Odontomas are most commonly occurring tumors of the jaws. Large odontomas may be associated with local disturbances such as eruption delay of permanent teeth. However &nbsp;cases of simultaneous pathologies are uncommon. Here we report a case of a complex odontoma associated with dentigerous cyst in relation to mandibular first molar. &nbsp

Anjan Shah

Madhumati Singh

Shouvik Chowdhury

English

eDENT Journals

 
Complex Odontoma associated with Dentigerous cyst  
 
Anjan Shah,1 Madhumati Singh,2 Shouvik Chowdhury3 
Introduction   
Various factors are responsible for eruption delay of permanent teeth. The causes range 
from supernumery teeth, neoplasms (E.g Ameloblastic fibroma), hamartomatous lesions 
(E.g Odontomas), cystic lesions (E.g Dentigerous cyst). It is rare however for two 
pathological conditions i.e. a hamartoma and cystic lesion to occur in the same site 
simultaneously.       
 
CASE REPORT  
 
A 14 year old boy reported in Oral and Maxillofacial Surgery department with 
chief complaint of pain and swelling on his right lower 1/3
rd
 of face since 2 months. His 
medical history was unremarkable. (Fig 1) 
 
On examination 3x3 cm swelling in the right mandibular body region extending 
anterior - posteriorly 2cm from the corner of mouth to tragus. Superior-inferiorly 2cm 
above the lower border of the mandible till lower border of mandible. Mouth opening 
was adequate. Intra-oral examination of the regions revealed the apparent absence of 
45, 46, 47, 48 and over retained 85. Breach in the corresponding mucosa through which 
pus extruded. Buccal and lingual cortices were expanded. There was no any other 
abnormality in other teeth in oral cavity. (Fig.2) 
 
A panoramic radiograph showed a uniformly dense rounded radio - opacity 
(3cm x 3cm) in the 47, 48 region surrounded by radiolucent lining and well demarcated 
radiolucency (3x3cm) anterior to radio - opacity associated with impacted 46. The right 
mandibular canal displaced inferiorly. There was no evidence of any root resorption. 
Clinical and radiological presentations are suggestive of two lesions. (Fig.3, 4) 
 
, 2010  © 2010   
 
ABOUT THE AUTHORS 
1. Anjan Shah 
Reader,  
Department of Oral and 
Maxillofacial Surgery, 
Raja Rajeshwari Dental 
College and Hospital, 
Bangalore. 
 
2. Madhumati Singh 
Prof. & HOD,   
Department of Oral and 
Maxillofacial Surgery, 
Raja Rajeshwari Dental 
College and Hospital, 
Bangalore. 
 
3. Shouvik Chowdhury 
Post graduate student 
Department of Oral and 
Maxillofacial Surgery, 
Raja Rajeshwari Dental 
College and Hospital, 
Bangalore. 
 
 
 
Corresponding Author:  
 
Dr Shouvik Chowdhury  
 
Post graduate student 
Department of Oral and 
Maxillofacial Surgery, 
Raja Rajeshwari Dental 
College and Hospital, 
Bangalore. 
 
email: 
lifeline143@gmail.com 
 
 
Abstract      
                         
Odontomas are most commonly occurring tumors of the jaws. Large odontomas may be 
associated with local disturbances such as eruption delay of permanent teeth. However,  
cases of simultaneous pathologies are uncommon. Here we report a case of a complex 
odontoma associated with dentigerous cyst in relation to mandibular first molar.  
 
Key words :  Odontogenic tumor, Dentigerous cyst, Impacted teeth 
 
CASE REPORT 
89 
, 2010  © 2010   
 
  
Fig 3. Pre-Operative OPG   
Fig 2.  Intraoral Photograph Fig 1. Extraoral Photograph 
Fig 4. Occlusal radiograph 
Fig 5.Complex Odontoma  Fig 6. Dentigerous cyst 
Fig 8. Post Operative OPG 
Fig 7. Specimen arrowed – Complex odontoma 
Non -  arrowed – Dentigerous cyst 
90 
, 2010  © 2010   
Differential diagnosis made on the basis of clinical and 
radiological examination :  
  
 
1) Ameloblastic Fibro-odontoma  
2) Calcified Odontogenic cyst  
3) Pindborg’s tumor 
4) Complex Odontoma with Dentigerous cyst. 
 
Definitive diagnosis i.e Complex Odontoma and 
Dentigerous Cyst made on the basis of histopathological. 
(Fig 5, 6 )  
 
Under GA intra-oral incision taken from the 43 
to ascending ramus. Inferior alveolar nerve was 
identified. 85 was extracted. Cystic lining was excised 
leaving behind 46 to erupt. Surgical excision of 
odontoma was done. The cavity was packed with ribbon 
gauge soaked with Bismuth Iodoform Paste. (Fig. 7, 8)  
 
DISCUSSION 
 
According to 1992 WHO classification of 
odontogenic tumors. These are four odontogenic 
tumors with mixed tissue i.e. Ameloblastic fibroma, 
Complex odontoma, Compound odontoma and 
Ameloblastic Fibro - odontoma.  
 
In this regard, odontomas are hamartomas 
composed of various dental tissues enamel, dentin, 
cementum and sometimes pulp. They are slow 
growing benign tumors showing non- aggressive 
behavior. They are classified as complex, when the 
calcified tissue present as an irregular mass composed 
mainly of mature tubular dentin or compound if there 
is superficial anatomic similarity to even rudimentary 
teeth. Complex odontomas are less common than 
compound in the ratio of 1:2. Complex odontomas are 
tend to occur in the posterior region of jaw and 
compound odontomas are more common in the 
anterior maxilla. They may be discovered at any age, 
although less than 10% are found in patients over 40 
years of age. Although they are commonly 
asymptomatic, clinical indicators of odontomas are 
retention of deciduous teeth, non eruption of 
permanent teeth. Pain, expansion of cortical bone and 
tooth displacement. Other symptoms include 
anesthesia in the lower lip and swelling in the affected 
area.  
 
Clinically odontomas are either complex or 
compound and are classified as : 
 
a) Intra - osseous :  odontomas occur inside the 
bone and may erupt (erupted odontomas) into 
the oral cavity. 
 
b) Extra - osseous : odontomas occurring in the 
soft tissue covering the tooth bearing portion of 
the jaws. 
      
Odontomas presents as a well defined radio-
opacity situated in bone, but with a density that is 
greater than bone and equal to or greater than that of 
tooth. It contains foci of variable density. A radiolucent 
halo, typically surrounded by thin sclerotic line, 
surrounds the radio-opacity. The radiolucent zone is 
the connective tissue capsule of a normal tooth follicle.  
 
Hitchin suggested that odontomas are inherited 
through a mutant gene or interference, possibly post 
natal, with genetic control of tooth development. 
Surgical removal of odontomas is included in the 
absence of any contraindication. 
 
As a result of there odontogenic nature, including 
epithelial and mesenchymal tissue odontomas can 
develop cystic transformation into dentigerous cyst. 
This cyst results from the cystic degeneration of 
enamel organ after partial or total development of the 
crown, cystic transformation of the follicle associated 
with the unerupted tooth may also occur when its 
eruption is impeded by the odontoma. 
 
In our patient the radiographic and histological 
findings when correlated, suggests that the origin of 
the dentigerous cyst was from the impacted 46.  
 
Surgical management– Enucleation of the cyst and 
excision of odontoma and packing the cavity open. 
Reasons 
  
a) Prevent nerve damage. 
 
b) Decrease risk of pathological fracture. 
 
c) Allow eruption of 46. 
 
 
CONCLUSION 
 
A case of swelling on the right posterior 
region of mandible, unusual in that two pathological 
lesion occurred simultaneously like cyst with 
odontoma. 
 
91 
, 2010  © 2010   
REFERENCES  
 
1) Manjol Vengal, Honey Arora et al : Large 
erupting complex odontoma : A case  report  
JCDA March 2007, Vol 73, No.2. 
 
2) C.C. Ragalli et al : Large erupting complex 
odontoma: IJOMS 2000; 29 : 373 - 374. 
 
3) Slootweg PJ : An analysis of the interrelationship 
of the mixed odontogenic tumors – ameloblastic 
fibroma, ameloblastic fibro – odontoma  and 
odontomas. Oral Surg 1981 : 51 :  266-76. 
 
4) Hitchin AD : The etiology of  the calcified 
composite odontoma. Brit Dent J 1971 ; 130 (11) 
475 -82. 
 
5) Cohen DM, Bhattacharyya I. Ameloblastic 
fibroma, ameloblastic fibroodontoma and 
odontoma. Oral and Maxillofacial Surg. Clin 
North Am 2004 : 16(3) 375-84.     
 
 
  
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Complex Odontoma associated with Dentigerous cyst

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Complex Odontoma associated with Dentigerous cyst

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