TEETH THAT HAVEN'T

BEEN CHANGED
Tutorial 6 Scenario 4
Facilitator : drg. Widya Puspita Sari, MDsc
 Member of group
11.. Leader : Mutiah Dwi Arini (2210070110005)
2. Secretary : Febriani Aulia Putri (2210070110092)
2.
3. M. Asfa Ubai Rafi
3. (2210070110014)
4. Wahyu Putri Harfini
4. (2210070110021)
5. Rafli al azra
5. (2210070110030)
6. Vionilla Detia Hadiyatul Fudla (2210070110035)
6.
7. Dwi Yufika Fidella
7. (2210070110056)
8. Arief Rahman
8. (2210070110058)
9. Nadya Alifia Azzahra
9. (2210070110064)
10. Ridra Alfarizi
10. (2210070110077)
 Scenario 4
A 22 year old man came to RSGM to have his right upper
jaw teeth checked which were small in size. These teeth
have not fallen out since childhood. To confirm the
diagnosis, the dentist performs a radiographocclusal
examination. The results of radiographic examination in
region 13-12 showed a radiopaque image which had tooth
denticles and impacted tooth 12.
 Learning Objectives
11.. Students are able to understand and explain the examination of the case
in the scenario
2. Students are able to understand
2. and explain radiographic interpretation in
the cases in the scenarios
3. Students are able to understand
3. and explain the classification of
neoplasms in the oral cavity
4. Students are able to understand
4. and explain the diagnosis in the scenario
5. Students are able to understand
5. and explain the etiology of the case in
the scenario
6. Students are able to understand
6. and explain the pathophysiology of the
cases in the scenarios
7. Students are able to understand
7. and explain the management of cases in
scenarios
1.1. Students are able to understand and explain the examination of
the case in the scenario
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mauris. Cras euismod, metus ac finibus finibus, felis dui suscipit purus, a
maximus leo ligula at dolor.When finding abnormal tissue in the oral cavity,
head and neck, several steps should be taken to identify the tissue. These
stages include a comprehensive medical history, lesion history, clinical and
radiographic examination as well as required laboratory examinations. This
stage leads to the next stage of management such as routine observation,
making a referral to a higher level of health facility, or conducting a
specimen examination before definitive action, namely a biopsy examination,
to support optimal management.
• Supporting investigation
Panoramic radiographs and CBCT can be used to detect
odontoma lesions. CBCT is an alternative technique that
can be considered in determining the boundaries of
odontoma lesions, expansion, thinning of cortical bone and
perforation. CBCT is more effective than panoramic
because there are no superimposed anatomical structures
and allows images to be made in the axial, coronal, sagittal panoramic radiography
and oblique planes. Clinically, CBCT has various
applications such as determining the location, extent of the
lesion, condition of the internal structure of the lesion, and
pathological conditions in the jawbone. Another benefit to
the diagnostic process, this three-dimensional imaging
can provide important information needed by surgeons in
planning surgery. The CBCT technique allows three-
dimensional visualization so that it can identify lesions and
clarify the structure in more detail. CBCT radiography
2. Students are able to understand and explain radiographic
interpretation in the cases in the scenarios
Evaluation of the Quality of Occlusal Radiography
Objects included in the radiograph
Anterior-posterior teeth on both sides
There is no overlapping
Minimal distortion and clear picture
Contrast, detail and sharpness are good
Conclusion:
the radiograph can be interpreted
Dental Interpretation
Tooth 12 has not yet erupted
Teeth and roots are clear
The mass hits the tooth that is about to erupt so
that the tooth inhibits its eruption
Lesion Interpretation
Location of lesion: anterior maxilla between teeth 12-15
Shape, number and borders: irregular, multilocular, the
edges of the lesion are clearly visible and the edges are
smooth
Internal: radiopaque mixed with radiolucent
External: slightly radiopaque radiolucent
Effects on surrounding tissue: inhibits the eruption of
tooth 12, causes tooth 13 to overlap, damages tissue
around the lesion.
Diagnosis:
compound odontoma
Differential diagnosis:
focal sclerosing osteitis, osteoma, periapical cemental
dysplasia, ossifying fibroma and cementoblastoma.
3. Students are able to understand and explain the classification of
neoplasms in the oral cavity
Benign neoplasms of the soft tissue of the oral cavity can be differentiated based on the
tissue of origin, namely benign neoplasms originating from epithelial tissue.
Ameloblastoma is a mass of cells that develops within the bone, or may develop on the
periphery of the bone. Ameloblastoma that develops within the bone can develop cystic
internal areas (cystic or multicystic) or induce proliferation of fibrous connective tissue
(desmoplastic).
Calcifying Epithelial Odontogenic Tumor (CEOT/Pindborg Tumor) is a very rare
neoplasm, only occurring in around 1% of odontogenic neoplasms. This neoplasm is
usually located in the bone and its cells can produce mineralized substances in an
amolide-like material.
Cementoblastoma is a slow-growing cementoblast mesenchymal neoplasm. This tumor
manifests as a bulbous cementum growth that develops around the root and root apex
of the tooth.
 Hyperplasia: Torus Palatinus and Torus Mandible. Torus is an idiopathic bony protrusion that can
occur in the midline of the hard palate, which is called torus palatinus, while that which can occur
on the lingual surface of the mandible is called mandibular torus.
Hyperostosis is an exophytic, hematomatous mass of most cortical bone, arising from the
surface of the bone. sometimes this hyperostosis can incorporate a small amount of internal
cancellous bone.
Odontoma is a benign, non-aggressive, odontogenic tumor and is an abnormality in tooth
development (hamartomatous). Odontoma develops from primordial odontogenic tissue. Its
composition is a combination of odontogenic epithelium and odontogenic ectomesenchyme. Usually
this tumor is asymptomatic, and the most common causes are impaction of permanent teeth and
persistence of primary teeth. 2 Odontomas were categorized as odontogenic tumors by the World
Health Organization (WHO) in 2005. Two types are known, namely compound and complex odontoma.
There are three types of compound odontoma. Denticular type consisting of two or more separate
denticles, each having a crown and root or hertwig epithelial sheath with a distribution of hard tooth
tissue comparable to that found in teeth. The particulate type consists of two or more separate
masses or particles that have no macroscopic resemblance to teeth and consist of abnormally
arranged hard tooth tissue. Denticulo particulate type consists of denticles and a mass of visible
particles together
4. Students are able to understand and explain the diagnosis in the
scenario
Compound odontoma is an odontogenic tumor that occurs due to repeated division of the tooth
germ or abnormalities in the dental lamina with the formation of the tooth germ. This odontoma
begins as a soft lesion on the bone during the period of tooth formation. . In patients with
developing odontoma, the structure appears to resemble a tooth germ.
Most of these lesions are asymptomatic, there is swelling in the alveolar bone of the teeth,
there are primary teeth that do not fall out on time, impacted teeth and are discovered
accidentally by radiological examination, or when radiographs are taken of teeth that have not yet
erupted.
 CHARACTERISTICS OF COMPOUND ODONTOMA
• Slow growing, non infiltrative lesion.
• Most often occurs in the maxilla, especially in the anterior maxilla (incisor - canine region)
• Can occur in both men and women in areas of erupted and unerupted teeth.
• Appears in the second and third decades of life.
• Failure to erupt permanent teeth due to the influence of compound odontoma.
• More common than complex odontoma.
Compound odontoma is diagnostic on radiographic examination. The differential diagnosis
of odontoma is other opaque lesions such as focal sclerosing osteitis, osteoma, periapical
cemental dysplasia, ossifying fibroma and cementoblastoma.
5. Students are able to understand and explain the etiology of the case
in the scenario
The etiology of odontoma is still unknown. This has been associated with various
pathological conditions, such as trauma during the development of deciduous
teeth, inflammatory or infectious processes, mature ameloblasts, residual Serres
cells (remnants of the dental lamina) or hereditary anomalies (Gardner's syndrome
and Hermann's syndrome), odontoblastic hyperactivity, and changes in the central
nervous system, changes in the genetic components responsible for controlling
tooth development.
6. Students are able to understand and explain the pathophysiology of
the cases in the scenarios
The pathophysiology of odontoma is the area of ​neoplastic proliferation of odontogenic cells
of the tooth germ where the epithelial and mesenchymal cells differentiate to ameloblastic and
odontogenic levels but fail to reach a normal state, so the tooth substance forms abnormally.
Epithelial and mesenchymal cells differentiate to form enamel, dentin and cementum which are
arranged in an abnormal tissue arrangement, namely in the form of denticles. Then the stromal
tissue stops its activity to form a capsule. Sometimes the tumor divides into septa. In normal
tooth growth, after the formation of hard tissue, degeneration of the dental lamina usually
occurs, and complex odontoma is related to this. Complex odontoma undergoes very little
morphodifferentiation so that it does not resemble the shape of a normal tooth. Meanwhile,
compound odontoma has a high degree of morphodifferentiation and histodifferentiation, so
that calcification will be found which gives a picture similar to normal dental anatomy.
7. Students are able to understand and explain the management of
cases in scenarios
Management of odontoma is carried out through a conservative surgical procedure
(enucleation), followed by treatment with fixed orthodontic appliances to assist tooth eruption
and adjust the position of the teeth in the jaw arch. management should be carried out as early
as possible, so that the management procedure can be simpler and can reduce treatment
costs and produce a better prognosis, and also generally the treatment for small odontoma
lesions is surgical excision and recurrent lesions usually do not occur, whereas for large
odontoma lesions , excision can affect the surrounding bone and tooth tissue. So we can
manage it through a conservative surgical procedure (enucleation).
Post-operative instructions emphasize maintaining the cleanliness of the surgical area,
avoiding hot food and drinks, consuming soft foods, and avoiding physically involving activities
for up to 48 hours after surgery. Patients are prescribed pain relievers and antibiotics to
prevent post-operative infections.
 CONCLUSION
Odontoma is a benign, non-aggressive, odontogenic tumor and is an abnormality in tooth
development (hamartomatous). Odontomas are classified into two types, namely compound and
complex odontoma. Compound odontoma usually has normal tooth tissue arranged in a regular
pattern and looks like a large number of small tooth structures called odontoids or denticles. The
odontoma complex consists of an irregular mass of calcified tissue with little or no resemblance
to a normal tooth.
Odontomas are usually asymptomatic, and can be detected incidentally on routine radiography
(panoramic and/or intra-oral X-ray), or when they are large enough to cause swelling of the jaw.
The differential diagnosis of odontoma is other opaque lesions such as focal sclerosing osteitis,
osteoma, periapical cemental dysplasia, ossifying fibroma and cementoblastoma.
THANK YOU