Compound Odontoma - Diagnosis and Treatment: Three Case Reports

Resident: Adam J. Bottrill
Date: 22DEC10
Region: Providence
Article title: Compound Odontoma - Diagnosis and Treatment:
Author(s): Branca Heloisa de Oliveira
Journal: Pediatric Dentistry
Page #s: 151-157
Vol:No Date: 23:2 2001
Major topic: Compound Odontoma
Minor topic(s): NA
Type of Article: Case Studies
Main Purpose: This paper describes 3 cases of compound odontomas diagnosed in children due to dislodgement or over-retention of primary anterior teeth and/or swelling of the cortical bone.

Key points in the article discussion:

I. General:

A. Odontomas: developmental anomolies formed of enamel and dentin with possible , variable amounts of pulpal and cement tissue. Can show anatomical similarity to teeth, in which case it labeled "compound." When it forms an irregular mass, described as "complex"

B. Major Characteristics of Compound and Complex Odontomas:




















C. Ameloblastic fibro-odontoma: General features of ameloblastic fibroma but with evidence of enamel and dentin.
1. 10yo
2. Central/Intraosseous tumors
3. Posterior Mandible
4. Well-defined, uni/multilocular radiolucent defect with variable amount of (dental) radiodense material.
5. Tx: Conservative surgical enucleation with GREAT prognosis.

D. Ameloblastic Fibrosarcoma: malignant counterpart of the ameloblastic fibroma. Usually a "re-diagnosis" of a progressing existing lesion.
1. 27.5 yo
2. Ill-defined, destructive radiolucent lesion that suggests malignant process.
3. Pain and swelling along with rapid clinical growth.
4. Tx: Radical surgical excision.
5. Long-term prognosis unsure.

E. Odontoameloblastoma: VERY RARE... with ameloblastomatous components with odontoma-like component.
1. Mandible of young patients
2. Radiolucent, destructive process that contains calcified structures.
3. Tx: Surgical resection. (curettaged lesions may reccur)
4. RARE... no known prognosis

II. Case I

A. 5 yo white female.
B. Presented with changing position of upper left primary central incisor (labially displaced and intruded). No Hx of trauma.
C. Radiographic exam: compound odontomas in palate.
D. Tx: Surgical resection. 3 tooth-like structures found within lesions.
E. When permanent teeth erupted, upper incisors proclined and midline is shifted.
F. Removable appliance used to improve position.

III. Case II

A. 12 yo female
B. Presented complaining of excess volume of gingiva in the area of upper right anterior region. No Hx of trauma.
C. Radiographic exam: compound odontoma buccal to the root of upper permanent lateral incisor.
D. Tx: Surgical resection. 7 tooth-like structures found.
E. 1 yr F/U confirmed that lateral incisor had returned to normal position. No recurrence of lesion.

IV. Case III

A. 11 yo male.
B. CC of overretained primary central incisor despite presence of permanent dentition elsewhere in the mouth.
C. Radiographic exam: odontoma-like lesion in the buccal region of primary incisor root.
D. Impacted corresponding permanent incisor.
E. Tx: Surgical removal with multiple tooth-like structures present.
F. Orthodontic device used to expose and guide tooth into place.
G. 3 years to bring into place with uneven gingival margins and incisal edge.

V. Discussion

A. The three cases were all diagnosed early and radiographically prior to excision. All found in the anterior maxilla.
B. One patient suffered trauma in the area. Some researchers claim trauma may contribute to odontoma development.
C. Delayed diagnosis (evident in case III) may result in complete root formation/impaction and necessitate surgical exposure.
D. Ideally, surgical removal of odontomas should occur when the roots of adjacent permanent teth are about half-formed.

VI. Conclusions

A. Evidence suggests that an individualized radiographic examination of any pediatric patient that presents clinical evidence of delayed permanent tooth eruption or temporary tooth displacement should be performed.
B. Early diagnosis of odontomas allows adoption of a less complex and less expensive treatment and ensures better prognosis.

Assessment of article: Good background and history of the pathology. I don't believe the author overstepped any bounds or made any rash conclusions based on these three cases. I know this may be hard to believe, but I don't have any complaints. Likey.