Complex composite odontoma

COMPLEX

COMPOSITE

A Clinical

and Histologic

ODONTOMA Report

Eli Olech, D.I).B.,

N.S., P.A.C’.D.,*

UnGcersity

College

of Illinois,

(‘himgo,

111.

of Ihtistry

ISTRODUCTION

DoiVroi~I~~s are tumors composed of one or more of the various elements that make up tooth structure. They arca caused by ncoplastic proliferation of the odontogenic cells of the tooth germ,’ and they may occur in any part of the mandible or maxilla. Often they arc associated with the absence of one or more teeth. They are benign and tend to erupt, especially if the). arc traumatized or become infected. They are usually symptomless and often prevent the erupt,ion of contiguous teeth ; they are frrquently discovered incidentally during routine roentgenographic examination of the jaws. These tumors are usually encapsulated and should be treated conservatively. If ankylosed, their removal may he difficult. Occasionally, they ma; cause a bulging of the jaw. Many casts have been rrportc?l, but relatively few have been of the caomplex compound type. Most of the reports have described odontomas occ*nrring in the of odontopenic tumors as lower jaw. 2-4 Thomal gives an excellent classification approved by the American ,4cademy of Oral Pathology. The complex composite odontoma may be smooth, lobulated, or of irregular shape. Sometirnes it, develops around the drown of a normally formed, unerupted tooth. It is composed of a varyin g c~onglomcration of enamel, dcntinc, cementurn, and pulp arranged in a bizarre fashion. The odontoma rqresrnts the inactive or mature form ot’ the odontoblastonla; it is t,hc end result, the calcified remains after the odontogpnic acti&> of the crlls becomes eshaustctl.” The following case is reported brcauso it involv(~d II tumlor of thus rarer type, a complex composite odont,omc. This lesion occurred in thcl uppc’r jaw and produced no sympt,oms until it bt~~;~rnc~secondarily infect&. Associated with it was the absence ol’ two molar tert,h.

0

CASE

REPORT

abscess

versity

CTinimZ Hisfory.-The patient, had ruptured spontaneously

Accepted for publication *Professor of Oral and of Illinois, College of

a well-developed the upper

in

April 10, Maxillofacial Dentistry;

right

19-year-old molar

girl, reported Ada. She had

that, a large consulted her

1962. Surgery and Clinical Professor

960

Director of of Surgery,

Minor Oral Surgery. College of Medicine.

Uni-

Volume 16 Number 8

COMPLEX

COMPOSITE

961

ODONTOMA

dentist region

who, on roentgenographic examination, found a “peculiar” radiopaque mass in the of the right tuberosity. On oral examination, a discharging fistulous tract was observed on the buccal surface in the upper right molar area. All teeth except the right upper second and third molars were present. Additional roentgenograms revealed an irregularly shaped radiopaque mass, measuring 3 by 2 cm., in the right tuberosity area. This mass was surrounded by a radiolucent zone. There was no sign of the missing upper second and third molars, and there was no history of their having been removed. All the remaining teeth were present and in good condition. There was no bulging in the area (Fig. 1). The clinical diagnosis was complex composite odontoma, secondarily infected.

Fig.

l.-4kClusal

roentgenogram

absence

showing odontoma of second and

occupying third molars.

tuberosity

area.

Note

also

Treatment.-Under local anesthesia, a mucoperiostesl flap was elevated on the buccal surface in the upper right molar region. Enough of the buccal bone was removed to expose the irregular mass, which was very hard and whitish in color. This mass was freed and removed in toto with its capsule. The flap was replaced into position and sutured with 3-O black silk. The usual postoperative instructions were given. The patient had an uneventful convalescence and recovery. The sutures were removed on the fifth day. The removed odontoma was irregularly oval in shape, very hard, and measured 3 by 2 cm. The specimen was sent for histologic examination (Figs. 2 and 3). Microscopic Description.-The specimen consisted mainly of an irregular mixture of enamel and dentine. Although most of the enamel was mature, remnants of enamel matrix could be seen in many areas. The dentine ranged from the nearly normal tubular variety, to irregular, to a completely atubular form. In many areas interglobular dentine could be seen. On one surface of the specimen, connective tissue resembling dental pulp lay adjacent

Fig.

Fig.

3.-Roentgenograms

P.--Photogra~)h

of removed

of surgical

odontoma

specimen.

showing

its varying

densities.

SUMMARY

A case of complex compound odontoma of the maxilla has been described, both clinically and histologically. This tumor was typical in every respect. It was discovered only after it had become secondarily infected; it had been

Volume Number

COMPLEX

16 8

Fig.

I.-Photomicrograph

Fig.

5.-Higher

of

magnification

COMPOSITE

cross section arranged

of

two

in

of

entire a bizarre

areas showing x75 ; reduced

963

ODONTOMA

odontoma pattern.

more I,$.)

showing

details

of

its

structure.

various

components

(Magnification,

symptomless previous to its infection; the contiguous teeth were absent. Following conservative treatment, by surgical removal, the postoperative result was excellent.

964 REFERENCES

1. Thoma, Kurt H. : Oral Pathology, ed. 4, 2. Wainwright, W. W.: Complex Odontoma; surg. 31: 447-454, 1945. 3. Knapp, Robert G. : Compound Composite J. Oral Surg. 4: 316, 1946. 4. Waldron, C. W., Peterson, Ralph G., and of the Mandible, J. Oral Surg. 4: 5. Thorns, Kurt H.: Oral Surgery, ed. 3? St.

Ht. Iiouis, L~vport. Otiout.ome

Z19.54, ‘I’hr~ (‘. \‘. Mosl~y (:ump:rn,v. of zL (kc, .ZIll. .I. OrthotloIItics ti of

lhtr

Marldiblc

; Report

Worman, H. G.: (1vmpound Compositt~ 48, 1946. Louis, 1958, The C. V. Mosby (‘ompany,

of

0r:rl

:i. (&XL,

Odontorm~ chap.

-19.