There are several developmental dental anomalies that people encounter in their life. One unique type of developmental dental defect is odontoma. Odontoma is derived from the odontogenic origin of the lesion. These are non-cancerous oral tumors that develop in the jaw. Often, they are formed by abnormal growth of the tissue that replicated the adjacent teeth, such as the enamel, dentin, and pulp.
Typically, odontomas are categorized into two types – compound odontoma, which resembles a cluster of tooth-like tissue and complex odontoma, which is formed as a globule of dental tissue in the jaw. Often odontomas are associated with unerupted permanent teeth.
Odontomas are usually asymptomatic. They are mostly diagnosed on routine dental x-ray examination while looking for the missing or impacted tooth. Treatment, if required, is done by simple local excision of the odontoma along with the extraction of the impacted teeth. Today’s article will highlight the original features of odontomas. Furthermore, we will discuss the types and treatments of odontomas.
What are odontomas?
Odontomas are developmental dental abnormalities that are formed in the jaws. It is mainly composed of all mature components that form hard and soft dental tissue, such as the enamel, dentin, and pulp. In most cases, odontomas resemble a collection of small teeth-like structures. (1)
Odontomas are usually slow-growing and often have limited growth in the jaw. They are well differentiated benign tumors that can be easily identified on dental x-rays. Typically, children between the age of 12-14 years are found with odontomas on routine dental examinations. Often odontomas are associated with one or more unerupted teeth.
What are the types of odontomas?
Typically, odontomas are categorized into two types –
Compound odontoma
Compound odontoma is a collection of small radiopaque masses that mostly resemble little tooth-like structures called denticles. It is formed by exuberant growth of the dental lamina or the proliferation of enamel organ. (2) Around 62% of the compound odontomas occur in the anterior maxillary region. Most of the compound odontoma is associated with the unerupted canine.
Complex odontoma
Complex odontoma is composed of haphazardly arranged dental hard or soft tissue. Unlike compound odontoma, complex odontoma does not resemble a regular tooth. Moreover, in a radiographic study, it is seen as a globule of dental tissue. (3) Complex odontomas are most commonly found in the posterior region of the mandible. It may or may not be associated with a missing tooth or an unerupted tooth.
What are the clinical features of odontomas?
Odontomas are one of the most common odontogenic tumors that interferes with the eruption of permanent teeth. Some of the clinical features of odontomas include –
- Usually, odontomas are asymptomatic
- They are small and have limited growth
- Odontomas are frequently found in the maxilla
- Compound odontoma is more often found in the anterior maxilla while the complex odontoma is located in the posterior regions of the jaw
- Dilated odontomas may resemble a primary, permanent or supernumerary tooth (4)
- In some, cases, patients may feel a bony swelling in the posterior mandible or anterior maxilla
How are odontomas diagnosed?
Odontomas are asymptomatic and usually diagnosed on routine dental x-ray studies. Some of the radiographic features of odontomas are listed below –
- The early lesions appear radiolucent with smooth and well-defined contours.
- As the odontoma develops, it forms a well-defined radiopaque appearance.
- Often the odontomas are small in size and do not exceed the size of the regular tooth.
- Large odontomas may cause expansion of the jaw.
- In most cases, odontomas may be discovered while looking for a missing tooth. They are associated with impacted, malposition, malformation, and displacement of the adjacent teeth. (5)
Complex odontomas have a characteristic ‘sunburst’ appearance wherein the lesion is seen as a radiopacity with the thin and uniform radiolucent rim. This resembles the radiographic appearance of osteosarcoma. (6)
Compound odontoma appears as a cluster of teeth-like structures encapsulated in a fine radiolucent rim. Often compound odontomas are associated with an unerupted or impacted tooth.
What is the treatment for odontomas?
Treatment of odontomas depends on the severity of the lesion. Most of the odontomas are asymptomatic, and patients do not prefer any treatment unless it hampers the growth of adjacent teeth. However, in case of jaw expansion caused by large odontomas or odontomas leading to tooth impaction, surgical excision of the lesion is preferred. The prognosis for simple local extraction of odontomas is excellent. They do not recur, and often, odontomas are not invasive. (7)
An oral surgeon performs the process of removal, and usually, the associated impacted tooth is also extracted due to lack of tooth development. Orthodontic assistance may be required in case of proper tooth alignment.
It is essential to follow-up for dental check-ups to check the healing site.
Take away message
Odontomas are one of the most common and unique types of odontogenic tumors. They are formed by the abnormal growth of the dental lamina or enamel organ into the jaws. Therefore, they contain all the hard and soft tissues such as enamel, dentin, and pulp.
Odontomas are clinically asymptomatic. In some cases, large odontomas may cause swelling in the jaw. There are two types of odontomas – compound odontoma found in the anterior maxilla and complex odontoma found in the posterior mandible.
The only sign associated with odontoma is the non-eruption of the permanent tooth. Often, during routine radiographic examinations, a dentist may diagnose the presence of odontoma. Treatment of odontoma mainly involves surgical excision of the lesion along with the extraction of the impacted tooth due to underdevelopment.