International Journal of Oral & Maxillofacial Pathology. 2012;3(2):!

"# ISSN 2231 2250

$%aila&le online at h tt':(( ) ) ) . *ou r na l gat e ) ay.co+ or )) ) .i *o + '. or g
Management of Unerupted Central Incisor Due to Compound Odontoma ! Case "eport
,ha+-her ,ingh. /alita Man0ia. 1i%e2 $0la2ha. 3itin ,har+a. ,u&ha-h 4han0er. 5harat ,an2hla
!#stract
O0onto+a- are ha+arto+ou- le-ion- or +alfor+ation- rather than true neo'la-+- an0 are
fre6uent cau-e of i-olate0 0elaye0 tooth eru'tion. O0onto+a- are a-y+'to+atic in nature an0
often 0iagno-e0 in the -econ0 0eca0e of life. 7he 're-ent ca-e re'orte0 )ith +i--ing tooth in
u''er front region. 4linical an0 ra0iogra'hic fin0ing are -ugge-ti%e of co+'oun0 o0onto+a.
8ence treat+ent )a- 'lanne0 for -urgical re+o%al of the le-ion follo)e0 &y ortho0ontic treat+ent.
$e%&ords O0ontogenic 7u+or-;4o+'oun0 O0onto+a;9elaye0 7ooth :ru'tion;Ortho0ontic
:xtru-ion;;orce0 :ru'tion;7ooth Mo%e+ent.
Shamsher Singh, Lalita Mandia, Vivek Adlakha, Nitin Sharma, Subhash Chander, Bharat Sankhla.
Management of Unerupted Central n!isor "ue to Compound #dontoma$ A Case %eport. nternational
&ournal of #ral and Ma'illofa!ial (atholog)* +,-+$./+0$12314. 5nternational &ournal of #ral and
Ma'illofa!ial (atholog). (ublished b) (ublishing "ivision, Celesta Soft6are (rivate Limited. All %ights
%eserved.
<ecei%e0 on: 0=(12(2011 $cce'te0 on: 21(0(2012
Introduction
$ +ixe0 o0ontogenic tu+our e+ulating all
the har0 ti--ue- 'ro0uct- of a +ature tooth
ger+. the o0onto+a i- 'ro&a&ly the +o-t
co++on ty'e of o0ontogenic tu+our or
ha+arto+a-.
1
$lthough u-ually locate0
'ericoronal to an i+'acte0 tooth. the
o0onto+a +ay al-o ari-e fro+ o0ontogenic
'rogenitor cell- )ithin the 'erio0ontal
liga+ent- an0 &eco+e locate0 &et)een
tooth root an0 are not a--ociate0 )ith
0i-tur&ance in eru'tion.
1
O0onto+a- exhi&it
co+'lete e'ithelial an0 +e-enchy+al
0ifferentiation to the 'oint that &oth ena+el
an0 0entin are for+e0.
2
>a&ell. Ja+e-. an0
Payne grou'e0 o0onto+a accor0ing to their
0e%elo'+ental origin: e'ithelial. co+'o-ite
(e'ithelial an0 +e-o0er+al) an0 connecti%e
ti--ue.
3
4linically. o0onto+a- are either
co+'lex or co+'oun0.
3
4o+'lex
o0onto+a- are le-- co++on than
co+'oun0 %ariety in the ratio 1:2.
4o+'oun0 o0onto+a- are +ore co++on in
the anterior region )hile co+'lex
o0onto+a- ten0 to occur in the 'o-terior
region of the *a). ?-ually o0onto+a- are
a-y+'to+atic; -i@e %arie- fro+ fe)
+illi+etre- to +any centi+etre- in their
0i+en-ion.
?n0er-tan0ing tooth 0e%elo'+ent an0
eru'tion )ill gui0e a clinician to 0iagno-e
an0 0ifferentiate nor+al fro+ an a&nor+al.
4on-tant e%aluation a&out the 0yna+ic- of
0entition i- e--ential for the 0iagno-i- an0
treat+ent of irregularitie- 0uring thi-
'roce--. 7he 're-ence of o0onto+a can
0elay the exfoliation of a 0eci0uou- tooth
an0 the eru'tion of the 'er+anent
-ucce--or-. )hich -houl0 &e carefully
o&-er%e0. 8ere. )e 're-ent a ca-e of
co+'oun0 o0onto+a along )ith clinical
're-entation. ra0iogra'hic feature-.
hi-to'athological feature- an0 -urgical
treat+ent an0 it- ortho0ontic correction.
Case report
$n 11 year ol0 &oy ca+e to the 9e'art+ent
of Pe0o0ontic- an0 Pre%enti%e 9enti-try )ith
the chief co+'laint of non"eru'tion of the
u''er right front tooth. Patient )a- healthy
an0 a-y+'to+atic. 8i- 'a-t 0ental an0
+e0ical hi-tory )a- not -ignificant. Intraoral
exa+ination re%eale0 that A11 )a- not
eru'te0 into the oral ca%ity. $ccor0ing to the
'atientB- +other. A21 )a- eru'te0 into oral
ca%ity three year- &ac2. 4linically &oth A12 &
A21 )ere fully eru'te0 (;igure 1). 7here )a-
no -ign of infla++ation. 'ain or infection an0
nor+al -urroun0ing +uco-a )a- nor+al. $n
intraoral 'eria'ical ra0iogra'h re%eale0
're-ence of A11 0ee' in al%eolar &one. 7he
cro)n of the uneru'te0 A11 )a- o%erla''e0
&y tooth li2e +a-- (;igure 2) an0 al+o-t
co%ering the central half of the uneru'te0
A11. 7he le-ion )a- clinically a-y+'to+atic.
5a-e0 on the clinical an0 ra0iogra'hic
e%aluation. a 0iagno-i- of o0onto+a )a-
+a0e.
7he eru'tion of tooth A11 )a- 'ro&a&ly
i+'e0e0 &y the tooth li2e +a--. 8ence.
-urgical re+o%al of the le-ion )a- 'lanne0.
/ocal anae-the-ia )a- gi%en on &oth -i0e of
the la&ial -ulcu- an0 'alate (infra"or&ital.
na-o'alatine ner%e &loc2 an0 infiltration).
Inci-ion )a- gi%en an0 a la&ial fla' )a-
rai-e0 +e0ial to A21 to the 0i-tal of A12
C2012 International Journal of Oral an0 Maxillofacial Pathology. Pu&li-he0 &y Pu&li-hing 9i%i-ion. 4ele-ta ,oft)are Pri%ate /i+ite0 . $ll <ight- <e-er%e0
Case "eport
D Shamsher Singh et al., ISSN 2231 ' 2250
region an0 t)o relea-ing inci-ion )ere gi%en
(;igure 3). $ -urgical &ur )a- u-e0 to
re+o%e the al%eolar &one co%ering the
inci-al e0ge of the A11. Once the inci-al
e0ge )a- ex'o-e0. the tooth li2e +a-- )a-
locate0 at a''roxi+ately the -a+e le%el a- it
)a- on ra0iogra'h. $ tooth li2e +a-- (;igure
) )a- re+o%e0 )ith the hel' of
+uco'erio-teal ele%ator; the -oc2et )a-
irrigate0 )ith -aline. 5lac2 -il2 -uture )ere
gi%en. $ co+'lete cour-e of anti&iotic- )a-
gi%en. -uture- )ere re+o%e0 after one )ee2
an0 healing )a- -ati-factory. 7he ti--ue )a-
-ent for hi-to'athological e%aluation.
9ecalcifie0. hae+atoxylin an0 eo-in -ection
of -'eci+en re%eale0 ho+ogenou-
eo-ino'hilic +a-- of 0entin )hich encircle-
the 'ul' li2e ti--ue )hich contain 0elicate
loo-e fi&rou- +atrix along )ith fe) %a-cular
-'ace- (;igure !).
$fter t)o +onth- of follo) u'. A11 -ho)- no
-ign of eru'tion. 8ence. it )a- 'lanne0 to
+o%e uneru'te0 A11 ortho0ontically. $
)in0o) )a- +a0e -urgically after gi%ing
local anae-the-ia an0 &eggB- &rac2et )a-
'lace0 on tooth A11. A12. A21 an0 A22.
Ortho0ontic )ire )a- tie0 u' )ith ligature
)ire an0 ela-tic threa0 )a- +o%e0 aroun0
A11 an0 tie0 u' aroun0 A21 an0 A12. (;igure
D) $fter 3 +onth- of treat+ent. A11 )a-
-een in the oral ca%ity al+o-t in align+ent to
a0*acent A21. (;igure =)
7he intraoral 'hotogra'h (;igure 1) an0 )ith 'reo'erati%e ra0iogra'h ((;igure 2) -ho)ing
uneru'te0 tooth A11. 7he -urgical ex'o-ure (;igure 3) an0 extracte0 -'eci+en (;igure ) 7he
he+atoxylin an0 eo-in -taine0 'hoto+icrogra'h of co+'oun0 o0onto+a -ho)ing ho+ogenou-
eo-ino'hilic +a-- of 0entin )hich encircle- the 'ul' li2e ti--ue (;igure !). 7he ortho0ontic
extru-ion )ith ela-tic- of tooth A11 ha- &een carrie0 out (;igure D). Po-to'erati%e 'hotogra'h
-ho)ing eru'te0 an0 aligne0 tooth A11 (;igure =).
Discussion
7he etiology of the o0onto+a i- un2no)n. It
ha- &een -ugge-te0 that local trau+a or
infection +ay lea0 to the 'ro0uction of -uch
a le-ion.

8itchin re'orte0 that o0onto+a-
are inherite0 or are 0ue to a +utagene or
interference. 'o--i&ly 'o-tnatal. )ith the
genetic control of tooth 0e%elo'+ent.
!
8o)e%er. Phili'-en et al. -ugge-te0 that the
for+ation of a co+'oun0 o0onto+a i-
'athogenically relate0 to the 'roce--
'ro0ucing hy'er0ontia. EMulti'le
,chi@o0ontiaE or locally con0itione0 acti%ity
of 0ental la+ina.
D
7he F8O ha- cla--ifie0 o0onto+a into t)o
ty'e- 0e'en0ing on their 0egree of
+or'ho0ifferentiation
2
. 7he co+'oun0
o0onto+a i- a le-ion in )hich all the 0ental
ti--ue- are re're-ente0 in an or0erly fa-hion
ISSN 2231 2250 Management of Unerupted Central Incisor Due to..... =
-o that there i- at lea-t -u'erficial anato+ic
re-e+&lance to teeth. In a co+'lex
o0onto+a. on the other han0. although all
the 0ental ti--ue- are re're-ente0. they are
for+e0 in -uch a ru0i+entary fa-hion that
there i- little or no +or'hologic re-e+&lance
to nor+al tooth for+ation
2
.
7he-e are u-ually a-y+'to+atic le-ion an0
&a-e0 on the 0ata of the -ur%ey of Phili'-en
et al the relati%e fre6uency of the co+'oun0
o0onto+a re're-ent- G " 3=H of all
o0ontogenic tu+our-. +a2ing it the +o-t
co++on o0ontogenic tu+our-
D
. 7he
a%erage age at 0iagno-i- i- 1=.2 year-
(range 0.! " =3 year-). ,e%enty fi%e
'ercentage of all ca-e are 0iagno-e0 at
aroun0 age 20 year- an0 -light 're0ilection
occurrence in +ale- co+'are to fe+ale
(1.2:1). 7he anterior +axilla i- the -ite of
+o-t co+'oun0 o0onto+a. an0 0iagno-i- i-
fre6uently +a0e on the &a-i- of the failure of
a 'er+anent tooth to eru't. In 0 " !0H of
ca-e-. an i+'acte0 'er+anent tooth i-
a--ociate0 )ith the co+'oun0 o0onto+a
=
.
$ccor0ing to o0onto+a -ur%ey of Phili'-en
et al
D
. the a%erage age at 0iagno-i- for
co+'lex o0onto+a i- 1G.G year- (range 2 "
= year-) an0 the inci0ence i- &et)een !
an0 30H. #H of the-e tu+our- occur
&efore age of 30 year-. Male- are +ore
co++only affecte0 than fe+ale- (1.!:1).
Mo-t co+'lex o0onto+a are locali@e0 in the
'o-terior region of the +an0i&le an0 often
i+'acte0 teeth are o&-er%e0 in 10 " !H
ca-e-
=.
Many intere-ting ca-e- of o0onto+a ha%e
&een re'orte0 )orl0)i0e.
#
5lan0 ,utton
(1###) fir-t re'orte0 the 're-ence of &ilateral
co+'oun0 o0onto+a in the +axillary -inu-.
5lan0 ,utton (1G22) foun0 a&nor+al -i@e0
co+'lex co+'o-ite o0onto+a that i-. =.D x
D.2 x 3.G c+ an0 )eighing ##3 g+.
co+'oun0 co+'o-ite o0onto+a containing
2000 0enticle- )a- re'orte0 &y 8er+an in
1G!=. 7ho+-on et al. in 1GD# re'orte0
+ulti'le co+'oun0 o0onto+a- of +axilla
an0 +an0i&le. 7he ter+ o0onto+a
-yn0ro+e )a- gi%en &y Manil (1G=) in a
ca-e that ha0 +ultifor+ o0onto+a &oth in
+axilla an0 +an0i&le. 1engal M et al.. foun0
large eru'ting co+'lex o0onto+a in the right
+an0i&lar angle region.
G
an0 >a&riel ,, et
al re'orte0 ulcerate0 le-ion +ea-uring a&out
2 c+ in 0ia+eter in the +olar region of the
fourth 6ua0rant.
10
<a0iogra'hically. co+'oun0 o0onto+a
-ho)- a collection of tooth"li2e -tructure- of
%arying -i@e an0 -ha'e -urroun0e0 &y a
narro) ra0iolucent @one. al-o 're-ent in thi-
ca-e re'ort
11
. $n o0onto+a ha- a li+ite0
gro)th 'otential. &ut it -houl0 &e re+o%e0
&ecau-e it contain- %ariou- tooth
for+ulation- that can 're0i-'o-e to cy-tic
change. interference )ith eru'tion of
'er+anent teeth an0 cau-e con-i0era&le
0e-truction of &one
#
. 4y-tic o0onto+a
increa-e in -i@e -lo)ly an0 cau-e large
ex'an-ion of &one. )hich i- not -een in the
're-ent ca-e.
D
Ia&an -tate- that o0onto+a- are ea-ily
enucleate0. an0 a0*acent teeth that +ay
ha%e &een 0i-'lace0 &y the le-ion are
-el0o+ har+e0 &y -urgical exci-ion
&ecau-e they are u-ually -e'arate0 &y a
-e'tu+ of &one.
3.12
7he treat+ent o'tion for
o0onto+a co+'ri-e- -urgical extraction.
fene-tration an0 'o-terior ortho0ontic
traction or -i+'le o&-er%ation )ith 'erio0ic
clinical an0 ra0iogra'hic exa+ination to
e%aluate the 'ath of eru'tion of teeth.
13"1!
In 're-ent ca-e. the 0elaye0 0iagno-i- of the
le-ion re-ulte0 in co+'lete root for+ation of
uneru'te0 tooth. +a2ing it nece--ary to u-e
ortho0ontic traction of the affecte0 tooth to
gui0e in a0e6uate 'o-ition in the 0ental
arch. 8ence. of all 'ae0iatric 'atient- that
're-ent clinical e%i0ence of 0elaye0
'er+anent tooth eru'tion or te+'orary tooth
0i-'lace+ent. )ith or )ithout hi-tory of
're%iou- 0ental trau+a. ra0iogra'hic
exa+ination -houl0 &e 'erfor+e0.
Conclusion
O0onto+a- are the +o-t co++on ty'e of
o0ontogenic tu+our- or ha+arto+a- an0
ari-e a- a re-ult of a&erration in the ti--ue-
re-'on-i&le for the for+ation of the teeth.
7he-e are u-ually a-y+'to+atic re6uire-
-urgical extraction an0 careful +onitoring to
gui0e uneru'te0 teeth in to nor+al
occlu-ion. 8ence re-ult- achie%e0 -ugge-t
that early 0iagno-i- of the o0onto+a- allo)-
the a0o'tion of a le-- co+'lex an0 le--
ex'en-i%e treat+ent an0 en-ure &etter
'rogno-i-.
!ut(or !ffiliations
1.9r.,ha+-her ,ingh. ,enior /ecturer.
9e'art+ent of Pe0o0ontic- an0 Pre%enti%e
9enti-try. 1ya- 9ental 4ollege. Jo0h'ur.
<a*a-than. 2.9r./alita Man0ia. /ecturer.
9e'art+ent of 4on-er%ati%e an0 :n0o0ontic-.
,uren0era 9ental 4ollege an0 <e-earch In-titute.
,riganganagar. 3.9r.1i%e2 $0la2ha. <ea0er.
9e'art+ent of Pe0o0ontic- an0 Pre%enti%e
9enti-try. ,u&harti 9ental 4ollege. Meerut. ?P.
# Shamsher Singh et al., ISSN 2231 ' 2250
.9r.3itin ,har+a. ,enior /ecturer. 9e'art+ent
of Pe0o0ontic- an0 Pre%enti%e 9enti-try.
!.9r.,u&ha-h 4han0er. ,enior /ecturer.
9e'art+ent of 4on-er%ati%e an0 :n0o0ontic-.
D.9r.5harat ,an2hla. ,enior /ecturer.
9e'art+ent of Oral Pathology. 1ya- 9ental
4ollege. Jo0h'ur. <a*a-than. In0ia.
!c)no&ledgement
Fe )oul0 li2e to than2 the -taff +e+&er- of the
oral 'athology 0e'art+ent for their -u''ort &
coo'eration.
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'athology"0iagno-i- an0 treat+ent. 3
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th
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ca-e re'ort. J 4an 9ent $--oc
200=;=3:1DG"=3.
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1!. Iat@ <. $n analy-i- of co+'oun0 an0
co+'lex o0onto+a-. J 9enti-t 4hil0
1G#G;!D:!" G.
Corresponding !ut(or
9r.,ha+-her ,ingh.
,enior /ecturer.
9e'art+ent of Pe0o0ontic- an0 Pre%enti%e
9enti-try. 1ya- 9ental 4ollege an0 8o-'ital.
Jo0h'ur. <a*a-than. In0ia.
Ph: LG1 G3!2=1=2=
:+ail: 0 r-h a+- he rM-in gh Nyahoo .co +
,ource of ,u''ort: 3il. 4onflict of Intere-t: 3one 9eclare0.