CBCT in the detection of odontoma

Abstract

OBJECTIVES: Odontoma is the most common among odontogenic tumors, representing 22- 23.9% of them. Impaction, aplasia, malformation, malpositioning, and devitalization of adjacent teeth are associated with 50-70% of odontomas. Two types of odontoma are distinguished, compound and complex. The typical features of compound odontoma are separate, rudimentary, closely positioned toothlike structures . When such buds form an amorphous and irregular conglomerate of dental tissue without a clear division, they are classified as complex odontoma. Both types are recognized more frequently in the permanent dentition, typically in the second or third decade of life. The anterior maxilla and the posterior part of the mandible are most commonly affected sites. CBCT findings in the detection of odontoma is reported. MATERIALS AND METHODS: 5 patients (4 women, 1 man, ranging from 12 to 51 years) were studied by a CBCT device with 90 KV and 13 mA, o,34 voxel size. Panoramic, cross sectional, multiplanar and 3D reformations were acquired. RESULTS: 3 complex and 2 compound odontomas were found. Odontomas were located: 1 in the right maxilla, 2 in the left maxilla, 1 in the left mandible, 1 in the right mandible. In the patient with odontoma in the right maxilla, it was adjacent to the nasopalatin canal, caused the impaction of 11, with persistency of 51. Of the 2 odontomas in left maxilla, one was adjacent to the maxillary sinus floor, the other one was buccally erupted. The odontoma in the left mandible was contiguous to the mandibular canal wall. RESULTS: Making a final diagnosis of odontoma only relying on panoramic or periapical radiographic appearance alone often presents a challenge, because odontomas can mimic other osseous or fibro-osseous lesions, and its recognition depends also on its position with respect to the x-ray beam incidence, due to overimposed adjacent anatomic structures or lesions, that can partially masquerade odontoma. Therefore, for differential diagnosis and treatment planning, the use of CBCT is highly recommended. CBCT in fact, thanks to tridimensional high resolution data acquisition, allows a correct identification of odontoma, avoiding overimposed structured noise, and of its relationship to contiguous anatomic structures. CONCLUSIONS: Making a final diagnosis of odontoma only relying on panoramic or periapical radiographic appearance alone often presents a challenge, because odontomas can mimic other osseous or fibro-osseous lesions, and its recognition depends also on its position with respect to the x-ray beam incidence, due to overimposed adjacent anatomic structures or lesions, that can partially masquerade odontoma. Therefore, for differential diagnosis and treatment planning, the use of CBCT is highly recommended. CBCT in fact, thanks to tridimensional high resolution data acquisition, allows a correct identification of odontoma, avoiding overimposed structured noise, and of its relationship to contiguous anatomic structures.