https://imcjms.com/public Ibrahim Medical College Journal of Medical Science https://imcjms.com/public/registration/journal_full_text/43 Tue, 02 Aug 2016 10:13:06 +0000 Odontomas are mixed odontogenic tumors composed of both epithelial and mesenchymal dental hard tissues. They are usually asymptomatic and are often discovered during routine radiography. A case of odontoma in a 21 year old man is described who presented with delayed eruption of upper central and lateral incisor teeth. The odontome was surgically removed followed by re-implantation of preserved extracted lateral incisor and a porcelain crown. Address for Correspondence:Dr. Mahfujul Haq Khan, Associate Professor, Department of Dentistry, Bangladesh Institute of Research & Rehabilitation in Diabetes, Endocrine & Metabolic Disorder (BIRDEM) and Ibrahim Medical College, 122 Kazi Nazrul Islam Avenue, Dhaka-1000, Bangladesh, email: mahtink@yahoo.com   A 21-year-old- man reported to the Department of Dentistry, BIRDEM Hospital, Bangladesh, with the complaint of missing upper right central and lateral incisors and hard swelling on apical region of that missing alveolus. He had normal shedding of upper deciduos central and lateral incisors teeth at the age of 6-8 years and since then no permanent dentition of upper right central and lateral incisors occured. The patient was healthy and well developed with an unremarkable medical history. He had no history of trauma to oro-facial region or dental extraction. There was no family history of unerupted teeth or hypodontia. Extra oral examination revealed no abnormality in the upper lips as well as in the right side of the maxilla. Intra oral examination revealed a well defined gingival hard swelling which was palpated in the apical area of unerupted incisors (Figure -1a). No inflammatory change was noticed on the overlying and marginal gingiva and interdental papilla. The space for the eruption of the maxillary right central incisors was naturally maintained in the dental arch but the space for lateral incisor was reduced due to medial drifting of maxillary right canine. No midline deviation was diagnosed in comparison to the dental arch and the facial midline. There was no regional lymphadenopathy. An intra oral periapical and panoromic radiograph revealed impacted lateral incisor with multiple radio-opaque structures around the crown of the unerupted incisors region obstructing the eruption of the tooth (Figure -1b). The mass was surrounded by a narrow radiolucent zone. On the basis of clinical examination and radiological evaluation, the case was diagnosed as a compound odontome with impacted lateral incisor. Surgical removal of the odontome, extraction of impacted lateral incisor and its re-implantation was planned.   Fig 1: (a): Missing upper right central and lateral incisors and a hard swelling on upper right anterior part of alveolus. (b): X-ray OPG shows  a calcified mass with multiple teeth like structures with impacted right lateral incisor, arrow indicates central incisor. (c): 15 pieces of tiny tooth like structure. (d): Final esthetic appearence   after surgical removal of odontome and re-implantation. After 3 months, the re-implanted lateral incisor was assessed clinically and radiologically. There was no significant mobility. Periapical radiograph showed new bone formation around the root of the re-implanted tooth. For esthetic purpose, a porcelain crown having a shape of central incisor was made on the lateral incisor (Figure-1d). A Maryland bridge was selected to distribute the occlusal load applied on the lateral incisor. Discussion The frequency of occurrence of odontomas varies greatly in different population groups. Odontomas are most common in Caucasian population where it accounts for over 65% of all odontogenic tumours.6 In contrast, odontomas are rare in Chinese populations with an occurrence of only 6% to 6.7%.7,8 It remains to be proved whether geographical variation is racially based.8 In general, odontomas mostly occur in the permanent dentition and are very rarely associated with the primary teeth.6 An odontome can occur at any age but most commonly occurs at 2nd decade of life and there is no gender predilection. Of all odontomas combined, 67% occured  in the maxilla and 33% in the mandible. The compound odontoma has predilection towards the anterior maxilla (61%) compared to only 34% of complex odontomas. In general, complex odontoma had a predilection for the posterior jaws (59%). Interestingly, both type of odontomas occur more frequently on the right side of the jaw then on the left (compound 62%, complex 68%).9,10,11   We are thankful to Dr. Alif, Dr. Hossein, Dr. Persa, Dr. Sakina and Dr. Fatema for technical support to complete a case report. Special thanks to Dr. Towfik Alam to complete the referrences. References 2.   Phillipsen H, Reichardt P, Praetorious F. Mixed odontogenic tumours and odontomas. Considerations on interrelationship. Review of literature and presentation of 134 new cases of odontomas. Oral Oncol 1977; 33: 86–99.  4.   Ida-Yanemochi H, Noda T, H S, T S. Disturbed tooth eruption in osteopetrotic (op/op) mice: histopathogenesis of tooth malformation and odontomas. J Oral Med Oral Pathol 2002; 31: 361–373.  6.   Regezi JA, Kerr DA, Courtney RM. Odontogenic tumors: Analysis of 706 cases. Journal of Oral Surgery 1978; 36: 771-778. 8.   Lu Y, Xuan M, Takata T, Wang C, He Z, Zhou Z, Mock D, Nikai H. A demographic study of 759 cases in a Chinese population. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, Endodontics 1998; 86(6): 707-714. 10.Cawson and Odell. Odontogenic tumors and tumors like lesions of the jaws. In essentials of Oral Pathology and Oral Medicine. 6th Ed, Churchill Livingstone 1998; 117-131. 2026 Ibrahim Medical College. All rights reserved.