Imaging diagnosis of compound - complex odontoma and impacted dental elements: a case report

O odontoma é o mais comum tumor odontogênico, definido como malformação benigna, geralmente descoberto na segunda década de vida, durante a investigação de erupção tardia de dentes adjacentes ou retenção prolongada de dentes decíduos. O odontoma é subdividido em composto e complexo. O Odontoma classificado como Composto é constituído por um conjunto de estruturas similares a dentes, de formas e tamanhos diversos, cercados por uma área delgada radiolúcida. Já o Odontoma Complexo se assemelha a uma massa calcificada que apresenta a mesma radiopacidade do tecido dentário, também cercado por uma área delgada radiolúcida. Ocasionalmente, esses dois aspectos podem ser vistos em uma mesma lesão. Frequentemente os odontomas podem provocar um aumento de volume ósseo local devido ao seu desenvolvimento. O diagnóstico é feito através de exames radiográficos de rotina e quando necessário pode-se também lançar mão de Radiografias Panorâmicas e Tomografia Computadorizada Cone Beam com o intuito de verificar sua extensão, as malformações e alterações de erupção causadas aos dentes adjacentes, assim como a classificação do tumor. Este relato de caso apresenta um Odontoma Composto-Complexo em um paciente de 13 anos, do sexo masculino, atendido em 2016 na Clínica de Diagnóstico Bucal II da Universidade Federal Fluminense, que apresentou elementos dentários 22 e 23 impactados, retenção prolongada do elemento 63 e aumento de volume na região anterior do lado esquerdo da maxila. Para obtenção do diagnóstico foram realizadas: Radiografias Periapicais, Radiografia Panorâmica e Tomografia Computadorizada Cone Beam. O objetivo deste trabalho foi elucidar as formas de diagnóstico por imagem que foram utilizadas neste caso clínico e quais as vantagens de cada exame.

Odontomas are the most common type of odontogenic tumors, defined as a benign malformation, usually diagnosed in the second decade of life, during the investigation of late adjacent teeth eruption or a delay in exfoliation of deciduous teeth. They are divided into two types: compound and complex. The odontoma classified as compound is composed of multiple small tooth-like structures, in several shapes and sizes, surrounded by a thin radiolucent rim. On the other hand, complex odontomas resemble a mass of calcified tissue that presents the same dental tissue radiopacity, also surrounded by a thin radiolucent rim. Occasionally, both aspects can be seen in the same lesion. Often, odontomas can cause a local increase in bone volume due to their development. The diagnosis is made through routine radiographic examination and, when it is necessary, it is possible to make use of panoramic radiographies and cone beam computed tomography with the purpose of verifying its extension, malformations and erupted alterations caused to the adjacent teeth, as well as the tumor classification. This case report presents a Compound-Complex Odontoma in a 13-year-old male patient, treated in 2016 at the Oral Diagnosis Clinic II of the Federal Fluminense University. He presented impacted teeth 22 and 23, delayed eruption of tooth 63 and volume increase in the left anterior maxilla site. Aiming the patient's diagnosis, the following exams were necessary: periapical radiographies, panoramic radiography, cone beam computed tomography. The aim of this paper is to explain the different image diagnostic tools which were used in this clinical study and what are the advantages of each exam.

Odontoma Recurrence. The Importance of Radiographic Controls: Case Report with a 7-Year Follow-Up.

Odontomas are benign tumors characterized by slow and limited growth with a rare recurrence. Odontomas are generally detected by radiographic findings in the radiopaque stage, where calcification of the tissues is observed. This article seeks to report the recurrence of a radiologically diagnosed odontoma to show the importance of radiographic controls after enucleation as a diagnostic and follow-up method. Case report: A female patient, 9 years old, attended dental care in 2020 due to malpositioned teeth. In the intraoral clinical examination, she presented stage II mixed dentition with crowding. A radiographic exam showed no associated lesions. The patient reported a history of odontoma removal and a supernumerary tooth in sextant II in 2016. Subsequently, she was referred to orthodontics, where permanent dentition with moderate anterior crowding in the maxilla and mandible was observed. The radiographic examination showed a radiopaque area compatible with odontoma, palatal to teeth 12 and 13. Conclusions: Although recurrence is rare, complete removal in the case of an odontoma is critical. This study demonstrates the importance of performing radiographic controls 5 years after enucleation of an odontoma, considering the stages of evolution.

Immunohistochemical expression of beta-catenin, BMP4 and TGF-beta in odontomas.

Changes in the expression of nuclear ß-catenin are responsible for tumorigenesis. Beta-catenin acts synergistically with the TGF-ß/BMPs pathway. This interaction leads to greater dentin deposition and may explain the differences between distinct tooth morphologies and hamartomas. The aim of this study was to investigate the role of ß-catenin, BMP4 and TGF-ß in the development of odontomas. This cross-sectional, retrospective, immunohistochemical study evaluated 30 compound odontomas, 30 complex odontomas and 17 tooth germs. The results showed that BMP4 and TGF-ß were more immunoexpressed in the ectomesenchyme of complex odontomas (median = 33.7, p < 0.001; median = 76.4, p = 0.002, respectively). Higher immunoexpression of BMP4 and TGF-ß was also observed in the epithelium of tooth germs (median = 2.0, p < 0.001; median = 120.3, p < 0.001, respectively). TGF-ß and BMP4 showed a positive and significant correlation (p < 0.001). Both TGF-ß and BMP4 were positively correlated with nuclear ß-catenin in ectomesenchyme (p = 0.047 and p = 0.023, respectively). Developing teeth exhibited higher concentrations of the proteins studied in odontogenic epithelium, especially during the bud and cap stages. Higher immunoexpression in odontomas occurred mainly in the ectomesenchyme. We therefore suggest that changes in the ectomesenchyme can lead to the development of odontomas.

Higher immunoexpression of CK14 from the Wnt-1/ß-catenin pathway in the development of odontomas.

Tooth development depends on a series of reciprocal signaling interactions between the oral epithelium and ectomesenchyme. This study aimed to investigate the role of CK14, a protein involved in Wnt-1/ß-catenin signaling, in odontogenesis and the development of odontomas. This cross-sectional, retrospective, immunohistochemical study analyzed 30 compound odontomas, 30 complex odontomas, and 17 tooth germs. Higher immunoexpression of CK14 was observed in odontogenic epithelial cells of tooth germs (p < 0.001) and odontogenic epithelial cells of odontomas (p < 0.001). There was higher immunoexpression of Wnt-1 and ß-catenin proteins in epithelial cells of tooth germs (p = 0.002 and p < 0.001, respectively), as well as in the ectomesenchyme of odontomas (p = 0.003 and p < 0.001, respectively). ß-Catenin was moderately and significantly correlated with CK14 in the membrane of reduced enamel epithelial cells in odontomas (p = 0.007). Higher immunoexpression of CK14 was observed in the odontogenic epithelium during the bud and cap stages and lower immunoexpression in the internal enamel epithelium during the bell stage. In odontomas, lower expression of Wnt-1/ß-catenin and higher immunoexpression of CK14 were found in odontogenic epithelial cells, especially adjacent to the mineralized material resembling the tooth formed in these lesions.

Odontogenic tumours in a Chilean population: a retrospective study of 544 cases based on 2022 WHO classification.

BACKGROUND: Odontogenic tumours are infrequent lesions. Studies on the frequency of odontogenic tumours from Latin America are scarce. This work aimed to determine the relative frequency of odontogenic tumours in a Chilean population using the 2022 World Health Organization classification. MATERIAL AND METHODS: This is a case series retrospective study. We reviewed 35,530 samples from 1975 to 2022 from the Oral Pathology Referral Institute and the Pathological Anatomy Service, Faculty of Dentistry, University of Chile. We utilized the 2022 World Health Organization classification for histological typification. RESULTS: According to 2022 World Health Organization classification, 544 odontogenic tumours were confirmed. The most frequent odontogenic tumours were: odontoma (n=241; 44.3%), ameloblastoma (n=109; 20.0%) and cemento-ossifying fibroma (n=71; 13.1%). Benign odontogenic tumours corresponded to 538 cases (98.9%) and malignant tumours were only six cases (1.1%). CONCLUSIONS: In our population, odontoma was the most frequent odontogenic tumour followed by ameloblastoma and cemento-ossifying fibroma. Malignant odontogenic tumours were very rare. The results of this study are similar to reports from America, but there are some differences concerning the data from Africa and Asia.

Tratamento de odontoma composto e cisto dentígero: relato de caso / Treatment of compound odontoma and dentigeral cyst: case report

Introdução: o odontoma é considerado como um frequente tumor odontogênico benigno, podendo ser classificado em tipo composto ou tipo complexo. O cisto dentígero é o mais comum entre os cistos odontogênicos de desenvolvimento, onde envolve a coroa da unidade dentária no nível da junção amelocementária. Há poucos estudos na literatura do encontro das duas lesões, acometendo o mesmo local na cavidade oral. O diagnóstico pode ser constituído por exame clínico e de imagem. Objetivo: apresentar um caso clínico de odontoma composto e cisto dentígero em região de parassínfise mandibular esquerda abordando as caraterísticas clínicas destas duas lesões e as adequadas formas de tratamento. Relato de caso: paciente do sexo masculino, 16 anos de idade, compareceu ao ambulatório do Centro Odontológico da Escola Bahiana de Medicina e Saúde Pública (Salvador, Bahia), portando encaminhamento de ortodontista, solicitando exodontia da unidade dentária 33 inclusa associada a um odontoma. Ao realizar exames físicos e imaginológicos detectou-se a hipótese diagnóstica de odontoma composto associado a unidade dentária, envolto em folículo pericoronário ou cisto dentígero. Foi realizada biópsia excisional das duas lesões e exodontia da unidade. A análise histopatológica confirmou o diagnóstico para odontoma composto associado a cisto dentígero na unidade 33. Ao acompanhamento de 03 meses, paciente apresentou neoformação óssea da região de parassínfise mandibular, mediante a análise de novos exames imaginológicos. Discussão: há poucos estudos na literatura da associação entre as duas lesões, porém relatos afirmam que o odontoma pode ser encontrado associado aos cistos odontogênicos. Por conta da falta de maiores estudos dessa associação, há escassez de recomendações terapêuticas de acordo com faixa etária e extensão do acometimento das lesões. Considerações finais: lesões comumente assintomáticas, tem o diagnóstico constituído por exame clínico e avaliação de exames de imagem(AU)

Introduction: odontoma is considered a frequent benign odontogenic tumor and can be classified as a compound or complex type. The dentigerous cyst is the most common among developmental odontogenic cysts, where it involves the crown of the dental unit at the level of the cementoenamel junction. There are few studies in the literature on the meeting of the two lesions, affecting the same site in the oral cavity. The diagnosis can be made by clinical and imaging examination. Objective: to present a clinical case of compound odontoma and dentigerous cyst in the left mandibular parasymphysis region, addressing the clinical characteristics of these two lesions and the appropriate forms of treatment. Case report: male patient, 16 years old, attended the outpatient clinic of the Centro Odontológico da Escola Bahiana de Medicina e Saúde Pública (Salvador, Bahia), having been referred by an orthodontist, requesting extraction of the included dental unit 33 associated with an odontoma. Upon physical and imaging examinations, the diagnostic hypothesis of a compound odontoma associated with a dental unit, surrounded by a pericoronal follicle or dentigerous cyst, was detected. Excisional biopsy of the two lesions and extraction of the unit were performed. The histopathological analysis confirmed the diagnosis of compound odontoma associated with dentigerous cyst in unit 33. At the 03-month follow-up, the patient presented bone neoformation in the mandibular parasymphysis region, through the analysis of new imaging exams. Discussion: there are few studies in the literature on the association between the two lesions, but reports state that odontoma can be found associated with odontogenic cysts. Due to the lack of further studies on this association, there is a lack of therapeutic recommendations according to age group and extent of lesion involvement. Final considerations: commonly asymptomatic lesions, the diagnosis consists of clinical examination and evaluation of imaging tests(AU)

Connexin 43 expression in tooth germ and benign odontogenic tumors.

OBJECTIVE: The aim of this study was to investigate and compare the immunohistochemical expression of connexin 43 (Cx43) in tooth germs (TGs), ameloblastic fibromas (AFs), ameloblastic fibro-odontomas (AFOs), and conventional ameloblastomas (AMs). STUDY DESIGN: Nine TGs, 12 AFs, 12 AFOs, and 27 AMs were evaluated for Cx43 expression by immunohistochemistry. RESULTS: Most of the TGs expressed Cx43 in the mesenchyme (77.6%) and in the late stages of odontogenesis. Cx43 was more highly expressed (P < .05) in the mesenchymal layer of all groups than in the epithelial layer except for the AFOs. When comparing the expression of Cx43 in the different layers of the analyzed groups, statistically significant differences were observed between AFO vs AM (*P = .0158) in the epithelial layer and between AF vs AFO (P** = .0046) in the mesenchymal layer. CONCLUSIONS: The results obtained in this study showed that Cx43 is a protein with important expression in the mesenchymal layer of the embryonic and odontogenic tissues studied. It could be speculated that Cx43 participates in mineralization events based on the relationship of the expression of this protein between the epithelial and mesenchymal layers of odontogenic tissues.

The molecular basis of odontogenic cysts and tumours.

The advances in molecular technologies have allowed a better understanding of the molecular basis of odontogenic cysts and tumours. PTCH1 mutations have been reported in a high proportion of odontogenic keratocyst. BRAF p.V600E are recurrent in ameloblastoma and KRAS p.G12V/R in adenomatoid odontogenic tumour, dysregulating the MAPK/ERK pathway. Notably, BRAF p.V600E is also detected in ameloblastic carcinoma, but at a lower frequency than in its benign counterpart ameloblastoma. Recently, adenoid ameloblastoma has been shown to be BRAF wild-type and to harbour CTNNB1 (ß-catenin gene) mutations, further suggesting that it is not an ameloblastoma subtype. CTNNB1 mutations also occur in other ghost-cell-containing tumours, including calcifying odontogenic cysts, dentinogenic ghost cell tumours and odontogenic carcinoma with dentinoid, but the link between CTNNB1 mutations and ghost cell formation in these lesions remains unclear. Regarding mixed tumours, BRAF p.V600E has been reported in a subset of ameloblastic fibromas, ameloblastic-fibrodentinomas and fibro-odontomas, in addition to ameloblastic fibrosarcoma. Such mutation-positivity in a subset of samples can be helpful in differentiating some of these lesions from odontoma, which is BRAF-wild-type. Recently, FOS rearrangements have been reported in cementoblastoma, supporting its relationship with osteoblastoma. Collectively, the identification of recurrent mutations in these aforementioned lesions has helped to clarify their molecular basis and to better understand the interrelationships between some tumours, but none of these genetic abnormalities is diagnostic. Since the functional effect of pathogenic mutations is context and tissue-dependent, a clear role for the reported mutations in odontogenic cysts and tumours in their pathogenesis remains to be elucidated.

Synchronous odontogenic tumors: A systematic review.

This systematic review aimed to incorporate published information about synchronous odontogenic tumors (SOTs) with an analysis of the demographic and clinical characteristics from the cases published in the literature. Case reports and case series of SOT were searched in PubMed, Web of Science, Scopus, and EMBASE. A descriptive statistical analysis was performed. Twenty-eight studies comprising 30 cases of SOTs were included. Considering all cases published, SOTs mostly occurred simultaneously in the maxilla and mandible (n = 19/63.3%). Lesions were bifocal in 13 (43.3% of all the 30 cases) and multifocal in 17 cases (56.7% of all the 30 cases). All SOTs available in the literature presented the same type of lesion, and two of them also involved another different SOT (n = 2/6.7% of all the 30 cases). Out of all published cases, the most frequent SOTs in the literature were odontomas (n = 10/33.3% of all the 30 cases), squamous odontogenic tumors (OTs) (n = 8/26.7% of all the 30 cases), calcifying epithelial OTs (n = 8/26.7% of all the 30 cases), and adenomatoid OTs (n = 2/6.7% of all the 30 cases). Considering all SOTs cases included, the overall recurrence was 13.3%. Inside a subgroup of the lesion, synchronous calcifying epithelial OT presented the highest (25%). Five cases (16.7% of all the 30 cases) had a previously associated syndrome, with two cases of Schimmelpenning syndrome being reported. Among published SOTs, odontomas were the most common. All SOTs available in the scientific literature showed the same type of OT and mainly affected both jaws simultaneously. Only a few of these cases were associated with a syndrome.

Spatial distribution of CD34 protein in primordial odontogenic tumour, ameloblastic fibroma and the tooth germ.

BACKGROUND: Primordial odontogenic tumour is a benign mixed neoplasm of recent description, which has histological similarities with other odontogenic tumours such as the ameloblastic fibroma. In this article, we investigate the architecture of the sub-epithelial layer of mesenchymal cells expressing the marker CD34 in primordial odontogenic tumour. OBJECTIVE: Analyse the spatial patterns of CD34 expression in primordial odontogenic tumour and compare them with those in ameloblastic fibroma and the normal tooth germ by means of objective imaging approaches, to better characterise these lesions. METHODS: Two cases of primordial odontogenic tumour, four cases of ameloblastic fibroma and two cases of tooth germ in cap and bell stages were used for morphological, structural and immunohistochemical analyses. RESULTS: CD34 expression was found in vascular endothelium of primordial odontogenic tumour, ameloblastic fibroma and tooth germ. In addition, a characteristic sub-epithelial expression was observed only in primordial odontogenic tumour, corresponding to 84%-86% of the sample boundaries. Moreover, the zone expressing CD34 corresponded with a higher cellularity, which was absent in ameloblastic fibroma and tooth germ. CONCLUSION: Image analysis of the primordial odontogenic tumour architecture revealed characteristics absent in other odontogenic tumours and tooth germs. This study provides additional information to support the idea that this neoplasm is a distinct entity from early stage AF or developing odontoma.

Tracionamento ortodôntico de incisivo central superior impactado associado a odontoma ­ relato de caso / Orthodontic traction of impacted upper central incisor associated with odontoma ­ case report

Resumo A impacção dental, distúrbio irruptivo caraterizado pelo impedimento de erupção espontânea do dente, apresenta baixíssima prevalência para incisivos centrais superiores. Os fatores etiológicos mais comumente envolvidos são a presença de dentes supranumerários, tumores odontogênicos e trauma na dentição decídua. A impacção do incisivo central superior provoca grande comprometimento estético e psicossocial. O sucesso da intervenção ortodôntica depende de diagnóstico precoce, localização do dente e relação deste com dentes adjacentes. Sendo assim, o cuidadoso diagnóstico, planejamento individualizado e criterioso acompanhamento radiográfico são imprescindíveis. O objetivo deste estudo foi relatar o caso clínico de um paciente em fase de dentadura mista com incisivo central impactado pela presença de um odontoma. Foi realizado o tracionamento ortodôntico pela técnica de erupção fechada com ancoragem em dentes posteriores. Foi mantida a integridade radicular do dente tracionado, bem como a dos dentes adjacentes. Além disso, foi obtida adequada margem gengival. Concluiu-se que o tracionamento de incisivos centrais superiores impactados, quando executado de maneira criteriosa, promove estética e função satisfatórias com consequente melhora na autoestima e interação psicossocial do paciente. (AU)

Abstract Dental impaction, an irruptive disorder characterized by the impediment of spontaneous tooth eruption, presents a very low prevalence for maxillary central incisors. The etiological factors are the presence of supernumerary teeth, odontogenic tumor, and primary dentition injuries. The impaction of the upper central incisor causes great aesthetic and psychosocial impairment. The orthodontic intervention success depends on early diagnosis, tooth location, and relationship with adjacent teeth. Therefore, careful diagnosis, individualized treatment planning, and careful radiographic follow-up are essential. This study aimed to report the clinical case of a patient with a central incisor impacted by the presence of an odontoma. Orthodontic traction was performed by the closed eruption technique with anchorage in posterior teeth. Tooth root integrity was maintained, as well as that of adjacent teeth. In addition, adequate gingival margin was obtained. It was concluded that an accurate traction of impacted upper central incisors promotes satisfactory aesthetics and function, with consequent improvement in the patients self-esteem and psychosocial interaction.(AU)

Tratamento de uma má oclusão de Classe II com propulsor mandibular Forsus associado à tração de canino inferior impactado devido ao odontoma ­ relato de caso / Treatment of a Class II malocclusion with Forsus appliance associated with traction of an impacted mandibular canine due to odontoma ­ a case report

Resumo O objetivo deste caso clínico foi relatar o tratamento de uma paciente portadora de má oclusão de Classe II com aparelho de propulsão mandibular fixo Forsus associado à tração de canino inferior retido devido a um odontoma. Após exame clínico e radiográfico, foi detectada a retenção prolongada do canino inferior decíduo direito devido à presença desse odontoma. O exame clínico também mostrou que a paciente apresentava uma má oclusão de Classe II. Após a extração do dente decíduo e excisão do odontoma, foi colado um acessório no canino retido e instalado o aparelho fixo. Inicialmente, foi planejada a instalação de um APM devido ao seu baixo custo, no entanto, a paciente não se adaptou e foi instalado um Forsus. Ao final de 48 meses, o canino inferior direito alcançou o plano oclusal e a má oclusão de Classe II foi corrigida. Após 2 anos da finalização do tratamento, os resultados obtidos se mostraram estáveis. O objetivo foi avaliar os efeitos dentários e tecidos moles no tratamento da má oclusão de Classe II leve a moderada de uma paciente no final de crescimento puberal, analisando o antes e depois da face no desenvolvimento dentofacial e os efeitos do aparelho de protração. Concluiu-se que o propulsor mandibular associado ao aparelho fixo corrigiu a má oclusão de Classe II basicamente através da protrusão dentoalveolar do arco inferior. (AU)

Abstract The objective of this case report is to present the treatment of a patient with Class II malocclusion with a Forsus fixed appliance associated with the traction of an impacted mandibular canine due to an odontoma. After clinical and radiographic examination, prolonged right primary mandibular canine retention was detected. In addition, the mandibular canine was impacted due to the presence of this odontoma. Clinical analysis also showed that the patient had a Class II malocclusion. After the extraction of the primary canine and excision of the odontoma, an orthodontic accessory was bonded to the impacted canine, and the fixed appliance was placed. Initially, an APM (mandibular protractor appliance) was planned due to its low cost. However, the patient did not cooperate with its use, and a Forsus was placed. At the end of 48 months, the right mandibular canine reached the occlusal plane, and the Class II malocclusion was corrected. (AU)

Odontoma composto extenso em paciente pediátrico: relato de caso / Extended compound odontoma in a pediatric patient: case report / Odontoma compuesta ampliada en paciente pediátrico: reporte de caso

Introdução: Odontomas são tumores odontogênicos, considerados hamartomas de desenvolvimento que frequentemente interferem na erupção dentária. O presente estudo tem como objetivo relatar o caso clínico de odontoma composto em região posterior da mandíbula, desde o achado radiográfico até o momento cirúrgico e confirmação diagnóstica com exame histopatológico. Relato do caso: trata-se de paciente do sexo feminino, 7 anos, branca, encaminhada da Unidade de Saúde da Família (USF) ao ambulatório do Serviço de Cirurgia e Traumatologia Buco-Maxilo-Facial do Hospital Universitário Oswaldo Cruz (UHOC), devido a um achado radiográfico radiopaco, de limites bem definidos, com halo radiolúcido circundante, no corpo da mandíbula do lado esquerdo, entre as raízes dos dentes 74 e 75. O tratamento proposto foi a excisão cirúrgica conservadora sob anestesia geral. Após a retirada da lesão, foram identificadas calcificações múltiplas diferentes tamanhos e formas, de assemelhando-se a dentículos, encaminhadas para exame histopatológico e confirmando o diagnóstico de odontoma composto. Após 7 dias, observou-se um processo de cicatrização satisfatório. Ela será acompanhada para analisar a progressão do reparo e movimentação da bolsa óssea na dentição permanente na região. Considerações finais: Portanto, recomenda-se o tratamento cirúrgico conservador, através da remoção completa da lesão e preservação máxima dos dentes retidos. Para isso, a identificação na fase inicial e o tratamento adequado são essenciais... (AU)

Introduction: Odontomas are odontogenic tumors, considered developmental hamartomas that often interfere with tooth eruption. The present study aims to report the clinical case of compound odontoma in the posterior region of the jaw, from the radiographic finding to the surgical moment and diagnostic confirmation with histopathological examination. Case report: this is a female patient, 7 years old, white, referred from the Family Health Unit (FHU) to the outpatient clinic of the Oral and Maxillofacial Surgery and Traumatology Service of the Oswaldo Cruz University Hospital (OCUH), due to a radiopaque radiographic finding, with well-defined limits and a surrounding radiolucent halo, in the body of the jaw on the left side, between the roots of teeth 74 and 75. The proposed treatment was conservative surgical excision under general anesthesia. After removal of the lesion, multiple calcifications of different sizes and shapes were identified, resembling denticles, referred for histopathological examination and confirming the diagnosis of compound odontoma. After 7 days, a satisfactory healing process was observed. She will be followed up to analyze the progression of bone pocket repair and movement in permanent dentition in the region. Final considerations: Therefore, conservative surgical treatment is recommended, through the complete removal of the lesion and maximum preservation of retained teeth. For this identification at an early stage and proper treatment are essential... (AU)

Odontoma mandibular inusual y su resolución: reporte de un caso / Unusual mandibular odontoma and its resolution: report of a case

Objetivo: El odontoma es una lesión hamartomatosa benigna formada por tejido dentario (cemento, esmalte, pul­ pa). Según su grado de diferenciación podrá ser clasificado en sus dos variantes: compuesto y complejo en una relación 2:1. El objetivo de este artículo es presentar un odontoma mixto de gran tamaño de localización mandibular y su resolución quirúrgica. Caso clínico: Se describe el caso de un paciente mascu­ lino de 16 años de edad, portador de ortodoncia, que presenta un odontoma mixto de gran tamaño de localización mandibular y su resolución quirúrgica utilizando planificación 3D y confección de placa de titanio customizada (AU)

Aim: Odontoma is a benign hamartomatous lesion formed by dental tissue (cementum, enamel, pulp). According to its degree of differentiation, it can be classified in its two variants: compound and complex in a 2:1 ratio. The objective of this article is to present a large mixed odontoma of mandi­ bular location and its surgical resolution. Clinical case: A 16-year-old male patient with ortho­ dontics, who presents a large mixed odontoma with mandibu­ lar location and its surgical resolution using 3D planning and customized titanium plate fabrication (AU)

Ocorrência simultânea de cisto dentígero e odontoma composto-complexo causando impacção dentária / Simultaneous occurrence of dentigerous cyst and compound-complex odontoma causing dental impaction

O presente trabalho ilustra e discute essa doença que representa o tumor odontogênico mais comum da prática clínica, o Odontoma. Para tal, apresenta um caso clínico com imagens clínicas e radiográficas esclarecedoras dos aspectos dessa doença, bem como discussão a partir de revisão narrativa de literatura direcionada para a carac-terização da doença. Relata-se o caso de um odontoma composto-complexo, uma forma incomum de odontoma, mas que mantém os demais aspectos usuais, sendo uma mulher de 21 anos com lesão radiopaca em maxila de-tectada devido à não erupção do 23. A remoção cirúrgica seguiu a partir de acesso anterior na maxila e o exame histopatológico mostrou os aspectos típicos de um Odontoma composto e complexo juntos. Independentemente da variante, nota-se que o Odontoma é quase sempre indolente, porém requer cuidados de remoção precoce devido à possibilidade de crescimento, de desenvolvimento de cistos e comprometimento de estruturas adjacentes devido a sua localização e possibilidade de crescimento (AU)

The present work illustrates and discusses this disease that represents the most common odontogenic tumor in clinical practice, the Odontoma. However, an unusual variation of the same is included here in the literature, char-acterized by the exams as a form of compound-complex odontoma additionally causing dentigerous cyst formation and dental impaction. The unusual case occurred in a 21-year-old woman, complaining of missing the tooth 23. The details of the exams allowed the visualization of compound and complex areas in the lesion, cystic formation and dental impaction. The histopathological findings confirmed the diagnosis of the Odontoma, and the interpreta-tion with the set of other exams led to the final diagnosis of Compound-complex odontoma with dentigerous cyst. The present case highlights the need for early removal of Odontoma due to the possibility of developing cysts, compromising adjacent structures, in addition to its growth potential already reported in the literature (AU)

Diagnóstico por imágenes de un odontoma complejo. Presentación de un caso / Diagnostic imaging of a complex odontoma. A case report

RESUMEN Los odontomas son los tumores más frecuentes del área bucal y maxilofacial. Presentamos un caso clínico de una paciente femenina de 50 años, con cuadros de sinusitis a repetición y dolor en región maxilar derecha. Se le realiza tomografía axial computarizada simple de macizo facial, donde se observó una imagen amorfa de densidad variable a nivel del hueso maxilar derecho, que involucraba la porción inferior del seno, compatible con tumor odontogénico, probablemente benigno, sugestiva de un odontoma complejo.

ABSTRACT Odontomas are the most common tumours located in the oral and maxillofacial region. We present a 50-year-old female patient with recurrent sinusitis and pain in the right maxillary region. A simple computed axial tomography of the facial mass was performed, where an amorphous image of variable density was observed at the level of the right maxillary bone, involving the lower portion of the sinus, compatible with an odontogenic tumour, probably benign and suggestive of a complex odontoma.

O papel de proteínas das vias WNT/ß-Catenina, TGF-ß/BMP4 e SHH na odontogênese e odontomas / The role of proteins from the WNT/ß-Catenin, TGF-ß/BMP4 and SHH pathways in odontogenesis and odontomas

O desenvolvimento do dente depende de uma série de interações sinalizadoras recíprocas entre o epitélio oral (EO) e o ectomesênquima derivado da crista neural, a via WNT com o TGF-ß e BMP4 tem sido implicada na tumorigênese. A via de sinalização tipo Wingless (Wnt) / ß-catenina é essencial para a ativação precoce da odontogênese e no desenvolvimento de tumores odontogênicos. O TGF-ß e as BMPs tem sido associadas aos processos de dentinogênese reacionária e reparadora. A sinalização de Shh pode regular a proliferação celular no ectomesênquima dentário, controlando assim a morfogênese dentária. O objetivo da pesquisa foi investigar a atuação de algumas proteínas das vias na odontogênese e na formação de odontomas e tumores odontogênicos mistos benignos, para isto, foi desenvolvido um estudo seccional restrospectivo e imuno-histoquímico contendo 23 odontomas compostos, 21 odontomas complexos, 17 germes dentários, 05 fibro-odontomas ameloblásticos e 01 fibroma ameloblástico. Os resultados encontrados demonstraram maiores imunoexpressões da via WNT/ß-catenina no epitélio dos germes dentários (p<0,001) e no fibroma ameloblástico, enquanto que, esteve no ectomesênquima dos odontomas (p<0,001) e fibro-odontomas ameloblásticos. A via WNT/ßcatenina correlacionou-se moderadamente e significativamente com a CK14 no epitélio (p = 0,007) dos odontomas. A BMP4 foi imunoexpressa, especialmente, no ectomesênquima dos odontomas complexos (mediana = 33,7; p<0,001). A via Shh foi mais imunoexpressa no epitélio dos germes dentários (p<0,001) e no ectomesênquima dos odontomas complexos (p=0,029). De forma similar, o TGFß apresentou maior imunoexpressão no epitélio dos germes dentários (p<0,001) e no ectomesênquima dos odontomas complexos (p = 0,002). O dente em desenvolvimento exibiu maiores concentrações para estas proteínas no epitélio odontogênico nas fases de botão e capuz e a expressão diferencial ocorreu, principalmente, no ectomesênquima dos tumores, o que indica que esse componente é de fato mais proliferativo (AU).

Tooth development depends on a series of reciprocal signaling interactions between oral epithelium (EO) and neural crest-derived ectomesenchyme, the WNT pathway with TGF-ß and BMP4 has been implicated in tumorigenesis. The Wingless (Wnt)/ß-catenin signaling pathway is essential for the early activation of odontogenesis and the development of odontogenic tumors. TGF-ß and BMPs have been associated with reactionary and reparative dentinogenesis processes. Shh signaling can regulate cell proliferation in dental ectomesenchyme, thus controlling dental morphogenesis. The objective of the research was to investigate the role of some proteins in the pathways in odontogenesis and in the formation of odontomas and benign mixed odontogenic tumors. tooth germs, 05 ameloblastic fibro-odontomas and 01 ameloblastic fibroma. The results found showed higher immunoexpressions of the WNT/ß-catenin pathway in the epithelium of tooth germs (p<0.001) and in ameloblastic fibroma, while it was in the ectomesenchyme of odontomas (p<0.001) and ameloblastic fibroodontomas. The WNT/ß-catenin pathway correlated moderately and significantly with CK14 in the epithelium (p = 0.007) of odontomas. BMP4 was immunoexpressed, especially in the ectomesenchyme of complex odontomas (median = 33.7; p<0.001). The Shh pathway was more immunoexpressed in the epithelium of tooth germs (p<0.001) and in the ectomesenchyme of complex odontomas (p=0.029). Similarly, TGF-ß showed higher immunoexpression in the epithelium of tooth germs (p<0.001) and in the ectomesenchyme of complex odontomas (p = 0.002). The developing tooth exhibited higher concentrations of these proteins in the odontogenic epithelium in the bud and cap phases and the differential expression occurred mainly in the ectomesenchyme of the tumors, which indicates that this component is in fact more proliferative (AU).

Hybrid odontogenic lesions: A systematic review of 203 cases reported in the literature.

BACKGROUND: Hybrid odontogenic lesions combine histopathological characteristics of two or more odontogenic cysts and/or tumours. The aim of this study was to evaluate the available data on hybrid odontogenic lesions (HOL) and to analyse their epidemiological/clinical features and biological behaviour. METHODS: An electronic search was done in January 2021 using multiple databases. Eligibility criteria encompassed publications with sufficient clinical and histological information to confirm the tumours' diagnoses. RESULTS: A total of 147 articles were included in this study, comprising 203 cases. Calcifying odontogenic cyst associated with odontoma (COC/OD) (37/18.2%) was the most common HOL. Females were more affected with a mean age of 24.9 years. Lesions presented as asymptomatic swellings, with a mean evolution time of 8.2 months (0.3-96), and mean tumour size of 4.8 cm (0.3-7). Radiographic aspects frequently showed radiolucent (139/68.4%) and unilocular (52/25.6%) images with well-defined limits (48/23.6%). The lesions mostly affected mandibular pre-molars (69/34%) and mandibular molars (69/34%) regions. Enucleation (89/43.8%) and surgical excision (59/29%) were the most common treatment modalities. The mean follow-up time was 33.8 months (0.5-216 months) and recurrences were observed in four cases (1.9%), all of which were central odontogenic fibroma associated with central giant cell granuloma (COF/CGCG). CONCLUSION: COC/OD is the most common HOL and recurrence is a rare event, being usually associated with the diagnosis of COF/CGCG.

Fibro - odontoma ameloblástico; reporte de caso clínico / Fibro - odontoma ameloblástico; relato de caso clínico / Ameloblastic fibro odontoma; clinical case report

El fibro - odontoma ameloblástico es un tumor odontogénico benigno con células epiteliales odontogénicas cúbicas, tejido conjuntivo fibroso embrionario y epitelio odontogénico primitivo. Se presenta con poca frecuencia y afecta principalmente a niños y adultos jóvenes entre la primera y segunda década de vida. Este trabajo es un reporte del caso clínico de un paciente de sexo masculino de 12 años de edad atendido en el Hospital de Odontología Infantil "Don Benito Quinquela Martín", al cual se le diagnostica un tumor odontogénico benigno asociado a un canino permanente inferior derecho impactado. Se realiza un plan de tratamiento integral, individualizado y con fuerte componente preventivo, trabajando siempre en constante interrelación con los servicios de Odontología Preventiva, Cirugía, Radiología y Ortodoncia del hospital. En una primera etapa se tratan las infecciones prevalentes y se realiza el refuerzo del huésped. Posteriormente se realiza la intervención quirúrgica para extirpar la lesión y las estructuras dentarias asociadas a esta. La evolución del paciente fue favorable permitiendo continuar su tratamiento en el servicio de Ortodoncia. Objetivo: Describir la situación clínica de un paciente masculino de 12 años de edad, con diagnóstico de fibro - odontoma ameloblástico con un enfoque interdisciplinario y dentro de un plan de tratamiento integral. Conclusión: El tratamiento realizado con un enfoque interdisciplinario y dentro de un plan integral, permitió lograr un resultado favorable en el abordaje del fibro - odontoma ameloblástico

O fibro - odontoma ameloblástico é um tumor odontogênico benigno com células epiteliais odontogênicas cuboides, tecido conjuntivo fibroso embrionário e epitélio odontogênico primitivo. Se apresenta com pouca frequência e afeta principalmente crianças e adultos jovens entre a primeira e segunda década de vida. Este trabalho é um relato de caso clínico de um paciente de sexo masculino de 12 anos de idade atendido no Hospital de Odontologia Infantil "Don Benito Quinquela Martín"; diagnosticado com um tumor odontogênico benigno associado a um canino permanente inferior direito impactado. É realizado um plano de tratamento integral, individualizado e com forte componente preventivo, trabalhando sempre em constante inter-relação entre os Serviços de Odontologia Preventiva, Cirurgia, Radiologia e Ortodontia do hospital. Numa primeira fase, são tratadas as infecções prevalentes e é realizado o reforço do hospedeiro. Posteriormente é realizada a intervenção cirúrgica para remover a lesão e as estruturas dentárias associadas a ela. A evolução do paciente foi favorável, permitindo que ele continue o tratamento no Serviço de Ortodontia. Objetivo: Descrever a situação clínica de um paciente masculino de 12 anos de idade, com diagnóstico de fibro - odontoma ameloblástico com uma abordagem interdisciplinar e dentro de um plano de tratamento integral. Conclusão: O tratamento realizado com uma abordagem interdisciplinar e dentro de um plano integral, permitiu alcançar um resultado favorável na abordagem do fibro - odontoma ameloblástico.

Ameloblastic fibro-odontoma is an infrequent benign odontogenic tumor with cubic odontogenic epithelia cells, embryonic fibrous connective tissue, and primitive odontogenic epithelium. It mainly affects children and young adults between the first and second decade of life. This article is a clinical case report of a 12 - year - old male patient seen at Hospital of Pediatric Dentistry "Don Benito Quinquela Martín," where he was diagnosed with a benign odontogenic tumor associated with an impacted permanent lower right canine tooth. The treatment plan included a multidisciplinary collaboration among the Departments of Preventive Dentistry, Surgery, Radiology, and Orthodontics. In the first stage, prevalent infections were treated and the host was strengthened. The second stage was the surgica removal of the lesion and associated dental structures. The patient's course was favorable and continued his treatment at the Department of Orthodontics. Objective: To describe the clinical course of a 12-year-old male patient diagnosed with ameloblastic fibro-odontoma managed with an interdisciplinary approach in the setting of a comprehensive treatment plan. Conclusion: An interdisciplinary management in the setting of a comprehensive plan resulted in a favorable approach to ameloblastic fibro-odontoma.