A 30-year-old Caucasian man presented with an 18-month history of an asymptomatic calcified mass, located on the buccal side of the alveolar ridge. Medical records did not present any underlying conditions. On intraoral examination, the lesion was located on the right side of the maxilla, showing mucosal fenestration with mineralized tissue measuring approximately 1 cm in diameter. Radiographic examination showed multiple radiopaque masses. Incisional biopsy was performed, and histological analysis revealed a presence of enamel matrix, dentin, and cementum, resembling tooth-like structures. Surgical removal was offered after the diagnostic confirmation of peripheral odontoma, but the patient refused because of the asymptomatic nature of the lesion.
Odontomas are the most common type of odontogenic tumors, being considered hamartomas when associated with dental development failure [
PO is extremely uncommon, with less than 25 cases reported in the literature [
The purpose of this article is to present a new case of erupted peripheral odontoma of the maxilla in a 30-year-old patient and to review and discuss the characteristics of the cases of PO in the craniofacial region described in the literature.
A 30-year-old male patient was referred with a diagnosis of an asymptomatic calcified mass located on the right side of the anterior maxilla, lasting 18 months. On the intraoral examination, a mucosal cutaneous fenestration with a mineralized tissue measuring approximately 1 cm in diameter was observed (Figure
Radiographic examination showing multiple radiopaque masses (a). Fenestration of the mucosa with a display of mineralized tissue (b). Histological analysis revealed the presence of enamel matrix, dentin, and cementum, resembling tooth-like structures (c).
Incisional biopsy was performed for the removal of the fragment, which then was placed in 10% neutral-buffered formalin and sent for histopathological analysis. The gross examination of the calcified specimen revealed a yellowish tumor with
The histopathological analysis revealed structures composed of enamel, dentin, pulp chamber, and cement in the same order of arrangement as that of a normal tooth. A mature tubular dentin and an enamel matrix were also observed (Figure
After the diagnostic confirmation of erupted peripheral odontoma, surgical removal was performed to reduce the lesion. The patient was free of symptoms after the procedure, and no complications were recorded.
Odontomas, by definition, refer to any tumor of odontogenic origin, although these entities are truly considered hamartomas [
Review of peripheral odontoma cases described in the literature.
Author | Age |
Gender | Location | Erupted PO | Histopathologic diagnosis |
---|---|---|---|---|---|
Present case | 30 | Male | Anterior maxillary region | Yes | Compound odontoma |
Custódio et al. | 11 | Female | Anterior maxillary region | No | Complex odontoma |
Sfakianou et al. | 7 Mo |
Male | Posterior mandible region | No | Peripheral developing odontoma |
Ahmed | 24 | Male | Posterior mandible region | Yes | Complex odontoma |
Bagewadi et al. | 22 | Male | Posterior mandible region | Yes | Complex odontoma |
Bereket et al. | 19 | Male | Posterior maxillary region | Yes | Compound odontoma |
Kudva et al. | 23 | Male | Posterior mandible region | Yes | Complex odontoma |
Raval et al. | 22 | Male | Anterior maxillary region | Yes | Compound odontoma |
Ohtawa et al. | 10 | Female | Posterior maxillary region | Yes | Complex odontoma |
Arunkumar et al. | 22 | Male | Posterior maxillary region | Yes | Complex odontoma |
Tejasvi and Babu | 22 | Female | Anterior mandible region | Yes | Compound odontoma |
Friedrich et al. | 3 | Male | Posterior maxillary region | No | Peripheral developing odontoma |
Serra-Serra et al. | 11 |
Male |
Posterior maxillary region |
Yes |
Complex odontoma |
Shekar et al. | 15 | Female | Posterior mandible region | Yes | Compound odontoma |
Silva et al. | 5 Mo |
Male |
Anterior maxillary region |
No |
Peripheral developing odontoma |
Ilief-Ala et al. | 2 | Female | Posterior maxillary region | Yes | Complex odontoma |
Vengal et al. | 23 | Male | Posterior mandible region | Yes | Complex odontoma |
Junquera et al. | 23 | Female | Posterior maxillary region | Yes | Complex odontoma |
Ide et al. | 39 | Male | Anterior maxillary region | No | Complex odontoma |
Ledesma-Montes et al. | 3 | Female | Posterior mandible region | No | Compound odontoma |
Giunta et al. | 21 | Male | Posterior mandible region | No | Compound odontoma |
PO is usually asymptomatic and detected during routine radiographic examinations or once there is a delay in tooth eruption [Rajendran et al., 2012]. The differential diagnosis of OP includes other tumors of odontogenic origin, exostoses, and osteomas [
The histogenesis of odontomas is primarily associated with remnants of soft tissues of the odontogenic epithelium, such as the gingival rests of Serres, which could lead to the production of mineralized structures similar to teeth as a result of odontoblastic hyperactivity and changes in the genetic component responsible for controlling dental development, including a reduction of epithelial-mesenchymal interactions [
This condition can also be attributed to some pathological conditions, such as local trauma, inflammatory process, and infectious and genetic anomalies [
Some of the peripheral odontomas reported in the literature might be erupted odontomas because of intraosseous lesions, often related to unerupted or spontaneously erupted teeth [
In the present case, the patient was referred to an evaluation due to exposure of the mineralized tissue in the oral cavity, suggesting a growth of the lesion and the presence of mild discomfort in the adjacent periodontal area. The type of force that may have led to mucosal fenestration was probably caused by physiological bone resorption, since there was no report of delayed dental eruption.
Histologically, PO resembles intraosseous odontomas, which can be classified as compound and complex. However, the absence of bone tissue is a finding also observed in the present case. This fact occurs due to the absence of bone erosion under the tumor, supporting the hypothesis of the development of this odontoma in the gingival tissue [
Clinically, some authors have described odontomas that erupted in older patients and whose lesions were histologically characterized as complex odontomas associated with noneruption of posterior teeth [
Peripheral odontoma is a rare benign odontogenic lesion that can be treated by local excision with good results. Both young and adult patients can present these alterations. A comprehensive evaluation with radiographic and histological examinations is important to establish the differential diagnosis and prevent unnecessary extensive resections.
This clinical case was presented at the Brazilian Society of Stomatology and Pathology (SOBEP) meeting, in the poster section category, and the abstract was published in the annals of the event, the Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology Journal.
The authors declare that there is no conflict of interest regarding the publication of this paper.
This work was supported by São Paulo Research Foundation (FAPESP) [2015/07727-9 and 2018/02568-8].