http://dx.doi.org/10.5272/jimab.2016223.

1217
Journal of IMAB
Journal of IMAB - Annual Proceeding (Scientific Papers) 2016, vol. 22, issue 3
ISSN: 1312-773X
http://www.journal-imab-bg.org
A CASE OF COMPOUND MAXILLARY
ODONTOMA AND MANDIBULAR HYPODONTIA
Radka Cholakova 1 , Ivan Chenchev 1 , Svetla Jordanova 2 , Diana Oncheva 2 ,
Ljubomir Chenchev3
1) Department of Oral Surgery, Faculty of Dental Medicine, Medical University
Plovdiv, Bulgaria.
2) Department of Orthodontics, Faculty of Dental Medicine, Medical University
Plovdiv, Bulgaria.
3) Student in Faculty of Dental Medicine, Medical University Plovdiv, Bulgaria.

ABSTACT: CASE REPORT:

Odontomas are formations which are still classified
as benign tumors by the World Health Organization. They
are lesions on any odontogenic tissue enamel, cement and
dentin, which are affected in different proportions and de-
gree. We present a case of compound odontoma on upper
jaw, on a 15 year-old girl, causing retention of a perma-
nent canine tooth. After the extirpation 16 tooth-like struc-
tures were uncovered. The mandible was diagnosed with
hypodontia of both 2nd premolars. Patients history showed
that there was a trauma in the area of the upper jaw at
younger age.
In this article we will present the clinical and radio-
graphic examination, the stages of the complex surgical-
orthodontic treatment and a discussion of the etiology of
the diagnosis, complications and the treatment itself.
In the department of orthodontics of the Faculty of
Dental Medicine - Plovdiv was admitted a 15 year-old girl
with an open bite and a persistent right deciduous maxil-
lary canine. Patients history showed that there was a trauma
in the frontal area at younger age that lead to the devitali-
zation of tooth 11. The history does not tell of any other
family members with missing teeth and also tells of no other
past diseases. Examination shows that the patient has an
open bite, Angle class II, with a persistent 63 tooth and dis-
coloration of tooth 11. It is also determined that both man-
dibular second premolars are missing. There were no indi-
cations of any other accompanying disease.
Fig. 1. Bite, front

Keywords: compound odontoma, supernumerary

teeth, tooth retention, odontogenic tumors, hypodontia,
complex treatment

INTRODUCTION:
Odontomas are formations which are still classified
as benign tumors by the World Health Organization. They
are lesions on any odontogenic tissue enamel, cement and
dentin, which are affected in different proportions and de-
gree. [1, 2, 3, 4] Even though they are similar to hamarto-
mas and malformations, the compound odontoma consists
of multiple small tooth-like structures often firmly adapted
to one another and covered by more or less continuous con- Fig. 2. Bite, right profile
nective tissue capsule. [1, 5] Odontomas are usually small
in size but when bigger they can contain up to a thousand
denticles. The complex odontoma consists of homogenous
amorphous mass of mature odontogenic tissues with some
kind of structural organization. The degree of morphologi-
cal differentiation varies for each lesion. A major part of
some is calcified matrix, while in other cases there are sec-
tions of pulp tissue in association with cords and buds.
Hypodontia is a condition of missing up to six tooth
germs, while if there are more than six missing germs, ex-
cluding wisdom teeth, it is called oligodontia. Hypodontia
is assumed to be a hereditary disease which most often af-
fects wisdom teeth, 2nd premolars and lateral incisors. The
absence of permanent teeth is called anodontia.

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 Fig. 3. Bite, left profile

Orthopantomography and 3D cone beam tomography revealed:

Fig. 4. Panorama view and display of retained 23 tooth and 63 tooth

Fig. 5. 3D cone beam tomography showing palatinal location of the odontoma

Radiographic assessment: Skeletal Class I

X-ray diagnose Radiographic diagnose (3D cone beam tomogra-
Hypodontia 35, 45 phy) - compound odontoma.
Impacted canine 23 Presence of a limited by a radiopaque unstructured
Diagnose of lateral cephalometry matter with tooth-like formations on the upper jaw in the
Hyperdivergent type of growth area of the right canine, located palatinally and occlusally

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from its germ. Missing germs of second mandibular Fig. 8. Stitched operative wound
premolars.
The patient was directed to the Department of Oral
Surgery for the extraction of the primary canine and extir-
pation of the formation. Under the effect of local anesthetics
tooth 63 was extracted, while a vestibular and palatinal
flaps were made. A capsulated formation was revealed con-
taining multiple rudimental tooth-like formations which
were removed in portions as the capsule was ruptured. There
was a total of 16 such teeth with irregular form and size
at different stage of differentiation. Histological study re-
vealed a compound odontoma

Fig. 6. Vestibular and palatal mucoperiosteal flap

DISCUSSION.
Odontomas are found at a frequency of 0.24% to
1.12% according to some authors and 0.64% out of all bi-
opsies in maxillo-facial surgery. They account for 30.4%
of all diagnosed odontogenic tumors. [4] Complex odon-
tomas are a little more common than the compound ones
at a proportion of 1:0.96. Men and women are almost
equally likely to be affected, but there is a characteristic
gender distribution for some nations (for Egyptians it is
0.37:1 for men/women, while for Japanese it is 1:0.65 for
men/women). The complex odontoma is common for peo-
ple about the age of 19.252.9 years, while the compound
Fig. 7. Tooth-like formation odontoma is diagnosed at an older age 25.144.8 years
old. Maxillary odontomas are most commonly located in
the frontal area, while the mandibular ones are usually lo-
cated in the molar area. [6] The etiology of the odontomas
is vaguely known. [4, 7] They can be formed from the tooth
germ or the teeth during their growth period induced by a
local trauma, infection, odontoblast hyperactivity, genetic
mutations. [2, 4, 7, 8, 9, 10] Odontomas are classified as
tumors but usually stop growing in size when the tissues
they are made of are fully mineralized. Their clinical
behavior differs from that of other body tumors as it is char-
acteristic for all non-tumor lesions which have dysplastic,
hemartoma and malformation traits.
Hypodontia in the deciduous dentition has a rate of
about 0.4-0.9% for the European population. For the per-
manent dentition it differs for each continent: Europe - men
4.6%, women 6.3%; Australia - men 5.5%, women 7.6%;
North American white race - men 3.2%, women 4.6%. Over-
all tooth agenesis for women is 1.37 times more common
than it is for men. [11, 12] Second mandibular premolar is
the most often affected, followed by the lateral maxillary
incisor and the second maxillary molar. [11, 13, 14, 15] It
is often observed as unilateral than it is as bilateral with
the exception of the lateral incisors which are usually af-
fected bilaterally. Genetics and environmental factors can
influence the development of the tooth germs. Mutations
of the homeobox gene MSX 1 leads to hypo-/oligodontia
of the premolars and molars. [11] External factors include
inflammation, chemotherapeutics or dioxin. However, many
cases are caused by genetic factors. Familial predisposition

/ J of IMAB. 2016, vol. 22, issue 3/ http://www.journal-imab-bg.org 1219

can be confirmed by the fact that hypodontia is a lot more
common for monozygotic twins in comparison to dizygotic
ones. [16, 17, 18]
CONCLUSION:
Overall the etiology of the odontomas is unknown.
They can be formations of the tooth germ or the tooth it-
self. In this case there is the tendency of suppression of the
development of the dental lamina and a development of
hypodontia. The stimulated growth of the maxilla is prob-
ably caused by the local trauma during the development
period of the tooth germs. The disturbance in the migra-
tion, proliferation and differentiation of the neural crest
cells and the interaction between the epithelial and mes-
enchymal cells in the initial stages of the development of
the dentition can be a possible cause for the simultaneous
appearance of odontoma and hypodontia.

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Please cite this article as: Cholakova R, Chenchev I, Jordanova S, Oncheva D, Chenchev L. A case of compound maxil-
lary odontoma and mandibular hypodontia. J of IMAB. 2016 Jul-Sep;22(2):1217-1220.
DOI: http://dx.doi.org/10.5272/jimab.2016223.1217

Received: 15/05/2016; Published online: 18/07/2016

Address for correspondence:

Dr. Radka Cholakova,
Department of Oral Surgery, Faculty of Dental Medicine,
Medical University Plovdiv, Bulgaria
E-mail: r_cholakova1978@abv.bg,
1220 http://www.journal-imab-bg.org / J of IMAB. 2016, vol. 22, issue 3/