The term odontoma was first described by Broca in 1866 as a benign odontogenic tumor of epithelial and mesenchymal origin characterized by slow growth and dental contents (enamel, dentin, cementum, and pulp). It is considered a tumor-like malformation (hamartoma), not a true neoplasm, in which all of the dental tissues are represented.
Odontomas are composed of all mature components of dental hard and soft tissue: enamel, dentin, and pulp tissue. Because of their limited slow growth and well-differentiation, they are generally considered to represent hamartomas rather than true. Based on radiographic and microscopic characteristics odontomas are subdivided into a compound and complex types. The compound type is characterized by tooth-like structures arranged in an orderly fashion and the complex type is characterized by dental tissues in a disorderly pattern without any anatomic resemblance to a tooth.
They are the most common odontogenic tumors and they interfere with eruption of permanent teeth. They begin to develop as normal dentition start to develop and cease when the teeth development ends. There is no sex predilection. They occur in young age group, with the average age being the second decade of life. They are usually asymptomatic and are discovered during a routine radiographic examination when there is delayed eruption of permanent tooth location somewhat more common in the maxilla. The compound type is more often in the anterior maxilla while the complex type occurs more often in the posterior regions of either jaw.
Although odontomas are usually asymptomatic, there are some clinical indicators such as retention of deciduous teeth, no eruption of permanent teeth, expansion of cortical bone, and displacement of teeth. Other symptoms include numbness in the lower lip and swelling in the affected area. Odontomas are usually small in size. The age at diagnosis is commonly in the second decade of life without gender predilection, occurring more often in the posterior region of the mandible.
The only real treatment of these dental tumors is removal by surgery. An early discovery and treatment will be beneficial to the patient. It is a benign tumor made of dental tissue and it is a fairly simple extraction in most cases. A speedy recovery is generally expected. Some complex tumors can result in complications after extraction. So it is essential to stay in contact with your surgeon. They don’t recur and are not invasive.
What is Odontoma?
Odontomas are best known as hamartomatous benign tumors rather than true neoplasms, arising from odontogenic tissues. Histologically, they are classified as compound and complex variety. They are composed of both epithelial and ectomesenchymal components. Both the epithelial and the ectomesenchymal tissues and their respective cells may appear normal morphologically, but they seem to have a deficit in a structural arrangement. This defect has led to the opinion that odontomas are hamartomatous lesions or malformations rather than true neoplasms.
A complex odontoma forms an irregular mass in a disorderly pattern. The complex type is unrecognizable as dental tissues, usually presenting as a radio-opaque area with varying densities. It usually appears in the posterior maxilla or in the mandible. It tends to occur in 70% in the posterior region of the mandible. There might be a missing tooth if it arises from a normal tooth follicle.
A compound odontoma forms a conglomeration of small structures resembling teeth. A compound odontoma still has the three separate dental tissues (enamel, dentin, and cementum), but may present a lobulated appearance where there is no definitive demarcation of separate tissues between the individual “toothlets” (or denticles). It usually appears in the anterior maxilla. It tends to occur in 62% in the anterior region of the maxilla and usually associated with the crown of an unerupted canine. It is formed by exuberant growth of the dental lamina or into a number of small enamel organs by the proliferation of the enamel organ.
Difference between Complex and Compound Odontoma
Compound odontomas can be detected easily due to their tooth-like appearance. Complex odontomas can be differentiated from cemento-ossifying fibromas due to their propensity to be associated with the crown of unerupted molar and they are more radiopaque than cement-ossifying fibromas. They can also develop at much younger age than cemento-ossifying fibromas. A dense bony island can be included in the differential. However, the presence of a soft tissue capsule is very useful in differentiation. Periapical cemental dysplasia may resemble complex odontomas but usually, they are multiple, surrounded by sclerotic borders and centered around apices of teeth, whereas odontomas are commonly found occlusal or overlapping the involved teeth.