Odontomas

Compound Odontoma and Dentigerous Cyst Associated With an Unerupted Maxillary Canine Tooth in a Weimaraner Dog: A Case Report

A 7-month-old, male, Weimaraner dog was presented for maxillary swelling. Clinical evaluation including radiographs and computed tomography revealed a large cystic lesion, unerupted right maxillary canine tooth, and mass presumed to be a compound odontoma. The cyst and mass were expansile and occupied a large portion of the nasal cavity displacing anatomical structures of the maxilla. The mass was excised via curettage through an intraoral surgical approach and the unerupted tooth and cystic lining were removed. Histopathology supported dentigerous cyst and compound odontoma. This case confirms the first report of concurrent development of dentigerous cyst and compound odontoma in a dog with successful treatment and 18-month follow-up with no recurrence.

Clinicoradiopathologic Analysis of Odontomas: A Retrospective Study of 242 Cases

Odontomas are considered hamartomatous lesions and are one of the two most common odontogenic tumors of the jaw. Odontomas are classified as compound or complex. Recently, ameloblastic fibro-odontoma (AFO) and ameloblastic fibro-dentinoma were reclassified as developing odontomas. Though clinically odontomas are usually asymptomatic, they have adverse effects on adjacent teeth such as tooth impaction, delayed eruption, displacement of teeth, over-retention of teeth, and can give rise to odontogenic cysts within the jaw. We sought to evaluate the clinicoradiopathologic presentations of odontomas by collecting and analyzing the clinical, radiographic, and pathologic data of odontomas diagnosed in our institution from 2013 to 2022. Over this 10-year period, there were 242 patients with a histopathological and/or radiographic diagnosis of odontoma. There was no gender predilection and ages ranged from 3 to 101 years (median, 14 years). The second decade of life was the most prevalent (57.4%). There was no jaw predilection; however, the anterior jaw was the most common location. Ninety-four (38.8%) cases presented with clinical findings. The most common finding was tooth impaction (n = 83). Nine (3.7%) cases were histopathologically confirmed to be associated with other lesions such as dentigerous cysts (n = 8) and nasopalatine duct cyst (n = 1). The median age (25 years) of patients diagnosed with odontomas associated with cysts was older than patients with odontomas (14 years) without associated cysts. Compound odontomas were the most common type of odontoma compared to complex and AFOs with 71.4%, 26.6%, and 2%, respectively. The majority of compound odontomas involved the anterior jaw (69.3%) and mandible (54.9%) while the majority of complex odontomas involved the posterior jaw (59.6%) and maxilla (54.7%). The four AFOs were in the posterior jaw and 75% involved the maxilla. The median age (12 years) of patients diagnosed with AFO was the youngest compared to patients diagnosed with compound (13 years) and complex (16 years). In conclusion, we analyzed the clinical, radiographic, and pathologic features of 242 new cases of odontomas. Our study reaffirms that odontomas frequently affect the pediatric population and can disrupt their dentition. Based on the result of this study, our clinical recommendation to prevent problems to adjacent teeth from odontomas is for dentists to be apt in the diagnose of odontomas to ensure that they are surgically removed in a timely manner.

Practical Approach to Radiopaque Jaw Lesions

Radiopaque lesions of the jaw are myriad in type and occasionally protean in appearance. In turn, the radiologic analysis of these lesions requires a systematic approach and a broad consideration of clinical and imaging characteristics to enable reliable radiologic diagnosis. Initially categorizing lesions by attenuation pattern provides a practical framework for organizing radiopaque jaw lesions that also reflects important tissue characteristics. Specifically, the appearance of radiopaque lesions can be described as (a) densely sclerotic, (b) ground glass, or (c) mixed lytic-sclerotic, with each category representing a distinct although occasionally overlapping differential diagnosis. After characterizing attenuation pattern, the appreciation of other radiologic features, such as margin characteristics or relationship to teeth, as well as clinical features including demographics and symptoms, can aid in further narrowing the differential diagnosis and lend confidence to clinical decision making. The authors review the potential causes of a radiopaque jaw lesion, including pertinent clinical and radiologic features, and outline a simplified approach to its radiologic diagnosis, with a focus on cross-sectional CT. An invited commentary by Buch is available online. ^©RSNA, 2021.

A Clinical, Radiographic and Histological Study of Unerupted Teeth in Dogs and Cats: 73 Cases (2001-2018)

Lack of dental eruption may be accompanied by development of dentigerous cysts and has also been rarely associated with neoplasia. However, little information is available on prevalence of unerupted teeth and associated lesions in dogs and cats. The main objective of this study was to describe the epidemiologic data of canine and feline dental patients with unerupted teeth, and assess the prevalence of associated dentigerous cysts and tumors. Secondary aims included the evaluation of possible factors implicated in cystic development, and description of the histological features of dentigerous cysts. Medical and dental records, intraoral photographs, intraoral radiographs of client-owned dogs and cats with clinically missing teeth examined between 2001 and March 2018 were reviewed. Collected data included signalment, reason for presentation, number, type, depth of inclusion and angulation of unerupted teeth, presence of cystic lesions or tumors, abnormalities affecting involved teeth, histopathological findings, performed treatment and outcome. Seventy-three animals (69 dogs and 4 cats) with 113 unerupted teeth were included. The most frequent unerupted tooth in dogs was the first premolar teeth (78%), followed by the canine and third molar teeth. Dentigerous cysts were diagnosed associated with 48 (44.4%) teeth in dogs and one out of five unerupted teeth in cats. The affected teeth in dogs were predominantly in horizontal inclination (40%) and in soft tissue inclusion (77%). Brachycephalic canine breeds were overrepresented. The only unerupted tooth in boxer dogs was the first premolar tooth (32 teeth). Ninety percentage of boxers with unerupted teeth developed associated lesions (25 dentigerous cysts and one tumor). Two ameloblastomas (one in a dog and one in a cat) and one osteosarcoma (in a dog) were diagnosed in association with three unerupted teeth. Histology was essential in diagnosing two odontogenic cysts not evident on radiographs. In all cases that were followed-up, treatment (i.e., extraction, extraction and surgical curettage, or operculectomy) appeared successful. Untreated dentigerous cysts showed progression at re-examination. None of the unerupted teeth without evidence of cyst at the time of diagnosis showed incipient cystic development. None of the evaluated factors were associated with lack of eruption and/or development of associated lesions.

Extensive Maxillary Odontomas in 2 Dogs

Two immature male dogs were presented for the treatment of extensive maxillary compound odontomas. In both cases, clinical evaluation and diagnostic imaging revealed extensive lesions invading and displacing anatomical structures of the maxilla. Histopathology confirmed the diagnoses in both cases. One dog was treated with partial rostral maxillectomy, and the other dog was treated with enucleation of the cystic lining and removal of tooth-like structures through a lateral rhinotomy utilizing an intraoral approach. This report illustrates the growth potential of maxillary compound odontomas in 2 dogs and highlights their subclinical appearance and excellent prognosis despite their extensive nature.

[Current situation of clinical research on impacted premolars]

Teeth impaction is a common developmental malformation in oral diseases. Impacted teeth are usually the canines, third molar, central incisors, premolars, and second molars. The prevalence of impaction of maxillary canines and mandibular wisdom teeth is higher than that of other teeth. Most recent studies have focused on the canines and third molars, but research on impacted premolars is limited. In clinical practice, the majority of orthodontic patients require premolar extraction. Thus, impacted premolars play important roles in orthodontic design and prognosis. This article provides an overview of recent research on impacted premolars and summarizes epidemiological features, localizations, and treatments, with the aim of guiding practitioners on orthodontic design and therapy.

Autotransplantation of Odontoma-Associated Impacted Teeth-A Treatment Strategy for Satisfying Immediate Esthetic Demands: A Case Report

Compound odontomas are common odontogenic tumors associated with permanent tooth impaction in the premaxilla. This report describes the case of a 14-year-old girl with an odontoma-associated impaction over the premaxilla that was treated using autotransplantation to satisfy an immediate esthetic demand. At postoperative follow-up conducted in the 14th month, a satisfactory cosmetic appearance with a healthy periodontal status was observed. In addition, the authors discuss the possible complications of autotransplantation and different treatment strategies for odontoma-associated impaction and for correcting bone defects in this case report. Autotransplantation for treating odontoma-associated impaction can be an alternative solution for satisfying an immediate cosmetic demand and providing a favorable outcome.

Benign Jaw Lesions

There are both odontogenic and nonodontogenic benign lesions in the maxilla and mandible. These lesions may have similar imaging features, and the key radiographic features are presented to help the clinician narrow the differential diagnosis and plan patient treatment. Both intraoral and panoramic radiographs and advanced imaging features are useful in assessing the benign lesions of the jaws. The location, margins, internal contents, and effects of the lesions on adjacent structures are important features in diagnosing the lesions.

Clinical parameter of odontoma with special emphasis on treatment of impacted teeth-a retrospective multicentre study and literature review

OBJECTIVES

Odontoma-separated into complex (CxOD) and compound (CpOD) subtypes-represents the most frequent odontogenic malformation. Retention of permanent teeth is a common symptom. Therefore, in a series of odontomas, an analysis of the management of retained teeth was conducted.

MATERIALS AND METHODS

In a retrospective multicenter study of two University Medical Centers and one private praxis in Germany, demographic and clinical data regarding odontomas from 01/2000-03/2015 were obtained. In particular, the influence of operative therapy on the dentition and on the treatment of impacted teeth was analyzed.

RESULTS

Forty-five patients with 15 CxOD and 30 CpOD were included. Initial symptoms were delayed eruption of permanent teeth (n = 11), pain (n = 4), and swellings (n = 2); 28 cases were discovered by incidence, all of them via panoramic radiographs. The mandible/maxilla ratio was about 1:0.55 (29/16). Thirty-five out of 45 odontomas were in close proximity of at least one tooth (n = 16 at molars). A total of 14 teeth were extracted (CxOD: n = 5; CpOD: n = 9). Extractions had to be conducted more often in older patients (mean age 39.8 vs. 25.6 years). Of the non-extracted teeth, 8 teeth were displaced and retained. Of those, 4 teeth were aligned in the dental arch via orthodontic help and 2 teeth erupted spontaneously after operation during the follow-up period. In all cases, no relapse was seen.

CONCLUSION

Odontomas can cause displacement as well as malformation and resorption of the adjacent teeth.

CLINICAL RELEVANCE

Mostly, removal of odontomas is conducted. Extirpation of odontoma can allow for normal tooth eruption, often rendering extractions avoidable. Orthodontic alignment, though sometimes challenging, is a reasonable therapeutic option. These findings underline the value of the panoramic radiograph in preventive dentistry in younger patients.

Odontomas and supernumerary teeth: is there a common origin?

The aim of the present work is to analyze all scientific evidence to verify whether similarities supporting a unified explanation for odontomas and supernumerary teeth exist. A literature search was first conducted for epidemiologic studies indexed by PubMed, to verify their worldwide incidence. The analysis of the literature data shows some interesting similarities between odontomas and supernumerary teeth concerning their topographic distribution and pathologic manifestations. There is also some indication of common genetic and immuno-histochemical factors. Although from a nosological point of view, odontomas and supernumeraries are classified as distinct entities, they seem to be the expression of the same pathologic process, either malformative or hamartomatous.

Management of complete impacted maxillary second deciduous molar with the aid of cone-beam computed tomography: Case report and a review of the literature

Complete impaction of primary teeth is a very rare condition and less seen at the dental office compared with permanent dentition. To report the use of cone-beam computed tomography in the management of a 7-year-old boy with completely impacted maxillary second deciduous molar due to the presence of odontoma and a cystic lesion.

Impeded eruption of mandibular canine

Odontome, tumor of odontogenic origin, is associated with disturbances in the eruption of teeth such as impaction, delayed eruption or retention of permanent teeth. It is seen on radiographic examination as a radiopaque lesion which may be single or multiple. Morphologically, odontomes are of two types-compound or complex and can be found at any age with high prevalence in maxilla than in mandible. In this case report, lack of eruption of permanent mandibular canine owing to presence of associated compound odontome is presented.

An unusual erupted complex composite odontoma: a rare case

Odontomas are malformations of the dental tissues and may interfere with the eruption of the associated tooth. Complex composite odontoma (CO) was described as a distinct entity for the first time by Broca in 1866. This lesion takes place due to the developmental disturbances where the dental components are laid down in a disorganized manner, due to failure of normal morphodifferentiation. Very few cases of erupted complex composite odontomas have been reported in the literature. The case reported here is of an odontoma found in the left mandibular body, associated with an impacted second molar of a 17-year-old Saudi male. Under local anesthesia the odontoma was surgically removed. Histopathological examination confirmed the diagnosis of CO. The impacted second molar which was left in the mandibular body erupted clinically after 6 months. Erupted CO is rarely seen in the mandibular left body. The early diagnosis, followed by a proper treatment at the right time, will result in a favorable prognosis.

Multiple compound odontomas in mandible: A rarity

Odontomas are benign odontogenic tumors composed of enamel, dentine, and cementum and pulp tissue. They are usually clinically asymptomatic, but often associated with tooth eruption disturbances. The present study reports an unusual case of eleven odontomas in the left lateral incisor-canine region of lower jaw. A 26 years old female presented to the department of orthodontics and dentofacial orthopedics in H.P. Govt. Dental College and Hospital Shimla for the treatment of misaligned teeth. Clinical examination revealed that the lower left lateral incisor was missing. Patient was advised for radiographs, which revealed a mixed radiopaque lesion associated to impacted lower left canine. The histological report in this case indicated a compound odontoma.

Complex Odontome associated with Maxillary Impacted Permanent Central Incisor: A Case Report

Odontomas, the most often seen ones among odontogenic tumors, are usually asymptomatic and discovered in routine radiographic examinations. Frequently it may interfere with the eruption of teeth. The purpose of this article is to present and discuss the case of a 12-year old child with a complex odontome, obstructing the eruption of left maxillary permanent central incisor. Radio opaque calcified masses were revealed in the radiograph and the masses were surgically removed to facilitate the eruption of the tooth.

How to cite this article: Shetty RM, Halawar S, Reddy H, Rath S, Shetty S, Deoghare A. Complex Odontome associated with Maxillary Impacted Permanent Central Incisor: A Case Report. Int J Clin Pediatr Dent 2013;6(1):58-61.

Odontoma: a retrospective study of 73 cases

Purpose

The purpose of the present study was to retrospectively evaluate the clinical findings and treatment results for impacted permanent teeth associated with odontomas.

Materials and Methods

We retrospectively investigated 73 odontomas in 72 patients who visited Kyungpook National University Dental Hospital from April 2004 through November 2011. The study was performed using medical records, panoramic radiographs, and pathological reports. Data gathered included age, gender, location, chief complaints, effects on dentition, and treatment of odontoma and the impacted tooth associated with odontoma.

Results

Most compound odontomas (46.7%) were found in the second decade and complex odontomas were not related to age. Odontomas showed no gender predilection. Fifty-five cases (75.3%) of odontomas were detected on routine dental radiographs. Sixty percent of compound odontomas occurred in the canine area and 57.1% of complex odontomas in the molar areas. Impaction of permanent teeth (61.6%) was the most common complication on the adjacent teeth. Most odontomas (84.9%) were removed surgically and impacted permanent teeth were managed by surgical removal (53.2%), orthodontic treatment (25.5%), or surgical repositioning (6.4%). There was a statistically significant relation between age and preservation of the impacted permanent teeth associated with odontomas (p<0.01).

Conclusion

Early detection and treatment of odontomas increase the possibility of preservation of the impacted tooth. Therefore, it would be suggested that periodic panoramic examination during the first and second decade of life might be beneficial for the early detection and better prognosis of odontomas.

Dentigerous cyst associated with multiple complex composite odontomas

Odontomas are considered to be hamartomatous malformations rather than true neoplasms. This most common odontogenic lesion results from the growth of completely differentiated epithelial and mesenchymal cells that give rise to ameloblasts and odontoblasts. Dentigerous cyst is an epithelium-lined sac enclosing the crown of an unerupted tooth. Apparently, the dentigerous cyst arises by the accumulation of fluid between reduced enamel epithelium and the tooth crown. Occasionally it is associated with supernumerary tooth or odontoma. We report a case of dentigerous cyst associated with complex composite odontoma and an impacted lateral incisor in a 30-year-old male patient.

The story of the missing canine

Odontomas are usually associated with permanent teeth and rarely with primary dentition. The consequences of their presence are several clinical complications. Presented here is a case where diagnosis and management of an odontome causing impaction of primary tooth is discussed thus emphasising need for alertness in a clinician using the aid of radiological examination for early detection and subsequent intervention.

Cemento-osseous dysplasia-like lesion and complex odontoma associated with an impacted third molar

We present a case of a 36-year-old female with a benign fibro-osseous lesion consistent with cemento-osseous dysplasia (COD) that was located coronally to the crown of an impacted mandibular third molar tooth and was associated with a complex odontoma. The pathogenesis of this unusual association is discussed and the odontogenic origin of COD is suggested.

A retrospective analysis of the characteristics, treatment and follow-up of 26 odontomas in Greek children

Odontomas represent the most common type of odontogenic jaw tumors among patients younger than 20 years of age. Clinically, they are often associated with eruption failure of adjacent permanent teeth, and are classified as compound and complex. The aim of the present retrospective study was to present the characteristics, treatment approach and outcome of odontomas in Greek children, over a ten-year period. Twenty six patients, 2 to 14 years of age (mean 9.3 years), with odontomas treated during the years 1999-2008 at the Department of Oral & Maxillofacial Surgery of a Children's Hospital, were included in the study. Data from patients' files were retrieved and they were recalled for review. Odontomas were equally distributed in the maxilla and mandible and 42.3% of them were located in the anterior maxilla. Of the odontomas, 80.7% were related to disturbances in tooth eruption. Bone expansion was observed in 65.3% of the cases. All odontomas were surgically removed, and related impacted permanent teeth were either left to erupt spontaneously, orthodontically guided into occlusion or were removed. Orthodontic intervention appeared to be necessary in older children, while in younger children spontaneous eruption was frequent. In the present study, odontomas were associated with unerupted or impacted teeth. Radiographic examination was essential to verify the presence of the tumor and early removal prevented tooth eruption failure and disturbances in a majority of the cases.

Two-stage surgical removal of large complex odontoma

PURPOSE

The surgical treatment of a large complex odontoma in the mandibular angle is reported. Four possible surgical approaches to remove a benign tumor in the mandibular angle are discussed.

PATIENT

A two-stage surgical treatment was chosen; first, removing most part of the lesion and preserving the second molar, decreasing the risk of a pathological mandibular fracture. A maxillo-mandibular fixation for a period of 4 weeks was used. The patient was oriented to maintain a soft diet. The second surgical stage occurred 3 months after the first one due to the significant bone consolidation observed, reducing the possibility of a mandibular fracture. The remaining lesion and the second molar were then completely removed.

CONCLUSIONS

This case demonstrates the value of the tridimensional computed tomography in treatment planning prior to any definitive surgery. A computed tomography should be made in every case of intraosseous lesion in order to establish the intraosseous extent of the tumor, cortical perforation, and soft tissue involvement for precise guidance for the surgical planning. It is recommended that the surgeon considers excision by an intraoral, lingual approach when indicated, and in two stages, when an extremely thin mandibular base is present.

Compound composite odontoma with unusual number of denticles - A rare entity

Compound odontoma is stated to be a hamartomatous lesion rather than a true odontogenic tumour. It has an unknown etiology and often suspected when there are retained deciduous teeth in children. Early detection and surgical enucleation of the tumour is recommended to prevent impaction of unerupted teeth. In this index case, multiple denticles or rudimentary teeth, numbering 37 were enucleated from the maxillary anterior region of a 17-year old male, which makes this case unusual. Evidence of concrescence, fusion and dilaceration were observed in the denticles enucleated, the size of which varied from 4 mm to 12.5 mm.

Complex Composite Odontoma

Odontomas are hamartomas composed of various dental tissues, i.e. enamel, dentin, cementum and sometimes pulp. They are slow-growing, benign tumors showing nonaggressive behavior. Most of the odontomes are asymptomatic with unknown etiology, although occasional signs and symptoms related to their presence do occur. Presented here is the case report of 10-year-old girl with impacted left central incisor.

A rare case of odontome in a 65-year-old lady

Odontomes are considered to be hamartomas rather than a true neoplasm. They are comparatively common odontogenic tumors, and may lead to interference with eruption of associated tooth. Compound odontomes are commonly seen in young adults, but if they occur in children they are usually associated with permanent dentition and prevent eruption of the associated tooth. We hereby report a case of large compound odontome in the mandibular body region of a 65-year-old woman. Because of difficulty in denture fabrication and associated pain on mastication, surgical removal of the lesion was done.

Adenomatoid odontogenic tumor concomitant with cystic complex odontoma: case report

This case report describes a 10-year-old female patient with an adenomatoid odontogenic tumor developing together with a cystic complex odontoma. This occurrence is considered very unusual. Immunohistochemical detection of cytokeratins AE1/AE3, CK5, CK8, CK10, CK14, CK19 and Ki-67 was performed.

Bilateral malformation of maxillary third molars

A case of bilateral compound odontomas in the region of the third molars in the maxilla is reported. The differential diagnosis for this case is discussed.

A case of unerupted lower primary second molar associated with compound odontoma

Odontoma is the most common type of benign odontogenic tumor, and often causes disturbances in the eruption of its associated tooth. Odontomas usually occur in the permanent dentition, and rarely occur solely in the primary dentition. This case report documents a six-year-old-child with a compound odontoma located in the mandible, which caused the impaction of the primary second molar.

Erupted compound odontoma: case report of a 15-year-old Sudanese boy with a history of traditional dental mutilation

A rare case of an erupted compound odontoma associated with a malformed and dilacerated maxillary left lateral incisor is reported. The patient, a 15-year-old immigrant Sudanese boy, had a malformed right lateral maxillary incisor and missing centrals. His guardian reported he had undergone traditional extraction of his primary teeth as a child whilst in Africa. Treatment and possible mechanisms for development of the condition are discussed. The number of refugees and migrants from Africa to developed countries has increased in the past 20 years. Australia in particular with its large population of recent migrants from areas in Africa where tooth mutilation is practised will likely see more patients with dental abnormalities in the respective populations.

Multiple osseous dysplasia arising from impacted teeth: report of a case associated with odontogenic lesions

We report a case of osseous dysplasia (OD) showing extremely rare clinical features. A 37-year-old Japanese woman was referred to our clinic complaining of a left alveolar bony swelling at an impacted canine. Radiographic examinations revealed a mixed radiopaque lesion involving the impacted left canine and also revealed an impacted left wisdom tooth with a cystic change and a clear radiopaque lesion suspected to be odontoma. All the extracted upper teeth and odontoma showed hypercementosis and the canine was fully involved in it. Histopathologically, they showed the same features and were diagnosed as OD. The findings of multiple OD from incompletely erupted teeth and odontoma in our case may well show that OD can arise from any tooth with periodontal ligaments and that focal OD can show expansive growth like the ossifying fibroma.

Relative Frequency of Central Odontogenic Tumors: A Study of 1,088 Cases from Northern California and Comparison to Studies from Other Parts of the World

PURPOSE

To determine the relative frequency of central odontogenic tumors in relation to all biopsy specimens and to one another in an oral pathology biopsy service and to compare the data with previous studies from different parts of the world.

METHODS

Files from the Pacific Oral Pathology Laboratory of the University of the Pacific, San Francisco, CA served as a source of material for this study. Files were systematically searched for all cases of central (intraosseous) odontogenic tumors during a 20-year period.

RESULTS

Central odontogenic tumors were identified in 1,088 (1.2%) cases out of the 91,178 accessed. Individually, of all odontogenic tumors, 75.9% were odontomas. The prevalence of the remaining tumors appears to be a rare occurrence. The second most common was ameloblastoma (11.7%), followed by odontogenic myxoma (2.2%). Odontomas are considered hamartomas or developmental anomalies. When excluded from the list of individual odontogenic tumors, ameloblastoma is the most common (48.5%), followed by odontogenic myxoma (9.2%), adenomatoid odontogenic tumor (7.3%), ameloblastic fibro-odontoma (7.3%), ameloblastic fibroma (6.5%), calcifying odontogenic cyst (6.5%), and odontogenic fibroma (6.1%). Each remaining tumor comprises less than 4%.

CONCLUSIONS

Studies related to the relative frequency of individual odontogenic tumors from different parts of the world are difficult to compare because most studies are outdated, the list of tumors is limited, and new entities are not included. To determine the real relative frequency, further studies should be conducted, especially in Western societies, by experienced pathologists in the field of odontogenic tumors.

Severe trauma in the primary dentition - diagnosis and treatment of sequelae in permanent dentition

A 2-year 6-month male presented after an intrusive injury sustained at 15 months of age. Intra-oral radiographs showed coronal dilaceration of the germ of the permanent central incisor and the presence of a calcified tissue mass in the area of the trauma which was identified after surgical removal as the permanent upper left lateral incisor. Immediate treatment and long-term options are discussed.

Clinical observations of odontomas in Japanese children: 39 cases including one recurrent case

Retrospective investigations of odontomas in Japanese children and one recurrent case were carried out. Thirty-nine cases of odontoma in 38 children were treated in the Paediatric Dentistry Clinic of Niigata University Dental Hospital between September 1979 and December 2002. The patients consisted of 23 males and 15 females and their ages ranged from 1 year 2 months to 14 years old. The chief complaints were delayed tooth eruption in 19 cases (five: primary teeth, 14: permanent teeth), retention of primary teeth in 11, incidentally found on the radiographic examination in eight cases, and swelling of the jaw in one case. Thirty-four cases (87%) were associated with tooth eruption disturbances. The most frequently affected region was the maxillary anterior region. Treatment consisted of surgical removal of odontomas in all cases, after which if the impacted teeth did not erupt, exposure of the crown and/or orthodontic traction was performed. Pathological diagnoses were compound odontoma in 30 cases, complex odontoma (n = 7), and compound and complex odontoma (n = 2). A retrospective study of the radiographs revealed the developing process of odontomas in four cases and odontoma disturbed tooth eruption since the early uncalcified developing stage. A recurrent case was a boy aged 6 years 5 months in whom the first surgical removal of odontoma was performed at the age of 1 year 8 months. Recurrence of an odontoma is very rare, but in very young children odontomas are in the early developing stages, containing uncalcified portions, so it is important to perform periodical observations until the succedaneous teeth erupt.

Benign odontogenic tumors of the mandible and maxilla

Benign odontogenic tumors are characterized by imaging findings of expansile growth and well-defined margins with smooth borders, and their appearance is very similar to that of odontogenic and nonodontogenic cysts. From the viewpoint of diagnostic imaging of odontogenic tumors, teeth are designed differently according to their origin from the apex or crown. Therefore, for differential diagnosis, it is necessary to select diagnostic methods that make it possible to evaluate these findings in detail. Intraoral and panoramic radiography are highly effective in examining the relationship between teeth and lesions, especially the vertical relationship. When a lesion is suspected in the mandible or maxilla on CT, MR imaging, or nuclear medicine, these procedures must be performed as supplementary imaging techniques. CT demonstrates well the degree of bone resorption, osteosclerosis, cortical bone swelling, destruction, and calcification. MR imaging is effective in differentiating between tumors and cysts, evaluating the infiltration of malignant tumors in the jawbone and surrounding soft tissue, and detecting bone marrow changes of the jaw. Differentiation between tumors and cysts must be achieved by contrast-enhanced studies. Combining plain radiography with advanced imaging techniques, including CT and MR imaging, can improve the accuracy of diagnosing odontogenic tumors.

Odontoameloblastoma. Clinico-pathologic study of three cases and critical review of the literature

The odontoameloblastoma (OA), is an infrequent neoplasm. To date, there are less than 50 cases reported as OA or ameloblastic odontoma in the English dental literature, but only 14 (including three of our own material), fulfill the histological criteria of the current WHO histological classification of odontogenic tumours. Nine occurred in men and five in women (male to female ratio 1.8:1). Age ranged from 2 to 50 years (mean 20.2 years), and nine cases (64.2%) were diagnosed during the first two decades. Maxilla and mandible were equally involved, and most cases occurred posterior to the canines (71.4%). Follow-up ranged from 6 months to 8 years (mean: 25.5 months). Of the 12 cases with informed follow-up, two recurred once (at 24 and 18 months, respectively), and one case had two documented recurrences, at 6 and 49 months. Although OA tends to occur at an earlier age than conventional ameloblastoma, it has practically the same potential to produce bone expansion, root resorption and recurrence. For these reasons OA should be treated in a similar fashion, with wide surgical excision and close follow-up for at least 5 years.

Odontogenic tumors: analysis of 127 cases

One hundred and twenty-seven cases of histologically confirmed odontogenic tumors were retrieved from a total of 5,289 oral and maxillary lesions diagnosed at the Division of Oral Pathology, Federal University of Rio Grande do Norte, during a period of 30 years (1970-1999). The most common histological diagnosis was odontoma (50.40%), followed by ameloblastoma (30.70%). The prevalence of odontogenic tumors was greater in females and the peak incidence occurred in the second and third decades of life. The main anatomical location was the mandible, and no malignant tumors were found.

Gingival peripheral odontoma in an adult: case report

BACKGROUND

Odontoma arising in the extraosseous soft tissue is extremely uncommon. We describe our experience of gingival peripheral odontoma in which the initial presentation was a small asymptomatic nodule.

METHODS

Case study.

RESULTS

A 44-year-old man reported with a firm gingival mass of the anterior maxilla which had been gradually enlarging over 5 years. Radiographic examination showed a dense radiopaque mass occupying most of the tumor and no evidence of underlying intraosseous lesion. The pathology was reported as odontoma.

CONCLUSIONS

This is the fourth reported case of peripheral odontoma in the gingiva.

Odontogenic tumors. A demographic study of 759 cases in a Chinese population

Seven hundred fifty-nine cases of odontogenic tumors retrieved from the files of College of Stomatology, West China University of Medical Sciences were classified according to the World Health Organization's Histological Classification of Odontogenic Tumors and compared with similar reports from other countries. Among these cases, 93.9% of the tumors were benign and 6.1% were malignant. Ameloblastomas predominated (58.6%) with a predilection for the mandible, while odontomas, generally regarded as the most frequent odontogenic tumor in North America, only accounted for 6.7%, the fourth most common tumor in this series. The mandible and the maxilla were divided into eight anatomic regions, and the distribution of each odontogenic tumor type amongst these regions was recorded. The relative incidence of each tumor type, patient age and gender were also compared with data from other selected large series. Geographic differences were noted in the relative incidence of ameloblastoma, odontoma and malignant odontogenic tumors among the Chinese/African, North American and Turkish/German groups. Ameloblastoma and malignant odontogenic tumors are not considered rare in a Chinese population.

Odontomas in a Chinese population

OBJECTIVE

To assess the pattern of distribution and age changes in odontomas in a Chinese population.

METHODS

Forty cases of odontomas found in Chinese patients for which the clinical notes, radiographs and histopathology reports were available were classified as either compound or complex odontomas on the basis of their radiological appearance. Thirty-nine were wholly within the alveolus and one in the maxillary antrum. The overall size of the 39 alveolar odontomas and the size of their central opacities were measured digitally from periapical radiographs.

RESULTS

Twenty-one of the 39 alveolar odontomas were complex (M/F = 8/13) and 18 compound (M/F = 10/8). The majority of cases presented in the second and third decades with an overall mean of 23 years. Thirty-eight per cent were found in the anterior maxilla. Complex odontomas had a predilection for the anterior maxilla and mandibular molar areas. The odontomas increased in size with increase in age.

CONCLUSIONS

The pattern of presentation of this Chinese series is broadly in agreement with other series. Odontomas tend to increase in size with the age of the patient, suggesting continuing growth.

Medieval example of cleft lip and palate from St. Gregory's Priory, Canterbury

An archaeologically retrieved skeleton from medieval Canterbury possibly of the late eleventh or twelfth century, displays clear evidence of cleft lip and palate. A case of cleft palate dating from the seventh century, is known from an Anglo-Saxon cemetery at Burwell. This is the first evidence for both cleft lip and palate in British archaeological material. The individual had survived into adulthood. Apart from an odontome, there was no osseous evidence of any other abnormalities. Artistic evidence of cleft lip dates to the fourth century B.C. and surgical intervention (A.D. 390) is known from China.

The radiological features of calcifying odontogenic cyst

Calcifying odontogenic cyst is a rare benign lesion of the jaws, with no particular specificity for age, sex or site. Three new cases are presented together with a review of the radiological literature. There appear to be no pathognomonic radiological features, although a superficial location on the affected bone and the presence of internal calcification may be useful signs. The role of radiology appears to be limited to determining lesion extent prior to surgery.