Odontoma Recurrence. The Importance of Radiographic Controls: Case Report with a 7-Year Follow-Up

Abstract

Odontomas are benign tumors characterized by slow and limited growth with a rare recurrence. Odontomas are generally detected by radiographic findings in the radiopaque stage, where calcification of the tissues is observed. This article seeks to report the recurrence of a radiologically diagnosed odontoma to show the importance of radiographic controls after enucleation as a diagnostic and follow-up method. Case report: A female patient, 9 years old, attended dental care in 2020 due to malpositioned teeth. In the intraoral clinical examination, she presented stage II mixed dentition with crowding. A radiographic exam showed no associated lesions. The patient reported a history of odontoma removal and a supernumerary tooth in sextant II in 2016. Subsequently, she was referred to orthodontics, where permanent dentition with moderate anterior crowding in the maxilla and mandible was observed. The radiographic examination showed a radiopaque area compatible with odontoma, palatal to teeth 12 and 13. Conclusions: Although recurrence is rare, complete removal in the case of an odontoma is critical. This study demonstrates the importance of performing radiographic controls 5 years after enucleation of an odontoma, considering the stages of evolution.

Keywords: complications; diagnostics; imaging; odontoma; recidivism; recurrence; tomography.

Figure 1

Cone-beam computed tomography (CBCT) of the maxilla. 2016, 6 years old, prior to first surgery. (a) The panoramic reconstruction shows the presence of a mesiodens supernumerary tooth between 11 and 21. (b) Axial section. Location of mesiodens vestibular to teeth 11 and 21. Presence of multiple denticles compatible with odontoma, in intraosseous evolution, distal to tooth 11, and palatal to teeth 12 and 13. (c) Coronal section. Presence of mesiodens in relation to teeth 11 and 21, surrounded by a radiolucent demarcation area. (d) Sagittal section. Presence of supernumerary, crown in apical position and root in coronal area. Presence of pericoronary sac. (e) Sagittal section. Presence of multiple radiopaque masses with irregular margins compatible with odontoma (Sections 5–18) in intraosseous evolution palatal to tooth 13. (f) Axial section. Presence of mesiodens (Sections 21–23) in vestibular relation to teeth 11 and 21. Presence of radiopaque masses compatible with odontoma (Sections 21–29) distal to tooth 11 and palatal to teeth 12 and 13. White arrow = mesiodens. Red arrow = odontoma.

Figure 2

Panoramic X-ray. 2020, four years after the first surgery. Maxillary sinuses of ample development, shape, contour, and characteristic transparency. Stage II mixed dentition. 13, 43, and 33 lack radiographic space for a correct position in the dental arch. Third molars in intraosseous evolution.

Figure 3

Extraoral and intraoral photographs for diagnosis and corrective orthodontic treatment planning.

Figure 4

Panoramic X-ray. 2021, five years after the first surgery. Presence of a radiopaque element with a denticle shape in relation to teeth 12 and 13. Red arrow = odontoma.

Figure 5

Cone-beam computed tomography (CBCT) of the maxilla. 2021, five years after the first surgery. (a) Panorex section. Presence of a radiopaque area, compatible with odontoma, overprojected to teeth 12 and 13, mesioangular. (b) Axial section. Multilobulated odontoma, located palatal to teeth 12 and 13, surrounded by a radiolucent demarcation line. Discrete external resorption in the cervical third of the palatal root of tooth 13. (c) Cross-section. Presence of odontoma (Sections 18–28) in intraosseous evolution, microdontic, mesioangular, coronal structural alteration. Palatally displaced tooth location with thinning and perforation of palatal bone cortex. The crown is located palatally and in contact with the cervical third palatal root of tooth 12 and the cervical and middle third palatal root of tooth 13. Root location is palatally displaced. Root middle third in contact with palatal root middle third of tooth 13. Pericoronary sac and periodontal ligament space of preserved thickness (scale 100%). Red arrow = odontoma.

Figure 6

Panoramic X-ray. 2023, 24 months after the second surgical removal. Permanent dentition. Third molars in intraosseous evolution. Anterior mandibular splinting.

Figure 7

Flow chart for study selection.