Impacted Upper Lateral Incisor in a 16-Year-Old Female-"Compound Odontome" the Culprit-A Case Report.

Odontoma is the most commonly found odontogenic tumor. Odontomas are an abnormal mass of calcified dental tissue, usually representing a developmental anomaly. They are benign and originate from an alteration of differentiated mesenchymal and epithelial odontogenic cells. They have the capacity of forming enamel, dentin, and cementum. Etiology in still unknown, but different theories have been postulated. Because these tumors are asymptomatic, 75% of all cases are diagnosed before the second decade of life, due to a delay in eruption of permanent teeth. Treatment of choice for these tumors is enucleation. The authors describe one such case of compound odontome obstructing the eruption of a permanent lateral incisor.

INTRODUCTION

The term “odontoma”, by definition alone, refers to any tumor of odontogenic origin. Through usage, however, it has come to mean a growth in which both the epithelial and the mesenchymal cells exhibit complete differentiation with the result that functional ameloblasts and odontoblasts form enamel and dentin.[1]

Presently, the World Health Organization classified odontoma within the category of odontogenic tumors composed of odontogenic epithelium and ectomesenchyme with or without formation of mineralized dental tissues. Most authorities accept the view today that odontoma represents a hamartomatous malformation rather than neoplasm.[2]

Odontomas are classified taking into account organization and degree of alteration of odontogenic cells. There are of two types: compound composite odontoma and complex composite odontoma. The former has superficial anatomic similarity to normal teeth, whereas the latter bears no morphological similarity even to rudimentary teeth.[3]

Here, we document the case of a 16-year-old girl with compound odontoma in the anterior part of the maxilla, which was surgically removed to facilitate the eruption of impacted permanent lateral incisor by orthodontic means.

CASE REPORT

A 16-year-old girl reported with complaints of missing anterior tooth on the left side of the upper jaw and proclined anterior teeth. Past dental history revealed no history of extraction in the maxillary anterior region. Clinical examination revealed edentulous space in the left maxillary permanent lateral incisor region.

Panoramic radiograph was taken, which showed a radiopaque mass in the alveolar part of the jaw bone in between left permanent central incisor and canine. Also, deeply impacted left permanent lateral incisor was observed.

Cone beam computed tomography (CBCT) imaging of the maxilla showed multiple hyperdense calcified mass resembling tooth in the left maxilla. The calcified mass measured 6.2 × 5.9 mm in the axial section, 6.8 × 6.1 mm in the coronal section, and 6.7 × 6.6 mm in the sagittal section at the greatest dimension. The impacted left permanent lateral incisor was seen 6.8 mm from the alveolar crest region of left permanent canine [Figure 1].

Figure 1

Cone beam computed tomography (CBCT) showing calcified mass resembling tooth structure in left anterior maxilla associated with impacted left permanent lateral incisor

On the basis of the clinical and radiographic findings, a provisional diagnosis of compound odontome in the left side anterior maxilla associated with impacted left permanent lateral incisor was made.

Considering the age of the patient, surgical removal of the compound odontome was planned followed by orthodontically guided eruption of impacted lateral incisor.

The patient was consented for surgical removal under local anesthesia. A full-thickness mucoperiosteal flap was elevated extending from right maxillary permanent central incisor to left first premolar region.

Bony window was created between left maxillary central incisor and canine region. About six calcified structures resembling tooth were removed. The crown of impacted tooth was exposed to facilitate the eruption by orthodontic means [Figure 2].

Figure 2

Surgical removal of the compound odontomes in the left anterior maxilla

Copious irrigation was performed with saline and the operated site was closed with interrupted sutures after reapproximating the flap. The specimens were sent for histopathological examination and were confirmed histopathologically as compound odontome.

DISCUSSION

Odontomas are the most common odontogenic tumor and are considered as hamartomatous growth rather than true neoplasm. Based on the morphological appearance and histological architecture, they can be either compound odontome or complex odontomes.[4]

Morphologically, compound odontomes almost resemble normal teeth and histologically the composition and architecture exactly resembles normal teeth. Unlike compound odontomes, complex odontomes are basically conglomerate mass of hard tissue of teeth without regular arrangement of the same histologically.[5]

In the current case, there was clinically missing left permanent lateral incisors. At this stage, it was suspected that failure in the formation left lateral permanent tooth germ as permanent maxillary lateral incisors were found to be the third most common congenitally missing teeth in the oral cavity next to the third molars and mandibular second premolars.[6]

On further radiographic investigation using orthopantomogram and CBCT, toothlike structures were seen coronal to the well-formed, deeply impacted left maxillary permanent lateral incisor. On the basis of the evidence of radiographic findings, it was concluded that the compound odontomes were primarily responsible for the impaction of left maxillary permanent incisor. Surgical removal of the compound odontomes was conducted to facilitate the orthodontically guided eruption of impacted permanent lateral incisor.

Hyperdontia otherwise called as supernumerary teeth can be supplemental or rudimentary type. In supplemental type, the supernumerary teeth will be of normal size and shape unlike the rudimentary type in which the tooth will be of abnormal shape and size.[6]

Supernumerary teeth structures are most common in the anterior maxillary region and more specifically in the form of mesiodens, which is an erupted rudimentary tooth between the permanent central incisors.[6]

Though compound odontomes are generally seen as multiple rudimentary toothlike structures within the jaw bone, similar to the single-tooth hyperdontia, they also have strong predilection for anterior maxillary region of the jaw bone.

CONCLUSION

Current case highlights the fact that though permanent maxillary lateral incisors are recognized as one of the most common congenitally missing teeth, clinical absence of the permanent maxillary lateral incisors always does not result from lack of formation of permanent tooth germ. Moreover, anterior maxilla being the most common site for an erupted single-tooth hyperdontia, as well as compound odontomes in the jaw bone, possibility of the compound odontome mass in the path of eruption of the well-formed permanent teeth resulting in impaction of the teeth in that region should always be considered.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.