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CENTRO ESCOLAR UNIVERSITY MAKATI

SCHOOL OF DENTISTRY

HOSPITAL DENTISTRY CASE ANALYSIS

COMPOUND ODONTOMA INVOLVING THE FOUR QUADRANTS OF THE


JAWS: A CASE REPORT AND REVIEW OF THE LITERATURE

PRESENTED BY:
DMD-4A (Group 3)

CARLOS, JUSTINE ERIKA MAY


DAYANGHIRANG, NINA DOMINIQUE
DELA CRUZ, ERNESTINE ANDREA A.
FERMIN, ATHENA MONIQUE D.
MACALANGGAN, AMENAH
MORING, JOHN RHOY
RUIZ, CARLEEN
SALAYSAY, JUDY PEARL
SALAZAR, ANDREA REI E.

ODONTOMAS

The most common odontogenic tumors


It is by definition refers to any tumor of odontogenic in origin
Representing 70% of all odontogenic tumors
It is a growth in which both the epithelial and mesenchymal cells exhibit
complete differentiation with the result that functional ameloblast and
odontoblasts forms enamel and dentin
It may present in two specific forms:
COMPOUND ODONTOMA
- Forms many separate, multiple small tooth-like structure
COMPLEX ODONTOMA
- Irregular mass of dentin and enamel without resemblance to a tooth

ETIOLOGY OF ODONTOMA

It is not known but environment causes such as infection, trauma, family


history and genetic mutation are hypothesized.

It constitutes 5-30% of all odontogenic tumors and is mostly found in the


posterior mandible and anterior maxilla. They are seen in with unerupted
teeth in 10-44% and about 17% of them are associated with impacted
maxillary lateral incisors.

PATHOPHYSIOLOGY

ORAL
EPITHELIUM
INITIATION OF TOOTH
FORMATION
PATHOPHYSIOLOGY
ENAMEL ORGAN CONSISTS OF
PERIPHERALLY LOCATED LOW
COLUMNAR CELLS AND CENTRALLY
LOCATED POLYGONAL CELLS

DENTAL PAPILLA AND DENTAL


SAC NOT WELL DEFINED

TOOTH BUD CONTINUES TO


PROLIFERATE, DOES NOT EXPAND
UNIFORMLY INTO A LARGE SPHERE
UNEQUAL GROWTH IN
DIFFERENT PARTS OF THE
TOOTHE BUD
CONTINUED UNEVEN GROWTH
OF THE ENAMEL ORGAN
UNORGANIZED
LESION WITH
FOLDING OF ENAMEL
ORGAN
ENAMEL, DENTIN, CEMENTUM
AND PULP
INTERRUPTED
MINERALIZATION AND ROOT

CONTINUED UNEVEN GROWTH


OF ENAMEL, CEMENTUM,
DENTIN AND PULP

INCOMPLETE
FORMATION OF TOOTH

FORMATION OF SMALL
ASYMPTOMATIC CALCIFIED
A.
TOOTH
IMPACTION

S.O.A.P

BONY HARD SWELLING OF


MAXILLA AND MANDIBLE
SUBJECTIVE

LACK OF MULTIPLE
TEETH/ EDENTULISM

PRESENCE OF TOOTH LIKE


STRUCTURES ON ANTERIOR
MAXILLA AND MANDIBLE

1. CHIEF COMPLAINT:
Not applicable
2. HISTORY OF PRESENT ILLNESS:
The patient was admitted to the faculty of dentistry, Cukurova University,
Adana, Turkey on June 11. His general dentist referred the patient due to
the lack of multiple teeth and presence of tooth-like structures with caries
detected clinical and radiographic examination.
3.

PAST MEDICAL HISTORY: unremarkable

4. REVIEW OF SYSTEMS:
A debile looking male with advanced sight disorder
5.
6.

FAMILY HISTORY: unremarkable


PERSONAL SOCIAL HISTORY: not applicable

OBJECTIVE
1. Extra-oral
- No paresthesia or pain
- Debile-looking male with advance sight disorder
- No swelling or cervical lympadenopathy
2. Intra-oral
- No paresthesia or pain
- Edentulism of posterior segment of maxilla and mandible
- Tooth-like structures penetrating the oral mucosa were apparent in the
anterior regions of the maxilla and mandible
3. Radiograph
- Multiple diffuse tooth-like opacities occupying the maxilla and the
mandible as well as both maxillary sinuses
- Posterior teeth were impacted due to the present calcified lesions
4. Cone beam Computed Tomography
- Masses occupied the basal and alveolar parts of the mandible at the
parasymphisis and body parts bilaterally
- Maxillary premolar and molar regions were occupied by the masses
- The masses extend to the rim of the orbita cavity superiorly and
bilaterally without significant extraosseous expansion
5. Incisional Biopsy
6. Histopathologic examination
- Showed dentin, cementum, enamel and pulp tissues arranged in a toothlike order

ASSESSMENT
Final Dental Diagnosis: Compound odontoma involving the for quadrants of
the jaws
Initial Dental Diagnosis: Compound odontoma involving the four quadrants
of the jaws
Medical Diagnosis: Mild Mental Retardation and severe myopia
Medical Differential Diagnosis: Gardeners Syndrome; Cleidocranial
Dysplasia

PLAN

The surgical treatment options include:


Enucleation
Resection/Reconstruction
The patient and family members refused an extensive surgery and
preferred symptomatic treatment.
The odontomas, which were penetrating oral mucosa, were removed
under local anesthesia.
The conventional treatment of odontomas complete removal with any
associated tissues.
The remaining parts were left in situ.
The healing was normal at the regions where lesions were removed.
A removable denture was fabricated and delivered to the prosthodontic
department.

The post-operative procedures are:


The patient was recalled every 3 months for clinical and panoramic
radiographic examination.
Another CBCT scan was taken after 12 months.
Both clinical and CBCT examinations showed that there was no
enlargement of the masses in any direction after 12 months. It was
concluded that the patient was in the course of asymptomatic status and
follow-ups were continued without further surgical intervention.
The patient was given a schedule of clinical and radiographic follow-ups.
No recurrences are expected
B.

CLINICAL FEATURES

Clinical intraoral examination showed edentulism in both posterior segments


in the maxilla and the mandible.

C.

Tooth-like structures with caries penetrating the oral mucosa were apparent
in the anterior regions of the maxilla and mandible.
No extra oral swelling
No cervical lymphadenopathy
RADIOGRAPHIC FEATURES

PANORAMIC RADIOGRAPH

Multiple and diffuse tooth-like opacities occupying the maxilla and the
mandible as well as both maxillary sinuses
The posterior teeth were impacted due to these lesions

CONE BEAM COMPUTED TOMOGRAPHY (CBCT)


D.

HISTOPATHOLOGIC FEATURES

E.

The histopathologic examination showed dentin, cement, enamel, and pulp


tissues arranged in a tooth-like order.
Microscopic features show the denticles of compound odontomas comprise a
central core, similar to pulp tissue, surrounded by primary dentin and covered
with partially demineralized enamel and primary cement.
The connective tissue capsule around the odontoma is similar in all respects
to the follicle surrounding a normal tooth.
An interesting feature is the presence of ghost cells in odontoma.
Ghost cells are pale, eosinophilic, swollen epithelial cells that have lost the
nucleus but show a faint outline of the cellular and and nuclear membrane.
They contain many tonofibrils.
DIFFERENTIAL DIAGNOSIS

Compound odontomas can be detected easily due to their tooth-like


appearance. Complex odontomas can be differentiated from due to their
propensity to be associated with crown of unerupted molar and they are more
radiopaque than cement-ossifying fibromas.
A dense bony island can be included in the differential. However, the presence
of a soft tissue capsule is very useful in differentiation. Periapical cemental
dysplasia may resemble complex odontomas but usually they are multiple,
surrounded by sclerotic borders and centered around apices of teeth, whereas
odontomas are commonly found occlusal or overlapping the involved teeth.
a. Ameloblastic fibro-odontoma

Noted mostly in first and second decades


Approximately 70% in mandible, usually
posterior region

b.

No gender predilection
May cause jaw expansion
Asymptomatic
Well defined with hyperostotic margin
Unilocular to multilocular
Often associated with an unerupted tooth
Ameloblastic fibro-odontoma has opaque
component(s) related to enamel and dentin in
the odontoma component
Adenomatoid odontogenic tumor
Narrow age range, 5 to 30 years, with most cases
noted during second decade
Female predilection
Anterior jaw location common
Association with unerupted tooth
Asymptomatic; occasionally produces expansion
alveolar bone
Rarely occurs in gingival soft tissue (peripheral)
May produce root divergence of adjacent teeth
Well defined, unilocular, often adjacent to crown
unerupted tooth
Opaque foci may be scattered within the lucency
snowflake or salt and pepper pattern

c. Calcifying Odontogenic Tumor

Chiefly in posterior mandible


Painless, slow growing
Mean age of occurrence is approximately 40 years
Occasional soft tissue origin (peripheral) noted as a
sessile gingival mass
Jaw expansion a common clinical presentation
Usually noted in association with an impacted tooth
Multilocular; most often with mixed radiolucent
and radiopaque features
Impacted tooth often obscured by tumorassociated calcification
Margins may be well defined or sclerotic and vague

d. Focal sclerosing osteomyelitis/Condensing Osteitis

Periapical inflammatory disease

of

of
in a

Results from a reaction to an infection of periodontal origin


This causes more bone production rather than bone destruction in the area
(most common site is near the root apices of premolars and molars)
The lesion appears as a radiopacity in the periapical area hence the sclerotic
reaction.
The sclerotic reaction results from good patient
resistance and a low degree of virulence of the
offending bacteria
Associated tooth may be carious or contains a
large restoration
Usually associated with a non-vital tooth

e. Ameloblastic fibro-odontoma

Benign, slow growing, expansile


epithelial odontogenic tumor with
odontogenic mesenchyme
May inhibit tooth eruption or displace
involved teeth although teeth in the
affected area are vital
Radiographically, shows a well-defined,
radiolucent area containing various
amounts of radiopaque material of
irregular size and form
The lesions are usually diagnosed
during the first and second decades of
life
It occurs with equal frequency in the
maxilla and the mandible
equal frequency in males and females
Sources:
web.squ.edu.om/med-Lib/MED_CD/E_CDs/.../docs/ch11.pdf

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