A 4 year old male patient presented with a firm, painless swelling in the area of tooth #63. Intraoral examination revealed a 6.0mm x 6.0mm painless hard buccal swelling over the superior area of the crown of tooth #63 (Fig. 1). The appearrance of the mucosa was normal in texture and color.
Radiographic examination consisted of an intraoral periapical film and a maxillary occlusal film (Figs. 2 & 3). The radiographs demonstrated a well defined mixed radiopaque-radiolucent abnormality with a smooth outer cortex with an internal radiolucent space surrounding multiple discreet opacities. These opacities had a density and composition similar to dental tissues. The abnormality was buccal to tooth #63.
The obvious diagnosis of this abnormality is the Compound Odontome. The compound odontome is a benign tumor of the jaws. Odontomes are composed of all components of dental tissues and are one of the most common odontogentic tumors. The compound odontome usually consists of multiple tooth-like denticles surrounded by a soft-tissue radiolucent capsule and by an outer smooth sclerotic cortex. The complex odontome is made up of varying degrees of dental tissues with no organization and presents as a thick radiopaque mass surrounded by a thin radiolucent line and outer thin cortex.
Most odontomes are usually asymptomatic and the main presenting sign is failure of a tooth to erupt. These are usually revealed on routine radiographic examination. Odontomes occur usually in the second decade with no gender predilection. The anterior maxilla is the most common site of occurrence but they are reported in all areas of the jaws. In this case the odontome had an interesting presenting feature of swelling which is uncommon for odontomes.
This odontome is of clinical interest due to its presentation as a buccal swelling. Of interest in this case is the radiographic examination which was prescribed. A modified maxillary occlusal film was indicated to reveal this firm abnormality. It was the use of this 90-degree technique which revealed a proper image of the swelling to arrive at a radiographic diagnosis of a compound odontome.
The value of occlusal radiography is often overlooked in the dental office. It is a simple technique readily available to the dentist and auxillaries which can greatly add to the diagnosis of dental abnormalities and lead to a correct radiographic diagnosis.
Dr. Bourgeois is Oral Health’s editorial board member for Radiology. He maintains a private practice in Toronto specializing in Oral & Maxilliofacial Radiology.
The author would like to extend his gratitiude to Dr. Helen Chiu for sharing this very interesting case.
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