International Journal of Oral & Maxillofacial Pathology.

2014;5(2):33-36 ISSN 2231 – 2250

Available online at http://www.journalgateway.com or www.ijomp.org

Case Report

Erupted Complex Odontoma: A Case Report

Paula Dantas Vieira, Emanuel Mendes Sousa, Silvan Correa, Clarinda Pires de Carvalho Mello, Clélea de
Oliveira Calvet, Clarissa Lopes Vieira
Abstract
The odontoma corresponds to the most common odontogenic tumor found in the oral cavity and
is considered by some authors just as a developmental anomaly. Histologically two types of
odontoma are determined: compound and complex. Both undergo a second classification
considering the location: (1) central odontoma have intra-bone location, (2) peripheral odontoma
have extra-bone location, usually in soft tissues like muscles, gums and mucosa, and (3) erupted
odontoma show themselves exposed to the oral cavity, may cause painful symptoms due to
inflammation, which is the rarest in the literature. The most frequent location is intraosseous, in
exceptional cases odontoma erupts in the oral cavity. This article reports a rare case of complex
odontoma that is in eruptive process in the oral cavity, being detected by radiographic findings
and indicated as a treatment to surgical removal of the same. Confirmation of diagnosis came
through the histopathologic examinations performed.

Keywords: Central Odontoma; Complex Odontoma; Developmental Anomaly; Erupted

Odontoma; Odontogenic Tumor; Peripheral Odontoma;.

Paula Dantas Vieira, Emanuel Mendes Sousa, Silvan Correa, Clarinda Pires de Carvalho Mello, Clélea de
Oliveira Calvet, Clarissa Lopes Vieira. Erupted Complex Odontoma: A Case Report. International Journal of
Oral & Maxillofacial Pathology; 2014:5(2):33-36. ©International Journal of Oral and Maxillofacial Pathology.
Published by Publishing Division, Celesta Software Private Limited. All Rights Reserved.

Introduction with dental inclusion in the oral cavity, the

9
Odontomas are characterized as benign odontoma is the most frequent. With
developmental anomalies and the most variable sizes and slow growth, the
common type of odontogenic tumors, odontoma are predisposed to be located in
representing about 20% of the maxillo- maxillary incisors and canines, followed by
1
mandibular tumors. In them, dental tissues all the mandible. They are usually diagnosed
can be seen, but presented in a different at routine radiographic examination or by the
arrangement of the tooth structure, often as patient searching the dentist due to the
5,10
single and intraosseous lesions, and can delay in tooth eruption. There are three
also be seen as multiple lesions or in the types of odontoma clinically recognized: (1)
2
dental arch. They are associated with the central odontoma, (2) peripheral odontoma,
permanent teeth in children, adolescents and (3) considered erupted odontoma, being
and young adults, although they may appear associated with impacted teeth positioning
at any age. Most of them are diagnosed in coronal to the tooth, thus allowing their
3,4 11
the second decade of life. exposure to the oral cavity. Generally, this
exposure can cause pain, inflammation of
According to the classification of the World adjacent soft tissue or even infection
3
Health Organization (WHO), the complex associated.
odontoma has disordered dental tissues,
5
forming a single solid mass. Its prevalence Radiographically, they have very distinctive
is low and there is no preference about race aspects. In particular, the complex
6
or sex. About its discussed etiology, some odontoma is characterized by a single
theories mention the local trauma, infection, calcified mass, also surrounded by a narrow
12
heredity or genetic disorders as etiological radiolucent line. It has a more difficult
factors. They affect both sexes although diagnosis, compared to the compound
many authors have reported a slight odontoma, since the complex odontoma has
2,7
predilection for males. Clinically the many differential diagnosis with other
odontoma is characterized as asymptomatic radiopaque lesions as osteoma, focal
lesions, but may show signs and symptoms sclerosing osteomyelitis, cementoblastoma,
associated, such as infection, retention of cementifying periapical dysplasia and
2
permanent teeth, swelling, diastema, bad ossifying fibroma.
8
position and malformation of adjacent teeth.
Between the pathologies that are associated

©2014 International Journal of Oral and Maxillofacial Pathology. Published by Publishing Division, Celesta Software Private Limited. All Rights Reserved
34 Paula Dantas Vieira, et al.
About histopathological features the
complex odontoma resembles small rooted
teeth in a loose fibrous matrix. It is formed in
major, for mature tubular dentin surrounding
circular cracks or cavities containing mature
enamel, which are removed during
decalcification. Their potential for
keratinisation is observed in the epithelial
12
cells of the enamel of some odontoma.
The treatment option for the odontoma,
regardless of classification, is its
conservative surgical removal, being
suggested the histopathological analysis
because of the similarity with the
ameloblastic fibroma and ameloblastic
13,14
odontoma. An early diagnosis associated
with a properly surgical procedure made on
time results in a favorable prognosis without
15
risks of relapse.
Thus, we present a case of erupted complex
odontoma, diagnosed and treated at the
Pediatric Dentistry Clinic of the University
CEUMA (UNICEUMA), Brazil.
Case Report
Patient C.A.D., 11 years-old, male, attended
the Pediatric Dentistry Clinic of the
University Ceuma (Uniceuma), São Luís,
Maranhão, Brazil, accompanied by his
mother, who reported that her son had
complained of pain related to the eruption of
the left upper canine. During the interview, it
was not found any relevant characteristic to
the case. At the intra-oral examination it was
observed that apparently the left upper
canine was in eruption process, since its
cusp was present in the oral cavity,
surrounded by an inflammatory process,
causing swelling, redness gum with pain
symptoms.
In periapical radiograph, there was an
impaction of the left upper canine positioned
above the ectopic bicuspids. In the location
that would be correct for left upper canine, it
was observed a calcified element, similar to
a tooth, containing in its interior a uniform
radiopaque image, surrounded by a
radiolucent image (Figure 1). In order to
determine the best location of the lesion,
additional radiographs were made, as the
occlusal incidence and Clark’s technique,
where the vestibular position was
determined. Based on clinical and
radiographic findings, we obtained the
diagnostic hypothesis of erupted complex
odontoma. Thus, it was determined the
surgical removal of the lesion and
subsequent histopathological analysis.
ISSN 2231 - 2250
In the histopathological examination the
surgical specimen showed macroscopically
the cystic form, measuring 2.8cm in
diameter, yellowish-white color and firm
consistency (Figure 2). Under microscopic
analysis, histological sections showed
calcified tissue resembling cementum and
dentin, interspersed with loose connective
tissue similar to the pulp (Figure 3).
Surrounding the area of mineralized tissue, it
was observed a capsule of denser
connective tissue, in which inflammatory
cells were seen with a predominance of
lymphocytes and plasma cells (Figure 4).
Thus, the diagnostic confirmation of
odontoma was obtained. After the period of
postoperative follow-up, the patient was
referred for orthodontic assessment in order
to investigate the possible orthodontic
traction of the impacted left upper canine.
Discussion
Odontomas are lesions that also have
questioned its definition in the literature and
are considered by some authors as
odontogenic tumor with higher incidence in
oral pathology. However, other authors
prefer to define it only as a developmental
16
anomaly (hamartoma). Queiroz et al.
reported that the odontomas are
odontogenic tumors in which it is composed
of tissues with mesenchymal and epithelial
origin, which undergo functional
11
differentiation. Pimenta et al. associated
odontoma with developmental anomalies,
also being formed by the complete
differentiation of specific cells. In most
cases, the odontomas present asymptomatic
form, being diagnosed by routine
radiographic findings or when they are made
in order to determine the absence of an
4
erupting permanent tooth. Serra-Serra,
3
Berin-Aytés and Gay-Escoda, in their
clinical cases, reported that the odontoma
was diagnosed by a radiographic finding, the
same happened in the case described here.
The odontoma can be compound or
complex, being the compound odontoma
presents with a higher incidence in the
anterior maxilla and the complex in the
3
posterior mandible. In relation to its
location, odontoma also suffer a
classification, being basically recognized as
central odontoma (intraosseous), peripheral
odontoma (extra-osseous) and erupted
11
odontoma. The intraosseous type is more
frequently reported. In exceptional cases,
can be seen as extra-osseous or in
ISSN 2231 – 2250
2
occlusion in the oral cavity. The cases of
erupted odontoma are rare. Only seventeen
cases have been reported in the literature,
which was first reported in 1980. Of them,
nine were compound odontoma, the others
being represented by eight complex
odontoma. Among the seventeen cases,
3
thirteen had an impacted tooth associated.
Figure 1: Diagnostic periapical x-rays
showing the odontoma in the region of left
upper canine.
Figure 2: Macroscopic vision of the removed
specimen.
The erupted odontomas are most often seen
in older people, probably the growth reaction
of the capsule contributing to this
phenomenon, as well as the process of
reabsorption from the edentulous alveolar
process. However, the eruption at a young
age is also possible, due to the presence of
the dental follicle resulting in bone
remodeling. It is probably that the
mechanism of eruption of odontomas
present differently from the dental eruption,
not related to contractility of fibroblasts, as
the odontoma, unlike teeth, do not have
17
periodontal ligament. This case can be
considered as a rare form of a complex
odontoma which is available in the oral
cavity unlike most cases, being associated
with the upper left canine, with the injury in
the process of eruption in the oral cavity of a
11 years-old patient. Often the complex
Erupted Complex Odontoma:... 35
odontoma is shown in the posterior
mandible, being reported more frequently
when intraosseous and, when its eruption in
the oral cavity is reported, there is a greater
susceptibility in older patients.
Figure 3: Calcified tissues remembering
dentin and cement, interspersed by loose
connective tissue similar to pulp (H&E; 4x)
Figure 4: Capsule denser connective tissue,
inflammatory cells seen with predominance
of lymphocytes and plasma cells (H&E; 10x)
The surgical removal of odontoma is always
considered as the most appropriate conduct,
and is of fundamental importance in cases
associated with tooth retention in order to
18
establish proper occlusal condition. Thus,
radiographic examinations, both panoramic,
periapical and occlusal incidences are
determinants, not only in diagnostic reasons
but also for surgical planning, which aims to
accurately delineate the tumor and its
15
location in relation to adjacent structures.
In this proper case, the Clark’s technique
was added in this radiographic protocol,
which confirmed the location of the lesion.
Conclusions
The early diagnosis of odontoma is
important for the prevention of dental and
36 Paula Dantas Vieira, et al. ISSN 2231 - 2250

craniofacial development problems, since a 8. Weismann R, Júnior A, Panarello A,

favorable prognosis depends on this early Beltrão R. Complex odontoma: 12 years
diagnosis followed by specific treatment in – case report. Rev ABO Nac.
the correct moment. Thus, the professional 2006;14(2):105-7.
staff should be aware of the importance of 9. Passeto M, Filho V, Gabrielli M, Hochuli-
clinical and radiographic examinations in Vieira E, Gabrielli M. Impacted lower
order to diagnose development central incisor associated with a
abnormalities as soon as possible. compound odontoma: a case report.
Rev ABO Nac. 2005;13(5):301-3.
Acknowledgments 10. Tejasvi MLA, Babu BB. Erupted
We would like to thank Ms.Ana Cléa Feitosa compound odontomas: a case report. J
Pestana, by creation of the histological slides and Dent Res Dent Clin Dent Prospects.
Professor Benedita de Jesus Leite Nunes, for the 2011;5(1):33-6.
assistance in surgery.
11. Pimenta R, Teixeira R, Prata-Tacchelli
Author Affiliations D, Barros M, Capp L, Moretti R.
1.Dr.Paula Dantas Vieira, ST, 2.Dr.Emanuel Odontoma: a case report. ACDC em
Mendes Sousa, ST, 3.Dr.Silvan Correa, ação. 2007;2(19):4-5.
Professor of Bucomaxillofacial Surgery, 12. Cé P, Prazeres C, Santos F, Woltmann
4.Dr.Clarinda Pires de Carvalho Mello, Professor M. Complex odontoma: atypical clinical
of Pathology, 5.Dr.Clélea de Oliveira Calvet, case report. RFO. 2009;14(1):56-60.
Professor of Pathology, 6.Dr.Clarissa Lopes 13. Pires L, Krüger M, Viana E, Kramer P,
Vieira, Professor of Stomatology, Department of Ferreira S. Odontoma: state of art and
Dentistry, University Ceuma (UNICEUMA), Rua
Josué Montello, São Luís, Brazil.
case report. Stomatos. 2007;13(24):21-
9.
1
References 14. Spini PH , Spini PH, Servato JP, Faria
1. Mendonça J, Lima C, Böing F, Bento L, PR, Cardoso SY, Loyola AM. Giant
Santos A. The giant complex odontoma complex odontoma of the anterior
in the body of the mandible: a case mandible: report of case with long follow
report. Rev Cir Traumatol up. Braz Dent J 2012;23(5):597-600.
BucoMaxilofac. 2009;9(2):67-72. 15. Losso E, Pizzatto E, Ulbrich L. Complex
2. Patriarca C. Complex odontoma odontoma associated to a primary
erupted. Rev Assoc Paul Cir Dent. maxillary canine: case report. RSBO.
2008;3(62):228-31. 2009;6(2):204-7.
3. Serra-Serra G, Berini-Aytés L, Gay- 16. Queiroz A, Silva F, Stuani A, Arnez M,
Escoda C. Erupted odontomas: A report Bosatto M. Compound odontoma in
of three cases and review of the pediatric dental patience: diagnosis and
literature. Med Oral Patol Oral Cir Bucal. treatment. Rev Inst Ciênc Saúde.
2009;6(14):299-303. 2005;2(23):163-8.
4. Nóia C, Júnior J, Pinto J, Rodrigues M. 17. Manoj Vengal M, Honey Arora B, Sujoy
Compound-complex odontoma: a case Ghosh B, Keerthilatha M Pai M. Large
report. UFES Rev Odontol. Erupting Complex Odontoma: A Case
2008;4(10):59-63. Report. JCDA. 2007;73(2):169-72.
5. Silva L, Bastos A, Lima J, Araújo M. 18. Freitas D, Freitas V, Mol V, Neto L, Mol
Tooth eruption after surgical removal of V. Dental element impacted by
na odontoma. Odontol Clín-Cient. compound odontoma. Rev Bras Cir
2007;1(6):97-102. Cabeça Pescoço. 2009;38(3):198-9.
6. Alves PM, Santos P, Cavalcanti A,
Corresponding Author
Queiroz L, Souza L. Clinical-
Dr.Clarissa Lopes Vieira,
histopathologic study of 38 odontomas. Rua Rio Anil, Qd. 7, Cond.,
Rev Odontol UNESP. 2008;4(37):357- Mar Del Plata, Casa 25, Recanto dos
61. Vinhais,
7. Ali Azhar DF, Kota MZ, El-Nagdy S. An São Luís – MA, Brazil-65070-018.
unusual erupted complex composite Ph: 55(98) 3236-7680/(98) 8897-1977
odontoma: a rare case. Case Rep Dent. Email: cleovi@gmail.com
2013;2013:106019.

Source of Support: Nil, Conflict of Interest: None Declared.