A CASE OF COMPOUND MAXILLARY ODONTOMA AND MANDIBULAR HYPODONTIA

Radka Cholakova1, Ivan Chenchev1, Svetla Jordanova2, Diana Oncheva2, 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. Journal of IMAB Annual Proceeding (Scientific Papers) 2016, vol. 22, issue 3 Journal of IMAB ISSN: 1312-773X http://www.journal-imab-bg.org


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 degree.[1,2,3,4] Even though they are similar to hamartomas 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 connective 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 morphological differentiation varies for each lesion.A major part of some is calcified matrix, while in other cases there are sections 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, excluding wisdom teeth, it is called oligodontia.Hypodontia is assumed to be a hereditary disease which most often affects wisdom teeth, 2nd premolars and lateral incisors.The absence of permanent teeth is called anodontia.

CASE REPORT:
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 maxillary canine.Patient's history showed that there was a trauma in the frontal area at younger age that lead to the devitalization 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 discoloration of tooth 11.It is also determined that both mandibular second premolars are missing.There were no indications of any other accompanying disease.Presence of a limited by a radiopaque unstructured matter with tooth-like formations on the upper jaw in the area of the right canine, located palatinally and occlusally from its germ.Missing germs of second mandibular premolars.
The patient was directed to the Department of Oral Surgery for the extraction of the primary canine and extirpation 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 containing 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 revealed a compound odontoma  Odontomas are found at a frequency of 0.24% to 1.12% according to some authors and 0.64% out of all biopsies in maxillo-facial surgery.They account for 30.4% of all diagnosed odontogenic tumors.[4] Complex odontomas 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 people about the age of 19.25±2.9years, while the compound odontoma is diagnosed at an older age -25.14±4.8 years old.Maxillary odontomas are most commonly located in the frontal area, while the mandibular ones are usually located 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 characteristic 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 permanent 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%.Overall 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 affected 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