Tratamento de odontoma composto e cisto dentígero: relato de caso / Treatment of compound odontoma and dentigeral cyst: case report

Introdução: o odontoma é considerado como um frequente tumor odontogênico benigno, podendo ser classificado em tipo composto ou tipo complexo. O cisto dentígero é o mais comum entre os cistos odontogênicos de desenvolvimento, onde envolve a coroa da unidade dentária no nível da junção amelocementária. Há poucos estudos na literatura do encontro das duas lesões, acometendo o mesmo local na cavidade oral. O diagnóstico pode ser constituído por exame clínico e de imagem. Objetivo: apresentar um caso clínico de odontoma composto e cisto dentígero em região de parassínfise mandibular esquerda abordando as caraterísticas clínicas destas duas lesões e as adequadas formas de tratamento. Relato de caso: paciente do sexo masculino, 16 anos de idade, compareceu ao ambulatório do Centro Odontológico da Escola Bahiana de Medicina e Saúde Pública (Salvador, Bahia), portando encaminhamento de ortodontista, solicitando exodontia da unidade dentária 33 inclusa associada a um odontoma. Ao realizar exames físicos e imaginológicos detectou-se a hipótese diagnóstica de odontoma composto associado a unidade dentária, envolto em folículo pericoronário ou cisto dentígero. Foi realizada biópsia excisional das duas lesões e exodontia da unidade. A análise histopatológica confirmou o diagnóstico para odontoma composto associado a cisto dentígero na unidade 33. Ao acompanhamento de 03 meses, paciente apresentou neoformação óssea da região de parassínfise mandibular, mediante a análise de novos exames imaginológicos. Discussão: há poucos estudos na literatura da associação entre as duas lesões, porém relatos afirmam que o odontoma pode ser encontrado associado aos cistos odontogênicos. Por conta da falta de maiores estudos dessa associação, há escassez de recomendações terapêuticas de acordo com faixa etária e extensão do acometimento das lesões. Considerações finais: lesões comumente assintomáticas, tem o diagnóstico constituído por exame clínico e avaliação de exames de imagem(AU)

Introduction: odontoma is considered a frequent benign odontogenic tumor and can be classified as a compound or complex type. The dentigerous cyst is the most common among developmental odontogenic cysts, where it involves the crown of the dental unit at the level of the cementoenamel junction. There are few studies in the literature on the meeting of the two lesions, affecting the same site in the oral cavity. The diagnosis can be made by clinical and imaging examination. Objective: to present a clinical case of compound odontoma and dentigerous cyst in the left mandibular parasymphysis region, addressing the clinical characteristics of these two lesions and the appropriate forms of treatment. Case report: male patient, 16 years old, attended the outpatient clinic of the Centro Odontológico da Escola Bahiana de Medicina e Saúde Pública (Salvador, Bahia), having been referred by an orthodontist, requesting extraction of the included dental unit 33 associated with an odontoma. Upon physical and imaging examinations, the diagnostic hypothesis of a compound odontoma associated with a dental unit, surrounded by a pericoronal follicle or dentigerous cyst, was detected. Excisional biopsy of the two lesions and extraction of the unit were performed. The histopathological analysis confirmed the diagnosis of compound odontoma associated with dentigerous cyst in unit 33. At the 03-month follow-up, the patient presented bone neoformation in the mandibular parasymphysis region, through the analysis of new imaging exams. Discussion: there are few studies in the literature on the association between the two lesions, but reports state that odontoma can be found associated with odontogenic cysts. Due to the lack of further studies on this association, there is a lack of therapeutic recommendations according to age group and extent of lesion involvement. Final considerations: commonly asymptomatic lesions, the diagnosis consists of clinical examination and evaluation of imaging tests(AU)

Ocorrência simultânea de cisto dentígero e odontoma composto-complexo causando impacção dentária / Simultaneous occurrence of dentigerous cyst and compound-complex odontoma causing dental impaction

O presente trabalho ilustra e discute essa doença que representa o tumor odontogênico mais comum da prática clínica, o Odontoma. Para tal, apresenta um caso clínico com imagens clínicas e radiográficas esclarecedoras dos aspectos dessa doença, bem como discussão a partir de revisão narrativa de literatura direcionada para a carac-terização da doença. Relata-se o caso de um odontoma composto-complexo, uma forma incomum de odontoma, mas que mantém os demais aspectos usuais, sendo uma mulher de 21 anos com lesão radiopaca em maxila de-tectada devido à não erupção do 23. A remoção cirúrgica seguiu a partir de acesso anterior na maxila e o exame histopatológico mostrou os aspectos típicos de um Odontoma composto e complexo juntos. Independentemente da variante, nota-se que o Odontoma é quase sempre indolente, porém requer cuidados de remoção precoce devido à possibilidade de crescimento, de desenvolvimento de cistos e comprometimento de estruturas adjacentes devido a sua localização e possibilidade de crescimento (AU)

The present work illustrates and discusses this disease that represents the most common odontogenic tumor in clinical practice, the Odontoma. However, an unusual variation of the same is included here in the literature, char-acterized by the exams as a form of compound-complex odontoma additionally causing dentigerous cyst formation and dental impaction. The unusual case occurred in a 21-year-old woman, complaining of missing the tooth 23. The details of the exams allowed the visualization of compound and complex areas in the lesion, cystic formation and dental impaction. The histopathological findings confirmed the diagnosis of the Odontoma, and the interpreta-tion with the set of other exams led to the final diagnosis of Compound-complex odontoma with dentigerous cyst. The present case highlights the need for early removal of Odontoma due to the possibility of developing cysts, compromising adjacent structures, in addition to its growth potential already reported in the literature (AU)

Odontomas: un reto para el tratamiento interdisciplinario del paciente de ortodoncia / Odontomas: a challenge for the interdisciplinary treatment of the orthodontic patient

El objetivo del presente trabajo es describir las técnicas para el diagnóstico y tratamiento de 3 casos clínicos de odontoma en pacientes ortodóncicos. En el caso 1, se trató a un paciente masculino de 17 años, que acudió para interconsulta con el servicio de ortodoncia, ya que no había erupcionado el canino superior izquierdo y el primer premolar superior izquierdo. El estudio anatomopatológico reveló odontoma complejo con áreas pindborgoides y acumulación de células fantasma. En al caso 2 se trató a un paciente femenino de 15 años. El estudio anatomopatológico reveló odontoma complejo. En el caso 3, se trató a un paciente masculino de 28 años que acudió a rehabilitación integral de su boca, y fue derivado a la cátedra de ortodoncia. En la radiografía panorámica se observó una imagen compatible con odontoma. Se remitió una muestra a anatomía patológica que confirmó el diagnóstico de odontoma. Conclusión: el conocimiento adecuado de las características clínicas, radiológicas y patológicas es necesario para un correcto diagnóstico y tratamiento. Es importante el trabajo interdisciplinario ortodoncista - cirujano para tratar estos casos (AU)

The objective of this work is to describe the techniques for the diagnosis and treatment of 3 clinical cases of odontoma in orthodontic patients. In case 1, a 17-year-old male patient was treated who came for consultation with the orthodontic service, since the upper left canine and the upper left first premolar had not erupted. Pathological study revealed complex odontoma with pindborgoid areas and accumulation of ghost cells. In case 2, a 15-year-old female patient was treated. The anatomopathological study revealed a complex odontoma. In case 3, a 28-year-old male patient was treated who attended comprehensive rehabilitation of his mouth and was referred to the orthodontic department. In the panoramic radiography, an image compatible with odontoma was observed. A sample was sent to pathological anatomy, which confirmed the diagnosis of odontoma. Conclusion: Adequate knowledge of the clinical, radiological and pathological characteristics is necessary for a correct diagnosis and treatment. Interdisciplinary orthodontist-surgeon work is important to treat these cases (AU)

Impactación dentaria por odontoma compuesto: reporte de caso y revisión de literatura / Dental impactation caused by odontoma: case report and literature review

Resumen Actualmente los odontomas son los tumores odontogénicos más frecuentes. Son considerados hamartomas, compuestos por células epiteliales odontogénicas y mesenquimatosas diferenciadas, y muestra tejidos dentales en su estructura. Se presenta una revisión de la literatura seguido por un reporte de caso de un odontoma compuesto en el maxilar inferior de un paciente de 13 años asociado a la inclusión del segundo molar inferior derecho (4.7). Se realizó la exéresis del tumor y la correspondiente biopsia para confirmar el diagnóstico.

Abstract At present time odontomas are the most common odontogenic tumors. They are hamartomas, composed of epithelial odontogenic and mesenchymal cells, presenting dental tissue in their structure. A literature review followed by a case report are presented. The case report presents a compound odontoma in the inferior maxillary of a 13-year-old patient, associated with the inclusion of the second right inferior molar (4.7). The exeresis followed by the biopsy of the tumor were performed to confirm the clinical diagnosis.

Management of compound odontoma with guided bone regeneration: a case report

An odontoma is a mixed benign odontogenic tumor, being a hamartomatous neoplastic lesion of odontogenic epithelial and mesenchymal cells that form enamel, dentine and cement, which occurs in the second to third decade of life, and is commonly a radiographic finding. The aim of this paper is to describe the management of a compound odontoma with guided bone regeneration. A 20-year-old asymptomatic male patient with no relevant surgical medical history underwent surgery for the enucleation of a compound odontoma followed by guided bone regeneration of the defect, and histopathological study of the specimen. The evolution was favorable, without any sign of recurrence. It is important to carry out a previous surgical plan, taking into account the size of the defect resulting from its enucleation, assess the need for guided bone regeneration and use complementary diagnostic resources for a satisfactory recovery.

Odontoma compuesto. presentación de un caso / Odontoma compound. presentation of a case

Se presentó el caso clínico de un niño de 8 años de edad, que acude a consulta de Estomatología del Policlínico "Mártires de Jamaica", del municipio Manuel Tames, de la provincia Guantánamo, acompañado de la madre preocupada por la no erupción del diente 21. Al examen clínico se observó ausencia clínica del 21 con espacio para su ubicación con ligero aumento de volumen en el fondo del surco vestibular a nivel de la zona de consistencia dura a la palpación. Se indicó radiografía panorámica observándose imagen radiolúcida con numerosas formaciones radioopacas en su interior que asemejan estructuras dentarias y una banda radiolúcida en su periferia que presuntivamente se diagnosticó como un odontoma compuesto, se remite al segundo nivel de atención para excéresis y diagnóstico definitivo. Se discuten algunas características de su etiología, diagnóstico y tratamiento(AU)

It was presented the clinical case of an 8-year-old boy, who was attended in the clinic of "Mártires de Jamaica" Polyclinic, in Manuel Tames municipality of Guantanamo province, accompanied by the mother concerned about the non-eruption of tooth 21 .On clinical examination, was observed absence of tooth 21 with space for its location with slight increase in volume at the bottom of the vestibular sulcus at the level of the area hard to palpation. Panoramic x-ray is indicated, with a radiolucent image with numerous radio opaque formations that resemble dental structures and a radiolucent band in its periphery presumptively diagnosed as a compound odontoma. It is referred to the second level of attention for excresis and definitive diagnosis. Some characteristics of its etiology, diagnosis and treatment were discussed(AU)

Odontoma Compuesto: Diagnóstico y Tratamiente Reporte de Casos & Revisión de la Literatura / Compound Odontoma: Diagnosis and Treatment Therapeutic Measures. Case Reports & Literature Review

RESUMEN: Los odontomas son los tumores odontogénicos benignos más prevalentes. Estos están conformados por tejido dentario, epitelio odontogénico y tejido mesenquimático. Se dividen en dos subtipos: odontomas compuestos, que presentan tejidos dentarios normales, pero con una alteración en su conformación y tamaño, y odontomas complejos, que presentan tejidos dentarios bien formados, pero rodeados de tejido desorganizado. Se presentan tres casos de pacientes sexo femenino, quienes acuden para evaluación y tratamiento debido al hallazgo radiográfico de odontoma compuesto. En el caso nº 1 se realizó la desinclusión del diente impactado, la exodoncia del diente remanente, la exéresis del odontoma compuesto, la instalación de un implante dental en el alveolo de la zona intervenida y, finalmente, el posicionamiento de injerto óseo. En el caso nº 2 se realizó la exodoncia del diente temporal remanente y la exéreis del odontoma compuesto. Ambos casos evolucionaron de manera favorable sin complicaciones post operatorias. En el caso nº 3 se realizó la fenestración del diente 18 y la exéreis del odontoma compuesto que retenía su erupción. Todos los casos evolucionaron de manera favorable sin complicaciones post operatorias. Dada la prevalencia de esta patología, es necesario un adecuado conocimiento sobre ella y sus características, para realizar un adecuado diagnóstico y tratamiento. Existen distintas medidas terapéuticas respecto a la rehabilitación de una zona edéntula como resultado de la exéresis de estos tumores. Esto depende principalmente de la edad del paciente. Al ser requeridas medidas rehabilitadoras, un punto importante a considerar es la posibilidad de realizar todos los procedimientos quirúrgicos en un solo tiempo operatorio.

ABSTRACT: Odontomas are the most common benign odontogenic tumors and are composed of dental tissue, odontogenic epithelium and mesenchymal tissue. They are divided into two subtypes: Compound odontomas, which present normal tooth tissue, but an alteration in their conformation and size, and complex odontomas, which present well-formed tooth tissue, but are surrounded by disorganized tissue. A bibliographic review was performed by one operator in Pubmed and Epistemonikos. After filtering by title and abstract, only one systematic review was selected. We present two clinical cases of compound odontoma in female patients at the Military Hospital in Santiago. Patients were referred for evaluation and treatment due to the radiographic finding of compound odontoma. In case # 1, the impacted tooth was disincluded, the remaining temporal tooth was extracted, and excision of the compound odontoma carried out; subsequently a bone graft implant was placed in the remaining socket. In case # 2, the remaining temporal tooth was extracted and compound odontoma excised. After that, natural eruption of the corresponding permanent tooth is expected. In case # 3, tooth 1.8 fenestration and excision of compound odontoma was performed. In this case also, natural eruption of the corresponding permanent tooth is expected. Given the prevalence of this pathology, adequate knowledge of compound odontomas and their characteristics is necessary for proper diagnosis and treatment. There are different therapeutic measures for the rehabilitation of an edentulous area following excision of compound odontoma. This depends mainly on the age of the patient. When rehabilitation measures are required, an important aspect to consider for the patient, is the possibility of a single surgical event, as was done in case # 1.

Diagnóstico precoz y tratamiento oportuno del odontoma compuesto en un niño Peruano de 3 años / Early diagnosis and timely treatment of composite odontoma in a peruvian child of 3 years

Los odontomas son los tumores odontogénicos benignos y asintomáticos más comunes en los maxilares. Generalmenteel diagnóstico y tratamiento ocurren entre la segunda y tercera década de la vida. El propósito del caso que presentamo sexplica que el diagnóstico precoz se puede obtener desde los primeros años de vida con la interpretación de los antecedentes anamnésicos, la evaluación clínica y radiográfica oportuna para realizar el tratamiento temprano de los odontomas, con el objetivo de evitar en los pacientes complicaciones y secuelas a futuro como la retención dentaria, reabsorción o dilaceración radicular, expansión ósea, formación quística y sus recurrencias.

Odontomas are the most common benign and asymptomatic benign tumor in the maxillaries. Diagnostic and treatment generally occur from the second decade of life. The purpose of the case presented explains the historical background,timely clinical and radiographic evaluation allow to obtain early diagnostics and therefore realize early treatment of odontomas, with the objetive to avoid future complications and aftermaths in patients as dental retention, root reabsorptionand dilacerations, bone expansion, cyst formation and recurrence.

Odontoma complejo erupcionado: reporte de un caso / Erupting complex odontoma: a case report

Los odontomas están compuestos de esmalte, dentina, cemento y tejido pulpar. Histológicamente se clasifican en 2 grupos: compuestos y complejos, mientras que clínicamente se clasifican en 3 tipos: odontoma central (intraóseo), odontoma periférico (extraóseo o de los tejidos blandos) y odontoma erupcionado. Epidemiológicamente son reportados como los tumores odontogénicos más frecuentes, sin embargo la erupción de este tipo de lesión es poco común, produciéndose en el 1,6% de los casos. Por lo general son asintomáticos, siendo comúnmente un hallazgo radiográfico, y en algunos casos pueden estar asociados con alteraciones de la erupción dentaria. Este estudio corresponde a un caso clínico de un odontoma complejo de gran tamaño que erupciona en la cavidad oral asociado a un molar retenido.

Odontomas consist of enamel, dentin, cementum, and pulp tissue. Histologically, they are classified into 2 groups: compounds and complexes. They are also clinically classified into 3 types: Central odontoma (intraosseous), peripheral odontoma (extraosseous or soft tissue odontoma) and erupted odontoma. Epidemiologically they are reported as the most frequent odontogenic tumor, however, the eruption of this type of lesion is rare, and odontoma occurs only in 1.6% of cases.

Ameloblastic Fibrodentinoma: A 12 Years follow-up of a Rare Entity.

Ameloblastic fibrodentinoma (AFD), according to the WHO is a neoplasm similar to ameloblastic fibroma, but also showing inductive changes that lead to the formation of dentine. AFD is a very rare odontogenic mixed tumor and only <40 cases have been reported so far. The origin, like other mixed odontogenic tumors is from the odontogenic apparatus. Two schools of thought exist, one to consider it as a variant of ameloblastic fibroodontoma and the other categorize it as a separate entity. An AFD in an 1½-year-old male patient with 12-year follow-up after treatment is presented.

Estudo clinicopatológico retrospectivo dos casos de tumores odontogênicos diagnosticados no Serviço de Patologia Cirúrgica da FOUSP no período de 1957 a 2012 / Retrospective clinicopathological study of cases of odontogenic tumors diagnosed in the FOUSP Surgical Pathology Service in 1957 and 2012

Os tumores odontogênicos formam um grupo complexo de lesões, de comportamento clínico variado e encontrado exclusivamente na região bucomaxilofacial. Originam-se a partir das células que normalmente teriam a função de formar o dente, processo esse denominado odontogênese, que tem seu início entre a sexta e a sétima semanas de vida intrauterina. O objetivo deste trabalho foi realizar um estudo clinicopatológico de tumores odontogênicos diagnosticados no Serviço de Patologia Cirúrgica da Faculdade de Oodontologia da Universidade de São Paulo de 1957 a 2012. Foram compilados das fichas de requisição de exames e/ou prontuários dados referentes ao sexo, idade no momento do diagnóstico, cor da pele (branca, negra, ou outras), sintomatologia, tamanho da lesão, duração, localização anatômica, aspectos radiográficos, diagnóstico clínico e histopatológico. Os casos diagnosticados como tumores odontogênicos foram revisados, por um examinador previamente calibrado, com o objetivo de reclassificação das lesões conforme proposição atual da Organização Mundial da Saúde em 2005. Todos os dados obtidos foram inseridos e tabulados no Microsoft Office Excel 2013 e analisados no software BioEstat 5.0. Medidas de frequência central e de dispersão foram obtidas e os resultados apresentados em forma de tabelas e gráficos. Na análise estatística, foi empregado o teste Z de duas proporções com nível de significância de 5%. No período compreendido de 01 de janeiro de 1957 a 31 de dezembro de 2012, foram diagnosticados 2.114 casos de tumores odontogênicos.

Do total de casos diagnosticados, 75 casos foram retirados da análise, pois representavam a mesma lesão em diferentes momentos. Portanto, 2.039 casos de tumores odontogênicos foram incluídos e, após revisão dos casos e reclassificação diagnóstica dos tumores odontogênicos, os 2.039 casos foram agrupados em 16 tipos histológicos diferentes, entre os quais 2.029 (99,51%) eram benignos e 10 (0,49%) malignos. De uma maneira geral, os tumores odontogênicos afetam pacientes na segunda e terceira décadas de vida, sem predileção por sexo, apresentam-se menores do que 1cm de diâmetro e são diagnosticados, em média, 2 anos após seu surgimento. A maioria das lesões acometem a região posterior da mandíbula, com exceção do odontoma e tumor odontogênico adenomatóide, e apresentam aspecto radiográfico radiolúcido inespecífico, o que dificulta um diagnóstico preciso sem a avaliação anatomopatológica.

Odontogenic tumors are a complex group of lesions, varied clinical behavior and found exclusively in the oral and maxillofacial region. Originate from cells that would normally have the function of forming the tooth, a process called odontogenesis, which begins between the sixth and seventh weeks of intrauterine life. The aim of this study was a clinicopathological study of odontogenic tumors diagnosed in Surgical Pathology Service of Oodontologia of the University of São Paulo from 1957 to 2012 were compiled from surveys of request forms and / or records data on gender, age at diagnosis, skin color (white, black, or other), symptoms, lesion size, duration, anatomic location, radiographic findings, clinical and histopathological diagnosis. The cases diagnosed as odontogenic tumors were reviewed by a calibrated examiner, in order to reclassify injuries as current proposition of the World Health Organization in 2005. All data were entered and tabulated in Microsoft Office Excel 2013 and analyzed in software BioEstat 5.0. Central frequency and dispersion measurements were obtained and the results presented in tables and graphs. In the statistical analysis, we used the Z test for similar proportions with 5% significance level. In the period of January 1, 1957 to December 31, 2012 were diagnosed 2,114 cases of odontogenic tumors. Of all diagnosed cases, 75 cases

were removed from the analysis because they represented the same injury at different times. Therefore, 2,039 odontogenic tumors were included and, after review of the cases and diagnostic reclassification of odontogenic tumors, 2,039 cases were grouped into 16 different histological types, including 2 029 (99.51%) were benign and 10 (0, 49%) malignant. In general, the odontogenic tumors affect patients in the second and third decades of life, with no gender preference, are presented less than 1cm in diameter and are diagnosed on average two years after its inception. Most injuries involve the posterior mandible, except for the odontoma and adenomatoid odontogenic tumor, and feature radiolucent radiological findings nonspecific, which hinders accurate diagnosis without pathological assessment.

Compound Odontoma Associated with Impacted Teeth: A Case Report.

Odontomas are developmental anomalies of the dental tissues and may interfere with the eruption of the associated tooth. Since, these lesions are asymptomatic, they are usually detected in routine radiographs only. Early diagnosis, prompt clinical decision making followed by a proper treatment at the right time, results in a favorable prognosis. The present report describes the surgical management of a case of compound odontoma in 11-year-old boy who presented with a complaint of missing tooth in maxillary anterior region. After the lesion was surgically removed under local anesthesia, histopathological examination confirmed the diagnosis of compound odontoma. The related literature is also reviewed in this article.

Impactación por odontoma en asociación con alteración de la fórmula dentaria / Impaction caused by odontoma associated with altered dental formula

Los odontomas son entidades odontogénicas mixtas, compuestas por una mezcla de células odontogénicas epiteliales y mesenquimatosas diferenciadas. Por lo inusual del hecho el objetivo de nuestro trabajo fue presentar un caso de asociación de impactación dentaria por un odontoma con la alteración de la fórmula dental. Se trata de un paciente masculino de 26 años, que acudió a la consulta externa de Cirugía Maxilofacial refiriendo dolor. Al examen físico se detectó asimetría facial por aumento de volumen duro elástico del tercio facial inferior derecho. Al examen físico bucal se observó persistencia del 65 y 85, ausencia clínica del 15, 47 y 48 con expansión de las corticales vestibular y lingual en región mandibular posterior derecha (región molar y retromolar) y presencia de una apertura en la mucosa de aproximadamente 8 mm por distal del 46, en la cima del reborde alveolar, de forma redondeada. En el estudio ortopantomográfico se visualizó una imagen radiopaca irregular en sus bordes, de 3 cm, asociada a la oligodoncia del 48 e impactación del 47, por lo que se decidió realizar la exéresis quirúrgica de la lesión conjuntamente con el 47, indicándose estudio histopatológico que confirmó la presencia de un odontoma complejo con áreas de tejido blando periférico que mostraban inflamación crónica. El paciente se mantiene bajo seguimiento clínico e imagenológico en su tercer mes postoperatorio. El objetivo de nuestro trabajo fue presentar un caso de asociación de impactación dentaria por un odontoma con la alteración de la fórmula dental(AU)

The mixed odontogenic odontomas are entities composed of a mixture of differentiated odontogenic epithelial and mesenchymal cells. The objective of this paper was to presente an unusual case of association of dental impaction caused by odontoma and altered dental formula. A male patient aged 26 years, who felt pain, attended the outpatient Oral and Maxillofacial Surgery service. The physical examination found facial asymmetry with facial hard elastic augmentation in the right facial lower third. The Intraoral physical examination showed persistence of oral 65th and 85th , clinical absence of 15th , 47th and 48th with expansion of the vestibular and lingual cortices in the right posterior mandibular area (retromolar and molar regions) and presence of rounded mucosal opening about 8 mm distal to the 46th , on top of the alveolar ridge. In the orthopantomographic study, a ± 3cm radiopaque image with irregular edges, associated with oligodontia of the 48th and impaction of the 47th , were observed. It was decided to surgically remove the lesion together with the 47th and to indicate histopathological study. It was confirmed that the patient had a complex odontoma with peripheral soft tissue areas that showed chronic inflammation. The patient is still followed-up from the clinical and imaging viewpoints after three months of surgery(AU)

Giant complex odontoma of the anterior mandible: report of case with long follow up

This paper describes an exceptional case of an enormous complex odontoma affecting the mandibular symphysis of a 9-year-old boy. Because of its dimensions, the lesion produced cortical bone expansion, dental displacement and impactation, which are clinical signs very seldom described for odontomas. The lesion was surgically excised in a conservative way using an intraoral approach with local anesthesia. After 7 years of follow up, all teeth had erupted and the mandibular bone healed totally. Because of its radiographic mixed radiolucent and radiopaque appearance and its expansive growth, it is imperative to make the differential diagnosis of giant complex odontoma for other more aggressive mixed odontogenic tumors, such as ameloblastic fibro-odontoma, odotoameloblastoma and cystic calcified odontogenic tumor. Conservative approach appears to be indicated in the treatment of such lesions.

Descrevemos um caso excepcional de um odontoma complexo gigante afetando a sínfise mandibular em um menino de nove anos de idade. Devido à sua dimensão esta lesão produziu expansão da cortical óssea, deslocamento dentário e impactação, sinais clínicos muito raramente descritos para odontomas. A lesão foi extirpada cirurgicamente de forma conservadora, utilizando uma abordagem intra-oral com anestesia local. Depois de sete anos de seguimento todos os dentes se encontram erupcionados e o osso mandibular totalmente curado. Devido à sua aparência radiográfica, mista radiolúcida e radiopaca, e seu crescimento expansivo, é imperativo fazer o diagnóstico diferencial de odontoma complexo gigante para outros tumores odontogênicos mistos mais agressivos, como o fibro-odontoma ameloblástico, odotoameloblastoma e tumor odontogênico cístico calcificante. Uma abordagem conservadora parece ser indicada no tratamento dessas lesões.

Ameloblastic fibro-odontoma masquerading as odontoma.

Ameloblastic fibro-odontoma (AFO) is a rare, benign epithelial mixed odontogenic tumor. It occurs as an intraosseous lesion, generally asymptomatic and more prevalent in children and adolescent. AFO is found on radiographic evaluation of patients with unerupted or impacted teeth in many cases. Histological examination reveals a fibrous soft tissue, islands of odontogenic epithelium and a disordered mixture of dental tissues. The treatment modality in most cases involves conservative surgery with enucleation. We present a case of 13-year-old boy with a missing right central incisor, mimicking-like odontoma on radiograph but proved to be AFO and treated with enucleation with preservation of impacted tooth. There was no recurrence after one year of follow-up. This report discusses the clinical, radiographical, histological features and surgical assessment to preserve the impacted tooth associated with AFO.

Extensive complex odontoma in the maxillary sinus: an uncommon presentation as a cause of chronic sinusitis / Extenso odontoma complexo em seio maxilar: uma apresentação incomum como causa de sinusite crônica

PURPOSE: This study reports a case of a extensive odontoma causing maxillary sinusitis. CASE DESCRIPTION: A 25-year-old man at clinical examination revealed discrete facial asymmetry and exposure of the lesion in the oral cavity. Imaging exams showed the presence of a well-defined radiopaque mass in the left maxilla, measuring approximately 7 cm and was intimately associated with the maxillary sinus and oral cavity. The mass was excised through an intraoral access under general anesthesia in the hospital and sent for histopathology, which was diagnosed as complex odontoma. The patient is under clinical follow-up and shows no signs of maxillary sinusitis and no oral sinus fistula. CONCLUSION: The odontoma is a common injury in clinical dentistry, but in some aggressive cases may cause sequelae in the patient, thus, caution the dentist for proper diagnosis and treatment.

OBJETIVO: Este estudo relata a apresentação de um extenso odontoma causando sinusite maxilar. DESCRIÇÃO DO CASO: Um homem de 25 anos ao exame clínico revelou assimetria facial discreta e exposição da lesão na cavidade oral. Os exames de imagem mostraram a presença de uma massa radiopaca bem definida na maxila esquerda, medindo aproximadamente 7 cm e estava intimamente associado com o seio maxilar e a cavidade oral. A massa foi extirpada através de um acesso intra-oral, sob anestesia geral em ambiente hospitalar e enviada para estudo histopatológico, onde foi diagnosticada como odontoma complexo. O paciente está sob acompanhamento clínico e não mostra sinais de sinusite maxilar e fístula bucossinusal. CONCLUSÃO: O odontoma é uma lesão comum na clínica odontológica, mas pode, em alguns casos, se apresentar de forma agressiva levando a danos ao paciente, e desta forma, é necessária atenção do cirurgião dentista para o correto diagnóstico e tratamento.

Ameloblastic fibro-odontoma of the anterior mandible in a 22-month-old boy.

We report an ameloblastic fibro-odontoma (AFO) presenting in the anterior mandible as a "bump on his gums" in a 22-month-old boy. An occlusal radiograph revealed a well-circumscribed radiolucency with scattered radiopaque foci. The tumor was enucleated under general anesthesia. The histologic findings were characteristic of an AFO, a mixed odontogenic tumor most common in the posterior jaws, primarily affecting individuals with an average age of 10 years. The clinical presentation, microscopic findings, differential diagnoses, and treatment are discussed.

Estudio clínico patológico de odontomas en una muestra de la población brasilera en un período de 15 años / Odontomas clinicopathological study in a sample of the brazilian population over a period of 15 years

Los odontomas son considerados el tipo más común de tumores odontogénicos, generalmente observados en exámenes radiográficos, siendo esa, la base de diagnóstico de muchos estudios. El objetivo del presente tarbajo fue la realización de un análisis retrospectivo descriptivo en el periodo comprendido entre enero de 1992 a enero de 2007 a partir de estudios anatómico-patológicos. Fueron evaluados 238 casos de tumores odontogénicos, de los cuales 44% eran odontomas. Los resultados demostraron que 68,52% de los casos ocurrieron en el género femenino, siendo la 1ª y 2ª décadas de vida las más prevalentes (46,3%). La mayoría de los casos (81,48%) se mostró asintomático, con una discreta predilección por el maxilar (57,41%). El tipo compuesto fue más frecuente que el complejo, con 53,7% y 46,3% de los casos, respectivamente. El presente estudio fue basado en diagnóstico anatomo-patológico, diferenciándose así de estudios ya publicados, que se basan en análisis radiográficos. A pesar de las diferencias entre los estudios sobre género, edad, extensión, localización y síntomas, varias similitudes fueron observadas. Nuevos estudios retrospectivos en diferentes poblaciones son necesarios para promover una mejor comprensión de los odontomas

Odontomas are considered the most common type of odontogenic tumors, usually observed in radiographic examination, which is the basis of diagnosis in many studies. The authors performed a descriptive retrospective analysis in the period from January 1992 to January 2007 from the Pernambuco University Oral Pathology Laboratory's records. Two hundred and thirty eight cases of odontogenic tumors were registered, in which 44% were odontomas. Results showed that 68.52% of the cases were female, with 1st and 2nd decades of life being most prevalent (46.3%). The majority of the cases (81.48%) were asymptomatic, with a discreet predilection to the maxilla (57.41%). The compound type was more frequent than the complex, with 53.7% and 46.3% of the cases, respectively. The present study was based in histological diagnosis, differently from other already published studies, which were based in radiographic analysis. In spite of the differences between the studies in gender, age, extension, location and symptoms, several similarities were observed. New retrospective studies in different populations are necessary in order to provide a better understanding of odontomas

Fibroodontoma ameloblástico: revisión de la literatura y reporte de dos casos / Ameloblastic fibroodontoma

El fibroodontoma ameloblástico (FOA) es una neoplasia benigna poco frecuente, con crecimiento lento y expansivo. Se presentan dos casos diagnosticados por hallazgo durante un examen radiográfico efectuado por retraso de la erupción dentaria, en los que se aplicaron diferentes criterios de tratamiento quirúrgico. Se revisan las características clínicas y anatomopatológicas de esta rara entidad.

The Ameloblastic Fibroodontoma is an unfrequent benign neoplasma characterized by slow growth and swallowing. This report describes two cases diagnosed during a radiographicexam conducted by delayed tooth eruption. In these cases, different surgical treatments were applied, with satisfactory final results in both. The clinical and pathological features of thisrare entity are revised.

Contribuição da tomografia computadorizada por feixe cônico (cone beam) no diagnóstico e plano de tratamento do odontoma complexo / Cone beam computed tomography contribution in the diagnosis and treatment of the complex odontoma

O presente trabalho apresenta o caso de uma paciente encaminhada à clínica de Estomatologia para avaliação de uma lesão intraóssea na maxila. Graças aos exames tomográficos computadorizados por feixe cônico (cone beam), observou-se uma extensa área hiperdensa, de evolução indeterminada, na região posterior de maxila do lado esquerdo. O diagnóstico presuntivo foi de odontoma complexo. O exame microscópico revelou presença de conglomerado irregular de esmalte, dentina, cemento e tecido pulpar. O diagnóstico final foi de odontoma complexo. A paciente encontra-se em proservação de 6 meses, sem sinais clínicos e radiográficos de recidiva.