Case Report: An association of the gubernacular canal, supernumerary tooth and odontoma with an impacted canine on cone-beam computed tomography

Abstract

This report describes a clinical case of asymptomatic compound odontoma in the anterior left side of the maxilla associated with an impacted canine and supernumerary tooth with a gubernacular canal of a 47- year-old female with no relevant medical history. Cone-beam computed tomography (CBCT) was performed for precise three-dimensional localization of each structure and assessment of their spatial relationship with the associated structures before surgery. The treatment protocol involved surgical enucleation of the odontoma and open extraction of both impacted and supernumerary teeth. The patient had uneventful healing and proceeded with the prosthodontic treatment plan. The dentist should be aware of the probability of a close relationship between the development of odontoma and presence of the gubernacular tract, which could be used as a future radiographic diagnostic criterion of an odontoma. Also, we recommend that more studies be performed in this field to deeply analyze the imaging characteristics of GT and its spatial association with various pathological lesions in the future.

Keywords: Compound Odontoma; Cone Beam CT; Gubernacular canal; Impacted Canine; Supernumerary teeth.

Figure 1.

a) Preoperative clinical intraoral photo showing buccal bulging opposite to the area of impacted left maxillary canine. b) preoperative panoramic radiograph showing impacted left maxillary canines and two radiopaque masses distal to it. c) preoperative periapical radiograph showing impacted canine, supernumerary tooth and radiopaque mass.

Figure 2.

a) Coronal cone-beam computed tomography (CBCT) scan showing impacted left maxillary canine, supernumerary tooth and odontoma with continuous follicular space b) Three-dimensional CBCT reconstruction showing palatal impacted maxillary left canine together with supernumerary tooth and odontoma c) Sagittal CBCT scan showing odontoma occlusal to supernumerary tooth d) Sagittal CBCT scan showing the proposed gubernacular canal (white arrow).

Figure 3.

Intra-operative clinical picture showing surgical procedures to extract impacted maxillary left canine, supernumerary and odontoma a) Labial approach to expose the odontoma. b) Exposing the supernumerary tooth c) Palatal approach to extract the impacted maxillary left canine d& e) Measuring size of odontoma, supernumerary tooth and follicular tissue.

Figure 4.

Histopathologic examination of the excised mass showed a tooth-like structure with dentin (long arrow), and enamel matrix (short arrow) confirming the diagnosis of compound odontoma ( Figure 4 a,b). Histological examination for the soft tissue mass showed odontogenic epithelial lamina arranged in islands and cords and surrounded by collagenous connective tissue which confirms the diagnosis of gubernacular tissue ( Figure 4c) (100X).