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ORIGINAL RESEARCH
Odontoma - a retrospective study from nagpur, india
Rajeshwar Chawla, Nitin Verma, Navnoor Gill, Ramninder Bawa, Harmanpreet Singh Sohal
ABSTRACT
Background: Odontoma represents tumor of odontogenic origin, which are considered to be hamartomatous rather
than a true neoplasm. Aims and Objectives: To retrospectively evaluate the types, clinical features and treatment given
for the management of odontomas. Materials and Methods: This study evaluated all cases of odontomas reported to department of Oral Pathology and Microbiology, Govt. Dental College and Hospital, Nagpur, India during 2012-2013. Data
collected includes medical records with socio-demographic details, panoramic radiographs, and pathological reports
and details of management. Results: The compound types were usually located in the anterior maxilla and the complex
type in posterior mandible; most of them were correctly diagnosed clinically and radiographically prior to confirmation
by histopathology reports of the specimens. Conclusion: Even though the exact etiology of odontomas is unknown surgical enucleation and curettage was done with very less chance of recurrences.
Keywords: Complex Odontomas; Compound Odontomas; Odontoma
Odontomas are the most common odontogenic tumors of
epithelial and mesenchymal origin.1 The term ‘odontoma’ was
coined by Paul Broca in 1867.2 Broca defined the term as tumors formed by overgrowth of complete dental tissue that
give rise to ameloblasts and odontoblasts.3,4 The majority of
odontomas are discovered during the second and third decades of life.5-7 They are usually asymptomatic, discovered on
routine radiographs and are commonly seen in permanent
dentition.4,8 This retrospective study was carried out in central
part of India (Nagpur vidharbha region) to evaluate the types,
clinical features and treatment given for the management of
odontomas.
Materials and Methods
A total number of 26 cases of odontomas accounting for 13.0%
(26/200) of odontogenic tumors were included in this study.
Out of 26 cases of odontomas, 57.69% (15/26) were complex
odontomas and 42.30% (11/26) were compound odontomas.
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Complex Odontoma: Considering the frequency out of 26 cases of odontomas, 15 cases of complex odontomas were present, accounting for 57.70% (15/26) of odontomas and 7.5%
(15/200) of odontogenic tumors. In this review, the mean age
of complex odontomas at the time of diagnosis was 30.8 years.
Out of 15 cases of complex odontomas, eleven cases occurred
before the age of 30 years while four cases occurred after the
age of 30 years. Gender distribution was 12 males and three
females reported, with male: female ratio of 4:1( Graph 1).
2015 Volume 7
Results
Radiological features were as follows. Out of 15 cases, radiographic picture of 11 cases were available. Radiographically,
the lesion appears as a more or less amorphous radiopaque
mass of calcified material. Tooth like radiopaque structures
are usually not detectable. Resorption of neighboring teeth
is rarely seen. Unerupted teeth were associated with complex odontomas in five cases. Histopathology reports shows
that, microscopically, the lesion consists of a well-delineated,
roughly spherical mass of a haphazard conglomerate of mature hard dental tissues. Some shows better ordered, tooth
like structures. Clear spaces and clefts that probably contain
mature enamel lost in the process of decalcification are often
seen. A thin fibrous capsule is usually seen surrounding the
lesion. The given sections show haphazard conglomerate of
enamel matrix, dentine, pulp tissue and cementum. Features
are suggestive of complex odontomas.
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This study evaluated all odontomas reported to of Govt. Dental College and Hospital, Nagpur during 2012-2013. A total
of 200 cases of odontogenic tumors were retrieved from the
files of department of Oral Pathology and Microbiology, Govt.
Dental College and Hospital, Nagpur. Data collected includes
medical records with socio-demographic details, panoramic
radiographs, and pathological reports and details of management. The results were analyzed and compared with the similar studies in literature.
The majority of cases of complex odontomas were found in
posterior mandible 86.7%(13/26) followed by posterior maxilla 13.3% (2/26). Clinical presentation of the complex odontome was usually a painless, slow growing and expanding lesion that is usually discovered on routine radiographs of the
jaw bones but in this review, 53.33% (8/15) cases reported
pain and swelling, 20% (3/15) had pain without swelling and
26.67% (4/15) with painless swelling. Impacted/ unerupted
teeth were noticed with 33.33% (5/15). Pus discharge and sinus formation was seen in 13.33% (2/15) cases.
I N T E R N AT I O N A L J O U R N A L O F D E N TA L C L I N I C S
Introduction
Graph 1: Age and gender distribution
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Chawla et al
Compound odontoma:The frequency of the lesion was as
follows. Out of 26 cases of odontomas, 11 cases were of compound odontomas, accounting for 42.30% (11/26) of odontomas and 5.5% (11/200) of odontogenic tumors. In this review,
the mean age of compound odontomas at the time of diagnosis was 20.4 years. Out of 11 cases of compound odontomas,
seven cases 63.6% (7/11) occurred in second decade of life,
while first, third, fourth and sixth decade had one case each.
Gender distibution shows that the male: female ratio of compound odontomas was almost equal (0.83:1) with five males
and six females (Graph 1). The maxillary anterior region was
the most frequent site for this lesion as compared to the complex odontomas, i.e., 54.5% (6/11) maxillary anterior region,
36.4% (4/11) posterior mandibular region and 9.1% (1/11) in
mandibular anterior region. It is seen that the anterior maxilla
holds a somewhat stronger tendency for being the predilection site for the compound odontomas as the posterior mandible does for the complex odontomas.
The compound odontome is usually a painless, non-aggressive lesion. In this review of 11 cases, six cases were reported
with pain with or without swelling while one patient exhibited
painless swelling. Three patients had come to the hospital for
orthodontic treatment. Impacted/ unerupted teeth were noticed in five cases. Radiographically, the compound odontomas appear as a radiopaque mass of calcified structures with
an anatomical similarity to normal teeth, though the teeth are
dwarfed and deformed. A narrow radiolucent zone in most
cases usually surrounds the compound odontomas.
The main Histopathological features separating the two types
of odontomas is that the compound odontomas show a high
degree of morphodifferentiation, resulting in a lesion consisting of many tooth like structures (denticles) generally enclosed
in a fibrous capsule. Each denticle is composed of enamel,
dentin, cementum and pulp tissue arranged regularly on the
whole, but showing many small divergences from the normal
pattern. One additional feature is the presence of ghost cells
in odontomas but in this review, no ghost cells were seen in
any case. These sections show denticles composed of enamel,
dentine and pulp tissue in a regular arrangement suggestive
of compound odontome.
Discussion
Odontomas are better defined as hamartoma than a true
neoplasm.2,9 As odontomas are composed of more than one
type of tissue, they are considered to be mixed odontogenic
tumors.10 The dental tissues in odontomas lack organization
due to disordered expression and localization of the extracellular matrix molecules in the dental mesenchyme.11 The exact
etiology of odontome is unknown.3,12 However, it has been
suggested that trauma, infection, inheritance or a mutagene
may lead to the development of such lesions.3 The etiology of
odontome is that most result from extraneous odontogenic
epithelial cells.13 When these buds are divided into several
particles they may develop individually to become numerous,
closely positioned malformed teeth or tooth-like structures.14
When the buds develop without such uncommon division
14
and consists of haphazard conglomerates of dental tissues,
they may develop into complex odontome. However, the
transition from one type to another is commonly associated
with varying degrees of morphodifferentiation or histodifferentiation or both, and it is often difficult to differentiate between both the types.2,14-16 Recently, Philipsen et al., put forth
the hypothesis that formation of a compound odontome is
pathogenically related to the process producing hyperdontia,
‘Multiple Schizodontia’ or locally conditioned activity of dental
lamina.2,8
W.H.O classified12 odontomas into three groups,2,14 such as
complex odontome, cmpound odontome and ameloblastic
fibro-odontome. There are essentially two types of odontomas: complex composite odontome and compound composite odontome. A new type known as Hybrid odontome is
also reported by some authors.2 Odontomas are painless, slow
growing and expanding lesions, usually discovered on routine
radiographs. The only difference between the complex and
compound odontomas is that the latter resembles quite closely to a tooth while the former does not.
Complex odontoma: The relative frequency of complex
odontomas among odontogenic tumors varies between 5%
and 30% in different series. The frequency of complex odontomas among odontogenic tumors was 7.5%, in accordance
with the survey conducted by Yong lu et al.17 The majority of
cases occur before the age of 30 years with a peak in second
decade of life. Based on the 139 cases of odontomas survey,8
the mean age at the time of diagnosis was 19.9 years, odontomas compared to 30.8 years reported in our study., i.e., nine
cases occurred before the age of 30 years with peak in second
and third decades. The male: female ratio varies between 0.8:1
to 1.5:1 in different surveys and in present study male: female
ratio of 4:1 was found with male predilection. This large difference in age and sex distribution is due to the small number
of sample size from where significant results are difficult to
achieve. Majority of cases of complex odontomas are found
in posterior mandible as seen in this series, in which 86.7% of
cases were seen in posterior mandible. Unerupted teeth are
associated with complex odontomas from 10% to 44.4% of
the cases18 comparable to 33.3% of cases in the present series.
Histologically, Odontoma contains normal appearing enamel
or enamel matrix, dentin, pulp tissue andcementum which
may or may not exhibit a normal relation to one another.19
Compound odontoma: The relative frequency of compound
odontomas among odontogenic tumors varies between 9%
to 37% in different surveys,8 making this tumor as one of the
most common odontogenic tumor. In his retrospective study,
compound odontomas account for 5.5% of odontogenic tumors. Based on the data collected,8 majority of cases appear
before the age of 20 years with a clear peak in second decade
of life as seen in present survey where 63.6% of the cases reported in second decade of life. The male:female ratio varies
between 1.2:1 to 1:1,8 comparable to 0.8:1 ratio in this study.
It is seen that the anterior maxilla holds a somewhat stronger tendency for compound odontomas than the posterior
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Odontoma - A retrospective study from Nagpur, India
mandible that shows predilection for complex odontomas.
Unerupted teeth are associated with compound odontomas
more often than complex odontomas as seen in the present
series i.e., 45.4% versus 33.3%. The main feature separating
the two types of odontomas is that the compound odontomas show a high degree of morpho-differentiation, resulting
in a lesion consisting of many tooth like structures enclosed
in a fibrous capsule. It has been found that 16% of complex
odontomas contain isolated areas of ghost cells8 but in present review, no case of complex or compound odontomas exhibited ghost cells. Association of complex odontomas with
calcifying odontogenic cyst has been absent in the present
study sample.
Conclusion
In conclusion, the exact etiology of odontomas is unknown
surgical enucleation and curettage was done with very less
chance of recurrences. This study increases our understanding
of the prevalence and occurrence of this unique tumor, thereby enabling us to diagnose and treat it more effectively.
Authors Affiliations
1. Rajeshwar Chawla, MDS, Professor and Head, JCD Dental College
and Hospital, Sirsa, Haryana, India, 2. Nitin Verma, MDS, Assistant
Professor, Punjab Govt. Dental College and Hospital, Amritsar, Punjab, India, 3. Navnoor Gill, MDS, Private Practitioner, Ohio, USA, 4.
Ramninder Bawa, MDS, Senior Lecturer, SGRDIDSR, Amritsar, Punjab,
India, 5. Harmanpreet Singh Sohal, BDS, Resident, Punjab Govt. Dental College and Hospital, Amritsar, Punjab, India.
2. Singh S, Singh M, Singh I, Khandelwal D. Compound composite
odontome associated with an unerupted deciduous incisor-A
rarity. Journal of Indian Society of Pedodontics and Preventive
Dentistry. 2005;23(3):146-50.
3. Shafer WG, Mk Levy BM. A textbook of oral pathology. 1983.
4. Chandra S, Bagewadi A, Keluskar V, Sah K. Compound composite
odontome erupting into the oral cavity: A rare entity. Contemporary clinical dentistry. 2010;1(2):123.
5. Bhaskar SN. Synopsis of Oral Pathology. Academic Medicine.
1961;36(7):845.
11. Ida‐Yonemochi H, Noda T, Shimokawa H, Saku T. Disturbed tooth
eruption in osteopetrotic (op/op) mice: histopathogenesis of
tooth malformation and odontomas. Journal of oral pathology
& medicine. 2002;31(6):361-73.
12. Kramer I, Pindborg JJ, Shear M. Histological typing of odontogenic tumors. World Health Organization. International Histological Classification of Tumors. Springer; 1992.
13. White SC, Pharoah MJ. Oral radiology: principles and interpretation: Elsevier Health Sciences; 2014.
14. Shetty RM, Halawar S, Reddy H, Rath S, Shetty S, Deoghare A.
Complex Odontome associated with Maxillary Impacted Permanent Central Incisor: A Case Report. International journal of
clinical pediatric dentistry. 2013;6(1):58.
15. Batra P, Gupta S, Rajan K, Duggal R, Prakash H. Odontomas-diagnosis and treatment: a 4 case report. J Pierre Fauchard Acad.
2003;19:73-6.
16. Piattelli A, Perfetti G, Carraro A. Complex odontoma as a periapical and interradicular radiopacity in a primary molar. Journal of
endodontics. 1996;22(10):561-3.
17. Mosadomi A. Odontogenic tumors in an African population:
analysis of twenty-nine cases seen over a 5-year period. Oral Surgery, Oral Medicine, Oral Pathology. 1975;40(4):502-21.
18. Bimstein E. Root dilaceration and stunting in two unerupted primary incisors. ASDC journal of dentistry for children.
1978;45(3):223-5.
19. Agrawal B, Gharote H, Nair P, Shrivastav S. Infected complex odontoma: an unusual presentation. BMJ case reports.
2012;2012:bcr2012006493.
http://doi.org/10.1136/bcr-2012006493.
How cite this article
Chawla R, Verma N, Gill N, Bawa R, Sohal HS. Odontoma - A retrospective study from Nagpur, India. International Journal of Dental Clinics.
2015;7(2):13-15.
Address for correspondence
Harmanpreet Singh Sohal, BDS,
Resident,
Punjab Govt. Dental College and Hospital,
Amritsar, Punjab, India.
Email: har_sohal@yahoo.in
6. Regezi JA, Kerr DA, Courtney RM. Odontogenic tumors: analysis
of 706 cases. Journal of oral surgery (American Dental Association: 1965). 1978;36(10):771-8.
7. de Oliveira BH, Campos V, Marçal S. Compound odontoma-diagnosis and treatment: three case reports. Pediatric dentistry.
2001;23(2):151-7.
Source of Support: Nil
Conflict of Interest: None Declared
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2015 Volume 7 Issue 2
1. Budnick SD. Compound and complex odontomas. Oral Surgery,
Oral Medicine, Oral Pathology. 1976;42(4):501-6.
10. Yadav M, Godge P, Meghana S, Kulkarni SR. Compound odontoma. Contemporary clinical dentistry. 2012;3(Suppl1):S13.
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References
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I N T E R N AT I O N A L J O U R N A L O F D E N TA L C L I N I C S
Conservative surgical enucleation is considered to be the
treatment of choice in both complex and compound odontomas with little chances of recurrence. Enucleation and currettage was performed in all cases with good prognosis with
one case of recurrence with complex odontomas. The possible
explanation for this was incomplete removal done at the time
of surgery, leaving behind the focus for future infection and
pain in posterior mandible. Hence, a second surgery was done
to treat the patient.
8. Philipsen H, Reichart P. Mixed odontogenic tumours and odontomas. Considerations on interrelationship. Review of the literature and presentation of 134 new cases of odontomas. Oral oncology. 1997;33(2):86-99.