Complex Odontoma Research Articles

Ameloblastic fibro-odontoma: a case report

Ameloblastic fibro-odontoma (AFO) is a rare mixed odontogenic tumor consisting of both ectodermal and mesenchymal components. It occurs predominantly in children and adolescents, especially in the mandibular posterior region. Histopathologically, AFO exhibits the combination of ameloblastic fibroma-like tissue and complex odontoma. A case of AFO in a 1-year-old child was presented. It produced an expansile lesion over the upper right anterior region and showed typical histopathological features of AFO. She was treated by enucleation with no recurrence observed after a follow-up period of 1 year.

Newly Recognized Oral Manifestations of Schimmelpenning Syndrome

Schimmelpenning syndrome (SS) is an unusual disease that is characterized by mucocutaneous, central nervous system, ocular, and skeletal abnormalities. Nevus sebaceus, usually with broad involvement of the scalp and face, represents the classic skin finding associated with SS. We report a 6-year-old female with SS who presented with a variety of oral lesions, including a number of intraosseous jaw findings that have not been previously described in patients with the syndrome. These findings include bilateral central giant cell granulomas (CGCG)—one lesion involving the left maxilla, which perforated into the soft tissues, and a second distinct lesion involving the right anterior hard palate. Both CGCGs were diagnosed at the patient's initial presentation. Although there have been 2 published reports of CGCG identified in patients with the syndrome, in both cases the occurrence of the lesion was thought to represent a coincidental finding. We argue that CGCG represents a true clinical manifestation of SS. One year later, the patient presented again, this time with bilateral maxillary expansion. Microscopic review of the surgical specimens revealed bilateral benign fibro-osseous lesions, both complicated with foci of CGCG, typical appearing complex odontomas, and multiple malformed teeth containing melanin. A hybrid adenomatoid odontogenic tumor-odontoma involving the anterior mandible was also removed at that time. The findings of pigmented teeth and a hybrid odontogenic neoplasm are novel and have not been previously reported in patients with SS. Although the genetic defect associated with SS has not been characterized, it is intriguing to speculate that a common gene may be important in the pathogenesis of tooth development, maxillofacial benign fibro-osseous disease, and CGCG.

Clinical observations of odontomas in Japanese children: 39 cases including one recurrent case

Retrospective investigations of odontomas in Japanese children and one recurrent case were carried out. Thirty-nine cases of odontoma in 38 children were treated in the Paediatric Dentistry Clinic of Niigata University Dental Hospital between September 1979 and December 2002. The patients consisted of 23 males and 15 females and their ages ranged from 1 year 2 months to 14 years old. The chief complaints were delayed tooth eruption in 19 cases (five: primary teeth, 14: permanent teeth), retention of primary teeth in 11, incidentally found on the radiographic examination in eight cases, and swelling of the jaw in one case. Thirty-four cases (87%) were associated with tooth eruption disturbances. The most frequently affected region was the maxillary anterior region. Treatment consisted of surgical removal of odontomas in all cases, after which if the impacted teeth did not erupt, exposure of the crown and/or orthodontic traction was performed. Pathological diagnoses were compound odontoma in 30 cases, complex odontoma (n = 7), and compound and complex odontoma (n = 2). A retrospective study of the radiographs revealed the developing process of odontomas in four cases and odontoma disturbed tooth eruption since the early uncalcified developing stage. A recurrent case was a boy aged 6 years 5 months in whom the first surgical removal of odontoma was performed at the age of 1 year 8 months. Recurrence of an odontoma is very rare, but in very young children odontomas are in the early developing stages, containing uncalcified portions, so it is important to perform periodical observations until the succedaneous teeth erupt.

Surgical management of a large complex odontoma of the mandibular angle-ramus region through intra-oral buccal approach--A case report

Large complex odontomas of the jaws are rare. A report of a large complex odontoma of the mandibular angle-ramus region enucleated through intra-oral buccal approach is presented. A review of the literature on different modalities of treatment is also undertaken. A large expansile complex odontoma of the angle-ramus region of the mandible was excised through an intraoral buccal approach under general anaesthesia. Recovery and immediate post-operative period were uneventful. There was no altered sensation in the distribution of the inferior alveolar nerve and lingual nerve; and wound healing was satisfactory. Post-operative radiograph 2 years after the operation showed satisfactory bone regeneration. Intraoral buccal approach to large complex odontomas of the angle-ramus region of the mandible is a relatively safe procedure with minimal complication.

A Mesolithic case of odontoma?

An ovoid yellowish object has been discovered in an Early Mesolithic collective burial located in the Meuse Basin: the Autours rockshelter (Prov. of Namur, Belgium). It was found among commingled hand and foot bones in a small crack of the rockshelter wall. Mineralogical, radiological and microscopic analyses showed that it was most probably a complex odontoma.

大きな上顎歯牙腫の１例

We describe a maxillary odontoma 48mm in longest diameter that was removed intraorally. An 18-yearold woman lacked right upper molar teeth and had a diffuse and hard swelling in this region. A computed tomographic scan showed a radiopaque mass lesion occupying most of the right sinus. While attempting to preserve the surrounding tissues, the lesion was segmented into several pieces by using bars and chisels and was then extracted. The reconstructed lesion measured 48 ×40×32mm. It was a complex odontoma. Odontoma consists of tooth elements, which can make cutting difficult. However, the hardness of odontomas has not been examined. We measured the microvickers hardness of the odontoma, as compared with that of teeth and cortical bones. The median values of enamel, dentin, and cortical bone were 312.0, 65.1, and 28.4, respectively. The median hardness of odontoma was 33.9, but hardness widely ranged from 13.6 to 295.1. The median hardness of the odontoma in our patient was greater than that of cortical bone, and cutting a long distance was not necessarily easy. However, the lesion could be removed with minimal invasion of the surrounding tissues. There has been no sequela, and the patient's progress remains good as of 21 months after the operation.

Odontoma: a clinicopathologic study of 81 cases.

Odontoma is the most common odontogenic tumor. It includes 2 types, the compound and complex odontomas. There has not been a series study of the clinical and histologic features of odontomas from Taiwan. This study evaluated the clinicopathologic features of odontoma in Taiwanese. Cases of odontoma treated from 1998 to 2002 identified from medical records were included. The microscopic features, radiographic features, and clinical history of the patients were reviewed and analyzed. A total of 81 odontomas in 81 patients (36 males and 45 females) were included. There were 62 compound and 19 complex odontomas. The mean age of the patients was 18 years with the majority of odontomas occurring in the first (32%) and second decade (38%) of life. Odontomas had a marked predilection for the maxilla (70%) and for the anterior region of the jaw (83%), particularly for the anterior maxilla (62%). Sixty four (79%) of the 81 odontomas were associated with 80 impacted teeth, including 71 permanent teeth, 2 deciduous teeth, and 7 supernumerary teeth. Of the 71 impacted permanent teeth, the maxillary central incisor (27%) was most commonly affected, followed by the maxillary canine (26%) and mandibular canine (24%). Histologic examination revealed enamel matrix in 90%, dentin in 100%, cementum in 88%, pulp tissue in 96%, fibrous capsule in 93%, ghost cells in 83%, reduced enamel epithelium in 86%, and nests of odontogenic epithelium in 58% of odontomas. Dentigerous cyst was associated with 9% of odontomas. In this series, odontomas occurred most often in the first and second decade of life. Although complex odontomas are usually found in the posterior jaw, in this Taiwanese series they were most commonly found in the anterior maxilla. Odontoma is frequently associated with an impacted tooth and occasionally with a dentigerous cyst. No recurrence of odontomas was found after surgical excision with follow-up of 1 to 15 years.

Visceral Carcinoma With Shadow Cell Differentiation Can Mimic Pilomatrix Carcinoma

We appreciate the interest of Drs. Zamecnik, Michal, and Mukensnabl in our recent publication on pilomatrix carcinoma (1). In their letter, these authors challenge the specificity of shadow cells in the diagnosis of pilomatrical neoplasms. Shadow cells are cornified cells in which, as a consequence of karyolysis, nuclei have faded but vague outlines of them still can be recognized. According to the latest edition of Ackerman's book Neoplasms With Follicular Differentiation, these cells represent faulty attempts at differentiation toward hair and are found only in conditions in which some follicular matrical cells are present (2). Although shadow cells are most commonly seen in pilomatricoma and its malignant variant, the pilomatrix carcinoma, it is well known that other lesions with follicular differentiation may have shadow cells on rare occasions. These include trichoepithelioma, desmoplastic trichoepithelioma, proliferating trichilemmal tumor, and panfolliculoma (3). Additionally, the occurrence of shadow cells has already been reported in keratoacanthoma, chondroid syringoma, and in some odontogenic tumors, notably the calcifying odontogenic cyst and the complex odontoma (4–6). Recently, Dr. Zamecnik et al. have described the presence of shadow cells in extracutaneous locations, namely in adenosquamous carcinomas of the colon and uterus (7). This has led these authors to suggest that the pathologist should be aware that shadow cell differentiation may occur in visceral carcinomas and that it is not diagnostic of matrical tumors. There are unquestionable morphologic similarities between the cells they describe and folliculosebaceous matrical shadow cells, although they are not quite identical to the shadow cells seen in matrical neoplasms. In this regard, we agree with the opinion of Drs. Hitchcock and Ellington (8) in that the cells that Zamecnik et al. describe show much less regular distribution of the clear zone previously occupied by the nucleus and a more filamentous cytoplasm than matrical shadow cells. In our cases, the diagnosis of pilomatrix carcinoma was made because the tumors showed architectural features that implied malignancy coupled with cytologic characteristics of matrical differentiation. In the cases presented by Zamecnik et al. the shadow cells were present in isolation, without demonstrating the classic findings of matrical tumors. Obviously, it cannot be assumed that the superficial morphologic appearance between true shadow cells and the cells described by Zamecnik et al. is per se indicative of a tumor with matrical differentiation. Whether tumors previously interpreted as pilomatrix carcinoma could have represented cutaneous metastases from poorly differentiated visceral carcinomas with shadow cell differentiation remains, in our opinion, speculative. In such cases it could be of interest to perform immunohistochemical studies of follicle-associated keratins to identify further differences (9). Finally, the differential diagnosis between pilomatrix carcinoma and the cutaneous metastases from an undifferentiated visceral carcinoma has also important prognostic considerations. Pilomatrix carcinomas are locally aggressive tumors that have a tendency to recur, especially when they are incompletely excised. Metastasis and death have resulted from these tumors but are rare. On the other hand, the prognosis for patients with cutaneous metastasis from a visceral carcinoma is ominous, and their life expectancy from the appearance of the metastases is on average less than one year. David Hardisson, M.D. Félix Contreras, M.D. Jesús Cuevas-Santos, M.D. M. Dolores Linares, M.D.

Characterisation of machinability of sintered steels during drilling

Complex odontoma is a rare odontogenic lesion reported in rodents (order: Rodentia) and odd-toed ungulates (order: Perissodactyla), to name a few, and only in bovine animals of the order Artiodactyla. A 3-year-old female giraffe presented with a steadily proliferating, firm mass in the rostral mandible. With further expansion and ulceration of the mass, the general condition of the giraffe deteriorated and it was euthanized. Post-mortem examination revealed greyish–white tissue with an irregular arrangement of yellowish hard tissue arranged in thin plates and intermingled areas of greyish soft tissue. Histologically, irregular proliferated odontogenic epithelium and mesenchyme, dentin, cementum and empty spaces, suggestive of decalcified enamel, were present. These findings are consistent with a diagnosis of complex odontoma, which should be added to the differential diagnoses of oral tissue proliferations in giraffes. To our knowledge, this is the first description of a complex odontoma in a giraffe.

A case of complex odontoma associated with an impacted lower deciduous second molar and analysis of the 107 odontomas.

Odontoma is a comparatively common odontogenic tumor, and it may lead to interference with the eruption of its associated tooth. Odontomas are mostly associated with permanent teeth, and they are rarely associated with deciduous teeth. The purpose of this report is to analyze 107 odontomas and to present a case of complex odontoma associated with a lower deciduous second molar. The 106 cases were analyzed with regard to the following parameters: age, gender, location, erupted teeth, congenital missing teeth, radiological features, histopathological features and prognosis. Of the 106 cases, 41 were complex odontoma, 62 were compound odontoma, and three were immature odontoma. Compound odontoma had a predilection for the anterior. Complex odontoma occurred more often at the mandible. Odontoma located above the tooth crown of lower deciduous molar did not behave clinically different from that associated with permanent tooth. An odontoma could be related with a supernumerary tooth or a missing tooth. If odontomas, which interfered with tooth eruption, were extirpated early, the impacted teeth would probably erupt normally and be normal in shape.

下顎粘膜部に露出した複雑性歯牙腫の 1 例

Odontoma, a typical one of odontogenic tumors, is not rarely found in our clinical procedure. It commonly occurs in the jaw bone. This case was recognized as exposed odontoma on the overlying mucosa of the mandible with inflammation in a 15 year-old male. Histopathological diagnosis was complex odontoma with dental caries-like lesion.

Recurrent ameloblastic fibro-odontoma in a 10-year-old boy

The ameloblastic fibro-odontoma is a rare odontogenic tumor.1-7 It is composed of connective tissue characteristic of an ameloblastic fibroma and calcified tissue identifying the tumor as a complex odontoma. The earlier used term “mixed tumor” was abandoned after the first World Health Organization (WHO) classification8 because of the fundamental decision that the odontogenic tumors should be classified according to the stages of dental development and not to the structures of the tumor.9 In the revised WHO classification10 of odontogenic tumors, a distinction was drawn between the ameloblastic fibro-odontoma and the ameloblastic fibro-dentinoma, both newly accepted entities. The diagnosis of an ameloblastic fibro-odontoma is based on the histologic evidence of an ameloblastic fibroma with active odontogenic epithelium embedded in an embryonal connective tissue. The cell-rich embryonal connective tissue is free of collagen and mimicks a primitive dental pulp. The active odontogenic epithelium is organized in bands and bud-like conglomerates and consists of 2 layers of round or cuboidal cells. The calcified tissues are those of a complex odontoma; compound odontomas do not occur in this entity. In the revised WHO classification10 of odontogenic tumors, the ameloblastic fibro-odontoma was categorized into the group “odontogenic epithelia with odontogenic ectomesenchyme, with or without formation of hard tissue.” In the following case report the differential diagnosis and therapy of this rare lesion are discussed.

Calcifying odontogenic cyst associated with complex and compound odontoma: Report of a case and immunohistochemical study.

A case of calcifying odontogenic cyst associated with complex and compound odontoma which appeared in the maxilla of a 15-year-o1d Japanese girl was reported with immunohistological examination. Radiologically, the lesion showed a cystic radiolucent area with odontoma-like radiopaque masses. Histopathological examination revealed the presence of ghost cells, calcified tissues and structures of complex and compound odontoma. Immunohistochemically, MIB-1 positive ratio was very low, but significant expression of Bcl-2 was observed in the neoplastic odontogenic epithelium. These results suggest that inhibition of apoptotic cell loss is more important than cell proliferation activity to the growth of the lesion in our case.

特異なＸ線像を呈した複雑性歯牙腫の１例

We report a case of complex odontoma that had unique radiological features. A 25-year-old man was referred to the Department of Dentistry and Oral Surgery, Sapporo General Hospital because of swelling and pain at the right side of the mandible. Panoramic radiographs showed a lesion with a mottled appearance over an impacted wisdom tooth. Computed tomographic examination clearly showed a lowdensity mass containing some cavernous-bone-like radiopacities. The mass was diagnosed to be a mandibular tumor and was removed surgically. The impacted wisdom tooth was then extracted. Histopathological examination of the mass revealed a complex odontoma, which was not suspected before operation. To our knowledge, there have been no previous reports of complex odontoma associated with the features of this case. We therefore describe and comment on this quite rare case.

歯原性腫ようの臨床統計的検討 ２３年間１１０例について

One hundred ten cases of odontogenic tumors histologically diagnosed according to the WHO classification (1992) were clinicostatistically evaluated at our clinic over the 23-year period from 1973 to 1996.The subjects consisted of 55 men and 55 women 40 to 80 years old.Histologically, the 107 benign tumors comprised 37 ameloblastomas, 36 compound odontomas, 20 complex odontomas, 4 calcifying odontogenic cysts, 3 odontogenic fibromas, 3 odontogenic myxomas, 2 ameloblastic fibro-odontomas, 1 adenomatoid odontogenic tumor, and 1 benign cementoblastoma. The 3 malignant tumors consisted of 2 primary intraosseous carcinomas and 1 malignant ameloblastoma.Most of the ameloblastomas occurred in the posterior portion of mandible, and many odontomas occurred in the incisor region of both the maxilla and the mandible.All tumors were treated surgically, and various of procedures were used.All three odontogenic carcinomas spread extensively throughout the mandible. There has been no evidence of disease in one patient, one patient died of the oral carcinoma, and the other patient died of lung metastasis.

A Case of Giant Complex Odontoma of the Mandible in an Infant

A Case of Giant Complex Odontoma of the Mandible in an Infant

Central (Intraosseous) Adenoid Cystic Carcinoma of the Mandible: Report of a Case with Periapical Involvement

Primary intraosseous salivary gland tumors are rare, with mucopidermoid carcinoma being the most frequent histotype. The authors present a case of adenoid cystic carcinoma, located in the mandibular incisor region, associated with pain. Endodontic treatment resulted in increased pain and progressive mandibular expansion. An apicoectomy was conducted, and an intraosseous adenoid cystic carcinoma was diagnosed at histological examination. The patient was treated by wide surgical resection, and is alive and well without recurrences or distant metastases 14 yr after the original diagnosis. The case presented herein calls attention to the preoperative clinical diagnosis of periapical lesions. Radiologically, focal sclerosing osteitis, cementoblastoma, cementifying and ossifying fibroma, periapical cemental dysplasia, complex odontoma, and calcifying epithelial odontogenic tumor should be considered in the differential diagnosis. In addition the unusual occurrence of salivary gland tumors in intraosseous location stresses the importance of systematic histological examination of any tissue sample obtained after endodontic procedures.

Large erupting complex odontoma

An unusual case of erupting complex odontoma is presented.

Large erupting complex odontoma

An unusual case of erupting complex odontoma is presented.

Cysts and cystic lesions of the mandible: clinical and radiologic-histopathologic review.

Many lesions that occur in the mandible have a cystlike radiographic appearance. These lesions are often difficult to differentiate on the basis of their radiographic features alone. Mandibular lesions may be odontogenic or nonodontogenic. Among odontogenic lesions without mineralization, ameloblastomas, odontogenic keratocysts, and dentigerous cysts can all appear as well-defined, unilocular, well-corticated, lucent lesions that are often associated with the crowns of impacted or unerupted teeth. Most radicular cysts appear as round or pear-shaped, unilocular, lucent lesions in the periapical region. Among odontogenic lesions with mineralization, complex odontomas contain multiple masses of dental tissue and compound odontomas contain multiple teeth or toothlike structures. Odontogenic myxomas are characterized by lytic osseous changes of varying size, which may be demarcated and expansile or exhibit ill-defined borders. Nonodontogenic lesions that mimic odontogenic lesions include benign fibro-osseous lesions (conventional or juvenile ossifying fibroma, focal or periapical cemento-osseous dysplasia, florid osseous dysplasia), traumatic bone cyst, lingual salivary gland inclusion defect, central giant cell granuloma, brown tumor of hyperparathyroidism, arteriovenous malformation, and mucoepidermoid carcinoma. The clinical and radiographic features of these mandibular lesions help establish a differential diagnosis, although microscopic tissue evaluation is generally necessary to accurately identify the lesion.