Dilated odontoma: an unusual case report and literature review

Abstract

Introduction: Dilated odontoma is the most severe form of a dens invaginatus, which is a rare dental malformation resulting from an invagination of the enamel organ into the dental papilla before calcification occurs. Observation: A healthy 7-years-old girl was referred to the oral surgery department to remove an impacted odontoma causing a delayed dental eruption of the right mandibular lateral incisor (tooth 42). The patient was painless and a lingual osseous swelling was observed. A computed tomography and a 3D segmentation revealed a shell-shaped mass in the position of the right mandibular lateral incisor, showing a complex anatomy. Surgical excision was carried out under general anesthesia. Histological analysis confirmed the diagnosis of DO. Discussion and conclusion: We performed a literature review investigating 16 cases of severe forms of dens invaginatus which required extraction. It highlighted the atypical aspect of our case and the importance of 3D imaging and segmentation in contributing to the accurate diagnosis and treatment of this dental malformation.

Dilated Odontoma Arising in the Mandibular Third Molar Germ: Report of a Case of an Unusual Lesion in an Uncommon Site

“…In four adult patients (three females and one male, age range of 28-60 years), the dilated odontoma involved the third molar region [8,9,14]. In addition to the case reported here, the dilated odontoma was detected incidentally in two cases [3,8]. In addition to its clinical uniqueness, the case reported here offers the possibility to discuss the proper terminology to use for this type of dental lesion.…”

“…It may affect either the primary or the permanent teeth and its incidence has been estimated to range between 0.04% to 10%, with a greater female predilection [ 1 ]. The maxillary lateral incisors are the most frequently affected teeth, followed by maxillary central incisors, premolars, and canines [ 2 , 3 ]. The anomaly, which can be also symmetric, uncommonly involves the mandibular teeth, especially in the molar region [ 4 ].…”

“…In type 2 and type 3, the invagination extends beyond the cemento-enamel junction either remaining within (type 2) or penetrating through (type 3) the root, leading in the latter case to the formation of an additional apical or lateral foramen. Swelling or pain related to a local periapical infection is the main clinical feature associated with dens invaginatus [ 3 ]. In rare cases, the invagination may significantly dilate, impairing the normal development of the involved tooth [ 2 , 3 , 6 ].…”

“…Swelling or pain related to a local periapical infection is the main clinical feature associated with dens invaginatus [ 3 ]. In rare cases, the invagination may significantly dilate, impairing the normal development of the involved tooth [ 2 , 3 , 6 ]. In this condition, which is commonly reported as dilated odontoma, the involved tooth shows a doughnut-like circular-oval shape with a radiolucent interior [ 2 , 3 , 6 , 7 , 8 , 9 , 10 , 11 ].…”

“…In rare cases, the invagination may significantly dilate, impairing the normal development of the involved tooth [ 2 , 3 , 6 ]. In this condition, which is commonly reported as dilated odontoma, the involved tooth shows a doughnut-like circular-oval shape with a radiolucent interior [ 2 , 3 , 6 , 7 , 8 , 9 , 10 , 11 ]. Thus, dilated odontoma is considered the extreme and most severe form of dens invaginatus [ 2 , 3 , 8 ].…”