Presentation
Chronic pain in the right mandibular teeth region. No contributory medical or trauma history.
Patient Data
Three-dimensional volumetric reconstruction, axial, oblique, and coronal sections of this patient reveal:
an irregular radio-opaque mass hindering the path of eruption of the right mandibular third molar, suggestive of a complex type of odontoma
displacement and directional change in the eruption pattern of the right mandibular third molar are observed
thinning of the adjacent buccal and lingual cortical plates is noted
calcified tooth-like structures are present bilaterally distal to the maxillary third molar, suggestive of supernumerary teeth, hyperdontia, or a compound odontoma
Case Discussion
Odontomas are the most common benign odontogenic tumor of jaws, considered as hamartomas of dental tissue components. The common age predilection is 18-25 years. Two common types of odontomas:
compound odontoma - composed of numerous tooth-like structures such as enamel, dentin, and pulpal tissues
complex odontomas - composed of dental tissues in a disordered and unorganised pattern
Mostly, they are asymptomatic, sometimes associated with an impacted or delayed eruption of the permanent tooth. Complex odontomas have a predilection for the mandibular molar region. Detection of these odontomas is done with panoramic radiographs, and occlusal radiographs to evaluate the location and proximity to adjacent teeth.
However, CBCT scan offers volumetric reconstructed images to assess the presence of supernumerary teeth, odontoma, impacted tooth, and position of the lesion, and to measure the proximity of the surrounding cortical bone.
As in this case, CBCT was taken to localize the position of impacted teeth and the odontoma in bucco-lingual direction as it was unclear from plain radiographs and physical exam. An incidental finding of bilateral supernumerary tooth or hyperdontia was noted in the distal aspect of the maxillary third molar.
Based on the radiographic presentation, the diagnosis of hyperdontia and complex odontoma was made.