Dentigerous cyst of mandible with multiple complex odontomes

Abstract

Odontomas are non-aggressive, hamartomatous developmental malformations or lesions of odontogenic origin which consist of enamel, dentin, cementum and pulpal tissue (hence, they are also called composite i.e. consisting of multiple or more than one type of tissue) and constitute 22% of all odontogenic tumors [1]. Two types of odontomas are recognized – compound and complex. Compound odontomas consist of encapsulated, discrete, small tooth-like structures or denticles in a fibrous connective tissue stroma. Complex odontomas on the other hand, consist of an irregular mixture or mass of mature hard and soft dental tissues which are poorly differentiated as enamel, dentin or cementum and hence have no resemblance to teeth [2]. The etiology of odontomas is unknown but genetic factors and environmental causes such as trauma and infection have been proposed. Most odontomas are discovered during the first two decades of life and there is no significant gender predilection. They often remain asymptomatic and undiscovered until revealed by routine radiography where they characteristically appear as dense, radiopaque masses [3]. Sometimes clinical indicators of their presence may include bone expansion, pain and tooth displacement or unerupted normal teeth. Enucleation is curative and recurrence is not a problem. We report a rare case of multiple complex odontomas in a 58 year old man, associated with a large dentigerous cyst of the anterior mandible, which was managed surgically. The unusual site of occurrence, age and manner of presentation and its association with a dentigerous cyst makes it interesting.