Piotr Stępień, Paweł Nieckula, Andrzej Wojtowicz
Odontoma – Odontogenic Tumour
– Case Description and Literature Review
Zębiak – guz zębopochodny – opis przypadków i przegląd piśmiennictwa
Department of Dental Surgery of the Dental Institute of Warsaw Medical University, PolandAbstract
Odontomas are odontogenic tumours, the histogenesis of which is related with tissue elements of which germs or particular tissues of teeth are formed. Odontogenic tumours constitute a huge variety of histopathologic types recreating dental tissues at different stages of odontogenesis. Odontoma tumours constitute nearly half of all odon-togenic tumours. The tumour rarely develops within the facial skeleton. The course of the disease is usually asymp-tomatic, which is connected with little dynamics of development. The paper presents two cases of patients treated in the Department of Dental Surgery Medical University of Warsaw in 2008 and 2009 year. Basing on current literature, clinicopathomorphological characteristics of complex odontoma as well as the neccessity of chirurgical treatment are presented (Dent. Med. Probl. 2010, 47, 1, 107–110).
Key words: odontoma, odontogenic tumour, delayed permanent teeth eruption.
Streszczenie
Zębiaki to guzy zębopochodne, ich histogeneza wiąże się z tkankami, z których powstają zawiązki zębów. Występuje różnorodność typów histopatologicznych zębiaków, odtwarzających tkankę zębopochodną na różnych etapach odontogenezy. Stanowią prawie połowę wszystkich guzów zębopochodnych. Guzy te występują stosunkowo rzad-ko w obrębie twarzoczaszki, zwykle bezobjawowo, co jest związane z niewielką dynamiką ich rozwoju. W pracy przedstawiono 2 przypadki pacjentów leczonych w Zakładzie Chirurgii Stomatologicznej WUM w 2008 i 2009 r. Na podstawie aktualnego piśmiennictwa przedstawiono właściwości kliniczno-patomorfologiczne zębiaka złożo-nego i konieczność leczenia chirurgiczzłożo-nego tego typu zmiany (Dent. Med. Probl. 2010, 47, 1, 107–110).
Słowa kluczowe: zębiak, guz zębopochodny, opóźnione wyrzynanie zębów stałych.
Dent. Med. Probl. 2010, 47, 1, 107–110 ISSN 1644-387X
ClINICAl CASe
© Copyright by Wroclaw Medical University and Polish Dental Society
Odontomas are one of the benign tu - mours and originate from dentinogenic tissues. These types of tumours spring up from the tissues developmental disorders of a dental organ caused by genetic alterations, injury or infection. They indicate little dynamics of growth and develop gradually inside the bones of mandible and max-illa, however, they have been also noticed in the soft tissues of the gums. The intensive growth of tumour occurs at the period of time of the eruption of the first permanent teeth (at the age of 6to 11) and at the period of time of the erup-tion of the wisdom teeth. The proliferaerup-tion of the tumour might lead to deformation of the alveolar process, disorder of the growth of the adjoining teeth resulting in their malposition, retention of
a permanent tooth and survival of a deciduous tooth in the alveolar arch. Their presence might cause disorder in the eruption of the perma-nent teeth, mainly incisors and canine teeth. Big tumours can bring about the neuralgic pain press-ing the ramuses of the trigeminal nerve [1, 2–15].
There are 3 types of odontomas varying in their histomorphologic structure:
– ameloblastic fibroodontoma is structured from connective tissue, epithelium of dentoplas-tic, enamel and dentine. It springs up on neoplasia, at times becoming relatively big, causing the sub-stantial bone defect. For the most part it is situated in the rear area of the mandible.
– odontoma mixtum is usually a single upgrowth surrounded by a capsule, consisting of
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some fragments of enamel, dentine, cementum and connective tissue, all arranged randomly. In more than 90% cases these tumours are diagnosed at children below 15 years old.
– odontoma complexum is also structured from all tooth tissues, despite the fact that their arrangement and disposition are similar to those of the correct tooth. Inside the tumour surrounded by the capsule one can find a couple of small, underde-veloped upgrowths looking like miniaturised teeth. They can be more often seen in maxillas.
Depending on the level of differentiation and maturity of the odontoblastic cells, all dental mor-phologic forms can be observed in the odontomas, ranging from multicellular stuctures to mature dental upgrowths [1, 3, 4, 16, 19–23].
Roentgenodiagnostics such as pantomogra- phic X-ray, teeth and occlusions X-ray are of the greatest importance to diagnose the odontomas. Radiological X-rays of odontomas are typical, their diagnosis and differentiation do not usually cause any particular difficulties. Depending on the level of the tumour development one can encounter in the radiological X-ray:
– bone defect in a form of cysts with sparse and irregular calcifications,
– homogenously saturated osteosclerotic up- growth,
– developed and under-developed tooth buds, – dwarfish, multiple teeth [4, 18, 24–26]. The surgical treatment allows to remove the tumour and its capsule. It is the best to conduct the surgery before the growth of juveniles, what enables to have a proper tooth eruption and to form the occlusion conditions. In some cases, the orthodontic treatment is advisable. The proce-dure is to use an elastic traction fixed by means of a clinch on the crown of an exposed unerupted tooth and tie it up to an orthodontic device. After a complete enucleation of a lesion, the recurrences are not observed. [2, 4, 18, 25–27].
Case Reports
Case 1
Patient (male), 30 years old, healthy in gener-al, came to the Department of Dental Surgery of Medical University of Warsaw in order to carry out sanitation of the oral cavity. The patient did not complain of any painful ailments, he was referred to the Department of Dental Surgery by his dentist. During the medical examination the mixed losses in maxilla and mandible as well as the radicular pulp in a state of gangrenous decomposition were stated. The pantomographic X-ray was taken and
displayed an entirely unerupted tooth 42 in its horizontal position and crossing the medial line. Nearby the unerupted tooth (above it), an oval osteosclerotic lesion showing a non-homogenous saturation with a clear osteolytic areola was found. (Fig. 1). For further diagnostics additional guided teeth X-rays and X-rays of occlusion-axial of man-dible were taken. The X-ray depicted the lesion with characteristic features for the odontoma.
After the initial diagnosis, the patient under-went an operation of a surgical extraction of a completely unerupted tooth 42 together with the osteosclerotic lesion. The surgery was performed in the ambulatory conditions with local anaes-thesia. The lesion in a form of numerous, small upgrowths resembling teeth and joined up with a connective tissue was enucleated in whole and the remaining extensive bone defect was filled up with Natix White preparation and two RTR cones (Fig. 2).
Fig. 1. A part of radiological image presenting an
oste-osclerotic lesion in the region of 41–42 teeth similar to odontoma and unerupted tooth number 42
Ryc. 1. Fragment zdjęcia pantomograficznego
przed-stawiającego w obrębie zębów 41–42 zmianę osteo-sklerotyczną przypominającą zębiaka oraz całkowicie zatrzymany ząb 42
Fig. 2. An intrasurgery image after removing an
odon-toma and unerupted tooth number 42
Ryc. 2. Zdjecie śródzabiegowe po usunięciu zębiaka
Odontoma – Odontogenic Tumour – Case Description and literature Review 109
The injury was tightly stitched. The patient was pre-scribed antibiotic treatment. The left material was sent to the histopathological examination.
Case 2
Patient (female), 11 years old, healthy in general, was referred to the Department of Dental Surgery of Medical University of Warsaw for consultation and a possible treatment of a lesion localized on the level of the teeth 14–13, which was diagnosed due to the radiological X-rays – a pantomographic and a tooth X-ray in the area of the 14 and 13 teeth. They disclosed an osteosclerotic lesion with
non-homogenous saturation and a clear osteolytic are-ola (Fig. 3, 4). The patient did not complain of any painful ailments during the examination, where-as during the clinical examination it wwhere-as stated a substantial ectasia of the alveolar process of the maxilla localized near the teeth 14 and 13, the lack of the teeth 14 and 13 and the presence of the tooth 53. The patient was scheduled for an opera-tion of a surgical extracopera-tion of the tumour in the ambulatory conditions with local anaesthesia. As a result, 25 micro teeth were isolated from the tumour mass. The injury borders were brought near with some stitches and after the surgery some recommendations were given. The patient was prescribed an antibiotics treatment.
To sum up, the odontomas are caused by mal-formation of the tooth hard tissues. A course of a disease is usually asymptomatic. The odontomas grow through years, it is connected with little dynamics of their development and growth. In the radiological examinations they are usually pre-sented as a well-saturated osteosclerotic lesion with a clear osteolytic areola. The presence of odon-tomas evoke the disorder in the growth of the per-manent teeth, which might cause their retention. The odontoma treatment must be radical to ena-cluate the tumour thoroughly in order to prevent their recurrence and malignant transformation.
Fig. 3. A radiological image presenting an
osteoscle-rotical lesion in area of 14–13 teeth
Ryc. 3. Zdjęcie pantomograficzne przedstawiające
zmianę osteosklerotyczną w obrębie zębów 14 i 13
Fig. 4. A radiological image of odontoma in the area
of 14–13 teeth. It is possibile to see another position of teeth 14 and 13
Ryc. 4. Zdjęcie zębowe zębiaka w obrębie zębów 14–13.
Widoczne przemieszczenie zębów 14 oraz 13
Fig. 5. The elements of a composite odontoma Ryc. 5. elementy zębiaka złożonego
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Address for correspondence:
Piotr Stępień Wańkowicza 7/90 02-796 Warszawa Poland tel. +48 607 041 636 e-mail: stepnius@wp.pl Received: 14.12.2009 Revised: 4.01.2010 Accepted: 11.02.2010
Praca wpłynęła do Redakcji: 14.12.2009 r. Po recenzji: 4.01.2010 r.
