Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Contacts Login 
Home Print this page Email this page Users Online: 268



 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2015  |  Volume : 3  |  Issue : 2  |  Page : 49-53

The prevalence, anatomic locations and characteristics of the odontomas using panoramic radiographs


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 Publication22-May-2015

Correspondence Address:
Dr. Hakan Kurt
Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Ankara University, Ankara
Turkey
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2321-3841.157523

Rights and Permissions
  Abstract 

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 Oct 22];3:49-53. Available from: https://www.joomr.org/text.asp?2015/3/2/49/157523


  Introduction Top


Odontomas are the most common variety of odontogenic tumors and derived from differentiated epithelial and mesenchymal cells. [1],[2] They were first described by Broca in 1866. [3] 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. [4] Although the etiology of odontoma is unclear, infections or local traumas may cause odontomas. [1],[2],[5],[6] Odontomas are dens radiopaque lesions with prominent margins surrounded by a thin radiolucency. [7],[8] The majority of odontomas occur in the first and second decades of life. [9] 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. [10] 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. [8] It is a malformation in which all the dental tissues are well-formed, but occurring in a less orderly pattern. [10] No individual tooth-like structures are seen. [5] 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. [10] The treatment of choice is removing the lesion surgically. [10],[11] 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 Top


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 6.12.10.0 (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 Top


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


Click here to view
Table 1: Anatomic locations and characteristics of the odontomas


Click here to view



  Discussion Top


Odontomas are benign tumors that consist of enamel, dentine, cementum and pulpal tissue. [12] 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 [13] 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. [14] 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. [15] reported 160 cases of odontoma in 40,999, and found incidence as 0.4%. Patil et al. [16] and Afify and Zawawi [17] 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. [1],[2],[6],[7] 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, [10],[14] others claim in males. [1],[11] The third group of studies reports showed no difference between males and females. [12],[15],[18] 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. [11],[12],[18] 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. [18] 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. [2],[5],[19] On the contrary, Olgac et al. [20] reported 67 complex odontomas but only 42 compound type. Tekkesin et al. also reported similar results. [15] 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. [12] On the other hand, 70% of odontomas [21] have some adverse effects on adjacent teeth such as delayed tooth eruption, impaction, displacement, and root resorption, widening follicular space, inflammation or cystic formation. [12],[15],[21],[22],[23] 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. [24] reported a case of dilaceration with the adenomatoid odontogenic tumor. Yeung et al. [25] 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. [1],[2],[12],[18],[26] It can also be associated with some syndromes such as basal cell nevus syndrome and Gardner syndrome. [2]

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 [27] 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. [28]

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.

 
  References Top

1.
Shafer WG, Hine MK, Levy BM. Cysts and tumours of odontogenic origin. In: Rajendran R, Sivapathasundharam B, editors. A Textbook of Oral Pathology. 6 th ed. Delhi: Elsevier; 2009. p. 254-309.  Back to cited text no. 1
    
2.
Hidalgo-Sánchez O, Leco-Berrocal MI, Martínez-González JM. Metaanalysis of the epidemiology and clinical manifestations of odontomas. Med Oral Patol Oral Cir Bucal 2008;13:E730-4.  Back to cited text no. 2
    
3.
Reddy GS, Reddy GV, Sidhartha B, Sriharsha K, Koshy J, Sultana R. Large complex odontoma of mandible in a young boy: A rare and unusual case report. Case Rep Dent 2014;2014:854986.  Back to cited text no. 3
    
4.
Bhoyar SC, Mishra YC. Compound composite odontoma - A case report. J Indian Dent Assoc 1986;58:537-9.  Back to cited text no. 4
[PUBMED]    
5.
Waldron AC. Odontogenic cysts and tumours. In: Neville BW, editor. Oral and Maxillofacial Pathology. 2 nd ed. Philadelphia: WB Saunders Company; 2002. p. 631-2.  Back to cited text no. 5
    
6.
de Oliveira BH, Campos V, Marçal S. Compound odontoma - Diagnosis and treatment: Three case reports. Pediatr Dent 2001;23:151-7.  Back to cited text no. 6
    
7.
White SC, Pharoah MJ. Benign tumours of the jaws. In: White SC, Pharoah MJ, editors. Oral Radiology: Principles and Interpretation. 5 th ed. Missouri: Mosby; 2004. p. 410-58.  Back to cited text no. 7
    
8.
Cawson RA, Odell EW, editors. Odontogenic tumours and tumour like lesions of the jaws. In: Essentials of Oral Pathology and Oral Medicine. 6 th ed. Edinburgh: Churchill Livingstone; 1998. p. 117-31.  Back to cited text no. 8
    
9.
Bhaskar SN. Synopsis of Oral Pathology. 6 th ed. St. Louis: C.V. Mosby; 1981.  Back to cited text no. 9
    
10.
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. 10
    
11.
Philipsen HP, Reichart PA, Praetorius F. Mixed odontogenic tumours and odontomas. Considerations on interrelationship. Review of the literature and presentation of 134 new cases of odontomas. Oral Oncol 1997;33:86-99.  Back to cited text no. 11
    
12.
Amado Cuesta S, Gargallo Albiol J, Berini Aytés L, Gay Escoda C. Review of 61 cases of odontoma. Presentation of an erupted complex odontoma. Med Oral 2003;8:366-73.  Back to cited text no. 12
    
13.
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. 13
    
14.
Buchner A, Merrell PW, Carpenter WM. Relative frequency of central odontogenic tumors: A study of 1,088 cases from Northern California and comparison to studies from other parts of the world. J Oral Maxillofac Surg 2006;64:1343-52.  Back to cited text no. 14
    
15.
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. 15
    
16.
Patil S, Doni B, Kaswan S, Rahman F. Prevalence of dental anomalies in Indian population. J Clin Exp Dent 2013;5:e183-6.  Back to cited text no. 16
    
17.
Afify AR, Zawawi KH. The prevalence of dental anomalies in the Western region of saudi arabia. ISRN Dent 2012;2012:837270.  Back to cited text no. 17
    
18.
Illa CP, Berini Aytés L, Sánchez Garcés MA, Gay Escoda C. Odontomas complejos y compuestos: Análisis de 47 casos. Arch Odontoestomatol 1995;11:423-9.  Back to cited text no. 18
    
19.
Lee CH, Park GJ. Complex and compound odontomas are clinico-pathological entities. Basic Appl Pathol 2008;1:30-3.  Back to cited text no. 19
    
20.
Olgac V, Koseoglu BG, Aksakalli N. Odontogenic tumours in Istanbul: 527 cases. Br J Oral Maxillofac Surg 2006;44:386-8.  Back to cited text no. 20
    
21.
Kaneko M, Fukuda M, Sano T, Ohnishi T, Hosokawa Y. Microradiographic and microscopic investigation of a rare case of complex odontoma. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998;86:131-4.  Back to cited text no. 21
    
22.
Sales MA, Cavalcanti MG. Complex odontoma associated with dentigerous cyst in maxillary sinus: Case report and computed tomography features. Dentomaxillofac Radiol 2009;38:48-52.  Back to cited text no. 22
    
23.
An SY, An CH, Choi KS. Odontoma: A retrospective study of 73 cases. Imaging Sci Dent 2012;42:77-81.  Back to cited text no. 23
    
24.
Dayi E, Gürbüz G, Bilge OM, Ciftcioglu MA. Adenomatoid odontogenic tumour (adenoameloblastoma). Case report and review of the literature. Aust Dent J 1997;42:315-8.  Back to cited text no. 24
    
25.
Yeung KH, Cheung RC, Tsang MM. Compound odontoma associated with an unerupted and dilacerated maxillary primary central incisor in a young patient. Int J Paediatr Dent 2003;13:208-12.  Back to cited text no. 25
    
26.
Ide F, Shimoyama T, Horie N. Gingival peripheral odontoma in an adult: Case report. J Periodontol 2000;71:830-2.  Back to cited text no. 26
    
27.
Morning P. Impacted teeth in relation to odontomas. Int J Oral Surg 1980;9:81-91.  Back to cited text no. 27
[PUBMED]    
28.
Sreedharan S, Krishnan IS. Compound odontoma associated with impacted maxillary incisors. J Indian Soc Pedod Prev Dent 2012;30:275-8.  Back to cited text no. 28
[PUBMED]  Medknow Journal  


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1]


This article has been cited by
1 An unusual case of 177 pieces of mandibular compound odontoma: 10-year follow-up
M.B. Erden Sahin,A. Calis,H. Koca
Journal of Stomatology, Oral and Maxillofacial Surgery. 2020;
[Pubmed] | [DOI]
2 Case of odontoma-related infection in a cleidocranial dysplasia
Afonso Martins,Patrícia Caixeirinho,Ana Fernandes
BMJ Case Reports. 2019; 12(7): e228748
[Pubmed] | [DOI]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Materials and Me...
Results
Discussion
References
Article Figures
Article Tables

 Article Access Statistics
    Viewed5132    
    Printed126    
    Emailed3    
    PDF Downloaded724    
    Comments [Add]    
    Cited by others 2    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]