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A CASE OF COMPOUND MAXILLARYODONTOMA AND MANDIBULAR HYPODONTIA

Radka Cholakova1, Ivan Chenchev1, Svetla Jordanova2, Diana Oncheva2,Ljubomir Chenchev3

1) Department of Oral Surgery, Faculty of Dental Medicine, Medical University– Plovdiv, Bulgaria.2) Department of Orthodontics, Faculty of Dental Medicine, Medical University– Plovdiv, Bulgaria.3) Student in Faculty of Dental Medicine, Medical University – Plovdiv, Bulgaria.

Journal of IMAB - Annual Proceeding (Scientific Papers) 2016, vol. 22, issue 3Journal of IMABISSN: 1312-773Xhttp://www.journal-imab-bg.org

ABSTACT:Odontomas are formations which are still classified

as benign tumors by the World Health Organization. Theyare lesions on any odontogenic tissue – enamel, cement anddentin, which are affected in different proportions and de-gree. We present a case of compound odontoma on upperjaw, on a 15 year-old girl, causing retention of a perma-nent canine tooth. After the extirpation 16 tooth-like struc-tures were uncovered. The mandible was diagnosed withhypodontia of both 2nd premolars. Patient’s history showedthat there was a trauma in the area of the upper jaw atyounger age.

In this article we will present the clinical and radio-graphic examination, the stages of the complex surgical-orthodontic treatment and a discussion of the etiology ofthe diagnosis, complications and the treatment itself.

Keywords: compound odontoma, supernumeraryteeth, tooth retention, odontogenic tumors, hypodontia,complex treatment

INTRODUCTION:Odontomas are formations which are still classified

as benign tumors by the World Health Organization. Theyare lesions on any odontogenic tissue – enamel, cement anddentin, which are affected in different proportions and de-gree. [1, 2, 3, 4] Even though they are similar to hamarto-mas and malformations, the compound odontoma consistsof multiple small tooth-like structures often firmly adaptedto one another and covered by more or less continuous con-nective tissue capsule. [1, 5] Odontomas are usually smallin size but when bigger they can contain up to a thousanddenticles. The complex odontoma consists of homogenousamorphous mass of mature odontogenic tissues with somekind of structural organization. The degree of morphologi-cal differentiation varies for each lesion. A major part ofsome is calcified matrix, while in other cases there are sec-tions of pulp tissue in association with cords and buds.

Hypodontia is a condition of missing up to six toothgerms, while if there are more than six missing germs, ex-cluding wisdom teeth, it is called oligodontia. Hypodontiais assumed to be a hereditary disease which most often af-fects wisdom teeth, 2nd premolars and lateral incisors. Theabsence of permanent teeth is called anodontia.

CASE REPORT:In the department of orthodontics of the Faculty of

Dental Medicine - Plovdiv was admitted a 15 year-old girlwith an open bite and a persistent right deciduous maxil-lary canine. Patient’s history showed that there was a traumain the frontal area at younger age that lead to the devitali-zation of tooth 11. The history does not tell of any otherfamily members with missing teeth and also tells of no otherpast diseases. Examination shows that the patient has anopen bite, Angle class II, with a persistent 63 tooth and dis-coloration of tooth 11. It is also determined that both man-dibular second premolars are missing. There were no indi-cations of any other accompanying disease.

Fig. 1. Bite, front

Fig. 2. Bite, right profile

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Fig. 3. Bite, left profile

Orthopantomography and 3D cone beam tomography revealed:

Fig. 4. Panorama view and display of retained 23 tooth and 63 tooth

Fig. 5. 3D cone beam tomography – showing palatinal location of the odontoma

Radiographic assessment:· X-ray diagnose· Hypodontia 35, 45· Impacted canine 23· Diagnose of lateral cephalometry· Hyperdivergent type of growth

· Skeletal Class I· Radiographic diagnose (3D cone beam tomogra-

phy) - compound odontoma.Presence of a limited by a radiopaque unstructured

matter with tooth-like formations on the upper jaw in thearea of the right canine, located palatinally and occlusally

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from its germ. Missing germs of second mandibularpremolars.

The patient was directed to the Department of OralSurgery for the extraction of the primary canine and extir-pation of the formation. Under the effect of local anestheticstooth 63 was extracted, while a vestibular and palatinalflaps were made. A capsulated formation was revealed con-taining multiple rudimental tooth-like formations whichwere removed in portions as the capsule was ruptured. Therewas a total of 16 such “teeth” with irregular form and sizeat different stage of differentiation. Histological study re-vealed a compound odontoma

Fig. 6. Vestibular and palatal mucoperiosteal flap

Fig. 8. Stitched operative wound

Fig. 7. Tooth-like formation

DISCUSSION.Odontomas are found at a frequency of 0.24% to

1.12% according to some authors and 0.64% out of all bi-opsies in maxillo-facial surgery. They account for 30.4%of all diagnosed odontogenic tumors. [4] Complex odon-tomas are a little more common than the compound onesat a proportion of 1:0.96. Men and women are almostequally likely to be affected, but there is a characteristicgender distribution for some nations (for Egyptians it is0.37:1 for men/women, while for Japanese it is 1:0.65 formen/women). The complex odontoma is common for peo-ple about the age of 19.25±2.9 years, while the compoundodontoma is diagnosed at an older age – 25.14±4.8 yearsold. Maxillary odontomas are most commonly located inthe frontal area, while the mandibular ones are usually lo-cated in the molar area. [6] The etiology of the odontomasis vaguely known. [4, 7] They can be formed from the toothgerm or the teeth during their growth period induced by alocal trauma, infection, odontoblast hyperactivity, geneticmutations. [2, 4, 7, 8, 9, 10] Odontomas are classified astumors but usually stop growing in size when the tissuesthey are made of are fully mineralized. Their clinicalbehavior differs from that of other body tumors as it is char-acteristic for all non-tumor lesions which have dysplastic,hemartoma and malformation traits.

Hypodontia in the deciduous dentition has a rate ofabout 0.4-0.9% for the European population. For the per-manent dentition it differs for each continent: Europe - men4.6%, women 6.3%; Australia - men 5.5%, women 7.6%;North American white race - men 3.2%, women 4.6%. Over-all tooth agenesis for women is 1.37 times more commonthan it is for men. [11, 12] Second mandibular premolar isthe most often affected, followed by the lateral maxillaryincisor and the second maxillary molar. [11, 13, 14, 15] Itis often observed as unilateral than it is as bilateral withthe exception of the lateral incisors which are usually af-fected bilaterally. Genetics and environmental factors caninfluence the development of the tooth germs. Mutationsof the homeobox gene MSX 1 leads to hypo-/oligodontiaof the premolars and molars. [11] External factors includeinflammation, chemotherapeutics or dioxin. However, manycases are caused by genetic factors. Familial predisposition

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Address for correspondence:Dr. Radka Cholakova,Department of Oral Surgery, Faculty of Dental Medicine,Medical University – Plovdiv, BulgariaE-mail: r_cholakova1978@abv.bg,

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CONCLUSION:Overall the etiology of the odontomas is unknown.

They can be formations of the tooth germ or the tooth it-self. In this case there is the tendency of suppression of thedevelopment of the dental lamina and a development of

hypodontia. The stimulated growth of the maxilla is prob-ably caused by the local trauma during the developmentperiod of the tooth germs. The disturbance in the migra-tion, proliferation and differentiation of the neural crestcells and the interaction between the epithelial and mes-enchymal cells in the initial stages of the development ofthe dentition can be a possible cause for the simultaneousappearance of odontoma and hypodontia.

Please cite this article as: Cholakova R, Chenchev I, Jordanova S, Oncheva D, Chenchev L. A case of compound maxil-lary odontoma and mandibular hypodontia. J of IMAB. 2016 Jul-Sep;22(2):1217-1220.DOI: http://dx.doi.org/10.5272/jimab.2016223.1217

Received: 15/05/2016; Published online: 18/07/2016