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Original Article

The prevalence, anatomic locations

and characteristics of the odontomas
using panoramic radiographs
Hakan Avsever, Hakan Kurt1, Tolga Berkay Suer2, Hilal Peker Ozturk, Bulent Piskin3
Departments of Dentomaxillofacial Radiology, 3Prosthodontics, Gulhane Military Medical Academy, Dentistry Center, 1Department of
Dentomaxillofacial Radiology, Faculty of Dentistry, Ankara University, Ankara, 2Department of Oral and Maxillofacial Surgery, Gulhane Military
Medical Academy, Haydarpasa Teaching Hospital, Istanbul, Turkey

A B S T R A C T

Objectives: Odontomas are the most common variety of odontogenic tumors and derived from differentiated epithelial and
mesenchymal cells. The purpose of this study is to evaluate the prevalence, types and localization of the odontomas in Turkish
patients. Materials and Methods: This was a retrospective study of panoramic images that were taken between April 2011 and
January 2014 in the Department of Dentomaxillofacial Radiology, Gulhane Military Medical Academy (GATA), Turkey. A total of
14,250 panoramic images were evaluated by an experienced dentomaxillofacial radiology specialist. The clinicopathologic features of
odontomas such as, anatomic location, distribution in gender, age of the patients and the incidence of the odontomas were assessed.
Results: A total of 22 odontomas in 20 patients (11 females; 9 males) (0.14%) were found of the 14,250 patients` panoramic view.
About 36.4% of the lesions were complex odontomas and 63.6% were diagnosed as compound odontomas. About 18.2% of all cases
were in the maxilla and 81.8% in the mandible. The anterior portion of mandible was found the most common location (40.9%) in this
study. Conclusions: According to the result of this study, the compound types of the odontomas are more common than complex
odontomas and the anterior mandible is the most affected site. It was noted that even though odontomas are the most common variety
of odontogenic tumors, they rarely occur.

Key words: Odontogenic tumor, odontoma, panoramic, prevalence, radiography

INTRODUCTION consisting of enamel, dentin, cementum, and pulp.[4]

Odontomas are the most common variety of odontogenic
tumors and derived from differentiated epithelial and
mesenchymal cells. [1,2] They were first described by
Broca in 1866.[3] Constituting 22% of all odontogenic
tumors, they lack proliferation potential. Rather than true
neoplasms, odontomas are probably a hamartomatous
malformation of functional ameloblasts and odontoblasts
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DOI:
10.4103/2321-3841.157523
Although the etiology of odontoma is unclear, infections
or local traumas may cause odontomas.[1,2,5,6] Odontomas
are dens radiopaque lesions with prominent margins
surrounded by a thin radiolucency.[7,8] The majority of
odontomas occur in the first and second decades of
life.[9] According to the latest classification of the World
Health Organization in 2005, two types of odontomas
can be found: Complex odontomas and compound
odontomas. Compound odontomas are usually located
in the anterior maxilla, over the crowns of unerupted
teeth, or between the roots of erupted teeth. These
lesions usually contain multiple radiopaque, miniature
tooth-like structures known as denticles.[10] As opposed to
compound odontomas, complex odontomas commonly
occur in the posterior mandible, frequently over an
impacted tooth, and can reach several centimeters in size.
[8]
It is a malformation in which all the dental tissues are

Address for correspondence: Dr. Hakan Kurt, Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Ankara University, Ankara,
Turkey. E-mail: mhakankurt@yahoo.com

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Avsever, et al.: The prevalence of the odontomas

well-formed, but occurring in a less orderly pattern.[10] (n = 4) in the maxilla. About 12.5% (n = 1)of the complex
No individual tooth-like structures are seen.[5] It has odontomas were located in the anterosuperior region, and
been reported in the literature to date that compound 50% (n = 4) in the posteroinferior region. About 25%
odontoma is twice as common compared to complex (n = 2) of the lesions were identified in the upper molar
odontoma. About 60% of complex odontomas occur region, and the last one was in the anteroinferior region.
in women.[10] The treatment of choice is removing the About 64.2% of the compound odontomas were detected
lesion surgically.[10,11] In the present study, we aimed to in the anterior region of the mandible (n = 9), and only
review the prevalence of the lesions, their gender and 1 compound odontoma was in the anterosuperior region.
age distribution, anatomic location, and involvement of
The rest of the lesions (28.5%) were identified in molar
adjacent structures in Turkish patients.
region of the mandible (n = 4). Additionally, various
abnormal conditions that were caused by odontomas
MATERIALS AND METHODS
such as 6 delayed eruptions [Figure 1a], 6 malpositions
[Figure 1b], 6 impactions [Figure 1c], 1 dilaceration of
This study was designed as a retrospective review of
adjacent tooth [Figure 1d], 1 resorption of adjacent tooth
14,250 panoramic radiographs that were examined
between April 2011 and January 2014 in the Department Table 1: Anatomic locations and characteristics
of Dentomaxillofacial Radiology, Gulhane Military Medical of the odontomas
Academy, Ankara, Turkey. Panoramic images had been Gender Age Localization Type Number of
taken because of various problems such as impacted odontomas
teeth, pathological lesions, orthognathic surgery, dental Male 36 Antero-inferior zone Compound 1
Female 28 Postero-inferior zone Compound 1
implants, endodontic lesions, etc., 192 panoramic images Female 46 Antero-inferior zone Compound 1
due to various reasons such as, poor image quality and Male 58 Antero-inferior zone Compound 1
Male 27 Postero-inferior zone Complex 2
technical reasons were excluded from the study. Totally Postero-superior zone
14,058 images were evaluated. Male 36 Postero-inferior zone
Compound 1
Female 17 Antero-inferior zoneCompound 1
Male 16 Antero-inferior zoneCompound 1
The panoramic images were performed using a Kodak Male 39 Antero-inferior zoneCompound 1
8000C digital panoramic system at 73 kVp, 12 mA and 13.9 s Female 24 Postero-inferior zone
Compound 1
exposure setting (Eastman Kodak Company, Rochester, Female 27 Postero-inferior zone
Complex 1
Male 34 Postero-inferior zone
Complex 1
NY). All images were examined by 12 years experienced Male 36 Antero-inferior zoneMaxilla complex/ 2
dentomaxillofacial radiology specialist. Kodak Dental Antero-superior zonemandible
Imaging Software Viewer, version 6.12.10.0 (Eastman compound
Female 41 Antero-inferior zone Complex 1
Kodak Company, Rochester, NY) was used for image Female 39 Postero-superior zone Complex 1
evaluation on a standard personal computer with calibrated Female 51 Antero-inferior zone Compound 1
Female 23 Postero-inferior zone Compound 1
monitor (HP Compaq LE1711 LCD Monitor, Palo Alto, Male 14 Antero-inferior zone Compound 1
CA, USA). The level of contrast and brightness of the Female 19 Antero-superior zone Compound 1
images were left to examiners choices. Female 54 Postero-inferior zone Complex 1

RESULTS

The types of odontomas, anatomic localization, the number

of lesions, age and gender of patients were noted [Table 1]. a b
All statistical analyses were performed using SPSS for Win.
version 15.0 (SPSS Inc., Chicago, ILL., USA). A total of
22 odontomas in 20 (0.142%) patients were detected in
14,058 cases, of whom 11 (55%) were female and 9 (45%) c d
were male. The mean patient age at the time of diagnosis
of the odontomas was 33.2 10.27 years (range 14-58
years). The radiologic appearance of the lesions confirmed
the presence of 8 complex odontomas (36.4%) and 14 e
compound odontomas (63.6%). About 81.8% (n = 18) of Figure 1: (a-e) The panoramic images of the several abnormal conditions
22 odontomas were located in the mandible and 18.2% that were caused by odontomas

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Avsever, et al.: The prevalence of the odontomas
root [Figure 1e] have also been detected.
DISCUSSION
Odontomas are benign tumors that consist of enamel,
dentine, cementum and pulpal tissue.[12] They are usually
found incidentally during routine radiologic evaluation
unless they are symptomatic. Since first described by
Broca in 1866, odontomas have been reported by several
authors and identified as the most frequent lesions among
all odontogenic tumors. The frequency of occurrence of
odontoma varies greatly in different reports and populations.
Sriram and Ravindra[13] reported that odontomas are
identified as the most frequent odontogenic tumor in
Caucation population. They also reported the incidence
of odontomas as 6% in odontogenic tumors. In another
study Buchner et al.[14] reported the incidence of odontoma
as 75.9% in all odontogenic tumors. According to their
result, it seems like they confirm Sriram and Ravindras
thesis. The reason for this remarkable high incidence rate of
odontomas may be the studies, which reported in literature,
are made among all odontogenic tumor cases. To the best
of our knowledge, there are only few studies that report
incidence of this lesion in population. Tekkesin et al.[15]
reported 160 cases of odontoma in 40,999, and found
incidence as 0.4%. Patil et al.[16] and Afify and Zawawi[17]
reported as 0.2% and 0.1% respectively. According to
our results, we found 0.14% prevalence rate in a sample
of the population. When compared to current literature
this prevalence rate seems little low. The reason for the
low prevalence of odontomas may be many patients in
Turkey do not refer to a hospital unless there are symptoms
suggesting an obvious pathology.
Odontomas affect the maxilla slightly more than the
mandible. According to many researchers anterior region
of the maxilla is the most common location for compound
odontomas. Complex odontomas were reported most
frequently in the posterior mandibular region.[1,2,6,7] In
general, the literature indicates that the frequency of
odontomas was higher in maxilla than in the mandible,
however, this study showed only 4 odontomas (%18.1)
in maxilla in 22 cases. When compared to the current
literature this result showed relatively low incidence rate
and this difference may be attributable to different sampling
size of the presented study. On the other hand, although
the reported tendency of odontomas arises in anterior
portion of the jaws, in our series we noted similar incidence
between two areas. According to the result of this study,
we found that the compound odontomas were more often
found in the anterior mandible. This result also was not
Journal of Oral and Maxillofacial Radiology / May-August 2015 / Vol 3 | Issue 2
in agreement with the previous reports in literature. We
also found 62.5% of complex odontomas were in the
posterior portion of mandible. This result also agrees with
the literatures higher frequency of complex odontomas in
the posterior mandible.
There is still a controversy among the studies about gender
predilection. While some authors have reported a greater
incidence in females,[10,14] others claim in males.[1,11] The
third group of studies reports showed no difference
between males and females.[12,15,18] In the present study, the
incidence was found as 55% on behalf of females.
Odontomas can be seen at any age, but most reports
showed greater incidence in the second and third decade
of life.[11,12,18] In the present study, we found that %45 of
the patients were in the second and third decade. Mean age
was found as 33.2 10.27 years. Some studies have also
reported an existence of a correlation between age and
type of odontomas.[18] According to this thesis compound
lesions are apparently more frequent in younger patients.
The results of our series coincide with this aspect.
World Health Organization identifies the types of
odontomas as compound and complex. Compound
odontoma is described as a formation that all dental tissues
are present and organized as tooth-like structures. The
complex type contains abnormal arrangement of dental
tissues, usually presenting as a radiopaque mass with varying
densities. Compound odontomas are seen more often than
complex ones.[2,5,19] On the contrary, Olgac et al.[20] reported
67 complex odontomas but only 42 compound type.
Tekkesin et al. also reported similar results.[15] In this study,
there was 1.75:1 ratio of compound to complex odontomas
and this result coincides with the literature to date.
Odontomas are one of the most seen benign odontogenic
tumor in oral region. Although they are frequently
asymptomatic but sometimes their presence can cause some
symptoms such as swelling, infection or associated signs
of impacted teeth. But in contrast, some authors reported
that especially complex odontomas were not asymptomatic.
They are frequently seen with a remarkable bone expansion
compared with compound odontomas. However, if no
symptoms occur, they can remain within the bone for many
years without producing any clinical signs.[12] On the other
hand, 70% of odontomas[21] have some adverse effects on
adjacent teeth such as delayed tooth eruption, impaction,
displacement, and root resorption, widening follicular space,
inflammation or cystic formation.[12,15,21-23] In the present
study, we found 45.4% (n = 10) of odontomas that have
radiologic findings on adjacent teeth. In addition to these
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Avsever, et al.: The prevalence of the odontomas
effects on adjacent teeth, we also detected dilacerations
caused by odontomas on adjacent tooth root in one case.
The presence of odontomas and adjacent teeth dilaceration
is extremely rare. To the best of our knowledge, only a few
reports emphasized dilaceration. Dayi et al.[24] reported a case
of dilaceration with the adenomatoid odontogenic tumor.
Yeung et al.[25] detected maxillary primary central incisor
root dilaceration associated with compound odontoma. In
our study, we detected dilaceration of adjacent permanent
tooth associated with odontoma. According to our point
of view, the physical presence of an odontoma may affect
the direction of root development, change of its angulation
and cause dilaceration.
In case of observation of a radiographic finding resembling
odontomas, differential diagnosis must be established with
several lesions depending on its location. If the lesion occurs
inter-root location, then focal residual osteitis, cementoma,
calcifying epithelial odontogenic tumors, adenomatoid
odontogenic tumors, supernumerary teeth or benign
osteoblastoma should be included in the differential diagnosis.
If the lesion is located at pericoronal level, then adenomatoid
odontogenic tumors, calcifying epithelial odontogenic tumors
or odontoameloblastoma should be included in the differential
diagnosis. When the lesion occurs in the maxillary sinus,
then it could be misdiagnosed with sinusitis, antral mycosis,
foreign bodies, retained root, peripheral osteoma, benign
mesenchymal neoplasms, antral sarcoma or carcinoma.
[1,2,12,18,26]
It can also be associated with some syndromes such
as basal cell nevus syndrome and Gardner syndrome.[2]
Although surgical treatment modality is generally preferred
option for the management of odontomas, there has
been no general agreement about the best approach
for odontomas. Morning[27] reported that removal of
odontoma led to the eruption of impacted teeth in %45 of
cases. In case of an existence of an odontoma in the way
of eruption surgical treatment could be a better option. To
avoid carcinoma, adenomatoid tumor or ameloblastoma;
it is suggested that there should be better routine clinical
and radiological follow-up.[28]
The present study revealed that the prevalence of odontomas
showed variations from other studies. This diversity may
depend on the sample of population, method of the studies
or racial and genetic differences. In conclusion, odontomas
are one of the benign tumors that are frequently seen in
both jaws. They have been detected in routine radiographic
examination only if they are asymptomatic. They usually
cause delayed eruption, so early detection and treatment of
odontomas could decrease the possibility of late eruption
or even tooth impaction due to overlying odontomas.
52 Journal of Oral and Maxillofacial Radiology / May-August 2015 / Vol 3 | Issue 2
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Cite this article as: Avsever H, Kurt H, Suer TB, Ozturk HP, Piskin B. The
prevalence, anatomic locations and characteristics of the odontomas using
panoramic radiographs. J Oral Maxillofac Radiol 2015;3:49-53.
Source of Support: Nil. Conflict of Interest: None declared.

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