ODONTOMA:

Growth in which both epithelial and mesenchymal cells exhibit complete

differentiation, with the result that functional ameloblasts and odontoblasts form
enamel and dentin.
Enamel and dentin are laid down in an abnormal pattern, because organization of
odontogenic epithelium fails to reach a normal state of morphodifferentiation.
Lesion is composed of more than one type of tissue, hence termed composite
odontoma.

Types:
1. Compound composite (Enamel, dentin laid are similar to normal teeth but smaller than
them).
2. Complex composite (Calcified tissues are an irregular mass with no resemblance even
to rudimentary teeth).

Etiology:

Unknown
Local trauma (or) infection
Inherited (or) mutant gene (or) interference.
Clinical features:

Sex: Male predilection (59%).

Age: It may be discovered at any age, from the very young to the very elderly, the
mean age of detection to be 14.8 years. In cawson it is between 10 and 20 years.
The most prevalent age for diagnosis and treatment is the second decade of life.
Site: Of all odontomas combined, 67% occurred in the maxilla and 33% in the
mandible.
The compound odontoma had a predilection, for the anterior maxilla (61%),
whereas only 34% of complex odontomas occurred here.
 In general, complex odontomas had a predilection for the posterior jaws (59%).
Interestingly, both types of odontomas occurred more frequently on the right side
of the jaw than on the left (compound, 62%; complex 68%).
Once fully calcified they do not develop further.
When odontomas have erupted, infection can develop in any of the stagnation
areas and abscess formation commonly follows.
Sometimes odontomas displaces teeth and block their eruption or become involved
in cyst formation.
The odontoma usually remains small, the diameter of the mass only occasionally
greatly exceeding that of a tooth. Occasionally, it does become large and may
produce expansion of bone with consequent facial asymmetry. This is particularly
true if a dentigerous cyst develops around the odontoma.
Asymptomatic swelling consisting of unerupted (or) impacted teeth.

Radiological Features:
Situated between roots of teeth and appear as irregular mass of calcified tissue
surrounded by a narrow radiolucent band with a smooth outer periphery.
Structures resembling teeth are seen in some instances.
Developing odontomas are mostly radiolucent and often go unnoticed.
Radiographically, following different stages are recognized depending on their
degree of calcification:
a) Initial ( Crypt like) Radiolucent stage
b) Intermediate stage of mixed radiolucency
c) Finally densely radiopaque

Histologic Features:
Normal appearing enamel (or) enamel matrix, dentin, pulp tissue, cementum are
present which may or may not exhibit a normal relation to one another.
 Connective tissue capsule around the odontoma is similar in all respects to follicle
surrounding a normal tooth.
Ghost cells are present.

DIFFERENTIAL DIAGNOSIS:

Calcifying epithelial odontogenic tumor (CEOT)

Ameloblastic fibrodentinoma
Ameloblastic fibro-odontome
Osteoma
Odontoameloblastoma
Focal sclerosing osteomyelitis.

Complex odontomas have to be differentiated from cementifying and central

ossifying fibromas.
Odontomas are more radiodense and usually occur in young persons than
cementifying and ossifying fibromas.
Periapical cemental dysplasia can be differentiated from odontomas as they are
multiple in numbers and centred in the periapical regions and may not have well-
corticated borders such as odontomas.
Osteomas can be easily differentiated from odontomas since they appear as central
radio-opaque lesions.
Ameloblastic fibro-odontoma and ameloblastic odontoma have to be differentiated
from a complex composite odontoma.
MANAGEMENT: Asymptomatic odontomas are often left untreated. Surgical curettage
is the treatment of choice. Recurrence is rare.

A.Compound Odontoma:

Definition: A malformation in which all the dental tissues are represented in a more
ORDERLY pattern than Complex odontoma. The lesion consists of many teeth like
structure. Most of these do not resemble normal tooth morphologically but in each
structure enamel, dentin, pulp, cementum are arranged as in normal tooth.

Clinical feature:

These consist of many separate, small, tooth-like structures (denticles), probably

produced by localised, multiple budding off from the dental lamina and formation
of many tooth germs.
Usually forms in the anterior part of the jaws and gives rise to a painless swelling.
The denticles may be seen radiographically as separate densely calcified bodies.
Histologically, the denticles are embedded in fi brous connective tissue and have a fi
brous capsule (Figs 8.46 and 8.47).
The mass should be enucleated as a potential obstruction to tooth eruption or cyst
formation.