Cirurgia de aproveitamento de dente incluso associada a odontoma: relato de caso / Surgery to use an impacted tooth associated with odontoma: case report / Cirugía para uso de diente incluido asociado a odontoma: reporte de caso

Introdução: Odontoma é o tipo mais comum de tumor odontogênico, contudo são lesões assintomáticas, de crescimento lento e indolor, descobertos geralmente em consultas de rotina, e que muito comumente são causadores de impactação dentária. Esse trabalho tem por objetivo relatar o caso clínico de uma criança que apresentava um odontoma composto na pré-maxila, ocasionando a impactação de seu incisivo central e comprometimento estético. Relato de caso: Paciente de 12 anos, em preparo para tratamento ortodôntico, no qual na etapa de exames de imagem, foi percebido um odontoma composto na região anterior da maxila o qual impedia a irrupção do dente 21, onde para que se conseguisse o melhor aproveitamento estético e funcional, foi indicado a remoção do tumor com 43 estruturas semelhantes a dentes e o tracionamento do dente associado. Conclusão: O tratamento do odontoma não costuma ter recidivas, permitindo o aproveitamento de possíveis dentes associados e manutenção de estruturas nobres adjacentes. Possibilitando também, o tracionamento do dente impactado ao arco dental, restituindo saúde e estética... (AU)

Introduction: Odontoma is the most common type of odontogenic tumor. They are asymptomatic, slow-growing lesions of unknown etiopathogenesis. They have a density similar to teeth, surrounded by a thin radiolucent halo. Objective: To report a clinical case of traction surgery of an impacted tooth associated with compound odontoma, and a brief literature review. Case report: Patient presented composite odontoma in the anterior region of the maxilla, preventing the eruption of tooth 21. The lesion was noticed during the preparation of the orthodontic treatment and for the success of such procedure, the treatment consisted of the excision of the lesion composed of 43 similar structures to teeth and the preparation of the traction of the maxillary central incisor. Conclusion: The removal of the odontoma was extremely relevant, with this, the impacted tooth was exposed, allowing the placement of the orthodontic button for its traction. Positioning the missing tooth in the dental arch, restoring health and aesthetics... (AU)

Introducción: El odontoma es el tipo más común de tumor odontogénico. Son lesiones asintomáticas, de crecimiento lento y de etiopatogenia desconocida. Tienen una densidad similar a los dientes, rodeados de un fino halo radiotransparente. Objetivo: Reportar un caso clínico de cirugía de tracción de un diente retenido asociado a odontoma compuesto, y una breve revisión de la literatura. Reporte de caso: Paciente presentó odontoma compuesto en la región anterior del maxilar, impidiendo la erupción del diente 21. La lesión fue notada durante la preparación del tratamiento de ortodoncia y para el éxito de dicho procedimiento, el tratamiento consistió en la escisión de la lesión. compuesto por 43 estructuras similares a los dientes y la preparación de la tracción del incisivo central maxilar. Conclusión: La remoción del odontoma fue de suma relevancia, con esto se logró exponer el diente impactado, permitiendo la colocación del botón de ortodoncia para su tracción. Posicionamiento del diente faltante en la arcada dentaria, restaurando la salud y la estética... (AU)

The epidemiology and management of odontomas: a European multicenter study.

INTRODUCTION: Odontoma is the most commonly diagnosed odontogenic tumor of the oral cavity. The objective of the present study was to assess the demographic variables, patterns, diagnostic features, and management issues of odontomas treated at several European departments of maxillofacial and oral surgery. MATERIALS AND METHODS: This study was conducted at 8 European departments of oral surgery between January 1, 2004, and December 31, 2018. Only patients with odontomas were included. The following data were recorded for each patient: gender, age, comorbidities, site, size of odontomas, radiographic features, type of odontoma, treatment of odontomas, treatment of associated teeth, complications, and recurrence. RESULTS: A total of 127 patients (70 male and 57 female patients) with odontomas were included. The mean age was 22 years; 71 odontomas were found in the mandible, whereas 56 in the maxilla. In the mandible, the most frequently involved subsite was the parasymphysis, while in the maxilla, the most common subsite was the upper incisor region. The mean size of included odontomas was 15.3 mm. On the whole, 62 complex odontomas, 50 compound odontomas, and 15 mixed-type odontomas were observed. Complete excision of the odontomas was performed in 121 patients. In 24 patients, the extraction of deciduous teeth was performed, and in 43 patients, one or more permanent teeth were removed. Finally, in 9 patients, a partial excision of the odontoma was performed. Recurrence was observed in 4 cases out of 127 patients. CONCLUSIONS: Dental practitioners should be aware of the distinct clinical and radiographic features of odontoma in order to perform an appropriate and early diagnosis. Conventional radiography, such as panoramic radiograph, is often sufficient technique for a diagnosis after clinical suspicion or for an incidental diagnosis to prevent later complications, such as impaction or failure of eruption of teeth.

Odontome composé: à propos d'un cas clinique

Les odontomes sont des tumeurs bénignes des maxillaires composées de dérivés de l'épithélium odontogène et de l'ectomésenchyme. Ils sont divisés en deux groupes: odontome composé et odontome complexe. L'odontome composé est constitué de nombreuses dents rudimentaires, de très petite taille, groupées dans un sac dont la paroi conjonctive est identique à celle du follicule dentaire normal. Il s'agit d'une jeune patiente qui s'est présentée à la consultation pour une tuméfaction maxillaire antérieure évoluant depuis 4 ans. La patiente a rapporté qu'elle a subi un traumatisme à l'enfance. L'évolution de la tuméfaction était asymptomatique. L'examen exobuccal était sans spécificité. L'examen endobuccal a montré la présence au niveau de la muqueuse vestibulaire du maxillaire antérieur, d'une tuméfaction dure à la palpation et indolore. La muqueuse de recouvrement était d'aspect normal. La TDM a montré des images radiopaques entourées d'un halo radioclaire au niveau du secteur maxillaire antérieur droit autour de la racine de la 11, avec une rupture de la corticale externe et sans envahissement des fosses nasales. Les données cliniques et radiologiques ont orienté vers un odontome composé. Une exérèse chirurgicale des odontomes a été réalisée. L'odontome fait partie des tumeurs odontogéniques benignes épithélio-mésenchymateuses mixtes. L'étiologie de l'odontome est inconnue. Il peut apparaître suite à un ancien traumatisme. Les odontomes composés sont asymptomatiques et découverts au cours d'un examen radiographique de routine. Le traitement consiste à l'extraction chirurgicale de l'odontome seule ou suivi d'un traitement orthodontique en cas d'inclusion d'une dent

Odontomas are benign jaw tumors composed of derivatives of odontogenic epithelium and ectomesenchyme. They are divided into two groups: compound odontoma and complex odontoma. A compound odontoma is made up of many rudimentary teeth, very small, grouped in a sac whose connective wall is identical to that of the normal tooth follicle. A young patient presented for the consultation for an anterior maxillary swelling that has progressed for 4 years. The patient reported that she suffered trauma as a child. The progression of the swelling was asymptomatic. The extra oral examination was unspecific. Intraoral examination showed the presence in the vestibular mucosa of the anterior maxilla, a swelling that was hard on palpation and painless. The covering mucosa was normal in appearance. CT showed radiopaque images surrounded by a radiolucent halo in the right anterior maxillary sector around the root of 11, with a rupture of the external cortex and without invasion of the nasal cavity. Clinical and radiological data have pointed to a compound odontoma. Surgical removal of the odontomas was performed. Odontoma is one of the benign mixed epithelial-mesenchymal odontogenic tumors. The etiology of odontoma is unknown. It can appear following an old trauma. Compound odontomas are asymptomatic and discovered during routine radiographic examination. Treatment consists of surgical extraction of the odontoma alone or followed by orthodontic treatment in the event of inclusion of a tooth.

Need for histopathological examination of odontomas

Odontomas are benign hamartomas which are often detected on routine radiographic examinations for other dental complaints. They are usually surgically removed but are rarely examined histopathologically. We report two cases with identical radiological features but different histopathological outcome, thus stressing the importance of histopathological examination of odontoma.