Discussion:
Odontomas represent an important entity among maxillary benign
odontogenic tumors [3]. Patients often have no pain, and odontoma is
accidentally diagnosed during routine checks or during a delayed
eruption permanent teeth or, more rarely, of milk teeth [6].
Odontogenic tumors may occur at any period of life from epithelial
tissue, ectomesenchyme or both with or without hard tissue formation
[7]. The etiology of odontomas is uncertain. There are several
hypotheses: local trauma during primary dentition, infection, family
history, hereditary abnormality, odontoblastic hyperactivity or
spontaneous genetic mutation [8]. Compound odontoma as well as
complex odontoma are benign, slow-growing pathological entities and
self-limiting [9]. Despite the high incidence of this tumor,
compound-complex type which shows both radiologic and histologic
characteristics of compound and complex types is not common in the
literature.
A bibliographic research on pubMed platform was performed. The articles
included were written in English language and published until 2021. Only
five publications (5 case reports and 1 retrospective study) report
cases of compound-complex odontomas [5, 10, 11]. Therefore, it shows
that our case report is uncommon.
There are different clinical aspects of odontoma. It can be either
intra-osseous, extra-osseous or erupted [5]. Most cases are intra
osseous as seen in our case. Although the anterior region of the maxilla
(67%) is the most prevalent location [12], our case was reported on
the posterior region of the mandible. Radiological appearance may vary
depending on the stage of development and degree of mineralization of
the tumor. Odontomas may be seen as radio transparent in the beginning.
Increasing mineralization leads to a corresponding increase in
calcifications, with constant decrease in radiotransparence. Mature
complex odontomas appear under form of round or ovoid radioopacities
with well-defined edges. The compound odontoma consists as a number of
radioopacities of different sizes, which resemble small dental
structures [13]. On histopathological examination, these two forms
of odontomas consist of all hard dental tissues –enamel, dentin and
cementum– as well as pulp tissue. These different tissues are mixed
anarchically in complex odontoma, whereas in the compound odontoma, they
organize themselves like a natural tooth, which are clearly
recognizable. Both types of lesions are surrounded by a fine conjunctive
capsule [5].
The treatment consists in a surgical removal of the lesion with
curettage. Their enucleation is simple as they are capsulated tumors
[2]. The recurrence is not common [12]. But an early discovery
and management allows us to be more conservative during the surgery, to
avoid degeneration of the lesion and retain the vitality and the
placement of adjacent tooth and eventually ensure a good prognosis.