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 Table of Contents  
CASE REPORT
Year : 2015  |  Volume : 2  |  Issue : 2  |  Page : 82-85

A rare case of complex odontome in posterior maxilla


Department of Oral and Maxillofacial Surgery, MGM Dental College and Hospital, Navi Mumbai, Maharashtra, India

Date of Web Publication20-Jul-2015

Correspondence Address:
Ashvin Wagh
Department of Oral and Maxillofacial Surgery, MGM Dental College and Hospital, Navi Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2348-2915.161208

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  Abstract 

Odontomas are considered to be a developmental anomalies resulting from the growth of completely differentiated epithelial and mesenchymal cells that give rise to ameloblasts and odontoblasts. A rare case of complex odontome in posterior maxilla involving maxillary sinus, associated with impacted tooth and erupting into oral cavity is presented in this article which was treated with an en block resection and palatal obturator.

Keywords: Complex, erupted odontome, odontome


How to cite this article:
Vaidya S, Sidana S, Gandevivala A, Wagh A. A rare case of complex odontome in posterior maxilla. J Dent Res Rev 2015;2:82-5

How to cite this URL:
Vaidya S, Sidana S, Gandevivala A, Wagh A. A rare case of complex odontome in posterior maxilla. J Dent Res Rev [serial online] 2015 [cited 2019 Aug 22];2:82-5. Available from: http://www.jdrr.org/text.asp?2015/2/2/82/161208


  Introduction Top


Odontome is a benign odontogenic tumor showing nonaggressive behavior and slow growth. [1] Clinically, it is classified as central (intra-osseous), peripheral (soft tissue or extra-osseous) and erupted odontome. Histologically, it is classified as compound odontome and complex odontome. According to World Health Organization 1992 classification complex odontome is a benign odontogenic tumor of mixed variety containing all types of dental tissues but in a disorderly pattern. It is thought that the complex odontome is a mature expression of ameloblastic fibro-odontoma.

Complex odontome occurs in second and third decade of life, female predilection (60%) and mostly occur in the mandibular first and second molar region. Incidence is less common than the compound odontome, not rare, but eruption through the oral mucosa is exceptional presentation. The treatment of choice is surgical excision of the lesion, confirmation of diagnosis by histo-pathological study and rehabilitation of the patient by appropriate means.

The objective of this article is to present a rare case of complex odontome in the posterior maxillary region involving maxillary sinus and associated with an impacted tooth and erupting into the oral cavity.


  Case Report Top


A 37-year-old female presented with a chief complaint of swelling in the upper left posterior maxilla with duration of 3 months. She gave a history of having her upper left first and second molars were removed 2 years ago. Extra-orally there was no gross facial asymmetry. On intra-oral examination, there was a nonhealing extraction socket with blackish hard mass in the upper left third molar region without any pus discharge. There was cortical expansion in the same region without any mucosal inflammation [Figure 1].
Figure 1: Pre-operative photograph

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Computed tomography scan (coronal view) showed a radio-opaque mass extending into left maxillary sinus reaching just short of the orbital floor [Figure 2] and [Figure 3]. Bony expansion of buccal and palatal cortical plates along with thickening of sinus lining was present [Figure 4] and [Figure 5]. A provisional diagnosis of complex odontome was made.
Figure 2: CT scan (coronal view)

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Figure 3: Cone beam computed tomograph

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Figure 4: CT scan (axial view)

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Figure 5: CT scan (axial view)

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Under naso-endotracheal intubation, a mucoperiosteal flap was raised in the upper left molar region. Bony hard lesion along with impacted tooth was noted, and en bloc excision was done [Figure 6] [Figure 7] [Figure 8]. The palatal obturator was given to close the oroantral communication following excision of the tumor.
Figure 6: Intra-operative photograph after elevation of flap

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Figure 7: Intra-operative photograph after excision of lesion

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Figure 8: Specimen

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Histo-pathologically, H and E stained decalcified tissue section shows irregularly arranged enamel matrix with small spaces. Large spaces seen in focal areas of a representative of decalcified enamel and the tissue is surrounded by dentinoid like material suggestive of immature complex odontome [Figure 9].
Figure 9: H and E stained soft tissue section

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  Discussion Top


Odontomas are most common benign tumor of jaw constituting 22% of all odontogenic tumor. It is considered to be hamartoma, that is, tumor like malformations. Odontomas are usually small resembling the size of the tooth. Large odonomas are rare. Complex odontomas are usually located in the posterior region of the mandible. [2],[3] In this case, complex odontoma was large with the size of 5 cm and located in the posterior maxilla. More commonly seen in females with a ratio of 1.5:1. The relative frequency of occurrence varies between 5% and 30%. It can occur at any age while the majority of cases (84%) occur before the age of 30. With a peak in the second decade of life, less than 10% are only found in the patients over 40 years of age. [4] Unerupted teeth are associated with 10-44% of complex odontome and delayed eruption of at least one permanent tooth, mostly being canines account for 74% in this case it was associated with impacted tooth.

Radiographic appearance of complex odontome depends on the stage of development and degree of mineralization. In the first stage, there is radiolucency due to lack of calcification. There is the presence of partial calcification in the intermediate stage while in the third stage the lesion usually appears radio-opaque with amorphous masses of dental hard tissue surrounded by a thin radiolucent zone corresponding to the connective capsule histologically. [5]

Enucleation and curettage are the treatment of choice, and there are very less chances of recurrence. Excision of larger erupted odontome may leave a large defect making primary closure difficult to achieve [Figure 10]. Palatal rotation flap, buccal fat pad graft, buccal mucosal flap can be used to close, but in this case as the defect was large, it was not close and palatal obturator was given to close the oroantral communication [Figure 11].
Figure 10: Post-operative photograph after 1 month

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Figure 11: Post-operative photograph with palatal obturator

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  Conclusion Top


A rare case of complex odonotoma in the posterior maxilla associated with impacted tooth is presented which was treated with en bloc resection and palatal obturator.

 
  References Top

1.
Reddy GS, Reddy GV, Sidhartha B, Sriharsha K, Koshy J, Sultana R. Large complex odontoma of mandible in a young boy: A rare and unusual case report. Case Rep Dent 2014;2014:854986.  Back to cited text no. 1
    
2.
Budnick SD. Compound and complex odontomas. Oral Surg Oral Med Oral Pathol 1976;42:501-6.  Back to cited text no. 2
[PUBMED]    
3.
Reichart AP, Philipsen HP. Odontogenic Tumors and Allied Lesions. London: Quintessence; 2004.  Back to cited text no. 3
    
4.
Arunkumar KV, Vijaykumar, Garg N. Surgical management of an erupted complex odontoma occupying maxillary sinus. Ann Maxillofac Surg 2012;2:86-9.  Back to cited text no. 4
[PUBMED]  Medknow Journal  
5.
Kodali RM, Venkat Suresh B, Ramanjaneya Raju P, Vora SK. An unusual complex odontoma. J Maxillofac Oral Surg 2010;9:314-7.  Back to cited text no. 5
[PUBMED]    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11]



 

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Abstract
Introduction
Case Report
Discussion
Conclusion
References
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