|Year : 2015 | Volume
| Issue : 2 | Page : 49-53
The prevalence, anatomic locations and characteristics of the odontomas using panoramic radiographs
Hakan Avsever1, Hakan Kurt2, Tolga Berkay Suer3, Hilal Peker Ozturk1, Bulent Piskin4
1 Department of Dentomaxillofacial Radiology, Gulhane Military Medical Academy, Dentistry Center, Ankara, Turkey
2 Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Ankara University, Ankara, Turkey
3 Department of Oral and Maxillofacial Surgery, Gulhane Military Medical Academy, Haydarpasa Teaching Hospital, Istanbul, Turkey
4 Department of Prosthodontics, Gulhane Military Medical Academy, Dentistry Center, Ankara, Turkey
|Date of Web Publication||22-May-2015|
Dr. Hakan Kurt
Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Ankara University, Ankara
Source of Support: None, Conflict of Interest: None
Objectives: Odontomas are the most common variety of odontogenic tumors and derived from differentiated epithelial and mesenchymal cells. The purpose of this study is to evaluate the prevalence, types and localization of the odontomas in Turkish patients. Materials and Methods: This was a retrospective study of panoramic images that were taken between April 2011 and January 2014 in the Department of Dentomaxillofacial Radiology, Gulhane Military Medical Academy (GATA), Turkey. A total of 14,250 panoramic images were evaluated by an experienced dentomaxillofacial radiology specialist. The clinicopathologic features of odontomas such as, anatomic location, distribution in gender, age of the patients and the incidence of the odontomas were assessed. Results: A total of 22 odontomas in 20 patients (11 females; 9 males) (0.14%) were found of the 14,250 patients` panoramic view. About 36.4% of the lesions were complex odontomas and 63.6% were diagnosed as compound odontomas. About 18.2% of all cases were in the maxilla and 81.8% in the mandible. The anterior portion of mandible was found the most common location (40.9%) in this study. Conclusions: According to the result of this study, the compound types of the odontomas are more common than complex odontomas and the anterior mandible is the most affected site. It was noted that even though odontomas are the most common variety of odontogenic tumors, they rarely occur.
Keywords: Odontogenic tumor, odontoma, panoramic, prevalence, radiography
|How to cite this article:|
Avsever H, Kurt H, Suer TB, Ozturk HP, Piskin B. The prevalence, anatomic locations and characteristics of the odontomas using panoramic radiographs. J Oral Maxillofac Radiol 2015;3:49-53
|How to cite this URL:|
Avsever H, Kurt H, Suer TB, Ozturk HP, Piskin B. The prevalence, anatomic locations and characteristics of the odontomas using panoramic radiographs. J Oral Maxillofac Radiol [serial online] 2015 [cited 2020 Apr 7];3:49-53. Available from: http://www.joomr.org/text.asp?2015/3/2/49/157523
| Introduction|| |
Odontomas are the most common variety of odontogenic tumors and derived from differentiated epithelial and mesenchymal cells. , They were first described by Broca in 1866.  Constituting 22% of all odontogenic tumors, they lack proliferation potential. Rather than true neoplasms, odontomas are probably a hamartomatous malformation of functional ameloblasts and odontoblasts consisting of enamel, dentin, cementum, and pulp.  Although the etiology of odontoma is unclear, infections or local traumas may cause odontomas. ,,, Odontomas are dens radiopaque lesions with prominent margins surrounded by a thin radiolucency. , The majority of odontomas occur in the first and second decades of life.  According to the latest classification of the World Health Organization in 2005, two types of odontomas can be found : c0 omplex odontomas and compound odontomas. Compound odontomas are usually located in the anterior maxilla, over the crowns of unerupted teeth, or between the roots of erupted teeth. These lesions usually contain multiple radiopaque, miniature tooth-like structures known as denticles.  As opposed to compound odontomas, complex odontomas commonly occur in the posterior mandible, frequently over an impacted tooth, and can reach several centimeters in size.  It is a malformation in which all the dental tissues are well-formed, but occurring in a less orderly pattern.  No individual tooth-like structures are seen.  It has been reported in the literature to date that compound odontoma is twice as common compared to complex odontoma. About 60% of complex odontomas occur in women.  The treatment of choice is removing the lesion surgically. , In the present study, we aimed to review the prevalence of the lesions, their gender and age distribution, anatomic location, and involvement of adjacent structures in Turkish patients.
| Materials and Methods|| |
This study was designed as a retrospective review of 14,250 panoramic radiographs that were examined between April 2011 and January 2014 in the Department of Dentomaxillofacial Radiology, Gulhane Military Medical Academy, Ankara, Turkey. Panoramic images had been taken because of various problems such as impacted teeth, pathological lesions, orthognathic surgery, dental implants, endodontic lesions, etc., 192 panoramic images due to various reasons such as, poor image quality and technical reasons were excluded from the study. Totally 14,058 images were evaluated.
The panoramic images were performed using a Kodak 8000C digital panoramic system at 73 kVp, 12 mA and 13.9 s exposure setting (Eastman Kodak Company, Rochester, NY). All images were examined by 12 years experienced dentomaxillofacial radiology specialist. Kodak Dental Imaging Software Viewer, version 184.108.40.206 (Eastman Kodak Company, Rochester, NY) was used for image evaluation on a standard personal computer with calibrated monitor (HP Compaq LE1711 LCD Monitor, Palo Alto, CA, USA). The level of contrast and brightness of the images were left to examiner's choices.
| Results|| |
The types of odontomas, anatomic localization, the number of lesions, age and gender of patients' were noted [Table 1]. All statistical analyses were performed using SPSS for Win. version 15.0 (SPSS Inc., Chicago, ILL., USA). A total of 22 odontomas in 20 (0.142%) patients were detected in 14,058 cases, of whom 11 (55%) were female and 9 (45%) were male. The mean patient age at the time of diagnosis of the odontomas was 33.2 ± 10.27 years (range 14-58 years). The radiologic appearance of the lesions confirmed the presence of 8 complex odontomas (36.4%) and 14 compound odontomas (63.6%). About 81.8% (n = 18) of 22 odontomas were located in the mandible and 18.2% (n = 4) in the maxilla. About 12.5% (n = 1)of the complex odontomas were located in the anterosuperior region, and 50% (n = 4) in the posteroinferior region. About 25% (n = 2) of the lesions were identified in the upper molar region, and the last one was in the anteroinferior region. About 64.2% of the compound odontomas were detected in the anterior region of the mandible (n = 9), and only 1 compound odontoma was in the anterosuperior region. The rest of the lesions (28.5%) were identified in molar region of the mandible (n = 4). Additionally, various abnormal conditions that were caused by odontomas such as 6 delayed eruptions [Figure 1]a, 6 malpositions [Figure 1]b, 6 impactions [Figure 1]c, 1 dilaceration of adjacent tooth [Figure 1]d, 1 resorption of adjacent tooth root [Figure 1]e have also been detected.
|Figure 1: (a-e) The panoramic images of the several abnormal conditions that were caused by odontomas|
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| Discussion|| |
Odontomas are benign tumors that consist of enamel, dentine, cementum and pulpal tissue.  They are usually found incidentally during routine radiologic evaluation unless they are symptomatic. Since first described by Broca in 1866, odontomas have been reported by several authors and identified as the most frequent lesions among all odontogenic tumors. The frequency of occurrence of odontoma varies greatly in different reports and populations. Sriram and Ravindra  reported that odontomas are identified as the most frequent odontogenic tumor in Caucation population. They also reported the incidence of odontomas as 6% in odontogenic tumors. In another study Buchner et al.  reported the incidence of odontoma as 75.9% in all odontogenic tumors. According to their result, it seems like they confirm Sriram and Ravindra's thesis. The reason for this remarkable high incidence rate of odontomas may be the studies, which reported in literature, are made among all odontogenic tumor cases. To the best of our knowledge, there are only few studies that report incidence of this lesion in population. Tekkesin et al.  reported 160 cases of odontoma in 40,999, and found incidence as 0.4%. Patil et al.  and Afify and Zawawi  reported as 0.2% and 0.1% respectively. According to our results, we found 0.14% prevalence rate in a sample of the population. When compared to current literature this prevalence rate seems little low. The reason for the low prevalence of odontomas may be many patients in Turkey do not refer to a hospital unless there are symptoms suggesting an obvious pathology.
Odontomas affect the maxilla slightly more than the mandible. According to many researchers anterior region of the maxilla is the most common location for compound odontomas. Complex odontomas were reported most frequently in the posterior mandibular region. ,,, In general, the literature indicates that the frequency of odontomas was higher in maxilla than in the mandible, however, this study showed only 4 odontomas (%18.1) in maxilla in 22 cases. When compared to the current literature this result showed relatively low incidence rate and this difference may be attributable to different sampling size of the presented study. On the other hand, although the reported tendency of odontomas arises in anterior portion of the jaws, in our series we noted similar incidence between two areas. According to the result of this study, we found that the compound odontomas were more often found in the anterior mandible. This result also was not in agreement with the previous reports in literature. We also found 62.5% of complex odontomas were in the posterior portion of mandible. This result also agrees with the literature's higher frequency of complex odontomas in the posterior mandible.
There is still a controversy among the studies about gender predilection. While some authors have reported a greater incidence in females, , others claim in males. , The third group of studies reports showed no difference between males and females. ,, In the present study, the incidence was found as 55% on behalf of females.
Odontomas can be seen at any age, but most reports showed greater incidence in the second and third decade of life. ,, In the present study, we found that %45 of the patients were in the second and third decade. Mean age was found as 33.2 ± 10.27 years. Some studies have also reported an existence of a correlation between age and type of odontomas.  According to this thesis compound lesions are apparently more frequent in younger patients. The results of our series coincide with this aspect.
World Health Organization identifies the types of odontomas as compound and complex. Compound odontoma is described as a formation that all dental tissues are present and organized as tooth-like structures. The complex type contains abnormal arrangement of dental tissues, usually presenting as a radiopaque mass with varying densities. Compound odontomas are seen more often than complex ones. ,, On the contrary, Olgac et al.  reported 67 complex odontomas but only 42 compound type. Tekkesin et al. also reported similar results.  In this study, there was 1.75:1 ratio of compound to complex odontomas and this result coincides with the literature to date.
Odontomas are one of the most seen benign odontogenic tumor in oral region. Although they are frequently asymptomatic but sometimes their presence can cause some symptoms such as swelling, infection or associated signs of impacted teeth. But in contrast, some authors reported that especially complex odontomas were not asymptomatic. They are frequently seen with a remarkable bone expansion compared with compound odontomas. However, if no symptoms occur, they can remain within the bone for many years without producing any clinical signs.  On the other hand, 70% of odontomas  have some adverse effects on adjacent teeth such as delayed tooth eruption, impaction, displacement, and root resorption, widening follicular space, inflammation or cystic formation. ,,,, In the present study, we found 45.4% (n = 10) of odontomas that have radiologic findings on adjacent teeth. In addition to these effects on adjacent teeth, we also detected dilacerations caused by odontomas on adjacent tooth root in one case. The presence of odontomas and adjacent teeth dilaceration is extremely rare. To the best of our knowledge, only a few reports emphasized dilaceration. Dayi et al.  reported a case of dilaceration with the adenomatoid odontogenic tumor. Yeung et al.  detected maxillary primary central incisor root dilaceration associated with compound odontoma. In our study, we detected dilaceration of adjacent permanent tooth associated with odontoma. According to our point of view, the physical presence of an odontoma may affect the direction of root development, change of its angulation and cause dilaceration.
In case of observation of a radiographic finding resembling odontomas, differential diagnosis must be established with several lesions depending on its location. If the lesion occurs inter-root location, then focal residual osteitis, cementoma, calcifying epithelial odontogenic tumors, adenomatoid odontogenic tumors, supernumerary teeth or benign osteoblastoma should be included in the differential diagnosis. If the lesion is located at pericoronal level, then adenomatoid odontogenic tumors, calcifying epithelial odontogenic tumors or odontoameloblastoma should be included in the differential diagnosis. When the lesion occurs in the maxillary sinus, then it could be misdiagnosed with sinusitis, antral mycosis, foreign bodies, retained root, peripheral osteoma, benign mesenchymal neoplasms, antral sarcoma or carcinoma. ,,,, It can also be associated with some syndromes such as basal cell nevus syndrome and Gardner syndrome. 
Although surgical treatment modality is generally preferred option for the management of odontomas, there has been no general agreement about the best approach for odontomas. Morning  reported that removal of odontoma led to the eruption of impacted teeth in %45 of cases. In case of an existence of an odontoma in the way of eruption surgical treatment could be a better option. To avoid carcinoma, adenomatoid tumor or ameloblastoma; it is suggested that there should be better routine clinical and radiological follow-up. 
The present study revealed that the prevalence of odontomas showed variations from other studies. This diversity may depend on the sample of population, method of the studies or racial and genetic differences. In conclusion, odontomas are one of the benign tumors that are frequently seen in both jaws. They have been detected in routine radiographic examination only if they are asymptomatic. They usually cause delayed eruption, so early detection and treatment of odontomas could decrease the possibility of late eruption or even tooth impaction due to overlying odontomas.
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