CASE REPORT

Compound Odontome: A Case Report

Vivek Rana1​, Nikhil Srivastava2​, Noopur Kaushik3​, Vrinda Sharma4​, Prerna Panthri5​, Madan Mohan Niranjan6​

A b s t r ac t
Introduction: Odontomas generally appear as small, solitary, or multiple radio-opaque lesions found on routine radiographic examinations.
Traditionally, odontomas have been classified as benign odontogenic tumors and are subdivided into complex or compound odontomas
morphologically. Frequently, they interfere with the eruption of the teeth.
Case report: This paper describes the case of a compound odontoma in a 10-year-old boy diagnosed after extraction of the retained right
primary mandibular first molar in the radiograph. A surgical excision was performed and the histopathological examination revealed a
compound odontome.
Conclusion: Early diagnosis of odontomas and complete removal ensures better prognosis.
Keywords: Calcified, Compound, Extraction, Mandible, Odontomes.
International Journal of Clinical Pediatric Dentistry (2019): 10.5005/jp-journals-10005-1575

Introduction 1–6
​Department of Pediatric and Preventive Dentistry, Subharti Dental
The term “odontoma” was first coined by Paul Broca in 1866, who
College and Hospital, Swami Vivekanand Subharti University, Meerut,
defined the term as tumor formed by the overgrowth of complete
Uttar Pradesh, India
dental tissue. Odontomas are developmental anomalies resulting from
Corresponding Author: Vivek Rana, Department of Pediatric and
the growth of completely differentiated epithelial and mesenchymal
Preventive Dentistry, Subharti Dental College and Hospital, Swami
cells that give rise to functional ameloblast and odontoblast.1​
Vivekanand Subharti University, Meerut, Uttar Pradesh, India, Phone:
Odontomas are nonaggressive hamartomatous developmental +91 9412015029, +91 9760122705, e-mail: drvivekrana11@rediffmail.com
malformation or lesions or odontogenic origin which consist of enamel,
How to cite this article: Rana V, Srivastava N, et al.​ Compound
dentin, cementum, and pulpal tissue.2​During odontoma development, Odontome: A Case Report. Int J Clin Pediatr Dent 2019;12(1):64–67.
enamel and dentin can be deposited in such a way that the resulting
Source of support:​Nil
structures show anatomically similar to normal teeth structures.3​
Conflict of interest​:​ None
In 1914, odontomes were classified according to their
developmental origin as epithelial, composite (epithelial and
mesodermal), and connective tissues. According to the WHO
combined, 67% occurred in maxilla and 33% in mandible.11​
classification, odontomes can be divided into three groups such as
The compound odontoma had a predilection for the anterior region,
complex, compound, and ameloblastic fibro-odontomes.4​
whereas complex odontoma had a predilection for the posterior
Compound odontomas commonly occur in the incisor-canine
region of the jaw. Interestingly, both types of odontomas occurred
region of the maxilla and complex odontomas are frequently
more frequently on the right side of the jaw than on the left side.12​
located in the premolar and molar region of both jaws.5​
Radiographically, compound odontomas are characterized by
multiple irregular radio-opaque lesions that vary in size and shape Case Description
and contains tooth-like structures called denticles, whereas complex A 10-year boy visited the Department of Paedodontics and Preventive
odontomas manifest as a radiopaque solid mass with occasional Dentistry, Subharti Dental College, with the chief complaint of the
nodular elements and surrounded by a fine radiotransparent zone. retained tooth in the lower right back tooth region. His medical history
The lesions are unilocular and are separated from the normal bone was non-contributory. There was no history of trauma to his orofacial
by a well-defined corticalization line.6​ region. There was no family history of unerupted teeth or hypodontia.
Odontomas generally appear as small, solitary, or multiple On palpation, there was no swelling or tenderness present. He was
radioopaque lesions found on routine radiographic examination. examined clinically and had all teeth erupted. He was examined
Odontoma may cause disturbances in the eruption of teeth such clinically and had all permanent teeth erupted with retained right
as impaction, delayed eruption, or retention of primary teeth.7​ primary mandibular first molar (Fig. 1), while the contralateral tooth,
The etiology of an odontoma is not clear,8​although local trauma, i.e., the mandibular premolars already erupted and were normally
infection, hereditary anomalies, odontoblastic hyperactivity, positioned in the arch, on the contrary, the right mandibular premolar
or alterations of the genetic components are responsible for erupted buccally. There was no history of extraction of the tooth.
controlling tooth development.9​ The extraction of the retained tooth was planned. After
Odontomas may be found at any age; however, most of them are extracting the same, small calcified structures were observed
detected in first two decades of life. There is no gender predilection (Fig. 2) in the extracted socket.
and most of the lesions are detected on routine radiographs.10​ Intraoral periapical radiograph (IOPA) revealed approximately
However, Budnick found a slight predilection for the occurrence 8–10 calcified or radiopaque structures which were similar to teeth
in males (59%) compared with females (41%). Of all the odontomas and were located between canine and second premolar (Fig. 3).

© The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.
org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to
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 Compound Odontome: A Case Report

Fig. 1: Retained right mandibular primary first molar Fig. 2: Calcified structures into the extracted socket

Fig. 3: Calcified radiopaque structures Fig. 4: Elevation of the flap

These structures present with a well-defined radiopacity situated in

the bone. These are extending from just below the crest toward at the
level of apex of the adjacent teeth. After the extraction of the primary
teeth, two vertical incisions were given followed by the elevation of
the flap (Fig. 4), and all the calcified tooth-like structures were surgically
removed. Finally, the wound was closed by the 3-0 silk suture (Fig. 5).
Gross as well as radiographic examination showed many
miniature teeth-like structures (Fig. 6), and these structures were
sent for histopathological examinations.
Decalcified sections of miniature tooth-like structures stained
with hematoxylin and eosin showed the regularly arranged dental
hard tissue resembling the tubular dentin with minimal fibrocellular
connective tissue stroma (Fig. 7).
Based on clinical, radiographic, and histopathologic features,
it was suggestive of compound odontome. The postoperative
radiograph showed complete excision of odontomas and wound
healing was satisfactory without any complications (Fig. 8).
Fig. 5: Wound closure by 3-0 silk suture

Discussion
Odontomas are relatively common, asymptomatic odontogenic The mean age of detection on an average is 14.8 years, with
hamartomatous malformations. The most common clinical the prevalent age being the second decade of life.
presentation for an odontoma is the association with impacted or There is a slight predilection for the occurrence in males (59%) as
retained primary teeth.12​ compared with females (41%). The compound odontome is known

International Journal of Clinical Pediatric Dentistry, Volume 12 Issue 1 (January–February 2019) 65

 Compound Odontome: A Case Report

Fig. 6: Calcified tooth-like structures

Fig. 7: Histopathological section

to occur more commonly in the maxilla (67%) than the mandible Fig. 8: Postoperative intraoral periapical radiograph
(33%), with a marked predilection for the anterior maxillary region
(61%).8,​13,​14​ 3 Ameloblastic fibro-odontome: consists of varying amounts
In 1914, Gabell, James, and Payne grouped odontome according of calcified dental tissue and dental papilla-like tissue, the
to their developmental origin: epithelial, composite (epithelial and later component resembling an ameloblastic fibroma. The
mesodermal), and mesodermal.1​ ameloblastic fibro-odontome is considered as an immature
In 1946, Thoma and Goldman gave a classification which is as precursor of complex odontoma.
follows:15​
Compound odontomas show a high degree of morpho-
• Geminated composite odontomes: two or more, more or less differentiation, resulting in a lesion consisting of many tooth-like
well-developed teeth fused together. structures generally enclosed in a fibrous capsule.9​
• Compound composite odontomes: made up of more or less The radiographic findings of odontomas depend on their
rudimentary teeth. stage of development and degree of mineralization. The first stage
• Complex composite odontomes: calcified structure bearing no is characterized by radiolucency due to the lack of calcification.
great resemblance to the normal anatomical arrangement of Partial calcification is observed in the intermediate stage, while in
dental tissues. the third stage, the lesion usually appears as radiopaque masses
• Dilated odontomes: the crown or root part of tooth shows a surrounded by radiolucent areas corresponding to the connective
marked enlargement. tissue histologically.17​In our case, compound odontome was found
• Cystic odontomes: an odontome that is normally encapsulated in the posterior region which is rare with an incidence of 54% in
by fibrous connective tissue in a cyst or in the wall of a cyst. the region of the maxilla and 26.2% in the posterior region.18​ The
absolute incidence of odontogenic tumors of the jaws varies from
According to the World Health Organization (WHO) classification,
0.02 to 0.1%, out of which, odontomas constitute about 22%.19​
odontomes can be divided into three groups:16​
The diagnosis is usually established on the basis of routine
1 Complex odontome: when the calcified dental tissues are simply radiological examination (panoramic and/or intraoral radiographs),
arranged in an irregular mass bearing no morphologic similarity or on evaluating the cause of delayed tooth eruption. 20​ The
to rudimentary teeth. treatment of choice is surgical removal of the lesion in all cases,
2 Compound odontome: composed of all odontogenic tissues in followed by the histopathological study to confirm the diagnosis.
an orderly pattern, which result in many teeth-like structures, Odontomas are treated by conservative surgical removal and
but without morphological resemblance to normal teeth. there is little probability of recurrence.21​Timely detection and surgical

66 International Journal of Clinical Pediatric Dentistry, Volume 12 Issue 1 (January–February 2019)

 Compound Odontome: A Case Report

enucleation of odontoma followed by curettage is recommended 9. Dagstan S, Goregen M, et al. Compound odontoma associated with
to prevent complications such as tooth loss, cystic changes, bone maxillary impacted permanent central incisor tooth: a case report.
expansion, and delayed eruption of permanent teeth.22​ The Internet Journal of Dental Science 2007;5(2).
10. Nelson BL, and Thompson LDR. Compound odontoma. Head Neck
Pathol 2010 Jun;4(4):290–291. DOI: 10.1007/s12105-010-0186-2.
C o n c lu s i o n 11. Sreedharan S, and Krishnan IS. Compound odontoma associated
Odontomas rarely erupt into the mouth and tend to be associated with impacted maxillary incisors. J Indian Soc Pedod Prev Dent 2012
Jul–Sep;30(3):275–278. DOI: 10.4103/0970-4388.105025.
with impacted as well as retained teeth. A thorough visual, manual
12. Kannan KS, Prabhakar R, et al. Composite compound odontoma-
as well as radiographic examination should be performed on all A case report. J Clin Diagn Res 2013 Oct;7(10):2406–2407. DOI: 10.7860/
pediatric patients who present with clinical evidence of delayed JCDR/2013/7432.3540.
eruption or missing tooth. Also, early diagnosis of odontomas allows 13. Yassin OM. Delayed eruption of maxillary primary cuspid associated
the adoption of a less-complex and less-expensive treatment and with compound odontoma. J Clin Pediatr Dent 1999;23:147–149.
ensures better prognosis. 14. Owens BM, Sachuman NJ, et al. Dental odontomas: a retrospective
study of 104 cases. Clin Pediat Dent 1997;21:261–264.
15. Syed MR, Meghana SM, et al. Bilateral complex odontomas in
References mandible. J Oral Maxillofac Pathol 2006;10:89–91.
16. Tomizawa M, Otsuka Y, et al. Clinical observations of odontomas
1. Patil S, Rahman F, et al. Odontomas: review of literature and report in Japanese children: 39 cases including one recurrent case. Int J
of a case. J Oral Maxillofac Pathol 2012;3:224–227. Paediatr Dent 2005;15:37–43. DOI: 10.1111/j.1365-263X.2005.00607.x.
2. Santosh BS, Anuradha V, et al. Erupting complex odontoma: Coronal 17. Areal-Lopez L, Silvestre DF, et al. Compound odontoma erupting
to impacted second molar associated with dentigerous cyst. J Oral in the mouth: Four years follow-up of a clinical case. J Oral Path
Health Comm Dent 2011;5(2):100–102. 1992;21:285–288. DOI: 10.1111/j.1600-0714.1992.tb01012.x.
3. Kumar BR, Shazia Q, et al. Odontomas and related lesions. Int J Biomed 18. Vaid S, Ram R, et al. Multiple compound odontomas in mandible: A
Investig 2011 Dec;3(1):24–29. rarity. Contemp Clin Dent 2012 Jul;3(3):341–343. DOI: 10.4103/0976-
4. Saigal S, Bhargava M, et al. Granular cell ameloblastoma—A case 237X.103633.
report. Oral Maxillofac Pathol J 2011;2:976–1225. 19. Kodali RM, Venkat Suresh B, et al. An unusual complex odontoma.
5. Stajcic ZZ. Odontoma associated with a primary tooth. J Pedod J Maxillofac Oral Surg 2010;9:314–317. DOI: 10.1007/s12663-010-0085-9.
1988;12:415–420. 20. Sharma U, Sharma R, et al. Compound composite odontoma with
6. Gloria L, and Singer SR. Concomitant occurrence of cemental unusual number of denticles—A rare entity. Saudi Dent J 2010;
dysplasia and compound odontoma in anterior mandible: report of 22(3):145–149.
case. J Orofac Sci 2010;2(2):37–40. 21. Waldron AC. Odontogenic cysts and tumours. Neville BW, ed. Oral
7. Snawder KD. Delayed eruption of the anterior primary teeth and their and Maxillofacial Pathology, 2nd edn. Philadelphia, PA, USA: WB
management: report of a case. ASDC J DentChild 1974;41:382–384. Saunders, 2002; pp. 631–632.
8. Shafer WG, Hine MK, et al. Cysts and tumours of the jaws. A Textbook 22. John JB, John RR, et al. Compound Odontoma Associated with
of Oral Pathology, 4th edn. Philadelphia, PA, USA: WB Saunders, 1997; Maxillary Primary Tooth – A Case Report. J Indian Acad Dent Spec
pp. 308–311. 2010;1:49–51.Q1

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