Sequestrating giant complex odontoma: a case report and review of the literature

Sturge-Weber syndrome with cemento-ossifying fibroma in the maxilla and giant odontoma in the mandible: A case report

Sturge-Weber syndrome (SWS) is a neurocutaneous syndrome with vascular lesions of the cerebral meninges, port wine spots on the face, and glaucoma of the eyes; it is a congenital, non-genetic disease whose etiology and mechanisms are unknown. In this report, we describe a rare case of SWS with unilateral large odontogenic tumors in the maxilla and mandible. The histopathological diagnosis of the maxillary bone lesion on biopsy was juvenile psammomatoid ossifying fibroma, which is considered a type of ossifying fibroma of craniofacial bone origin. However, the final pathological diagnosis of the excision was cemento-ossifying fibroma derived from periodontal ligament cells, and we discuss the histopathology in detail. In addition, the mandibular lesion was one of the largest odontomas reported to date. Furthermore, in this case, we suggest the possibility that the maxillary and mandibular bone lesions are not separate lesions, but a series of lesions related to SWS.

A Giant Posterior Maxillary Intra-Sinusal Complex Odontoma: A Clinical Case

Odontomas are the most common odontogenic neoplasms. They are generally small and asymptomatic. This article presents an unusual case of a giant maxillary complex odontoma, which obscured a part of the maxillary antrum and impacted a tooth. This was discovered during an episode of maxillofacial cellulitis. In this case, surgical excision of the lesion was performed under general anesthesia, and the closure was performed with a fat pad pedicled flap. A brief review of the literature was performed to analyze the characteristics of this clinical entity and their implication in the treatment.

Clinical and radiological characteristics of odontomas: A retrospective study of 90 cases

PURPOSE

Odontomas represent a common clinical entity among odontogenic tumors, but are not well-addressed in the Vietnamese population. The present study aimed to determine the clinical and preclinical characteristics of odontomas and associated factors in the Vietnamese population.

MATERIALS AND METHODS

This retrospective study retrieved data from histopathological diagnoses from 2 central hospitals of Odonto-Stomatology in Ho Chi Minh City, Vietnam during 2004-2017. The odontomas were classified as complex (CxOD) or compound (CpOD) subtypes. The epidemiological, clinical, and radiological characteristics of the odontomas, stratified by subtype and sex, were obtained and analyzed.

RESULTS

Ninety cases, consisting of 46 CxODs and 44 CpODs, were included. The average age of patients was 32.4 (±20.2) years. The patients with CxOD were older than those with CpOD (P<0.05). Clinically, 67% of patients showed an intraoral bone expansion. Approximately 60% of patients with CxOD exhibited a painful symptom, about 3-fold more than those with CpOD (P<0.05), whereas almost all patients with CpOD exhibited perturbations of dentition, unlike those with CxOD (P<0.05). Radiologically, CxOD was characterized by a larger dimension than CpOD in both sexes (P<0.05), and CpOD induced complications in adjacent teeth more often than CxOD (P<0.05). The development of odontoma with advancing age differed significantly in odontoma subtypes related to their pathological origins, and between the sexes, resulting from different physiological states.

CONCLUSION

The findings of this study highlight the value of clinical and radiological features of odontomas and their associated factors for the early diagnosis and adequate treatment of younger patients.

Rare giant complex composite odontoma of mandible in mixed dentition: Case report with 3-year follow-up and literature review

Introduction

and importance: Complex odontomas are hamartomas representing a conglomeration of all dental tissues. When developed, they rarely become giant and even more rare to become giant in children. This report presented an unusual giant mandibular complex odontoma in very young patient. It also provided a literature analysis and better understanding of clinical features of such giant lesions in the mandible.

Case presentation

An 8-year-old boy presented with swelling in the right side of the mandible. After clinical and radiological exams, a provisional diagnosis of giant composite odontoma was made. This lesion led to jaw expansion, asymmetrical face, and teeth eruption alterations. Surgical excision of the lesion was performed, and histopathological examination confirmed the diagnosis. The patient's follow-up showed that normal jaw size and facial symmetry was restored with no evidence of recurrence for 3 years.

Clinical discussion

A literature review of reported mandibular large odontomas was made. All published reported cases of giant odontoma in the mandible caused bone expansion with or without pain. According to the literature, this paper described the youngest patient with giant complex odontoma in the mandible. This was also the first reported case from Syria.

Conclusion

Giant complex composite odontoma of the mandible can develop at any age causing facial asymmetry, however, with good prognosis and predictable surgical treatment.

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This report presented an unusual giant mandibular complex odontoma in a young patient.

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It provided a literature analysis and better understanding of clinical features of such giant lesions in the mandible.

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According to literature, this is the youngest patient with giant odontoma in the mandible, and the first from Syria.

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Odontomas tend to expand the jaw when they become giant.

Complex Odontoma at an Unusual Site in a Child: A Case Report

Odontomas are known as the most common odontogenic tumor and usually present without clinical symptoms. It can be divided into compound odontoma and complex odontoma. Compound odontomas are calcified tissue and they bear similarity to the teeth, whereas complex odontomas do not show similarity to the tooth. Diagnosis of the odontomas is usually accidental on radiographic examination. Complex odontomas are commonly seen in the posterior mandible. Apart from the few case reports regarding the complex odontoma of the anterior mandibular region, reported occurrence in this site is rare. Here, authors described a case of a child who presented with a chief complaint of swelling in the anterior mandibular canine region. After clinical examination and required investigations, provisionally, it was diagnosed as complex odontoma. It was surgically removed and histopathological examination confirmed the provisional diagnosis.

How to cite this article: Ahammed H, Seema T, Cheranjeevi J. Complex Odontoma at an Unusual Site in a Child: A Case Report. Int J Clin Pediatr Dent 2021;14(3):438–440.

Reawakening of Ancestral Dental Potential as a Mechanism to Explain Dental Pathologies

During evolution, there has been a trend to reduce both the number of teeth and the location where they are found within the oral cavity. In mammals, the formation of teeth is restricted to a horseshoe band of odontogenic tissue, creating a single dental arch on the top and bottom of the jaw. Additional teeth and structures containing dental tissue, such as odontogenic tumors or cysts, can appear as pathologies. These tooth-like structures can be associated with the normal dentition, appearing within the dental arch, or in nondental areas. The etiology of these pathologies is not well elucidated. Reawakening of the potential to form teeth in different parts of the oral cavity could explain the origin of dental pathologies outside the dental arch, thus such pathologies are a consequence of our evolutionary history. In this review, we look at the changing pattern of tooth formation within the oral cavity during vertebrate evolution, the potential to form additional tooth-like structures in mammals, and discuss how this knowledge shapes our understanding of dental pathologies in humans.

Unusual giant complex odontoma: A case report

Odontomas are benign, non-aggressive, and the most common odontogenic tumor of the jaws. Composed of dental tissues, it can be classified as compound or complex odontomas depending on their radiological and histological features. Among them, complex odontomas are less common and usually is presented as a small and asymptomatic radiopaque mass surrounded by a radiolucent halo, found on routine radiographic examination. Although benign tumors, odontomas can reach large sizes leading to facial asymmetry and decreasing bone strength, which predisposes fractures and infection. Our aim was to present a case report of an unusual giant mandibular odontoma on the left mandibular angle and ramus successfully treated by surgical excision and highlight the importance of the earlier diagnostic to minimize damages.

Association between odontoma size, age and gender: Multivariate analysis of retrospective data

Background

The variety of characteristics related to odontoma research, including an unexplored one such as size, merits a multivariate approach that allows the adequate drawing of inferences with pertinent conclusions. The objective of this study is to establish the possible association between some characteristics related to the odontoma, tumor size among them.

Material and Methods

The sociodemographic characteristics of 60 patients were evaluated. Diagnosis, size, location, type of treatment performed, and prognosis were determined. These data were analyzed descriptively and through multivariate models.

Results

Thirty-four compound and 26 complex odontomas in 32 men and 28 women were observed. The age average of patients was 15.6±11 years. Most of the odontomas presented a size inferior to 10 mm. A statistically significant association was observed between the routine radiographic finding and the absence of dental eruption (p=0.0001). The model of linear regression adjusted between odontoma size and age (β=0.321, p=0.01), as well as the model of logistic regression adjusted between gender (men) and tumor size (OR=12; 1.7 - 93 IC 95%, (p=0.01) were statistically significant.

Conclusions

Statistically significant associations between odontoma size and age, and between the male gender and odontomas smaller than 10 mm were found adjusting by other confounding variables. These results could grant clinicians a greater knowledge of the context of odontoma characteristics, which in turn could favor a better diagnostic and therapeutic decision-making.

Key words:Odontoma, compound odontoma, diagnosis, multivariate analysis.

Sequential Removal of a Large Odontoma in the Angle of the Mandible

Odontomas are the commonly occurring benign tumors of the jaw, which are odontogenic in origin. Lesion originates as the dental components are laid down in a disorganized manner, due to failure of normal morphodifferentiation. They are considered as hamartomatous developmental malformations rather than a true neoplasm. Mostly, these asymptomatic lesions are discovered as an incidental finding. Large odontomas may give rise to local disturbances, such as eruption delay of permanent teeth, asymmetric tooth eruption, malpositioning, displacement, resorption, or occasional devitalization of adjacent teeth. Odontomas may erupt into the mouth and tend to be associated with impacted teeth and other cystic lesions. The odontomas have a tendency to become symptomatic due to local infection such as sinusitis, infected adjacent tooth, and the exposure of tumor to oral environment. The aim of this paper is to elucidate the primary features and treatment of these lesions, depending on published data and individual witness.

Giant complex odontoma in the posterior mandible: A case report and literature review

Odontomas are considered a type of odontogenic hamartoma, and are generally reported not to exceed 3 cm in diameter. Some authors have referred to odontomas with a diameter exceeding 3 cm as giant odontomas. As hamartomas, giant odontomas generally show no signs or symptoms, but if they perforate the mucosa to become exposed in the oral cavity, oral and maxillofacial infections can result. Surgical removal and a histopathological examination may also be required to differentiate them from osteomas, cemento-osseous dysplasia, or mixed odontogenic tumors. This report presents the case of a 28-year-old woman with a giant odontoma in the right mandibular third molar area. Based on a review of the literature published since 2010, only 11 cases of “giant” or “large” odontomas have been reported, most of which were of the complex odontoma type. It was confirmed that they tend to occur in the right posterior mandible.

Complex Odontoma: A Case Report with Micro-Computed Tomography Findings

Odontomas are the most common benign tumors of odontogenic origin. They are normally diagnosed on routine radiographs, due to the absence of symptoms. Histopathologic evaluation confirms the diagnosis especially in cases of complex odontoma, which may be confused during radiographic examination with an osteoma or other highly calcified bone lesions. The micro-CT is a new technology that enables three-dimensional analysis with better spatial resolution compared with cone beam computed tomography. Another great advantage of this technology is that the sample does not need special preparation or destruction in the sectioned area as in histopathologic evaluation. An odontoma with CBCT and microtomography images is presented in a 26-year-old man. It was first observed on panoramic radiographs and then by CBCT. The lesion and the impacted third molar were surgically excised using a modified Neumann approach. After removal, it was evaluated by histopathology and microtomography to confirm the diagnostic hypothesis. According to the results, micro-CT enabled the assessment of the sample similar to histopathology, without destruction of the sample. With further development, micro-CT could be a powerful diagnostic tool in future research.

Management of large erupting complex odontoma in maxilla

We present the unusual case of a large complex odontoma erupting in the maxilla. Odontomas are benign developmental tumours of odontogenic origin. They are characterized by slow growth and nonaggressive behaviour. Complex odontomas, which erupt, are rare. They are usually asymptomatic and are identified on routine radiograph but may present with erosion into the oral cavity with subsequent cellulitis and facial asymmetry. This present paper describes the presentation and management of an erupting complex odontoma, occupying the maxillary sinus with extension to the infraorbital rim. We also discuss various surgical approaches used to access this anatomic area.

Histopathological insight of complex odontoma associated with a dentigerous cyst

Odontomas and dentigerous cysts are common findings for practicing dental professionals. However, simultaneous occurrence of pathologies like odontoma and dentigerous cyst are uncommon and their diagnosis based on the radiographic appearance alone is a challenge to overcome. They together are a potential for complications like attaining large size, root resorption, destruction of the jaw bones and sometimes neoplastic changes like ameloblastoma. This paper presents a case of complex odontoma associated with dentigerous cyst in relation to a retained deciduous tooth in the maxillary anterior region and confirming its diagnosis histopathologically.

Histopathological insight of complex odontoma associated with a dentigerous cyst

Odontomas and dentigerous cysts are common findings for practicing dental professionals. However, simultaneous occurrence of pathologies like odontoma and dentigerous cyst are uncommon and their diagnosis based on the radiographic appearance alone is a challenge to overcome. They together are a potential for complications like attaining large size, root resorption, destruction of the jaw bones and sometimes neoplastic changes like ameloblastoma. This paper presents a case of complex odontoma associated with dentigerous cyst in relation to a retained deciduous tooth in the maxillary anterior region and confirming its diagnosis histopathologically.