Pediatric Oral Surgery-Removal Of A Compound Odontoma.

Southern Georgia Oral Surgery

What is a compound Odontoma?
A compound odontoma has the three separate dental tissues (enamel, dentin and cementum), but may present  as a lobulated appearance where there is no definitive demarcation of separate tissues between the individual "toothlets".  Several small abnormal teeth surrounded by a fibrous sac tumor of enamel and dentin arranged in the form of anomalous miniature teeth.  The associated tissue usually appears as characteristic dentigrous cyst type.  It usually appears in the anterior maxilla and in some instances a compound odontoma can be positioned in a manner that compromises the adjacent teeth.  It is usually asymmtomatic and in most cases only be discernable with utilization of a radiograph.  However, cases have been reported to exhibit focal swelling of the affected site.  This appearance would and could be the impetus for the patient to be evaluated by a dentist.

Differential Diagnosis

Compound odontomas can be detected easily due to their tooth-like appearance. Complex odontomas can be differentiated from cemento-ossifying fibromas due to their propensity to be associated with crown of unerupted molar and they are more radiopaque than cement-ossifying fibromas. They can also develop at much younger age than cemento-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

Radiographic Features

The borders are well-defined, often with a cortex surrounding a soft tissue capsule. The internal structure is largely radiopaque. They often interfere with normal eruption of teeth. They can be associated with impacted, malposition, malformation, and displacement of adjacent teeth.

Treatment

Compound and complex odontomas are easily removed by simple excision. They do not recur and are not invasive.

Case Study
The patient presented as an 8yr old male, No Meds, NKDA
The patient was referred from their general dentist in order to be evaluated for a radiopaque mass in right maxillary region.  The patients clinical evaluation revealed a prominence of the buccal aspect of the right maxilla, that was non-tender or fluctuant.  Primary teeth "B" and "C" were present, but were mobile, decayed and required extraction.  Radiographically, there was a radiopaque mass positioned above teeth "B" and "C".  The mass was approximately 1cm x 1cm and inhibited the eruption of  the permanant premolar.  The plan was to remove the affected primary teeth and remove the mass/associated tissue for biopsy.  The procedure was performed under IV sedation successfully.
It was our intention not to place bone graft material in the bony defect after the surgery.  The goal was to allow full maturation of the remaining premolar, which should spontaneously assume its position in the dentition.  The patient will receive follow up every 6 months for a clinical evaluation and serial radiographs.

Path Report

Decalcified sections show multiple "toothlets" which show abnormal morphologic pattern.  Fragments of bone and connective tissue also appear.  Remnants of what appears to represent a dentigerous cyst associated with the lesionis also noted. 

Post op Visit
The patient returned one week later to examine the surgical site post-operatively.  Minimal swelling was evident and the patient exhibited no complaint of discomfort.  A bone graft to obliterate the bony defect was not suggested as to not inhibit the eruption of the permanant tooth.  The patient will be place on a 6 month recall for further observation and evaluation of the region.
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