ODONTOMAS

Olori-Oko D.D.S

OUTLINE
INTRODUCTION LITERATURE REVIEW OF EPIDEMIOLOGY CLINICAL PICTURE RADIOLOGIC FEATURES HISTOPATHOLOGIC STRUCTURE. CONCLUSION

INTRODUCTION
Odontogenic tumors are derived from primordial, tooth-forming tissues and present in a large number of histologic patterns. They are found exclusively in the mandible & maxilla, and occasionally, the gingiva. They could be benign or malignant.

INTRODUCTION
If benign, their origin could be odontogenic epithelium alone, with or without ectomesenchyme, or of ectomesenchyme alone. There may or may not be extracellular, tooth-related hard tissue formation. They could also be intra-osseous or peripheral.

INTRODUCTION
Odontomas are benign, intra-osseous tumors of odontogenic origin that develop from ectomesenchyme and ectoderm with hard tissue formation (WHO 1994 Classification). They are however viewed as hamartomas by pathologists. What matters however is that they are abnormal.

EPIDEMIOLOGY
Odontogenic tumors are rare. They show distinct geographical variation in their distribution. In North & South America, odontomas are reported as the most common. Buchner et al. reported odontomas as comprising of 75.9 % of odontogenic tumors in a study from America.

EPIDEMIOLOGY
In Africa & most of Asia, ameloblastoma is most seen. The prevalence of odontomas among Africans varies from 0.9 % to 2.4 %. Reasons for this disparity include 1. Initially, any tumor of the oral region was called an odontoma by Broca in 1866.

EPIDEMIOLOGY
Malassez in 1885 expanded the meaning of odontoma to include such lesions as ossifying fibroma. Sutton in 1888 did so to include cysts of all types. In 1946, Thoma and Goldman narrowed the meaning of the word odontoma to mean those tumors that contained mature tooth structures.

EPIDEMIOLOGY
2. The term odontome is, even in literatures today, used to designate a non-neoplastic, developmental anomaly or malformation that contains enamel and dentine. 3. Most odontomas are discovered on routine radiographs and do not produce clinical symptoms. This may be responsible for the low incidence observed in Africans most of whom don't seek medical consultation unless there are symptoms that disturb daily or nocturnal activities.

GEMINATED ODONTOME

GESTANT ODONTOME

INVAGINATED ODONTOME

EVAGINATED ODONTOME

ENAMELOMA

EPIDEMIOLOGY
4. Odontomas are chance findings on, usually, panoramic radiographs taken for holistic management purposes. The emphasis during diagnosis here is the presenting complaint and so PAR are more popular due to cost, time & technological as well as expatriate constraints.. They, as such will not be detected even if present. 5. Genetic and environmental influences have also been suggested.

EPIDEMIOLOGY
Usually found between ages 10 and 20 years. More complex than compound odontomas are noticed as age of patient increases. Equal sex predilection. Studies everywhere are consistent on this except in Europe where women are usually more. No consensus of opinion on which jaw is more affected. In Africa & Asia, the mandible is more predominant. In Europe, an equal predisposition has been reported. In the US, the maxilla is reported.

EPIDEMIOLOGY
Compound odontomas occur more in the maxilla while the complex variant is more in the mandible. In maxilla, anterior>premolar>molar. In mandible posterior>anterior>molar>angle. Said to be a defect, not in formation, but orientation of ALL the cells that form the dental tissues. Continuum from Ameloblastic fibroma to Ameloblastic fibro-dentinoma to Ameloblastic fibro-odontoma to odontomas.

CLINICAL PICTURE
Usually asymptomatic, hence no complaints from patient. If there is, it is of a painless hard swelling. History usually reveals a previously slowly increasing swelling with subsequent stabilization. Position for compound Odontomas is usually the anterior part of the jaws. For complex odontoma, it is the posterior part.

MAXILLARY ODONTOMA

CLINICAL PICTURE
The mass may start to erupt and infection follows, especially in complex Odontomas that escape diagnosis until late in life. Infection develops in one of the many stagnation areas, and abscess formation commonly follows. In other cases, they displace teeth, resorb their roots or block their eruption. They may also become involved in cyst formation or undergo resorption.

ODONTOMAS

RADIOGRAPHIC FEATURES
Develop like surrounding teeth with initial (cryptlike) radiolucent phase, intermediate stage of mixed radiolucency, finally densely radio-opaque. The denticles of the compound odontoma may be seen radiographically as separate denselycalcified bodies. In complex Odontomas, when calcification is complete, an irregular radio-opaque mass is seen containing areas of densely radio-opaque enamel.

COMPOUND ODONTOMA

COMPOUND ODONTOMA

COMPLEX ODONTOMA

COMPLEX ODONTOMA

COMPLEX ODONTOMA

COMPLEX ODONTOMAS

COMPOUND ODONTOMAS

HISTOPATHOLOGY
Histologically, the denticles of the compound odontoma are embedded in fibrous connective tissue, and have a fibrous capsule. The complex odontoma mass consists of all the dental tissues in a disordered arrangement, but frequently with a radial pattern. The pulp is usually finely branched so that the mass is perforated, like a sponge, by small branches of pulp.

ODONTOMA

COMPOUND ODONTOMA

COMPLEX ODONTOMA

COMPLEX ODONTOMA

CONCLUSION
A half-full cup person would see the positive side, and state ameloblastomas as more dominant in africans. A half-empty cup person would state that it is because of all the aforementioned reasons odontoma is being denied pride of place. However, half-full theories do not drive research or scientific knowledge. We wouldnt want that now, would we?

REFERENCES
Regezi J. A and Sciubba J, Oral Pathology. Clinical Pathologic Correlations, Saunders. Philadelphia (1993). Pages 362-397 Cawson R. A; Odell E. W. Oral Pathology (5th Edition). Edinburg Churchill Livingstone, London(1993) Cawson R. A; Odell E. W. Colour atlas of Oral Pathology (5th Edition). Edinburg Churchill Livingstone, London(1993)

REFERENCES
Thesis on QOL after mandibular resection and reconstruction in AKTH, Kano. BY Lawal H S. Soames JV & Southam JC. Oral Pathology. Oxford Univ. Press, 4th Edition (2005). Ladeinde A. L, Ajayi O. F, Ogunlewe M. O, Adeyemo W. L, Arotiba G. T, Bamgbose B. O and Akinwande J. A. Odontogenic tumors: A review of 319 cases in a Nigerian teaching Hospital. Oral Surg Oral Med Oral pathol oral radiol Endod. 99(2005). PP 191-195 Adebayo E T,Ajike S O, and Adekeye E O; Odontogenic tumors in children and adolescent; A study of 78 Nigerian cases. J Craniomaxfac surg 30 (2002) pp 267-272.

REFERENCES
Odukoya O, Odontogenic tumors: analysis of 289 Nigerian cases. J Oral Pathol med 24(1995)pp 454-457. Arotiba J. T, ogunbiyi J. O and Obiechina A. E. odontogenic tumors: A 15 year review from Ibadan, Nigeria. Br J Oral Maxillofac Surg 1997.35:363-367 Epidemiology of odontogenic tumors in estonia. Pathogenesis and clinical behaviour of ameloblastoma. Tiia Tamme, Tartu Univ. Nov 2005. Sriram G and Shetty R. P, odontogenic tumors: a study of 250 cases in an Indian teaching hospital. Oral surg oral med oral pathol oral Radiol Endod 105(2008)pp e14-e21

REFERENCES
Arotiba J T, Ajike S O, Akadiri O A, Fasola A O, Akinmoladun V I,Adebayo E T, Okoje V N, Kolude B, Obiechina A E; Odontogenic tumors; Analysis of 546 cases from Nigeria. J Maxillofac oral surg 6 (2007) pp44-50. Shafer W G , Hine M R, Levy B M ; A textbook of oral pathology (4th edition) W B Saunders, Philadephia . 1993 pp 254-265. Tawfik M. A, Zyada M. M. Odontogenic tumors in Dakahlia, Egypt: analysis of 82 cases oral surg oral med oral pathol Radiol Endod 109(2010)pp e67-e73.

REFERENCES
Slootweg P J ; an analysis of the interrelationship of the mixed odontogenic tumors; Ameloblastic fibroma,Ameloblastic fibro-odontoma and the odontomas.oral surg 51(1981) pp266. Efunkoya A A. The pattern of presentation and management of oral malignancies in Aminu Kano Teaching Hospital. Unpublished work. Michael M, Ghali G E, Peter E L and Peter D W; Petersons principle of oral and maxillofacial surgery.( 2nd edition ) B C Decker inc 2004 pp

Na so e finish o..