Orthodontic management of an impacted maxillary incisor due to odontoma

Abstract

Odontomas are a heterogeneous group of jaw bone lesions, classified as odontogenic tumors which usually include well-diversified dental tissues. Odontomas are the most common type of odontogenic tumors and generally they are asymptomatic. Two types of odontomas are described: compound and complex based on either the appearance of well-organized tooth-like structures (compound odontomas) or on a mass of disorganized odontogenic tissues (complex odontomas). Compound odontomas have a predilection for the anterior maxilla, whereas complex odontomas have a predilection for the posterior mandible. Odontomas frequently interfere with eruption of teeth leading to their impaction. This is a case report of a 14-year-old girl with an unerupted maxillary right central incisor due to a complex composite odontoma a rare occurrence in anterior maxilla. Surgical excision of the odontoma and orthodontic treatment to get the impacted maxillary right central incisor into alignment is discussed.

Odontoma: a retrospective study of 73 cases

“…In the present study, the male incidence was 47.9% (35/73). Odontomas develop and mature while the corresponding teeth are forming and cease development when the associated teeth complete development 3,6. Many studies reported that odontomas were usually detected in the second decade of life 1,12-15.…”

“…Surgical removal with or without denudation of the impacted teeth has been usually performed for treatment of odontoma 2,6,17. There has been no general agreement on the best management approach for impacted teeth associated with odontomas.…”

“…On the basis of gross, radiographic, and microscopic features, odontomas are sub-classified into compound odontoma (small toothlike structures) and complex odontoma (a conglomeration of dentin, enamel, and cementum) 1-5. Similar to teeth, once fully calcified, they do not develop further, and multiple odontomas are rare 6. In general, they constitute 22% of all odontogenic tumors of the jaws 7.…”

“…Partial calcification is observed in the intermediate stage, while in the third stage the lesion usually appears as radiopaque masses surrounded by radiolucent areas corresponding to the connective tissue histologically 2,5. Odontomas are generally asymptomatic, often associated with delayed eruption, or impaction of permanent teeth 1-3,6,7,9-11. There have been many studies of odontomas dealing with clinical investigations, radiographic features,1,2,12-15 and case reports,5,7,8,16,17 however, these investigations included no results of treatments associated with the impacted permanent teeth according to age.…”

Histopathological insight of complex odontoma associated with a dentigerous cyst

“…These lesions are composed of more than one type of tissue and for this reason, have been called as composite odontomas 3 4. They can be considered as slow-growing benign tumours showing non-aggressive behaviour 5…”