A novel approach for the manag ement of an odontome

Abstract

Introduction: Odontomes are hamartomatous developmental mal-formations of odontogenic origin which manifest as denticles, oramorphous masses comprising of all, or some of the dental tissues.They commonly occur in the pre-maxillary region and associatedcomplications include delayed or non-eruption of permanent teeth,retention of the primary teeth and dentigerous cyst formation.Management usually requires both surgical and orthodonticintervention. We describe the spontaneous eruption of an impactedcentral incisor, associated with an odontome, without surgicalintervention in a 9 years old Chinese boy.Clinical management: Clinical and radiographic examinationsrevealed the presence of an odontome inhibiting the eruption ofthe permanent maxillary left central incisor. Consequently, theadjacent lateral incisor had tipped mesially to occupy the spaceintended for the central incisor. A maxillary removable appliancewas fitted to distalise the mesially tipped lateral incisor to createspace for eruption of the impacted central incisor prior to surgicalremoval of the odontome. After 2 months, the lost space wasregained. Furthermore, this intervention appeared to initiateeruption of the previously unerupted central incisor despite thepresence of the odontome. Subsequently, the regained space wasmaintained and after 7 months, the central incisor erupted spon-taneously. Nevertheless, the position of the odontome remainsunchanged so the patient is currently under regular review.Conclusion: It appears that spontaneous eruption of an uneruptedtooth associated with an odontome is possible without surgicalintervention provided factors such as size and location of theodontome, position of the unerupted tooth and space available arefavourable.