07/24/09 Delayed tooth eruption associated with an ameloblastic firbro-odontoma

Resident: Adam J. Bottrill
Date: 24JUL09
Region: Providence
Article title: Delayed tooth eruption associated with an ameloblastic firbro-odontoma
Author(s): Flaitz, Catherine M. DDS, MS; Hicks, John MD, DDS, PhD
Journal: Pediatric Dentistry
Volume #: Number; Page #s): 23: 253-254
Year: 2001
Major topic: Delayed eruption associated with ameloblastic fibro-odontoma
Minor topic(s): Differential diagnosis for delayed eruption
Type of Article: Case review
Main Purpose: Discussion and differential diagnosis for delayed eruption
Overview of method of research: Case study

Findings: Healthy 31 month-old Hispanic boy presented with unerupted primary left mandibular canine. Bony, hard mass at site of unerupted tooth. Facial asymmetry. Pt occluding on soft tissue covering bony swelling. PA revealed RL with dilacerations of M root of 1st primary molar and displacement of developing premolar. RL lesion is expansile, mixed radiolucent/ radiopaque lesion surrounds crown of unerupted canine. Histo eval revealed cords and islands of odontogenic epithelium, conglomerate foci of enamel and dentin and small tooth-like structures. Connective tissue in the sample resembled the dental papilla. DX: Ameloblastic Fibro-Odontoma (AFO)

Key points in the article discussion: Odontogenic cysts and neoplasms are an uncommon reason for delayed eruption of primary teeth but should be included in the DD. Odontomas are the most common associated lesion, but presence of bony expansion should lead us to explore other etiologies.
A. AFO: Uncommon odontogenic tumor.
1. Resembles ameloblstic fibroma and complex odontoma. Slow growing, painless swelling. Delayed eruption. Unilocular or multilocular. Well-defined margins. Varied radiopacities. Central opacity resembles the same density as a tooth. Can displace teeth. Several cm large.
2. Mean age: 8-11.
3. Occurs equally in both jaws
a. anterior when in maxilla
b. posterior when in mandible
4. Tx: conservative curettage with possible splint. Recurrence following conservative surgery is uncommon.
B. DDX: AOT, COC, CO (most common)
1. CO: asymptomatic developmental abnormality (hamartoma)
a. pericoronal molar region.
b. delayed eruption
c. typically opaque with thin margin of lucency, a developing odontoma may actually resemble AF-O.
d. minimally expansile
2. AOT: benign tumor usually found during second decade.
a. anterior maxilla
b. no bony expansion
c. well-defined, unilocular RL around crown tooth.
3. COC: uncommon with varying clinical behavior.
a. in children, typically cystic type.
b. anterior region
c. peak in 2nd and 3rd decade
d. unilocular/multilocular associated with unerupted tooth
e. 50% associated with tooth-like opacities.
f. Tx: enucleation with uncommon recurrence.

Summary of conclusions: Delayed eruption of a SINGLE primary tooth is very uncommon. After ruling out trauma, neoplasms and odontogenic tumors become the most common etiology. This article outlined a short DDX of the condition.

Assessment of article: A concise DDX for delayed eruption of single primary tooth in the absence of traumatic event. This article could use a conclusion paragraph. Builds up to a real cliffhanger and then leaves the audience with no closure!