|Year : 2012 | Volume
| Issue : 3 | Page : 225-227
Management of impacted incisor associated with multiple compound odontomes
Sandhya Maheshwari1, ND Gupta2, Mohd Toseef Khan1, Wamiq Shamim3
1 Department of Orthodontics and Dental Anatomy, Dr. Z A Dental College AMU, Aligarh, India
2 Department of Periodontics and Implantology, Dr. Z A Dental College AMU, Aligarh, India
3 Department of Orthodontics, MPCD and RC, Gwalior, India
|Date of Web Publication||11-Jun-2013|
Mohd Toseef Khan
Department of Orthodontics and Dental Anatomy, Dr. Z A Dental College AMU, Aligarh
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Odontomes represent a hamartomatous malformation rather than a neoplasm. Compound odontome bear same superficial anatomical similarity to normal teeth. The presence of the odontomes is the common cause of failure of eruption of the teeth present adjoining them. In the cases where impacted teeth are present in favorable position, these teeth can be made to erupt at a suitable position in dental arch. This is a case report of interdisciplinary management of compound odontoma.
Clinical Relevance to Interdisciplinary Dentistry
- This case shows the importance of multidisciplinary management of impacted incisor associated with odontomes.
- Each specialist is important at various stages of treatment, everyone needs to be consulted to prevent any irreversible damage to patient
- Orthodontist and periodontist need to be in continuous touch throughout the treatment in order to maintain the periodontal integrity of such cases.
- Root resorption may ensue in the teeth that are moved from an ectopic position; endodontist must be consulted whenever it is suspected.
Keywords: Compound odontomas, deimpaction, interdisciplinary management, unerupted teeth
|How to cite this article:|
Maheshwari S, Gupta N D, Khan MT, Shamim W. Management of impacted incisor associated with multiple compound odontomes. J Interdiscip Dentistry 2012;2:225-7
|How to cite this URL:|
Maheshwari S, Gupta N D, Khan MT, Shamim W. Management of impacted incisor associated with multiple compound odontomes. J Interdiscip Dentistry [serial online] 2012 [cited 2023 Jun 10];2:225-7. Available from: https://www.jidonline.com/text.asp?2012/2/3/225/113273
| Introduction|| |
Adelay in time between the exfoliation of a deciduous tooth and the eruption of its permanent successor is known as dental retention.  This occurs when tooth eruption does not occur within a normal period. Cahill and Marks established that 'though a viable dental follicle is required for tooth eruption, tooth eruption is a series of metabolic events in alveolar bone characterized by bone resorption and formation on opposite sides of the dental follicle, and the tooth does not contribute to this process. There are many other factors responsible for failure of eruption. 
Impedence in the path of eruption itself may be due to a myriad of reasons, one of the rarer one being the presence of an 'odontoma.' The term odontoma is used for describing the growth in which functional odontogenic tissues co-differentiate simultaneously. The odontoma is often defined as a hamartoma rather than a true neoplasm. Out of the odontogenic tumors, these represent the largest group with around 22-67% of odontogenic tumors turning out to be odontomas.  These may occur because of trauma, infection, hereditary factors, and even may be idiopathic, but whatever may be the initiating factor, mostly odontomas result from extraneous buds of odontogenic epithelial cells. 
Odontomas are mostly associated with unerupted/impacted teeth and appear as solitary and asymptomatic lesions unless secondarily associated with cysts or infection and are diagnosed on routine radiographic examination. Radiographically, they present as a mixed radiolucent-radio opaque lesions surrounded by a radio-opaque 'halo' rather than a solid radio-opaque mass as in osteomas or other ossifying/sclerotic lesions. 
A case report of compound odontoma with unerupted permanent anterior teeth is presented here.
| Case Report|| |
A 17-year-old boy presented with the complaint of missing teeth in Department of Orthodontics. His past medical and dental history was non-contributory. Left maxillary permanent central incisor was clinically missing, and maxillary permanent lateral incisor was palatally displaced and present palatal to maxillary permanent canine [Figure 1]a. There was hard bony elevation in the place of maxillary permanent central incisor. All other permanent teeth with the exception of third molars were erupted and were of normal size and anatomy. Radiographic features are summarized in [Figure 1]b.
| Management|| |
Surgical plan and procedure
The objective of the treatment plan were to
- Surgically removing all the odontomas;
- Erupt the unerupted incisors orthodontically;
- Fully align all teeth in the arch.
Written informed consent was obtained. The surgical procedure was carried under local anesthesia. A crestal incision was made, and conservative buccal mucoperiosteal flap was raised. Odontomes and impacted incisor was exposed and odontomes removed [Figure 1]c taking care not to affect the prognosis of unerupted tooth. Bone was also removed from the bucco-incisal aspect of unerupted maxillary incisor to expose 3/4 th of the crown. The bracket tied with ligature wire of 0.010" was bonded, the flap repositioned [Figure 2]a. Surgical Coe pak (GC Asia Dental Pvt. Ltd - INDIA, Road # 11, Jubilee Hills, Hyderabad - 500033) was given, and the patient was recalled after one week and sutures were removed [Figure 2]b. Orthodontic alignment of the impacted teeth was done using straight wire appliance, and good occlusion and acceptable esthetic results are achieved [Figure 2]c.
| Discussion|| |
The majority of odontomas in the anterior segment of the jaws are of the compound composite type (61%), while those in the posterior segment are of the complex composite type (34%). There is no gender or age predilection.  The World Health Organization has subdivided odontomas into a compound and complex type based on histological criteria. Compound odontomas consist of multiple miniature or rudimentary teeth, whereas complex odontomas appear as an amorphous and disorderly pattern of calcified dental tissues. Although odontomas are classified as odontogenic tumors according to the WHO classification, they lack proliferative potentiating.  In effect, complex odontomas can cause slight bone expansion - a characteristic that distinguishes them from compound odontomas, which cause greater expansion. Situations such as tooth impaction or mal-positioning have been associated, as well as malformation, resorption, and devitalization of the adjacent teeth in 70% of odontomas. Because of their odontogenic nature, including epithelial and mesenchymal tissues, odontomas can also develop cystic transformation into a dentigerous cyst. 
Impacted teeth can cause serious dental and esthetic difficulties, especially in the anterior part of maxilla, as well as associated psychological problems; therefore, most commonly require surgical exposure and orthodontic guidance during eruption.  The choice of treatment is surgical removal followed by orthodontic management of impacted teeth. The possibility of relapse exists when resection is carried out in the non-calcified stage of the lesion. ,
| Conclusion|| |
Interdisciplinary approach in treating such cases should be preferred; as such cases need multiple specialists at various stages of treatment. A good functional occlusion, better esthetic can be achieved without sacrificing the teeth in the area of odontomes.
| References|| |
|1.||Costa CT, Torriani DD, Torriani MA, da Silva RB. Central incisor impacted by an odontoma. J Contemp Dent Pract 2008;6:122-8. |
|2.||Ralph E, McDonald DD, Avery DR, Jeffrey A. Dentistry for the Child and Adolescent. 8 th ed. Mosby: St Louis Missouri; 2004. |
|3.||Cuesta SA, Albiol JG, Aytés LB, Escoda CG. Review of 61 cases of odontoma. Presentation of an erupted complex odontoma Med Oral 2003;8:366-73. |
|4.||Cildir SK, Sencift K, Olgac V, Sandalli N. Delayed Eruption of a mandibular primary cuspid associated with compound odontoma. J Contemp Dent Pract 2005;4:152-9. |
|5.||Teruhisa U, Murakami J, Hisatomi M, Yanagi Y, Asaumi J. A Case of unerupted lower primary second molar associated with compound odontoma. Open Dent J 2009;3:172-6. |
|6.||Singh S, Singh M, Singh I, Khandelwal D. Compound composite odontome associated with an unerupted deciduous incisor-A rarity. J Indian Soc Pedod Prev Dent 2005;23:146-50. |
|7.||Bayram M, Özer M, Sener I. Maxillary canine impactions related to impacted central incisors: Two case reports. J Contemp Dent Pract 2007;6:72-81. |
|8.||Calatrava L. Lecciones de patología quirúrgica oral maxilofacial. Ma-drid: Oteo; 1979. p. 455-60. |
|9.||López-Areal L, Silvestre Donat F, Gil Lozano J. Compound odontoma erupting in the mouth: 4-year follow-up of a clinical case. J Oral Pathol Med 1992;21:285-8. |
[Figure 1], [Figure 2]