Case Report

Compound Odontoma-Diagnosis and Treatment in Pedıatrıc Dentıstry: Three Case Reports

Alem Coşgun¹, Behiye Sezgin Bolgül^1*, Ezgi Meriç¹ and Berk Turgay^2
1Department of Pedodontics, Mustafa Kemal University, Turkey
²Department of Oral and Maxillo Facial Surgery, Mustafa Kemal University, Turkey

^*Corresponding author: Behiye Sezgin Bolgül, Department of Pedodontics, Mustafa Kemal University, Hatay, Turkey

Published: 18 May, 2018
Cite this article as: Coşgun A, Bolgül BS, Meriç E, Turgay B. Compound Odontoma-Diagnosis and Treatment in Pedıatrıc Dentıstry: Three Case Reports. Clin Surg. 2018; 3: 1971.

Abstract

Odontomas are the most common odontogenic tumors. They are considered to be hamartomas rather than neoplasms, and are composed of natural teeth tissues: enamel, dentin, and cementum and pulp tissue. They are broadly classified into compound odontoma (small tooth like structures) and complex odontoma (a conglomeration of dentin, enamel and cementum). Generally, odontomas have been associated with trauma during primary dentition as well as with inflammatory and infectious processes, hereditary anomalies (Gardner syndrome, Hermann's syndrome), odontoblastic hyperactivity and alterations in the genetic components responsible for controlling dental development. This study presents three cases of odontoma and treatments.
Keywords: Compound odontoma; Child; Tumors

Introduction

Odontomas are the most common odontogenic tumors. They are considered to be hamartomas rather than neoplasms, and are composed of natural teeth tissues: enamel, dentin, cementum and pulp tissue [1]. According to the World Health Organization classification, two distinct types of odontomas are acknowledged: complex and compound odontomaIn complex odontomas, all dental tissues are formed, but appeared without an organized structure. In compound odontomas, all dental tissues are arranged in numerous tooth-like structures known as denticles [2]. Generally these malformations are intraosseous, but occasionally they may erupt into the oral cavity [3,4]. The etiology of the odontoma is unknown. Generally, odontomas have been associated with trauma during primary dentition as well as with inflammatory and infectious processes, odontoblastic hyperactivity and alterations in the genetic components responsible for controlling dental development [5]. Odontomas can also manifest as part of syndromes, such as basal cell nevus syndrome, Gardner syndrome, familial colonic adenomatosis, Tangier disease or Hermann syndrome [6]. Conservative surgical excision is the treatment of choice. Compound and complex odontomas are well encapsulated and easily enucleated from the surrounding bone [7].

Case Presentation

Case 1
13-year-old boy referred to our clinic because of an unerrupted maxillary santral incisor (Figure 1). The lesion was disturbing the eruption of the maxillary central incisor (Figure 2). Lesions removed surgically (Figure 3). The histopatological examination confirmed that the lesions are compound odontomas. Following the surgery, the persistant tooth started eruption (Figure 4 and 5).
Case 2
A trauma patient referred to our clinic with a broken central tooth (Figure 6). The tooth was broken due to a bicycle accident two years ago. He was 11-year-old boy. The central incisor was root canal treathed. There weren’t any known syndrome or systemic disease of the patient. We thought that the etiology of the odontoma might be releated to the trauma so we removed the odontoma because it might affect the prognosis of the tooth (Figure 7). Odontomas removed surgically (Figure 8). The histopatological examination confirmed that the lesion is a compound odontoma. We restorated the tooth after root canal treatment (Figure 9 and 10).
Case 3
9-year-old boy referred to our clinic because of an unerrupted maxillary santral incisor (Figure 11). The lesion was disturbing the eruption of the maxillary central incisor (Figure 12). The lesion was removed surgically (Figure 13). The histopatological examination confirmed that the lesion is a compound odontoma. Following the surgery, the persistant tooth started eruption (Figure 14 and 15).

Figure 1

Figure 2

Figure 3

Figure 4

Figure 5

Figure 6

Figure 7

Figure 8

Figure 9

Figure 10

Figure 11

Figure 12

Figure 13

Figure 14

Discussion

Odontomas represent the most common type of odontogenic benign jaws tumors among patients younger than 20 years of age [8]. In our cases reported, the incidence age of odontoma is consistent with the literature. Odontomas are slow-growing, asymptomatic neoplasms found in jaws. In about 80% of cases, they are associated with impacted or un erupted teeth. Although they are commonly asymptomatic, clinical indicators of odontoma may include retention of deciduous teeth, non eruption of permanent teeth, pain, expansion of the cortical bone, tooth displacement [9]. Orthodontic treatment may be indicated to correct malocclusion. İn our two cases reported, odontomas are associated with un erupted teeth. The treatment according to the available literature is surgical extraction with complete removal of any associated soft tissues, since the odontoma may interfere with eruption of the permanent tooth displace the adjacent teeth or give rise to a dentigerous cyst [6].

Figure 15

Conclusion

The results achieved indicate that early diagnosis of odontomas in primary dentition is essential in order to prevent later complications, requires less expensive treatment, ensure better prognosis, avoid relapse of the lesion, avoid displacement or devitalisation of adjacent tooth.

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