound odontoma are about twice as common as the complex type. [6],[7],[8],[9],[10],[11],[12] The present case is localized posterior region of mandibula bilaterally that is rarely in literature. The lesions lead to half-impacted second molar tooth in right posterior region of mandibula and absence of eruption of tooth in left posterior region of mandibula.

Odontomas are found during survey of delayed eruption of adjacent teeth or retained deciduous teeth. Most of the odontomas are associated with pathologic changes including malformation, impaction, delayed eruption, malpositioning, cyst formation or displacement and resorption of adjacent teeth. Despite predominantly associated with permanent teeth, they also occur in association with deciduous teeth and they are often involved with impacted teeth. [13],[14]

Panoramic radiography can be used detection of odontomas. But it cannot give enough information to management and treatment planning and CBCT is the better imaging method to evaluate this type masses for management and treatment planning. CBCT can give more information than panoramic radiography. CBCT has also data from all the two dimensional images including panoramic radiography and it has three dimensional images. CBCT has low radiation dose, short imaging time and better image resolution in comparison with CT. [15],[16]


  Conclusion Top


This case report presents bilateral complex odontoma that is rarely in literature. CBCT is the better imaging methods evaluate these lesions. CBCT should use assessment of odontomas.

 
  References Top

1.
White SC, Pharoah MJ. Oral radiology. Principles and Interpretation. 6 th ed. St Louis, The CV Mosby; 2009.  Back to cited text no. 1
    
2.
Soluk Tekkesin M, Pehlivan S, Olgac V, Aksakalli 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. 2
    
3.
Chrcanovic BR, Jaeger F, Freire-Maia B. Two-stage surgical removal of large complex odontoma. Oral Maxillofac Surg 2010;14:247-52.  Back to cited text no. 3
    
4.
Singh V, Dhasmana S, Mohammad S, Singh N. The odontomes: Report of five cases. Natl J Maxillofac Surg 2010;1:157-60.  Back to cited text no. 4
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5.
Schulz M, Reichart PA, Stich H, Lussi A, Bornstein MM. Bilateral malformation of maxillary third molars. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;108:e25-31.  Back to cited text no. 5
    
6.
Arunkumar KV, Vijaykumar, Garg N. Surgical management of an erupted complex odontoma occupying maxillary sinus. Ann Maxillofac Surg 2012;2:86-9.  Back to cited text no. 6
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Mathew A, Shenai P, Chatra L, Veena K, Rao P, Prabhu R. Compound odontoma in deciduous dentition. Ann Med Health Sci Res 2013;3:285-7.  Back to cited text no. 7
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8.
Vaid S, Ram R, Bhardwaj VK, Chandel M, Jhingta P, Negi N, et al. Multiple compound odontomas in mandible: A rarity. Contemp Clin Dent 2012;3:341-3.  Back to cited text no. 8
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Hammoudeh JA, Kleiber GM, Nazarian-Mobin SS, Urata MM. Bilateral complex odontomas: A rare complication of external mandibular distraction in the neonate. J Craniofac Surg 2009;20:973-6.  Back to cited text no. 9
    
10.
D'Cruz AM, Hegde S, Shetty UA. Large Complex Odontoma: A report of a rare entity. Sultan Qaboos Univ Med J 2013;13:E342-5.  Back to cited text no. 10
    
11.
Dayan D, Waner T, Harmelin A, Nyska A. Bilateral complex odontoma in a Swiss (CD-1) male mouse. Lab Anim 1994;28:90-2.  Back to cited text no. 11
    
12.
Spini PH, Spini TH, Servato JP, Faria PR, Cardoso SV, Loyola AM. Giant complex odontoma of the anterior mandible: Report of case with long follow up. Braz Dent J 2012;23:597-600.  Back to cited text no. 12
    
13.
Sebastian AA, Ahsan A, George AJ, Aby J. An unusual triad: Bilateral dilated odontoma, hypodontia and peg laterals. Dent Res J (Isfahan) 2013;10:674-7.  Back to cited text no. 13
    
14.
Kodali RM, Venkat Suresh B, Ramanjaneya Raju P, Vora SK. An unusual complex odontoma. J Maxillofac Oral Surg 2010;9:314-7.  Back to cited text no. 14
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Kobayashi TY, Gurgel CV, Cota AL, Rios D, Machado MA, Oliveira TM. The usefulness of cone beam computed tomography for treatment of complex odontoma. Eur Arch Paediatr Dent 2013;14:185-9.  Back to cited text no. 15
    
16.
Hunter AK, Muller S, Kalathingal SM, Burnham MA, Moore WS. Evaluation of an ameloblastic fibro-odontoma with cone beam computed tomography. Tex Dent J 2012;129:619-24.  Back to cited text no. 16
    


    Figures

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



 

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