Case Report: Unusual association of gubernacular canal, supernumerary tooth and odontoma with an impacted canine on cone beam computed tomography

Abstract

This report describes a clinical case of asymptomatic compound odontoma in the anterior left side of the maxilla associated with an impacted canine and supernumerary tooth with a gubernacular canal of a 47- year-old female with no relevant medical history. Cone-beam computed tomography (CBCT) was performed for precise three-dimensional localization of each structure and assessment of their spatial relationship with the associated structures before surgery. The treatment protocol involved surgical enucleation of the odontoma and open extraction of both impacted and supernumerary teeth. Patient had uneventful healing and proceeded with the prosthodontic treatment plan. An experienced clinician can accurately diagnose a compound odontoma, as it has distinctive clinical and radiographic features. Thus, early detection and management of odontomas can help correction of any dental irregularity and avoid further complications.

CBCT Assessment of Gubernacular Canals on Permanent Tooth Eruption in Down’s Syndrome

“…As mentioned previously, both the gubernacular canal and cord are intraoral structures very important to the tooth-eruption process, although a small number of studies in the literature about GC and cord demonstrated their influence in permanent teeth eruption physiologic processes, especially in the follicular theory [5,6]. The gubernacular cord is a structure composed of conjunctive tissue which connects the permanent tooth follicle to the gingiva and is located in the maxillary alveolar ridge below deciduous teeth guiding the course of permanent teeth eruption [7].…”

“…Mixed dentition is a stage of growth and development that begins with the dental eruption of the first permanent teeth at about 6 years old and continues until 12 years old [1][2][3]. In this stage, the oral cavity undergoes certain physiologic changes including deciduous teeth root resorption followed by exfoliation of permanent teeth within the gubernaculum dentis, which is made by the gubernacular cord, after which, osteoblastic activity forms the gubernacular canal, which is important in the eruption process, representing an eruption path through maxillary bone [4,5].…”

“…GC obstruction might occur for various reasons such as impacted teeth, abnormal teeth orientation, maxillary atresia, overly dense bone, excessively soft tissue, craniofacial abnormalities, genetic abnormalities such as Down's syndrome (DS), supernumerary teeth, and odontogenic tumors such as odontoma [5,14]. Ds, also known as trisomy 21, is a genetic disorder caused by the presence of an extra part of a third copy of chromosome 21.…”

Tratamento E Análise Histopatológica De Odontoma Complexo: Relato De Caso

“…Due to the abnormal and disorganized development of the epithelial and mesenchymal cells (ABDUL et al, 2014;ISOLA et al, 2017), that give rise to the enamel, dentin, cement and pulp tissue, odontomas are considered developmental anomalies of the hamartoma type (KÄMMERER et al, 2016;ISOLA et al, 2017) and not true neoplasms (BOFFANO et al, 2012;ABDUL et al, 2014;KUDVA et al, 2016;AKERZOUL et al, 2017;MALTAGLIATI et al, 2020). They are also denominated benign tumors of odontogenic origin (MURPHY et al, 2014;AKERZOUL et al, 2017;SPEIGHT;TAKATA, 2018;ELSAYED et al, 2020).…”

“…Based on the histological and radiographic characteristics, odontomas are classified as compound or complex (BOFFANO et al, 2012;ABDUL et al, 2014;ISOLA et al, 2017;LEVI-DUQUE et al, 2019;ELSAYED et al, 2020). Radiographically, the compound type is shown as solitary or multiple small structures, similar to teeth that are not completely equal to a normal tooth, but have and ordered pattern of dental structures, enamel, dentin, cement and pulp.…”