Professional Documents
Culture Documents
Dr. Oliveira and Dr. Campos are assistant professors, and Dr. Maral is associate professor, Department of Community and
Preventive Dentistry, Faculty of Dentistry, Rio de Janeiro State University, Brazil. Correspond with Dr. Oliveira at
branca@uerj.br
Abstract
Odontomas are the most common type of odontogenic tumors formed of enamel and dentin but they can also have variables
and generally they are asymptomatic. This paper describes three amounts of cement and pulp tissue.1 During the development
cases of compound odontomas diagnosed in children due to of the tumor, enamel and dentin can be deposited in such a
dislodgement or over-retention of primary anterior teeth and/or way that the resulting structures show an anatomic similarity
swelling of the cortical bone. In all cases, the surgical excision of to normal teeth, in which case the lesion is classified as a com-
the lesions was performed and, in one case, orthodontic treatment pound odontoma. However, when the dental tissues form a
was adopted in order to move an impacted permanent tooth to its simple irregular mass occurring in a disorderly pattern, it is
normal position. The results achieved indicate that the early di- described as a complex odontoma.2 Compound odontomas ap-
agnosis of odontomas allows the adoption of a less complex and pear more frequently than complex odontomas.3,4
expensive treatment and ensures better prognosis. (Pediatr Dent These odontogenic tumors can be found anywhere in the
23:151-157, 2001) dental arches. The majority of odontomas which are located
in the anterior region of the maxilla are compound, while the
O
dontomas are considered to be developmental anoma- great majority of odontomas located in the posterior areas, es-
lies resulting from the growth of completely differen- pecially in the mandible, are complex odontomas.1,5,6
tiated epithelial and mesenchymal cells that give rise The etiology of the odontoma is unknown.7 However, it has
to ameloblasts and odontoblasts. These tumors are basically been suggested that trauma and infection at the place of the
Fig 12. Case 3. Occlusal radiograph showing small mineralized structures mouth. Intraoral radiographic examination showed a com-
in the interior of the lesion. pound odontoma-like lesion, located buccally to the root of
the upper permanent lateral incisor (Fig 7). The lesion con-
Case reports taining seven structures like small teeth in different developing
stages was removed surgically (Fig 8). One year after the sur-
Case 1 gery it was verified that the permanent lateral incisor had
A 5-year-old white female presented to the pediatric dental returned to its normal position and that there was no recur-
clinic with a chief complaint of changing position of the up- rence of the lesion (Fig 9).
per left primary central incisor. During the examination, the
upper left primary incisor crown revealed a labial displacement Case 3
and showed an intrusion when compared to the crowns of the An 11-year-old male patient presented to the pediatric dental
neighboring teeth (Fig 1). According to the mother there was clinic for routine dental care. He was worried about the pres-
no previous dental trauma. ence of an upper primary central incisor, although the
Radiographic examination (Clarks Technique) revealed the neighboring teeth were all permanent. The mother reported
presence of two lesions of compound odontomas in the pala- that when the child was five months old he fell hitting his
tal region of the upper primary central incisors (Fig 2). Surgery mouth on the floor and after that the primary teeth erupted
was performed to remove the two lesions and three mineral- with a dark discoloration. Clinical examination showed an
ized structures showing a tooth-like appearance were found overretention of the tooth and an increased volume next to the
within them (Fig 3). The surgical procedure was performed by distal area of the root of the primary upper right central inci-
an oral surgeon assisted by a pediatric dentist. The patient was sor (Fig 10).
treated under local anesthesia, without any premedication and Radiographic examination (Clarks and Occlusal Tech-
the patients behavior during the procedure was classified as nique) revealed the presence of an odontoma-like lesion in the
definitely positive, according to Frankl Behavior Rating Scale.17 buccal region of the primary incisor root. The lesion caused
Postoperative oral and written instructions specifically related an impacted position of the corresponding permanent incisor
to the maintenance of an appropriate oral hygiene, ingestion (Fig 11). Due to its complexity, the case was managed by a
of cold and soft meals, refraining from physical exercise dur- multidisciplinary team including a pediatric dentist, an orth-
ing 48 hours, and management of pain were given to the odontist and an oral surgeon. Afterward, a periodontist was also
patients mother. The primary incisors were left in the arch and consulted. Surgical removal of the odontoma was performed
buccal reduction of the position of the upper left primary lat- and a number of calcified small structures looking like teeth
eral incisor was observed (Fig 4). When the upper permanent were found in it, as was anticipated from the occlusal radio-
central incisors erupted into the oral cavity, their crowns were graph (Fig 12). The surgery was performed by an oral surgeon
proclined. A removable appliance was used to improve their assisted by a pediatric dentist. The patient was treated under
position. Three years after the surgery all permanent anterior local anesthesia, without any premedication.
teeth were present in the maxillary dental arch, but a discrep- Because the impacted permanent tooth showed a fully
ancy in the upper midline could be noticed (Fig 5). formed root resulting in little spontaneous eruption potential,
it was decided that an orthodontic device would have to be
Case 2 placed in order to guide the impacted tooth into its position.
A 12-year-old female patient presented to the pediatric dental So, at the time of the surgery, a bracket was bonded to the la-
clinic complaining about an increased volume of gingiva in the bial surface of the crown (Fig 13). After healing of the soft
root region of the upper right permanent central and lateral tissues, traction of the unerupted maxillary right central inci-
incisors and upper right permanent canine, and also a proclined sor was initiated (Figs 14 and Fig 15). Later, it was decided
labial crown of the upper right permanent lateral incisor (Fig that, in order to achieve a better control of the movement of
6). The patient reported no trauma in the upper region of the the tooth, the palatal bar should be replaced by a partial fixed
appliance (Fig 16). All orthodontic procedures were performed