|Year : 2013 | Volume
| Issue : 4 | Page : 177-179
An erupted Odontoma associated with impacted maxillary right lateral incisor: A case report
S Prathibha Rani1, Dempsy Chengappa2, A Anantharaj3, P Praveen4, R Sudhir5
1 Department of Pedodontics and Preventive Dentistry, D.A.P.M.R.V. Dental College and Hospital, Bengaluru, Karnataka, India
2 Dental Officer (Pedodontist), Army Hospital, R&R, New Delhi, India
3 Professor and HOD, Department of Pedodontics and Preventive Dentistry, D.A.P.M.R.V. Dental College, Bengaluru, Karnataka, India
4 Professor, Department of Pedodontics and Preventive Dentistry, D.A.P.M.R.V. Dental College, Bengaluru, Karnataka, India
5 Lecturer, Department of Pedodotnics and Preventive Dentistry, D.A.P.M.R.V. Dental College, Bengaluru, Karnataka, India
|Date of Web Publication||22-Jan-2014|
S Prathibha Rani
D.A.P.M.R.V. Dental College, 24th Main, J.P Nagar 1st Phase, Bengaluru - 560 078, Karnataka
Eruption of an odontoma is infrequent and here we report a rare case of an erupted odontoma which was associated with an impacted maxillary right lateral incisor which was confirmed by the histopathological report.
Keywords: Compound composite odontoma, odontomas, supernumerary tooth
|How to cite this article:|
Rani S P, Chengappa D, Anantharaj A, Praveen P, Sudhir R. An erupted Odontoma associated with impacted maxillary right lateral incisor: A case report. SRM J Res Dent Sci 2013;4:177-9
|How to cite this URL:|
Rani S P, Chengappa D, Anantharaj A, Praveen P, Sudhir R. An erupted Odontoma associated with impacted maxillary right lateral incisor: A case report. SRM J Res Dent Sci [serial online] 2013 [cited 2020 Nov 27];4:177-9. Available from: https://www.srmjrds.in/text.asp?2013/4/4/177/125602
| Introduction|| |
Odontoma by definition refers to any tumor of odontogenic origin in which both the epithelial and the mesenchymal cells exhibit complete differentiation with the result that functional ameloblasts and odontoblasts form enamel and dentin. 
According to the World Health Organisation odontomas are of two types complex odontomas, a malformation in which all dental tissues are present, but arranged in a more or less disorderly pattern; and compound odontomas, a malformation in which all of the dental tissues are represented in a pattern that is more orderly than that of the complex type and enamel, dentine, cementum and pulp are arranged as they would be in the normal tooth. 
The erupted odontomas are the ones which are present coronal to an erupting or impacted tooth or superficially in bone.  Eruption of odontoma is infrequent and in literature there are only about 20 documented cases.
Thus the aim of this paper is to report a rare case of an erupted compound odontoma in maxillary anterior region with the impaction of the upper lateral incisor and unpleasant appearance.
| Case Report|| |
The present case report is about an 11-year-old male patient who reported to Department of Pedodontics, DAPM R V Dental College Bangalore, with a chief complaint of broken irregular upper front tooth which had appeared a few years ago. The patient gave a history of having had a fall 10 years ago. He had visited a dentist about 3 years ago when the tooth was first noticed. No treatment was initiated for the tooth then. Intraoral examination revealed an irregular calcified mass in relation to the upper right lateral incisor region [Figure 1]. The upper central incisors were rotated and hypoplastic with irregular crown structure. The upper right canine was tilted distally and labially. The lower central incisors were found to be clinically missing, which was confirmed radiographically. There was no history of any systemic disease or syndrome though the patient gave a history of infection and pus discharge around the irregular calcified mass in relation to the upper right lateral incisor. Intraoral periapical radiographs of the region revealed a dense irregular calcified mass in relation to the upper right lateral incisor and a well-defined margin of tooth embedded within the mass. This was confirmed with a maxillary occlusal view radiograph and the panoramic radiograph [Figure 2].
Surgical excision of the calcified mass along with the embedded tooth was planned. After infiltration of local anesthesia (2% lignocaine 1:80,000 adrenaline) the whole calcified mass along with the tooth was extracted [Figure 3]. The socket was curetted to remove any remnants and sutured using 3.0 silk sutures. The healing of the site was uneventful and the suture removal was carried out after a week. The specimen along with the tooth was sent for histopathological evaluation. The stained decalcified tissue sections revealed dentin like tissue along with pulpal areas [Figure 4]. The patient is being considered for prosthetic rehabilitation.
|Figure 3: Photograph of gross specimen of odontoma and supernumerary tooth after excision|
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| Discussion|| |
Odontoma is the most common odontogenic tumor in maxilla. Compound odontoma is most commonly found in the upper incisors and canine areas. ,, In our case the odontoma was found in the maxillary right lateral incisor region.
Majority of the compound odontoma cases are diagnosed before the age of 20 years , and an increased prevalence of these tumors is observed in children and adolescents.  Our patient's age was 11 years.
Odontomas have an incidence of 22-67% of all maxillary tumors. Clinically, these are asymptomatic lesions often associated with alterations in permanent or temporary tooth eruption. The on the occasion of routine diagnosis is usually established radiological studies (panoramic and/or intraoral X-rays), or on evaluating the cause of delayed tooth eruption.  In the present case, the lateral incisor was surrounded by a radiopaque mass when viewed in radiograph and obstructed the eruption of 12.
The etiological factors for odontomas are pathological conditions such as local trauma, inflammatory and/or infectious process, hereditary anomalies (Gardners syndrome, Hermanns syndrome), odontoblastic hyperactivity and alterations in the genetic component responsible for controlling dental development. ,, The history in our case revealed that the patient had a fall 10 years back.
In certain exceptional circumstances spontaneous eruption of an odontoma into the oral cavity is seen with the exposure of the tumor through the oral mucosa. This could lead to pain, inflammation or infection with associated suppuration.  The patient in the present case complained of occasional pus discharge and discomfort.
The treatment of choice is surgical removal of the lesion in all cases, followed by histopathological study to confirm the diagnosis. ,, Recurrence following surgical excision has been found to be rare, though sometimes found in very young children in whom the odontomas are in early developing stages containing uncalcified portions.  In our case excision of the entire lesion was done along with the impacted loose maxillary lateral incisor, in order to overcome the risk of inflammation, infection and cystic degeneration.
| Conclusion|| |
Based on the above case report it can be concluded that the early diagnosis of the odntomas and their prompt treatment is essential for a dentist to prevent further complications and to restore the occlusal, esthetic and functional integration of the arch.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]