Contemporary Clinical Dentistry
  Home | About us | Editorial board | Search
Ahead of print | Current Issue | Archives | Advertise
Instructions | Online submission| Contact us | Subscribe |


Login  | Users Online: 122  Print this pageEmail this pageSmall font sizeDefault font sizeIncrease font size 

 Table of Contents  
Year : 2011  |  Volume : 2  |  Issue : 1  |  Page : 37-40  

Orthodontic management of an impacted maxillary incisor due to odontoma

1 Department of Orthodontics and Dentofacial Orthopedics, Rural Dental College, Loni, Ahmednagar, India
2 Shri Sai Baba Hospital, Shirdi, Rahata, Ahmednagar, India
3 Department of Oral Pathology and Microbiology, Rural Dental College, Loni, Ahmednagar - 413 736, India
4 Department of Oral Medicine and Radiology, Rural Dental College, Loni, Ahmednagar - 413 736, India

Date of Web Publication12-Apr-2011

Correspondence Address:
Rahul S Baldawa
302, Department of Orthodontics and Dentofacial Orthopedics, Rural Dental College, Loni 413 736. Rahata, Ahmednagar, Maharashtra
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0976-237X.79312

Rights and Permissions

Odontomas are a heterogeneous group of jaw bone lesions, classified as odontogenic tumors which usually include well-diversified dental tissues. Odontomas are the most common type of odontogenic tumors and generally they are asymptomatic. Two types of odontomas are described: compound and complex based on either the appearance of well-organized tooth-like structures (compound odontomas) or on a mass of disorganized odontogenic tissues (complex odontomas). Compound odontomas have a predilection for the anterior maxilla, whereas complex odontomas have a predilection for the posterior mandible. Odontomas frequently interfere with eruption of teeth leading to their impaction. This is a case report of a 14-year-old girl with an unerupted maxillary right central incisor due to a complex composite odontoma a rare occurrence in anterior maxilla. Surgical excision of the odontoma and orthodontic treatment to get the impacted maxillary right central incisor into alignment is discussed.

Keywords: Complex odontoma, impacted incisor, odontogenic tumour, odontoma, orthodontic treatment

How to cite this article:
Baldawa RS, Khante KC, Kalburge JV, Kasat VO. Orthodontic management of an impacted maxillary incisor due to odontoma. Contemp Clin Dent 2011;2:37-40

How to cite this URL:
Baldawa RS, Khante KC, Kalburge JV, Kasat VO. Orthodontic management of an impacted maxillary incisor due to odontoma. Contemp Clin Dent [serial online] 2011 [cited 2022 Jun 25];2:37-40. Available from:

   Introduction Top

Odontoma belongs to a group of dentigerous tumors developing in jaw bones in stages of odontogenesis. The term "odontoma," by definition alone, refers to any tumor of odontogenic origin. However, most authorities accept the view today that the odontoma represents a hamartomatous malformation rather than a neoplasm. According to definition of WHO, it is a congenital developmental defect, resulting from growth of completely differentiated epithelial and mesenchymal cells, in which all kinds of dental tissues occur. Similar to teeth, once fully calcified, they do not develop further. [1]

According to WHO classification (1992), two type of odontomas are acknowledged.

  • Compound odontomas malformations with representation of all dental tissues and exhibiting an orderly distribution in which numerous tooth-like structures known as denticles are found.
  • Complex odontomas malformations in which all dental tissues are likewise represented, but showing a disorganized distribution.

The first is approximately twice as common as complex odontoma.

This lesion is composed of more than one type of tissue, and for this reason, has been called a composite odontoma.[2] Accordingly we have

  • Complex composite odontoma
  • Compound composite odontoma
Other types of odontomas are sometimes also seen, presenting combinations of the characteristics of compound and complex odontomas (i.e. mixed odontomas), while in other cases the lesions cannot be assigned to either of the two types (cystic adenomas). [3],[4]

Although the etiology of this malformation is not yet known, there is some evidence to show that there is a genetic basis for both complex and compound composite odontomas. Heredity is a possible factor and persistent lamina could be the hidden inherited developmental anomaly. Other theories have been proposed, including local trauma, infection, family history, and genetic mutation. [5]

   Case Report Top

A 14-year-old, healthy female patient reported to the Department of Orthodontics, with the chief complaint of unerupted upper front tooth. Her medical history was not significant. Extraoral examination revealed no facial asymmetry [Figure 1]. Intraoral examination revealed unerupted maxillary right central incisor associated with a mild asymptomatic swelling which was slightly mobile on palpation, butwith no inflammation of the overlying mucosa [Figure 2].
Figure 1: (a and b) Pre-treatment extraoral photographs

Click here to view
Figure 2: Pre-treatment intraoral photographs

Click here to view

Intra-oral periapical, occlusal, and panoramic radiographs revealed the presence of the right central incisor with a radiopaque mass present incisally, thereby obstructing its eruption [Figure 3].On the basis of clinical and radiographic findings, a provisional diagnosis of odontoma was established.
Figure 3: (a, b and c) Pre-treatment radiographs

Click here to view

Complete excision of the odontoma under local anesthesia and orthodontic treatment for alignment of the impacted incisor was planned. Accordingly, an 0.018" MBT prescription preadjusted edgewise appliance was bonded on the upper arch. There was adequate space for the alignment of the impacted central incisor in the arch. After the initial leveling and aligning, surgical removal of the odontoma was done under local anesthesia.

A mucoperiosteal flap extending from the labial surface of right canine to the left canine was reflected and the calcified mass was exposed [Figure 4]. This was carefully excised without disturbing the unerupted tooth. The calcified structure measured 13 mm mesiodistally and 6 mm incisocervically [Figure 5].The specimen was sent for histopathological examination which confirmed it as a complex composite odontoma with haphazardly arranged hard tissues of tooth like dentin and globules of cementum-like material [Figure 6].Curettage was done in the area and the area was debrided of any remnants. The layer of bone covering the labial surface of the impacted right central incisor was removed and the crown was exposed.
Figure 4: Surgical exposure of the odontoma

Click here to view
Figure 5: Excised specimen

Click here to view
Figure 6: Photomicrograph shows mixture of dental tissues arranged haphazardly [H and E stain, ×16]

Click here to view

A Begg's bracket with a ligature wire extending was bonded onto the impacted incisor [Figure 7]. The area was irrigated and the mucoperiosteal flap was sutured back in position. The ligature wire extending from the bracket bonded on the impacted incisor was tied to the archwire thereby causing forced extrusion of the impacted incisor. The patient was recalled at 4-week intervals for tightening the ligature wire. After two visits, the right central incisor erupted into the oral cavity. 0.012" nickel titanium wire was engaged piggyback on the erupting incisor with a 0.016' x 0.022" stainless steel base archwire.
Figure 7: Begg's bracket with ligature wire extending bonded on the impacted incisor

Click here to view

Six weeks later the impacted tooth was properly aligned in the arch. The Begg's bracket was replaced with a 0.018" MBT prescription bracket, and final finishing and detailing was achieved [Figure 8].The total active treatment duration was 18 months. Retention was by means of upper Hawley's retainer. [Figure 9] shows the extraoral photographs of the patient displaying a pleasing smile. [Figure 10] shows the post-treatment radiographs of the patient.
Figure 8: Post-treatment intraoral photograph

Click here to view
Figure: 9: (a and b) Post-treatment extraoral photographs

Click here to view
Figure 10: (a, b, and c) Post-treatment radiographs

Click here to view

   Discussion Top

The term "odontoma," by definition alone, refers to any tumor of odontogenic origin. Through usage, however, it has come to mean a growth in which both the epithelial and the mesenchymal cells exhibit complete differentiation, with the result that functional ameloblasts and odontoblasts form enamel and dentin.

Paul Broca was the first person to use the term "odontoma" in 1867. He defined the term odontoma as "tumors formed by the overgrowth of transitory or complete dental tissues." Odontomas are hamartoma arising during normal tooth development, and they often reach a fixed size and are composed of mature enamel, dentin, cementum, and pulp tissues. [6]

Odontomas of all types comprise approximately 22% of odontogenic tumors of jaws. [7] There is no gender predilection and an odontoma can occur at any age but most commonly occurs in the second decade of life. [8]

Of all the odontomas combined, 67% occurred in the maxilla and 33% in the mandible. The compound odontoma has predilection toward the anterior maxilla (61%), whereas only 34% of complex odontomas occurred here. In general, complex odontoma had a predilection for the posterior jaws (59%) and lastly the premolar area (7%). Interestingly, both types of odontoma occurred more frequently on the right side of the jaw than on the left (compound 62%, complex 68%). [3],[7],[9]

The complex odontoma occurs predominantly in the second and third decades of life and the majority arises in the molar region of the mandible. They are often associated with the crowns of unerupted teeth and occasionally may take the place of a tooth. For these reasons they may be discovered, when small, as incidental findings when investigating a patient with a tooth missing from the dental arch. As the lesion enlarges it usually presents as a painless, slow-growing expansion of the jaw, but may become infected and present with pain, particularly if it communicates with the mouth. Multiple odontomas are rare.

Radiographically, a fully formed complex odontoma appears as a radiopaque lesion, sometimes with a radiating structure, but in the developing stages it shows as a well-defined radiolucent lesion in which there is progressive deposition of radiopaque material as calcification of the dental tissues proceeds. The mature lesion is surrounded by a narrow radiolucent zone analogous to the pericoronal space around unerupted teeth.

Histologically, the fully developed complex odontoma consists of a mass of disorderly arranged, but well-formed enamel, dentine, and cementum. Dentine forms the bulk of the lesion and, on surfaces not covered by enamel or cementum, is in contact with tissue resembling the normal pulp. In decalcified sections, the areas occupied by enamel appear as empty spaces except where enamel maturation is incomplete when the spaces contain remnants of enamel matrix with a fibrillar appearance. The developing complex odontoma will contain varying amounts of soft tissue which include odontogenic epithelium and mesenchyme, and structures resembling enamel organs. Developing lesions show histological features of all stages in odontogenesis and may be difficult to differentiate from ameloblastic fibroma and ameloblastic fibro-odontoma. [10]

The treatment of choice is surgical excision. In general, the prognosis of these tumors is very favorable, with a scant tendency toward relapse.

   References Top

1.King N, Wu I.The management of impacted teeth due to an odontoma. Dent Asia 2002:18-23.  Back to cited text no. 1
2.Shafer WG, Hine MK, Levy BM. Cysts and tumours of odontogenic origin. In A Textbook of Oral Pathology. 4 th ed. Philadelphia: W. B. Saunders Company; 2000. p. 258-317.   Back to cited text no. 2
3.Lopez-Areal L, Silvestre Donat F, Gil Lozano J. Compound odontoma erupting in the mouth: 4- year follow-up of a clinical case. J Oral Pathol Med 1992;21:285-8.  Back to cited text no. 3
4.Iwamoto O, Harada H, Kusukawa J, Kameyama T. Multiple odontomas of the mandible: A case report. J Oral Maxillofac Surg 1999;57:338-41.  Back to cited text no. 4
5.Reichart PA, Philipsen HP. Complex odontoma. In Odontogenic tumours and allied lesions. Chicago: Quintessence Pub. Co. Ltd. 2004. p. 141-9.   Back to cited text no. 5
6.Gurdal P, Sectin T. Odontomas. Quintessence Int 2001;32:336-7.  Back to cited text no. 6
7.Bhaskar SN. Odontogenic tumours of the jaws. In Synopsis of Oral Pathology 7 th ed. New York: CBS Publishers and Distributors; 1990. p. 260-308.   Back to cited text no. 7
8.Garvey MT, Barry HJ, Blake M. Supernumerary teeth - An overview of classification, diagnosis and management. J Can Dent Assoc 1999;65:612-6.   Back to cited text no. 8
9.Cawson and Odell. Odontogenic tumours and tumour like lesions of the jaws. In Essentials of Oral Pathology and Oral Medicine. 6 th ed. Philadelphia: Churchill Livingstone; 1998. p. 136-55.  Back to cited text no. 9
10.Soames JV, Southam JC. Odontomes and Odontogenic Tumours.In Oral Pathology. 4 th ed. Oxford: Oxford University Press; 2005. p. 221-38.  Back to cited text no. 10


  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10]

This article has been cited by
1 Erupting Compound Odontome - A Case Report
Shreyas N. Shah, Falguni Patel
Journal of Evolution of Medical and Dental Sciences. 2021; 10(18): 1361
[Pubmed] | [DOI]
Atatürk Üniversitesi Dis Hekimligi Fakültesi Dergisi. 2021; : 1
[Pubmed] | [DOI]
3 Comprehensive treatment of a child with an extensive composite odontoma
I.V. Fomenko, A.L. Kasatkina, E.V. Filimonova, D.V. Mel’nikova
Stomatologiya. 2020; 99(4): 67
[Pubmed] | [DOI]
4 Jaw lesions associated with impacted tooth: A radiographic diagnostic guide
Hamed Mortazavi,Maryam Baharvand
Imaging Science in Dentistry. 2016; 46(3): 147
[Pubmed] | [DOI]
5 Compound Odontoma associated with Maxillary Canine: A Case Report
Eby Aluckal, Eldhose K George, Sanju Lakshmanan, Shilpa Chikkanna, Abraham Kunnilathu
Journal of Scientific Dentistry. 2016; 6(2): 46
[Pubmed] | [DOI]
6 Odontoma associated with impacted mandibular canine: surgically guided eruption
Murilo Maia NASCIMENTO,Carolina Medeiros de ALMEIDA,Cassiano Francisco Weege NONAKA,Tony Santos PEIXOTO,Ana Flávia GRANVILLE-GARCIA,Edja Maria Melo de Brito COSTA
RGO - Revista Gaúcha de Odontologia. 2016; 64(2): 198
[Pubmed] | [DOI]
7 Surgical Management of Compound Odontoma Associated with Unerupted Tooth
Andrea Pacifici,Daniele Carbone,Roberta Marini,Luciano Pacifici
Case Reports in Dentistry. 2015; 2015: 1
[Pubmed] | [DOI]
8 Eruption of Odontomas into the Oral Cavity: A Report of 2 Cases
Sreenivasan Bhargavan Sarojini,Ektah Khosla,Thomas Varghese,Leena Johnson Arakkal
Case Reports in Dentistry. 2014; 2014: 1
[Pubmed] | [DOI]
9 The usefulness of cone beam computed tomography for treatment of complex odontoma
T. Y. Kobayashi,C. V. Gurgel,A. L. Cota,D. Rios,M. A. A. Machado,T. M. Oliveira
European Archives of Paediatric Dentistry. 2013; 14(3): 185
[Pubmed] | [DOI]
10 Compound odontoma—Case report
Helena Salgado,Pedro Mesquita
Revista Portuguesa de Estomatologia, Medicina Dentária e Cirurgia Maxilofacial. 2013; 54(3): 161
[Pubmed] | [DOI]
11 Odontoma: a retrospective study of 73 cases
Seo-Young An,Chang-Hyeon An,Karp-Shik Choi
Imaging Science in Dentistry. 2012; 42(2): 77
[Pubmed] | [DOI]


    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Add to My List *
* Registration required (free)  

  In this article
    Case Report
    Article Figures

 Article Access Statistics
    PDF Downloaded436    
    Comments [Add]    
    Cited by others 11    

Recommend this journal