Odontoma mandibular inusual y su resolución: reporte de un caso / Unusual mandibular odontoma and its resolution: report of a case

Objetivo: El odontoma es una lesión hamartomatosa benigna formada por tejido dentario (cemento, esmalte, pul­ pa). Según su grado de diferenciación podrá ser clasificado en sus dos variantes: compuesto y complejo en una relación 2:1. El objetivo de este artículo es presentar un odontoma mixto de gran tamaño de localización mandibular y su resolución quirúrgica. Caso clínico: Se describe el caso de un paciente mascu­ lino de 16 años de edad, portador de ortodoncia, que presenta un odontoma mixto de gran tamaño de localización mandibular y su resolución quirúrgica utilizando planificación 3D y confección de placa de titanio customizada (AU)

Aim: Odontoma is a benign hamartomatous lesion formed by dental tissue (cementum, enamel, pulp). According to its degree of differentiation, it can be classified in its two variants: compound and complex in a 2:1 ratio. The objective of this article is to present a large mixed odontoma of mandi­ bular location and its surgical resolution. Clinical case: A 16-year-old male patient with ortho­ dontics, who presents a large mixed odontoma with mandibu­ lar location and its surgical resolution using 3D planning and customized titanium plate fabrication (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)

Fibro-odontoma ameloblástico: reporte de un caso / Ameloblastic fibro-odontoma: a case report

Objetivo: Presentar el caso de una patología poco común como es el fibro-odontoma ameloblástico (FOA), su manejo interdisciplinario y su resolución quirúrgica. Caso clínico: En este reporte de caso describimos un FOA en una paciente de 10 años, ubicado en el cuerpo mandibular derecho, asociado a las raíces de molares temporales que generó la retención de premolares. Se realizó la enucleación completa de la lesión, exodoncia de los temporales asociados y se decidió mantener los dientes definitivos y esperar su erupción espontánea. Es importante considerar la posibilidad de mantener el diente retenido si este no dificulta la exéresis de la lesión, ya sea para su erupción espontánea o rescate ortodóntico, lo cual es posible observar en este caso en el que se aprecia una evolución intraósea favorable. Con respecto al seguimiento, se recomienda el control a largo plazo con el fin de controlar la erupción del órgano dentario o la aparición de posibles recidivas (AU)

Aim: To present a clinical case of a rare pathology, the ameloblastic fibro odontoma (AFO), its interdisciplinary management and its surgical resolution. Clinical case: In this case report we describe an AFO in a 10-years-old patient, localized in the right hand side of the body of the mandible, associated with the roots of temporary molars that generated the retention of the premolars. Complete enucleation of the lesion and the extraction of the associated temporary molars were performed. It was decided to keep the permanent teeth and to wait for their spontaneous eruption. It is important to consider the possibility of keeping the retained teeth if it does not hinder the excision of the lesion, either for its spontaneous eruption or orthodontic rescue, which is possible to see in this case, in which a favorable intraosseous evolution is appreciated. With regard to follow-up, long-term monitoring is recommended in order to control the eruption of the dental organ or the appearance of possible recurrences (AU)

Diagnosis of ameloblastic fibro-odontoma: case report / Diagnóstico de fibro-odontoma ameloblástico: relato de caso

Objective: the present report describes the clinical, radiographic, and histopathological features of an ameloblastic fibro-odontoma (AFO) lesion. Case report: we report a clinical case of a 14-year-old boy with asymptomatic edema. Panoramic radiography detected a unilocular lesion with defined margins located in the posterior region of the mandible. The internal structure of the lesion presented several degrees of radiopacity with the involvement of the third molar. Cone-beam computed tomography revealed expanded buccal and lingual cortical bones, perforation of the lingual cortical bone, and displacement of the mandibular canal. AFO was suspected based on the radiographic and clinical characteristics. Total excision was performed and histologically examined, confirming the diagnosis of AFO. No recurrence occurred during a 24-month follow-up period. Final considerations: the evaluation of the clinical, radiographic, and histopathologic findings needs to be accurate for a correct diagnosis and appropriate treatment for case of AFO since the presentation is often asymptomatic.(AU)

Objetivo: o presente relato descreve as características clínicas, radiográficas e histopatológicas de uma lesão de fibro-odontoma ameloblástico (FOA). Relato de caso: relatamos o caso clínico de um menino de 14 anos com edema assintomático. A radiografia panorâmica detectou lesão unilocular com margens definidas e localizada na região posterior da mandíbula. A estrutura interna da lesão apresentava vários graus de radiopacidade com envolvimento do terceiro molar. A tomografia computadorizada de feixe cônico revelou as corticais ósseas vestibular e lingual expandidas, perfuração da cortical óssea lingual e deslocamento do canal mandibular. FOA foi a hipótese diagnóstica com base nas características radiográficas e clínicas. A excisão total foi realizada e examinada histologicamente, confirmando o diagnóstico de FOA. Nenhuma recorrência ocorreu durante um período de acompanhamento de 24 meses. Considerações finais: a avaliação das características clínicas, radiográficas e histopatológicas contribuíram para um diagnóstico correto e o tratamento adequado para o caso de FOA, uma vez que a lesão é frequentemente assintomática.(AU)

Compound odontoma causing impaction of primary tooth in a 4-year-old child: case report / Impacção de dente decíduo por presença de odontoma composto em criança de 4 anos: relato de caso

Objetivo: relatar um caso raro de impacção de um incisivo decíduo inferior pela presença de odontoma composto, bem como descrever a sua abordagem clínica. Relato de caso: paciente do sexo masculino, com 4 anos de idade, apresentava ausência do incisivo lateral decíduo inferior esquerdo. O exame radiográfico mostrou impacção do incisivo não erupcionado próximo a estruturas radiopacas sugestivas de odontoma composto. O paciente foi acompanhado por dois anos, momento em que se realizou abordagem cirúrgica do caso. Após a cirurgia, a hipótese de diagnóstico de odontoma composto foi confirmada e com o acompanhamento ocorreu a erupção dos incisivos centrais permanentes inferiores. O paciente foi encaminhado para tratamento ortodôntico. Considerações finais: esse relato de caso aborda um caso raro de odontoma composto associado à não erupção de dente decíduo, uma vez que odontomas costumam ser detectados preferencialmente na segunda década de vida do paciente, sendo associados à impacção de dentes permanentes. Além disso, apresenta um protocolo de abordagem clínica para esses casos quando diagnosticados em idade precoce no paciente infantil.(AU)

Objective: to report a rare case of impaction of a primary mandibular incisor due to the presence of a compound odontoma and describe its clinical management. Case report: a 4-year-old boy presented with a "missing" primary left mandibular lateral incisor. Radiographs showed impaction of the unerupted incisor by adjacent radiopaque structures consistent with a compound odontoma. The patient was recalled periodically for 2 years, at which time surgical excision was performed. The diagnosis of compound odontoma was confirmed histologically, and the permanent mandibular central incisors erupted uneventfully; the patient was referred for orthodontic treatment. Final considerations: this case report describes an unusual case of compound odontoma associated with an unerupted deciduous tooth; odontomas are rare in this age range, occurring predominantly in the second decade of life and in association with impaction of permanent teeth. We also propose a protocol for clinical management of such early-onset cases.(AU)

Odontoma complejo en posición supernumeraria. Reporte de caso / Complex odontoma in supernumerary position. Case report

RESUMEN Fundamento: Los odontomas son entidades odontogénicas benignas mixtas, compuestas por una mezcla de células odontogénicas epiteliales y mesenquimatosas diferenciadas, las mismas pueden ser compuestas y complejas. Los hallazgos radiográficos de estos tumores en posiciones supernumerarias son raras menores al 1 %. Objetivo: Describir el caso clínico de un odontoma complejo infrecuente. Presentación de caso: Paciente femenina de 18 años con un trauma facial, que durante el diagnóstico imagenológico se le encontró una imagen anterosuperior de aspecto tumoral en posición supernumeraria, por lo que se decidió realizar la exéresis quirúrgica de la lesión después de finalizado el tratamiento del trauma. El diagnóstico clínico histopatológico fue de un odontoma complejo. Conclusiones: Se recomienda realizar las vistas imagenológicas tipo ortopantomografías o panorámicas a cada paciente que vaya a ser operado de cirugía bucal a fin de poder detectar de forma precoz cualquier alteración en la anatomía y de esta manera estudiar tanto el comportamiento de los odontomas como de otras lesiones intraóseas, lo que puede garantizar un tratamiento temprano y con ello un mejor pronóstico para el paciente.

ABSTRACT Background: Odontomas are mixed benign odontogenic entities, composed of a mixture of odontogenic epithelial and differentiated mesenchymal cells, they can be compound and complex. Radiographic findings of these tumors in supernumerary positions are rare, less than 1%. Objective: To describe the clinical case of a non-frequent complex odontoma. Case report: 18-year-old female patient with facial trauma, during the imaging diagnosis it was found an anterosuperior tumor image in supernumerary position, thus decided to perform the surgical excision of the lesion after the trauma treatment. The histopathological clinical diagnosis was a complex odontoma. Conclusions: It is recommended to perform standard panoramic radiograph imaging for each patient to be operated on oral surgery to detect any early anatomy alteration, so this way to study both, the behavior of odontomas as well as other intraosseous lesions, which can guarantee an early treatment and a better prognosis for the patient.

Cisto ósseo traumático associado a odontoma composto: relato de um caso incomum / Aneurismal bone cyst with a compound odontoma: unusual case report

Introdução: o cisto ósseo traumático (COT) é um pseudocisto que se apresenta assintomático e é descoberto frequentemente em exames de rotina. Outra lesão também presente nos maxilares é o odontoma, sendo dividido em dois subtipos, o composto e o complexo; os odontomas são geralmente descobertos como um achado acidental, visto que não apresentam sintomatologia. Objetivo: relatar um caso incomum de um COT, associado à odontoma composto (OC). Relato de caso: paciente do gênero masculino, 16 anos de idade, compareceu à clínica escola de odontologia da Universidade Federal de Campina Grande (UFCG), campus Patos, PB, referenciado pelo cirurgião-dentista após solicitar exame radiográfico para tratamento ortodôntico e observar lesão radiolúcida em região anterior da mandíbula. Durante a anamnese, o paciente não relatou nenhuma alteração sistêmica ou doença de base, mas relatou trauma de infância na região acometida. No exame clínico intraoral, não foi observado nenhum aumento de volume na região. Realizou-se palpação na região, não havendo relato de dor. Ao analisar a radiografia panorâmica, observou-se a presença de pequenas estruturas calcificadas com radiopacidade semelhante às estruturas dentárias, delimitada por uma linha radiolúcida, sugestiva de OC. Para melhor localização, delimitação, relação com estruturas anatômicas e planejamento cirúrgico da lesão, foi solicitado um exame de tomografia computadorizada de feixe cônico (TCFC). Considerações finais: com base nos achados clínicos e radiográficos, optou-se por abordagem cirúrgica da lesão cística e enucleação do OC, sob anestesia local. No pós-operatório de um ano, o paciente evoluiu satisfatoriamente sem queixas clínicas.(AU)

Introduction: traumatic bone cyst (TBC) is a pseudocyst that usually presents asymptomatically and is found frequently in routine exams. Another lesion also present in the jaws is odontoma. The odontoma is divided into two subtypes, the compound and the complex; odontomas are usually discovered as an accidental finding, since they do not present symptomatology. Objective: the present article aims to report an unusual case of a TBC associated with a composite odontoma. Case report: a 16-year-old male patient attended the Clinic School of Dentistry of the Universidade Federal de Campina Grande (UFCG), Patos-PB campus, referenced by the dentist after identify radiolucent lesion in the anterior region of the mandible on radiographic examination for orthodontic treatment. During the anamnesis, the patient did not report any systemic alteration or underlying disease, but reported trauma in the region affected in childhood. The intra oral clinical examination, was not observed any increase in volume in the region. Palpation was performed in the region, and there was no report of pain. When analyzing panoramic radiography the presence of small calcified structures with radiopacity similar to dental structures was observed, delimited by a radiolucent line, suggestive of compound odontoma. To better location, delimitation, compared with anatomy and surgical planning of the injury, it was requested an cone beam computed tomography (CBCT). Final considerations: based on the clinical and radiographic findings, we opted for a surgical approach to cystic lesion and enucleation of composite odontoma, under local anesthesia. In the one-year postoperative period, the patient progresses satisfactorily without clinical complaints.(AU)

Odontoma composto associado a incisivo central superior impactado: relato de caso / Compound odontoma associated with impacted upper central incisor: case report

Introdução: o odontoma é um tipo de tumor do epitélio odontogênico com ectomesênquima, podendo estar relacionado à presença de dentes não irrompidos. O tratamento consiste em excisão cirúrgica da lesão. Nor-malmente, dentes impactados são assintomáticos, sendo descobertos em radiografias de rotina. A impactação é causada por fatores sistêmicos ou etiológicos locais. Objetivo: reportar um caso clínico de uma criança com impactação dentária de um incisivo central superior esquerdo associado a um odontoma, enfatizando e discutindo a técnica cirúrgica e o planejamento realizado. Relato de caso: paciente de 13 anos de idade, do gênero feminino, com a não erupção do incisivo central superior esquerdo, ao exame clínico, apresentou ausência clínica do dente 21, persistência do dente 61 e um discreto aumento de volume entre os elementos 61 e 22. Foi solicitada uma tomografia computadorizada de feixe cônico (cone beam) da região, na qual se diagnosticou a presença de uma massa radiopaca envolta por um halo radiolúcido sugestivo de odontoma composto, alterando a posição e impedindo a erupção do dente 21, que se encontrava em posição transal-veolar. O plano de tratamento proposto foi remoção cirúrgica do odontoma e tracionamento do dente não irrompido. Conclusão: a remoção cirúrgica de patologias associadas e as manobras referentes aos dentes envolvidos devem ser realizadas no momento mais oportuno e com adequado planejamento, evitando lesões a estruturas nobres e permitindo, assim, um processo de reparo adequado e uma completa restauração da saúde bucal do paciente. (AU)

Introduction: Odontoma is a type of tumor of the odontogenic epithelium with ectomesenchyme and it may be related to the presence of unerupted teeth. The treatment consists of surgical excision of the lesion. Usually, unerupted teeth are asymptomatic and discovered in routine radiographs. Impaction is caused by local systemic or etiological factors. Objective: The present study aims to report a clinical case of a child with an impacted upper central incisor associated with an odontoma, highlighting and discussing the surgical technique and treatment planning. Case report: A 13-year-old female patient without eruption of the left upper central incisor. After clinical examination, the absence of tooth 21, persistence of tooth 61, and a discrete volume increase between elements 61 and 22 were observed. A cone beam computed tomography of the region was requested, which diagnosed the presence of a radiopaque mass involved by a radiolucent halo suggestive of compound odontoma. This condition changed the position and prevented the eruption of tooth 21, which was found in a transalveolar position. The treatment plan proposed was the surgical removal of the odontoma and orthodontic traction of the unerupted tooth. Conclusion: The surgical removal of associated pathologies and maneuvers related to the teeth involved should be performed in a timely manner, with adequate planning, preventing lesions in noble structures, thus allowing an adequate repair process and a complete restoration of the oral health of the patient. (AU)

Peripheral Developing Odontoma or Peripheral Ameloblastic Fibro-Odontoma Erupting to Oral Cavity Case Report / Odontoma en Desarrollo Periférico o Fibro-Odontoma Ameloblástico Periférico Eruptando a Cavidad Oral Reporte de Caso

ABSTRACT: The appearance of mixed odontogenic tumors into the oral cavity is a rare event. It is considered that some mixed tumors are only a stage in the complete development of a hamartomatous formation such as ameloblastic fibroodontoma and odontoma. Both pathologies share in common cellular elements which at one point makes them indistinguishable from each other. We present the case of a 21 year old patient who showed a mandibular growth whose histological elements present characteristics of both pathologies. The treatment was surgical excision of the lesion. There were no complications or recurrences to periodic reevaluation.

RESUMEN: La aparición de tumores odontogénicos mixtos en la cavidad oral es un evento raro. Se considera que algunos tumores mixtos son solo una etapa en el desarrollo completo de una formación hamartomatosa como el fibro-odontoma ameloblástico y odontoma. Ambas patologías comparten elementos celulares comunes que en un punto los hacen indistinguibles entre sí. Presentamos el caso de un paciente de 21 años que mostró un crecimiento mandibular cuyos elementos histológicos presentan características de ambas patologías. El tratamiento fue la escisión quirúrgica de la lesión. No hubo complicaciones o recurrencias a la reevaluación periódica.

Hybrid lesion formed by a complex odontoma and dentigerous cyst: radiographic and histomorphological findings: a case report

Hybrid lesions of the oral cavity are infrequent and share characteristics with a number of other pathologies. both odontomas and dentigerous cysts are of odontogenic origin, but their simultaneous occurrence is rare and scarce. clinical and radiographic examinations are not conclusive, making their identification difficult, while histopathological studies can reveal their defining characteristics. the aim of this report was to describe the radiographic and histomorphological findings of a hybrid lesion formed by a complex odontoma and a dentigerous cyst, affecting the mandible of a 22-year-old man, from Cartagena, Colombia, who had no relevant medical history, and no symptoms or discomfort in the affected area.

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.

Odontoma compuesto: revisión de la literatura y reporte de un caso con 40 dentículos / Compound odontoma: a review of the literature and report of a case involving 40 denticles

El odontoma compuesto es un tumor benigno odontogénico conformadopor varios dentículos o dientes rudimentarios los cuales se encuentran conformados de tejido dental organizado. Su etiología no está biendefi nida pero se atribuye a traumatismos durante la primera dentición, así como a procesos infl amatorios o infecciosos, anomalías hereditarias o alteraciones en el gen de control del desarrollo dentario. Su presencia se encuentra entre los tres tumores odontogénicos más frecuentes, en diferente orden según el autor que se consulte. Está relacionado por logeneral con una alteración en la erupción o malposición dental. Tiene predilección en hueso maxilar, frecuentemente asintomáticos, se caracterizan por un crecimiento lento, diagnosticándose de forma casualmediante exámenes radiográfi cos de rutina entre la segunda y terceradécada de la vida. En este estudio se presenta el caso de un pacientefemenino de 14 años de edad, con presencia de un odontoma compuestode 40 dentículos, en la región parasinfi siaria izquierda, tratado medianteenucleación, y colocación de injerto óseo.

The compound odontoma is a benign odontogenic tumor composed ofseveral denticles or rudimentary teeth made up of organized dentaltissue. Its etiology is not well defi ned but is attributed to trauma duringthe fi rst dentition, as well as to infl ammatory or infectious processes, inherited abnormalities, odontoblastic hyperactivity or alterations in the gene that controls tooth development. It is among the 3 mostcommon odontogenic tumors, though its ranking among these varies depending on the author consulted. It is usually associated with analteration in the eruption or malposition of teeth. It has a predilection for the maxillary bone, and is often slow-growing and asymptomatic. Odontomas are diagnosed incidentally during routine X-ray examinations of patients between the second and third decades of life. In this study, we present the case of a 14-year-old female patient with the presence of a compound odontoma comprised of 40 denticles inthe left parasymphyseal region, which is treated by enucleation andbone graft placement.

Fibrosarcoma ameloblástico en la mandíbula / Ameloblastic fibrosarcoma arising in the mandible

Ameloblastic fibrosarcoma is a rare odontogenic neoplasm and is considered the malignant counterpart of ameloblastic fibroma. The diagnosis is made by histopathological and immunohistochemical evaluation, since the epithelial component remains benign and the mesenchymal component becomes malignant. Until 2012, only 72 cases were published in English-literature. This article presents a case of intraoral mass at the posterior mandible of a 23 year-old female patient. Panoramic radiography showed a multilocular radiolucent lesion with ill-defined borders and tooth involvement. The mandibular canal presented loss of architecture also. The computed tomography images (bone window) showed hypodense lesion leading to expansion, tapering and irregular destruction of cortical, and tooth involvement. Incisional biopsy was performed for histopathological evaluation. The results revealed a mixed lesion with epithelial and mesenchymal cellular proliferation. At immunohistochemical analysis, the mesenchymal portion was vimentin positive and the epithelial component was positive for cytokeratin AE1-AE3. It also showed p53 intense labeling in all tumorous cells. The final diagnosis was ameloblastic fibrosarcoma. The lesion was surgically excised with clear margins. The radiographic appearance, even imperative for treatment planning, poorly contributed to final diagnosis, which was reached by histopathological and immunohistochemical evaluations. The treatment is still controversial, without a definition regarding chemotherapy and radiotherapy as coadjutant treatment(AU)

El fibrosarcoma ameloblástico es una neoplasia odontogénica poco frecuente y es considerada la contraparte maligna del fibroma ameloblástico. El diagnóstico se realiza mediante la evaluación histopatológica e inmunohistoquímica, ya que el componente epitelial sigue siendo benigno y el componente mesenquimal se convierte en maligno. Hasta 2012, solo 72 casos fueron publicados en la literatura inglesa. En este artículo se presenta un caso de masa intraoral en la mandíbula parte posterior, de una paciente de 23 años de edad. La radiografía panorámica mostró una lesión radiolúcida multilocular con bordes mal definidos y con un diente incluso en la lesión. El canal mandibular también presentaba pérdida de la arquitectura. La tomografía computarizada (TC) (ventana de hueso) presentó lesión hipodensa que provocaba una expansión que se estrechaba y destruía irregularmente la cortical, además envolvía la pieza dentaria. Se realizó biopsia incisional para evaluación histopatológica. Los resultados revelaron una lesión mixta con proliferación celular epitelial y mesenquimal. En el análisis inmunohistoquímico, la porción mesenquimal fue positivo para vimentina y el componente epitelial fue positivo para citoqueratina AE1-AE3. También mostró marcación intensa para p53 en todas las células tumorales. El diagnóstico final fue de fibrosarcoma ameloblástico. La lesión fue extirpada quirúrgicamente con márgenes de seguridad. El aspecto radiológico, aunque imprescindible para la planificación del tratamiento, poco contribuyó al diagnóstico final, que fue alcanzado por las evaluaciones histopatológicas e inmunohistoquímicas. El tratamiento sigue siendo controvertido, sin una definición respecto de la quimioterapia y la radioterapia como tratamiento coadyuvante(AU)

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.

Unusual Form of Complex Odontome: A Case Report.

Odontomas are the most characteristic among odontogenic tumors of the jaws, which are benign, slow-growing and non-aggressive. There are various theories, or etiological factors were quoted for occurrences of odontomas. Being asymptomatic in nature sometimes it may interfere with the eruption of the associated tooth leading to impaction or delayed eruption. Most of the lesions are diagnosed accidently on routine radiological examination in the second and third decades of the life. The sole management mainly depends on the early diagnosis, histopathological examination and surgical removal of the lesion. Here, we were presenting an interesting case of unusually large complex odontoma associated with pain, as well as missing molar is reported.

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.

Odontoma compuesto: casos clínicos y revisión de la literatura / Compound odontoma: case reports and review of the literature

Objetivo: el objetivo de este trabajo es describir los odontomas compuestos desde una perspectiva actual, a partir de casos clínicos. Casos clínicos: se presentan cuatro casos de niños a los que se les realizó la enucleación de un odontoma, cuyas biopsias confirmaron el diagnóstico inicial. En los controles a distancia, no se registraron recidivas en ninguno de los casos. Conclusión: un odontoma compuesto está constituido por esmalte, dentina y, ocasionalmente, cantidades variables de cemento y pulpa que forman un conjunto de estructuras similares a dientes denominadas dentículos. Su etiología es desconocida. Son asintomáticos, por lo cual, generalmente, se diagnostican como hallazgos radiográficos. El tratamiento consiste en la escisión quirúrgica del odontoma.