This case report describes the management of an unerupted central incisor tooth due to a compound odontoma. A 11-year-old boy presented with a missing upper right central incisor. Radiographs revealed the crown of the unerupted tooth was overlaid by a tooth-like mass. The mass was surgically removed. Histopathological examination confirmed a diagnosis of compound odontoma. As the tooth did not erupt after surgery, orthodontic treatment using elastic threads was used to extrude the tooth into alignment over 3 months. Compound odontomas contain all dental tissues organized in an orderly pattern resembling teeth. Surgical removal followed by orthodontic treatment successfully managed this case
This case report describes the management of an unerupted central incisor tooth due to a compound odontoma. A 11-year-old boy presented with a missing upper right central incisor. Radiographs revealed the crown of the unerupted tooth was overlaid by a tooth-like mass. The mass was surgically removed. Histopathological examination confirmed a diagnosis of compound odontoma. As the tooth did not erupt after surgery, orthodontic treatment using elastic threads was used to extrude the tooth into alignment over 3 months. Compound odontomas contain all dental tissues organized in an orderly pattern resembling teeth. Surgical removal followed by orthodontic treatment successfully managed this case
This case report describes the management of an unerupted central incisor tooth due to a compound odontoma. A 11-year-old boy presented with a missing upper right central incisor. Radiographs revealed the crown of the unerupted tooth was overlaid by a tooth-like mass. The mass was surgically removed. Histopathological examination confirmed a diagnosis of compound odontoma. As the tooth did not erupt after surgery, orthodontic treatment using elastic threads was used to extrude the tooth into alignment over 3 months. Compound odontomas contain all dental tissues organized in an orderly pattern resembling teeth. Surgical removal followed by orthodontic treatment successfully managed this case
International Journal of Oral & Maxillofacial Pathology. 2012;3(2):!
"# ISSN 2231 2250
$%aila&le online at h tt':(( ) ) ) . *ou r na l gat e ) ay.co+ or )) ) .i *o + '. or g Management of Unerupted Central Incisor Due to Compound Odontoma ! Case "eport ,ha+-her ,ingh. /alita Man0ia. 1i%e2 $0la2ha. 3itin ,har+a. ,u&ha-h 4han0er. 5harat ,an2hla !#stract O0onto+a- are ha+arto+ou- le-ion- or +alfor+ation- rather than true neo'la-+- an0 are fre6uent cau-e of i-olate0 0elaye0 tooth eru'tion. O0onto+a- are a-y+'to+atic in nature an0 often 0iagno-e0 in the -econ0 0eca0e of life. 7he 're-ent ca-e re'orte0 )ith +i--ing tooth in u''er front region. 4linical an0 ra0iogra'hic fin0ing are -ugge-ti%e of co+'oun0 o0onto+a. 8ence treat+ent )a- 'lanne0 for -urgical re+o%al of the le-ion follo)e0 &y ortho0ontic treat+ent. $e%&ords O0ontogenic 7u+or-;4o+'oun0 O0onto+a;9elaye0 7ooth :ru'tion;Ortho0ontic :xtru-ion;;orce0 :ru'tion;7ooth Mo%e+ent. Shamsher Singh, Lalita Mandia, Vivek Adlakha, Nitin Sharma, Subhash Chander, Bharat Sankhla. Management of Unerupted Central n!isor "ue to Compound #dontoma$ A Case %eport. nternational &ournal of #ral and Ma'illofa!ial (atholog)* +,-+$./+0$12314. 5nternational &ournal of #ral and Ma'illofa!ial (atholog). (ublished b) (ublishing "ivision, Celesta Soft6are (rivate Limited. All %ights %eserved. <ecei%e0 on: 0=(12(2011 $cce'te0 on: 21(0(2012 Introduction $ +ixe0 o0ontogenic tu+our e+ulating all the har0 ti--ue- 'ro0uct- of a +ature tooth ger+. the o0onto+a i- 'ro&a&ly the +o-t co++on ty'e of o0ontogenic tu+our or ha+arto+a-. 1 $lthough u-ually locate0 'ericoronal to an i+'acte0 tooth. the o0onto+a +ay al-o ari-e fro+ o0ontogenic 'rogenitor cell- )ithin the 'erio0ontal liga+ent- an0 &eco+e locate0 &et)een tooth root an0 are not a--ociate0 )ith 0i-tur&ance in eru'tion. 1 O0onto+a- exhi&it co+'lete e'ithelial an0 +e-enchy+al 0ifferentiation to the 'oint that &oth ena+el an0 0entin are for+e0. 2 >a&ell. Ja+e-. an0 Payne grou'e0 o0onto+a accor0ing to their 0e%elo'+ental origin: e'ithelial. co+'o-ite (e'ithelial an0 +e-o0er+al) an0 connecti%e ti--ue. 3 4linically. o0onto+a- are either co+'lex or co+'oun0. 3 4o+'lex o0onto+a- are le-- co++on than co+'oun0 %ariety in the ratio 1:2. 4o+'oun0 o0onto+a- are +ore co++on in the anterior region )hile co+'lex o0onto+a- ten0 to occur in the 'o-terior region of the *a). ?-ually o0onto+a- are a-y+'to+atic; -i@e %arie- fro+ fe) +illi+etre- to +any centi+etre- in their 0i+en-ion. ?n0er-tan0ing tooth 0e%elo'+ent an0 eru'tion )ill gui0e a clinician to 0iagno-e an0 0ifferentiate nor+al fro+ an a&nor+al. 4on-tant e%aluation a&out the 0yna+ic- of 0entition i- e--ential for the 0iagno-i- an0 treat+ent of irregularitie- 0uring thi- 'roce--. 7he 're-ence of o0onto+a can 0elay the exfoliation of a 0eci0uou- tooth an0 the eru'tion of the 'er+anent -ucce--or-. )hich -houl0 &e carefully o&-er%e0. 8ere. )e 're-ent a ca-e of co+'oun0 o0onto+a along )ith clinical 're-entation. ra0iogra'hic feature-. hi-to'athological feature- an0 -urgical treat+ent an0 it- ortho0ontic correction. Case report $n 11 year ol0 &oy ca+e to the 9e'art+ent of Pe0o0ontic- an0 Pre%enti%e 9enti-try )ith the chief co+'laint of non"eru'tion of the u''er right front tooth. Patient )a- healthy an0 a-y+'to+atic. 8i- 'a-t 0ental an0 +e0ical hi-tory )a- not -ignificant. Intraoral exa+ination re%eale0 that A11 )a- not eru'te0 into the oral ca%ity. $ccor0ing to the 'atientB- +other. A21 )a- eru'te0 into oral ca%ity three year- &ac2. 4linically &oth A12 & A21 )ere fully eru'te0 (;igure 1). 7here )a- no -ign of infla++ation. 'ain or infection an0 nor+al -urroun0ing +uco-a )a- nor+al. $n intraoral 'eria'ical ra0iogra'h re%eale0 're-ence of A11 0ee' in al%eolar &one. 7he cro)n of the uneru'te0 A11 )a- o%erla''e0 &y tooth li2e +a-- (;igure 2) an0 al+o-t co%ering the central half of the uneru'te0 A11. 7he le-ion )a- clinically a-y+'to+atic. 5a-e0 on the clinical an0 ra0iogra'hic e%aluation. a 0iagno-i- of o0onto+a )a- +a0e. 7he eru'tion of tooth A11 )a- 'ro&a&ly i+'e0e0 &y the tooth li2e +a--. 8ence. -urgical re+o%al of the le-ion )a- 'lanne0. /ocal anae-the-ia )a- gi%en on &oth -i0e of the la&ial -ulcu- an0 'alate (infra"or&ital. na-o'alatine ner%e &loc2 an0 infiltration). Inci-ion )a- gi%en an0 a la&ial fla' )a- rai-e0 +e0ial to A21 to the 0i-tal of A12 C2012 International Journal of Oral an0 Maxillofacial Pathology. Pu&li-he0 &y Pu&li-hing 9i%i-ion. 4ele-ta ,oft)are Pri%ate /i+ite0 . $ll <ight- <e-er%e0 Case "eport D Shamsher Singh et al., ISSN 2231 ' 2250 region an0 t)o relea-ing inci-ion )ere gi%en (;igure 3). $ -urgical &ur )a- u-e0 to re+o%e the al%eolar &one co%ering the inci-al e0ge of the A11. Once the inci-al e0ge )a- ex'o-e0. the tooth li2e +a-- )a- locate0 at a''roxi+ately the -a+e le%el a- it )a- on ra0iogra'h. $ tooth li2e +a-- (;igure ) )a- re+o%e0 )ith the hel' of +uco'erio-teal ele%ator; the -oc2et )a- irrigate0 )ith -aline. 5lac2 -il2 -uture )ere gi%en. $ co+'lete cour-e of anti&iotic- )a- gi%en. -uture- )ere re+o%e0 after one )ee2 an0 healing )a- -ati-factory. 7he ti--ue )a- -ent for hi-to'athological e%aluation. 9ecalcifie0. hae+atoxylin an0 eo-in -ection of -'eci+en re%eale0 ho+ogenou- eo-ino'hilic +a-- of 0entin )hich encircle- the 'ul' li2e ti--ue )hich contain 0elicate loo-e fi&rou- +atrix along )ith fe) %a-cular -'ace- (;igure !). $fter t)o +onth- of follo) u'. A11 -ho)- no -ign of eru'tion. 8ence. it )a- 'lanne0 to +o%e uneru'te0 A11 ortho0ontically. $ )in0o) )a- +a0e -urgically after gi%ing local anae-the-ia an0 &eggB- &rac2et )a- 'lace0 on tooth A11. A12. A21 an0 A22. Ortho0ontic )ire )a- tie0 u' )ith ligature )ire an0 ela-tic threa0 )a- +o%e0 aroun0 A11 an0 tie0 u' aroun0 A21 an0 A12. (;igure D) $fter 3 +onth- of treat+ent. A11 )a- -een in the oral ca%ity al+o-t in align+ent to a0*acent A21. (;igure =) 7he intraoral 'hotogra'h (;igure 1) an0 )ith 'reo'erati%e ra0iogra'h ((;igure 2) -ho)ing uneru'te0 tooth A11. 7he -urgical ex'o-ure (;igure 3) an0 extracte0 -'eci+en (;igure ) 7he he+atoxylin an0 eo-in -taine0 'hoto+icrogra'h of co+'oun0 o0onto+a -ho)ing ho+ogenou- eo-ino'hilic +a-- of 0entin )hich encircle- the 'ul' li2e ti--ue (;igure !). 7he ortho0ontic extru-ion )ith ela-tic- of tooth A11 ha- &een carrie0 out (;igure D). Po-to'erati%e 'hotogra'h -ho)ing eru'te0 an0 aligne0 tooth A11 (;igure =). Discussion 7he etiology of the o0onto+a i- un2no)n. It ha- &een -ugge-te0 that local trau+a or infection +ay lea0 to the 'ro0uction of -uch a le-ion.
8itchin re'orte0 that o0onto+a- are inherite0 or are 0ue to a +utagene or interference. 'o--i&ly 'o-tnatal. )ith the genetic control of tooth 0e%elo'+ent. ! 8o)e%er. Phili'-en et al. -ugge-te0 that the for+ation of a co+'oun0 o0onto+a i- 'athogenically relate0 to the 'roce-- 'ro0ucing hy'er0ontia. EMulti'le ,chi@o0ontiaE or locally con0itione0 acti%ity of 0ental la+ina. D 7he F8O ha- cla--ifie0 o0onto+a into t)o ty'e- 0e'en0ing on their 0egree of +or'ho0ifferentiation 2 . 7he co+'oun0 o0onto+a i- a le-ion in )hich all the 0ental ti--ue- are re're-ente0 in an or0erly fa-hion ISSN 2231 2250 Management of Unerupted Central Incisor Due to..... = -o that there i- at lea-t -u'erficial anato+ic re-e+&lance to teeth. In a co+'lex o0onto+a. on the other han0. although all the 0ental ti--ue- are re're-ente0. they are for+e0 in -uch a ru0i+entary fa-hion that there i- little or no +or'hologic re-e+&lance to nor+al tooth for+ation 2 . 7he-e are u-ually a-y+'to+atic le-ion an0 &a-e0 on the 0ata of the -ur%ey of Phili'-en et al the relati%e fre6uency of the co+'oun0 o0onto+a re're-ent- G " 3=H of all o0ontogenic tu+our-. +a2ing it the +o-t co++on o0ontogenic tu+our- D . 7he a%erage age at 0iagno-i- i- 1=.2 year- (range 0.! " =3 year-). ,e%enty fi%e 'ercentage of all ca-e are 0iagno-e0 at aroun0 age 20 year- an0 -light 're0ilection occurrence in +ale- co+'are to fe+ale (1.2:1). 7he anterior +axilla i- the -ite of +o-t co+'oun0 o0onto+a. an0 0iagno-i- i- fre6uently +a0e on the &a-i- of the failure of a 'er+anent tooth to eru't. In 0 " !0H of ca-e-. an i+'acte0 'er+anent tooth i- a--ociate0 )ith the co+'oun0 o0onto+a = . $ccor0ing to o0onto+a -ur%ey of Phili'-en et al D . the a%erage age at 0iagno-i- for co+'lex o0onto+a i- 1G.G year- (range 2 " = year-) an0 the inci0ence i- &et)een ! an0 30H. #H of the-e tu+our- occur &efore age of 30 year-. Male- are +ore co++only affecte0 than fe+ale- (1.!:1). Mo-t co+'lex o0onto+a are locali@e0 in the 'o-terior region of the +an0i&le an0 often i+'acte0 teeth are o&-er%e0 in 10 " !H ca-e- =. Many intere-ting ca-e- of o0onto+a ha%e &een re'orte0 )orl0)i0e. # 5lan0 ,utton (1###) fir-t re'orte0 the 're-ence of &ilateral co+'oun0 o0onto+a in the +axillary -inu-. 5lan0 ,utton (1G22) foun0 a&nor+al -i@e0 co+'lex co+'o-ite o0onto+a that i-. =.D x D.2 x 3.G c+ an0 )eighing ##3 g+. co+'oun0 co+'o-ite o0onto+a containing 2000 0enticle- )a- re'orte0 &y 8er+an in 1G!=. 7ho+-on et al. in 1GD# re'orte0 +ulti'le co+'oun0 o0onto+a- of +axilla an0 +an0i&le. 7he ter+ o0onto+a -yn0ro+e )a- gi%en &y Manil (1G=) in a ca-e that ha0 +ultifor+ o0onto+a &oth in +axilla an0 +an0i&le. 1engal M et al.. foun0 large eru'ting co+'lex o0onto+a in the right +an0i&lar angle region. G an0 >a&riel ,, et al re'orte0 ulcerate0 le-ion +ea-uring a&out 2 c+ in 0ia+eter in the +olar region of the fourth 6ua0rant. 10 <a0iogra'hically. co+'oun0 o0onto+a -ho)- a collection of tooth"li2e -tructure- of %arying -i@e an0 -ha'e -urroun0e0 &y a narro) ra0iolucent @one. al-o 're-ent in thi- ca-e re'ort 11 . $n o0onto+a ha- a li+ite0 gro)th 'otential. &ut it -houl0 &e re+o%e0 &ecau-e it contain- %ariou- tooth for+ulation- that can 're0i-'o-e to cy-tic change. interference )ith eru'tion of 'er+anent teeth an0 cau-e con-i0era&le 0e-truction of &one # . 4y-tic o0onto+a increa-e in -i@e -lo)ly an0 cau-e large ex'an-ion of &one. )hich i- not -een in the 're-ent ca-e. D Ia&an -tate- that o0onto+a- are ea-ily enucleate0. an0 a0*acent teeth that +ay ha%e &een 0i-'lace0 &y the le-ion are -el0o+ har+e0 &y -urgical exci-ion &ecau-e they are u-ually -e'arate0 &y a -e'tu+ of &one. 3.12 7he treat+ent o'tion for o0onto+a co+'ri-e- -urgical extraction. fene-tration an0 'o-terior ortho0ontic traction or -i+'le o&-er%ation )ith 'erio0ic clinical an0 ra0iogra'hic exa+ination to e%aluate the 'ath of eru'tion of teeth. 13"1! In 're-ent ca-e. the 0elaye0 0iagno-i- of the le-ion re-ulte0 in co+'lete root for+ation of uneru'te0 tooth. +a2ing it nece--ary to u-e ortho0ontic traction of the affecte0 tooth to gui0e in a0e6uate 'o-ition in the 0ental arch. 8ence. of all 'ae0iatric 'atient- that 're-ent clinical e%i0ence of 0elaye0 'er+anent tooth eru'tion or te+'orary tooth 0i-'lace+ent. )ith or )ithout hi-tory of 're%iou- 0ental trau+a. ra0iogra'hic exa+ination -houl0 &e 'erfor+e0. Conclusion O0onto+a- are the +o-t co++on ty'e of o0ontogenic tu+our- or ha+arto+a- an0 ari-e a- a re-ult of a&erration in the ti--ue- re-'on-i&le for the for+ation of the teeth. 7he-e are u-ually a-y+'to+atic re6uire- -urgical extraction an0 careful +onitoring to gui0e uneru'te0 teeth in to nor+al occlu-ion. 8ence re-ult- achie%e0 -ugge-t that early 0iagno-i- of the o0onto+a- allo)- the a0o'tion of a le-- co+'lex an0 le-- ex'en-i%e treat+ent an0 en-ure &etter 'rogno-i-. !ut(or !ffiliations 1.9r.,ha+-her ,ingh. ,enior /ecturer. 9e'art+ent of Pe0o0ontic- an0 Pre%enti%e 9enti-try. 1ya- 9ental 4ollege. Jo0h'ur. <a*a-than. 2.9r./alita Man0ia. /ecturer. 9e'art+ent of 4on-er%ati%e an0 :n0o0ontic-. ,uren0era 9ental 4ollege an0 <e-earch In-titute. ,riganganagar. 3.9r.1i%e2 $0la2ha. <ea0er. 9e'art+ent of Pe0o0ontic- an0 Pre%enti%e 9enti-try. ,u&harti 9ental 4ollege. Meerut. ?P. # Shamsher Singh et al., ISSN 2231 ' 2250 .9r.3itin ,har+a. ,enior /ecturer. 9e'art+ent of Pe0o0ontic- an0 Pre%enti%e 9enti-try. !.9r.,u&ha-h 4han0er. ,enior /ecturer. 9e'art+ent of 4on-er%ati%e an0 :n0o0ontic-. D.9r.5harat ,an2hla. ,enior /ecturer. 9e'art+ent of Oral Pathology. 1ya- 9ental 4ollege. Jo0h'ur. <a*a-than. In0ia. !c)no&ledgement Fe )oul0 li2e to than2 the -taff +e+&er- of the oral 'athology 0e'art+ent for their -u''ort & coo'eration. "eferences 1. /e)i- <. :%er-ole. 4linical outline of oral 'athology"0iagno-i- an0 treat+ent. 3 r0 e0. 54 9ec2er Inc; 2002. '2G#"G. 2. Mc0onal0 J. 9enti-try for the chil0 an0 a0ole-cent. # th :0. :l-e%ier; 200=:1D"!. 3. 5atra Puneet. >u'ta ,h)eta. <a*an Iu+ar. 9uggal <itu. 8ari'ar2a-h. O0onto+e 9iagno-i- an0 7reat+ent: $ 4a-e <e'ort. JP;$ 2003;1G:=3"D. . ,hafer. 8ine. /e%y. $ 7ext 5oo2 of Oral Pathology. th :0. F.5. ,aun0er- & 4o; 1GG3:30#"12. !. 8itchin $9. 7he etiology of the calcifie0 co+'o-ite o0onto+e-. 5r 9ent J 1G=1;130:=!. D. Phili'-en 8P. <eichart P$. Praetoriou- ;. Mixe0 O0ontogenic 7u+or- & O0onto+a-. 4on-i0eration- on Interrelation-hi'. <e%ie) of /iterature an0 Pre-entation of 13 3e) 4a-e- of O0onto+a-. Oral Oncol 1GG=;33:#D"GG. =. <eichart P$. Phili'-en 8P. Oral Pathology: 4olour atla- of 0ental +e0icine. 7hei+e ,tuttgart: 2000. 23#" G'. #. ,ingh ,. ,ingh M. ,ingh I. Ihan0el)al 9. 4o+'oun0 co+'o-ite o0onto+e a--ociate0 )ith an uneru'te0 'ri+ary central inci-or" a rarity. J In0ian ,oc Pe0o0 Pre% 9ent 200!;23:1D"!0. G. 1engal M. $rora 8. >ho-h ,. Pai I. /arge eru'ting co+'lex o0onto+a: $ ca-e re'ort. J 4an 9ent $--oc 200=;=3:1DG"=3. 10. >a&riel ,erra",erra. /eonar0o 5erini" $ytJ-. 4o-+e >ay":-co0a. :ru'te0 o0onto+a-: $ re'ort of three ca-e- an0 re%ie) of the literature. Me0 Oral Patol Oral 4ir 5ucal 200G;1(D):2GG"303. 11. Fhite. Pharaoh. Oral <a0iology " Princi'le- an0 Inter'retation. th :0. Mo-&y; 2000. '3G!"=. 12. Ia&an /5. Pe0iatric Oral an0 Maxillofacial -urgery. Phila0el'hia: ,aun0er-; 1GG0. '111"2. 13. ;ran2 4. 7reat+ent o'tion- for i+'acte0 teeth. J $+ 9ent $--oc 2000;131:D23" 32. 1. /iu J. 8-iao 4. 4hen 8. 7-ai M. Ortho0ontic correction of a +an0i&ular fir-t +olar 0ee'ly i+'acte0 &y an o0onto+a: $ ca-e re'ort. Kuinte--ence Int 1GG=;2#:3#1"!. 1!. Iat@ <. $n analy-i- of co+'oun0 an0 co+'lex o0onto+a-. J 9enti-t 4hil0 1G#G;!D:!" G. Corresponding !ut(or 9r.,ha+-her ,ingh. ,enior /ecturer. 9e'art+ent of Pe0o0ontic- an0 Pre%enti%e 9enti-try. 1ya- 9ental 4ollege an0 8o-'ital. Jo0h'ur. <a*a-than. In0ia. Ph: LG1 G3!2=1=2= :+ail: 0 r-h a+- he rM-in gh Nyahoo .co + ,ource of ,u''ort: 3il. 4onflict of Intere-t: 3one 9eclare0.