Super Odontoma – A Destructive Swarm Entity

Odontoma is a common benign odontogenic tumor seen mostly in permanent dentition. This case report presents the management of a 5-year-old child who had impacted primary maxillary canine associated with a compound composite odontome with multiple denticles – a rare entity. Odontomas are usually asymptomatic but can cause problems like disturbances in the eruption of teeth such as impaction or delayed eruption, retention of primary teeth or abnormalities in position of teeth such as tipping or displacement of adjacent teeth [1].

Panoramic radiography can be used in the detection of odontomas. But it cannot give enough information to management and treatment planning [2]. Cone Beam Computed Tomography is the best diagnostic imaging method currently available; it provides higher resolution for hard tissues, determines accurate location of retained teeth and their relationship to adjacent tissues and minimizes patient radiation exposure [3].

Conservative surgical excision of odontomas is the treatment of choice as these are well encapsulated and can be easily enucleated from surrounding bone and there is little possibility of recurrence. In the present case the unerupted primary maxillary canine was with the odontomas so surgical removal along with the odontomes was done. A 5-year-old boy came with the chief complaint of decayed teeth. On intraoral examination, there were multiple carious teeth and a missing primary maxillary right canine which was associated with slight swelling labially but asymptomatic. On palpation, it was bony hard in consistency. Panoramic radiograph showed numerous radiopaque masses adjacent to the roots of the first primary molar arranged in a flower pattern of 2 x 2cm in diameter [Table/Fig-1]. Based on the clinical and radiographic evaluation, the diagnosis of early childhood caries and impacted primary canine due to compound composite odontoma was made. A differential diagnosis of ameloblastic fibroodontoma and odontoameloblastoma was made. They show a great resemblance to common odontomas, especially in the radiographic examination.

[Table/Fig-1]:

Panoramic radiograph revealing numerous radiopaque masses adjacent to the roots of the first primary molar

The enucleation of the entire lesion was planned under local anesthesia. A sulcular incision was placed buccally and a mucoperiosteal flap was raised from distal aspect of maxillary lateral incisor to mesial aspect of second primary molar. Bone was removed with a bur to expose the calcified mass [Table/Fig-2]. The mass was removed and followed by curettage of lining to remove any remnants. The tissue was sent for histopathological examination. The sharp bony margins were rounded and irrigated with povidone iodine. After adequate hemostasis suturing was done with 3 – 0 black silk sutures. The retrieved specimen revealed few tooth like structures and few were fused total of 25 with well differentiated dental tissues [Table/Fig-3]. The postoperative period was uneventful.

[Table/Fig-2]:

Surgical exposure of odontome

[Table/Fig-3]:

Multiple denticles (25)

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