Compound odontoma: a combination of operative and orthodontic therapy

BACKGROUND: Compound odontoma is an odontogenic tumor composed of epithelial and ectomesenchymal cells with a potential to generate a mass of irregular dentin and enamel tissue, thus forming a number of small, irregular, fibrous tissue connected growths containing enamel, dentin, cement or pulp tissue, which frequently cause problems on permanent tooth eruption. CASE REPORT: A 9-year-old boy presented for delayed eruption of the upper right medial and lateral permanent incisors. X-ray showed an irregular bone mass shadow in the region of upper right incisors, on additional analysis diagnosed as a compound odontogenic tumor. History data revealed a previous trauma that had caused avulsion of deciduous incisors. TREATMENT: Odontogenic tumor was removed by operative procedure in local anesthesia and referred for histology. Eruption of the permanent lateral incisor occurred at 2 months and reached occlusal plane at 3 months of the procedure. However, medial permanent incisor showed absence of the eruption impulse, probably due to the completed root growth. In such a case, the operative-orthodontic treatment includes corticotomy and placement of a clasp upon the medial incisor crown. A specially designed orthodontic fixed appliance enables the retained permanent medial incisor to pull out by force and reach occlusal plane. This case confirms one of the possible theories on the genesis of odontoma, with dental trauma as a significant and common cause, and illustrates the operative-orthodontic therapeutic option