Odontoma is a hamartomatous lesion of odontogenic origin involving both epithelial and mesenchymal tissues. Although it is not an uncommon lesion yet in certain conditions it can lead to complications if left untreated. This is a retrospective review of 30 diagnosed odontoma cases from the archives of Department of Oral & Maxillofacial Surgery, Government Dental College & Hospital, Nagpur, India. Out of these 30 cases, 17 were diagnosed as complex odon toma and 13 cases as compound odontoma. Two of these unusual cases have been described which emphasize the importance of early & appropriate treatment to prevent further morbidity.
The term odontoma was first used by Paul Broca in 1867 who defined it as “tumors formed by the overgrowth of transitory or complete dental tissues”. Howard listed odontoma as the fourth category of supernumerary tooth. However this category is not universally accepted. The term “odontoma” was earlier referred to “any tumor of odontogenic origin” [
As per the current understanding odontoma is considered to be a hamartomatous malformation rather than true neoplasm [
According to the WHO classification, a complex odontoma is a malformation in which all the dental tissues are represented, individual tissues being mainly well formed but occurring in a more or less disorderly pattern; where as a compound odontoma is a malformation in which all the dental tissues are represented in a more orderly pattern than in the complex odontoma so that the lesion consists of many tooth like structures [
This study was aimed to present the data on a series of 30 diagnosed cases of odontomas along with a comparative analysis with previous statistics and also to present two unusual cases of odontomas encountered during the study period.
All the cases diagnosed as odontoma from 1998 to 2003 were retrieved from the archives of the department of Oral & Maxillofacial surgery in Government Dental College, Nagpur, India. A total 30 cases were enucleated and analyzed with respect to age, gender and location (Chart 1 and Chart 2). Almost all the cases were submitted to the department of Oral & Maxillofacial Pathology with the clinical impression of odontoma [
Statistical information relative to the age of the patients, incidence, location and type of odontoma reveals that out of these 30 cases, 17 were complex odontomas and 13 cases were compound odontomas. Mean age of patients with complex odontoma was 29 years, the male: female ratio being 12:5 and 88.2% complex odontoma were seen in posterior mandible. Mean age of patients with compound odontoma was 28.3 years, the male: female ratio being 6:7 and 69.2% were seen in anterior maxilla. Out of this series; the following two special have been discussed to signify the need for early diagnosis & treatment of an apparently benign hamartomatous lesion.
A 21 year old male patient was referred to the division of Oral & Maxillofacial surgery with a complaint of pain, swelling and pus discharge from the left cheek. A diffuse intraoral and an associated extra oral bony hard swelling was seen in relation to the left posterior quadrant (
bone was expanded and thinned out (
The gross specimen revealed hard tissues associated with a soft tissue counterpart & necrosed areas at the periphery (
A 27 year old male patient was referred to the division of Oral & Maxillofacial Surgery, GDC, Nagpur; with a complaint of missing teeth, swelling, discomfort, difficulty in chewing and unaesthetic appearance. The patients’ family history was non contributory.
Clinical examination revealed that upper and lower incisors were missing; although lower right central and lateral incisors were partly erupted (
in the mandibular anterior region (
to 13 mm. Few of them exhibited fusion and dilacerations (
The mandibular lesion appeared to be larger as compared to the maxillary swelling, thereby suggesting that patient had numerous denticles even in the lower anterior arch. It can be hypothesized that such an aggressive hamartomatous proliferation might have been due to some genetic imbalance or mutation affecting the anterior portion of both the arches simultaneously during intrauterine period.
The aim of selecting and highlighting these two peculiar cases is that they aptly display limits of an entire spectrum which can clinically manifest under this entity. The current opinion states that odontomas are hamartomatous in nature [
According to Neville et al. (1995) compound odontomas are twice as commonly observed as the complex odontomas; whereas in our series almost 2/3rd cases were that of complex odontomas. Another observation of this series is that compound odontomas were equally distributed among males and females whereas the complex ones had a predilection for males and the latter seems to vary considerably from that observed by Neville et al. [
In the present study, it was noted that the distribution
of compound and complex odontoma was dependent upon the site of lesion. The compound odontoma occurred predominantly in the anterior jaw; this is in accordance with Slootweg & Utrechet [
Budnick S.D. in 1976 observed that prevalent age for the diagnosis and treatment of odontomas was the second decade of life with a mean age of 14.8 years [
In a review of 104 cases of odontomas, Owens et al. identified 67 (64.4%) compound, 32 (31.0%) complex, and 5 (4.6%) diagnoses of both compound and complex odontomas [
As stated previously, one case in the present analysis was that of infected complex odontoma; a long standing lesion which became aggressive due to secondary infection. The odontoma appeared to protrude out of the left cheek with purulent discharge through a fistulous tract & an apparent space infection that could have lead to cellulitis.
Another unusual presentation was that of multiple odontomas with more than 40 denticles enucleated from a single lesion in the maxillary anterior region & a larger synchronous lesion in the mandibular anterior arch that could not be enucleated. The English literature reveals that Sharma et al. (2010) reported a case of compound composite odontoma with 37 denticles.
A review of English literature showed 12 cases of multiple compound odontomas excluding this report; such cases are at times associated with Cleido cranial dysostosis or Gardner’s syndrome (GS). Patients affected by GS are at a greater risk of developing cancer in various organs; therefore surveillance of such patients is recommended. Dental anomalies usually seen in GS are impacted teeth, supernumerary teeth, odontomas, and congenitally missing teeth [12,13]. According to Philipsen and Reichart the compound odontoma represents a histomorphological malformation which is closely related to the pathological process producing hyperdontia, multiple schizodontia or hyperactivity of dental lamina. The treatment of choice for compound odontomas continues to be conservative surgical removal.
Recurrence is generally not observed if the associated lining epithelium is removed intact (Kaban and Troulis, 1990) [
These cases signify the severity of naive appearing hamartomatous lesions like odontomas and the complications they can present if left as such. Although the treatment modality is enucleation; but this has to be altered in cases of syndromic association & occurence of complex odontoma with ameloblastic fibro odontoma. Such long standing patients have greater chances of developing ameloblastic fibrosarcoma. Clinically; a complex odontoma may not be differentiated from a hamartomatous or a neoplastic lesion and a compound odontoma may cause excessive morbidity during secondary infection as elaborated in these reports.