Dilated odontoma: an unusual case report and literature review

P Galvez,C Castain,S Catros,A Bres,E Garot,M Fenelon,A Crelier

doi:10.1051/mbcb/2020067

Abstract

Introduction: Dilated odontoma is the most severe form of a dens invaginatus, which is a rare dental malformation resulting from an invagination of the enamel organ into the dental papilla before calcification occurs. Observation: A healthy 7-years-old girl was referred to the oral surgery department to remove an impacted odontoma causing a delayed dental eruption of the right mandibular lateral incisor (tooth 42). The patient was painless and a lingual osseous swelling was observed. A computed tomography and a 3D segmentation revealed a shell-shaped mass in the position of the right mandibular lateral incisor, showing a complex anatomy. Surgical excision was carried out under general anesthesia. Histological analysis confirmed the diagnosis of DO. Discussion and conclusion: We performed a literature review investigating 16 cases of severe forms of dens invaginatus which required extraction. It highlighted the atypical aspect of our case and the importance of 3D imaging and segmentation in contributing to the accurate diagnosis and treatment of this dental malformation.

Highlights

Dens invaginatus (DI) or dens in dente is a rare dental malformation which was first formalized by Baume in 1874
Thanks to its mesio-version, the right mandibular canine spontaneously erupted in position of the lateral incisor. 24 months later, an orthopantomogram revealed a complete healing of the lesion and an orthodontic treatment started to treat her overbite (Fig. 7)
We have found in the literature 16 cases of type III DI which required extraction

Summary

Introduction

Dens invaginatus (DI) or dens in dente is a rare dental malformation which was first formalized by Baume in 1874 It is a developmental anomaly resulting from an invagination of the enamel organ into the dental papilla before mineralization occurs. In rare type III Oehlers classification, the invagination extends apically beyond the CEJ and perforates the surface of the root to create a second lateral foramen (type IIIa) or apical foramen (type IIIb) [3] (Fig. 1). The dental practitioner performed an orthopantomogram and suspected a delayed eruption of the right mandibular lateral incisor (tooth 42) caused by an impacted odontoma (Fig. 2). Each type of tissue was characterized by a particular color in order to further evaluate the lesion anatomy (Fig. 3) This 3D analysis revealed an enamel invagination and a complex pulp canal anatomy, contributing to the diagnosis of DO for the tooth 42. Thanks to its mesio-version, the right mandibular canine (tooth 43) spontaneously erupted in position of the lateral incisor. 24 months later, an orthopantomogram revealed a complete healing of the lesion and an orthodontic treatment started to treat her overbite (Fig. 7)

Discussion

Conclusion