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Unusual presentation of a tooth associated with an adenomatoid odontogenic tumour Nimit J Patel Simon Toms Fraser McDonald Joanna Johnson Louis McArdle Dental Update 2024 46:6, 707-709.
Authors
Nimit JPatel
BDS (Hons), MFDS, RCPS(Glas), PGCert(DentEd)
Paediatric Dentistry, Guy's and St Thomas' NHS Foundation Trust
Unilocular radiolucent lesions of the dental hard tissues can present regularly, however they are impossible to diagnose definitively without appropriate imaging and histopathology. A case is reported that involves a 14-year-old that presented with a history of an unerupted maxillary first premolar. An initial Dental Panoramic Tomograph (DPT) did not identify any localized opacities and was diagnosed as a dentigerous cyst. A Cone Bean Computed Tomogram (CBCT) identified calcified opacities resulting in a re-evaluated radiological interpretation. With the help of a multidisciplinary approach, the removal of the benign lesion allowed orthodontic traction to extrude the tooth and for it to be brought into alignment.
CPD/Clinical Relevance: This report highlights the importance of three-dimensional imaging as an adjunct to aid diagnosis and highlights the importance of multidisciplinary teams in the management of clinical challenges.
Article
Adenomatoid odontogenic tumours are benign, slow growing lesions and are more often found in the maxilla than the mandible in a ratio of 2.1:1.1, 2 The ratio of occurrence in males and females is skewed 1:1.9, however, certain Asian populations demonstrate the ratio as being 1:3.2.3 They often present in the second decade of life and, according to the WHO classification of odontogenic tumours, are primarily composed of odontogenic epithelium with ductal type structures.4 The lesion can present as three different variants (follicular, extrafollicular and peripheral) and radiographically are unilocular; with two-thirds of cases presenting with radio-opaque foci.5 Areas of the tumour can also appear cystic.6 Treatment for this type of tumour is enucleation or curettage: recurrence is reported to be rare, with only three cases highlighting reappearance.7 Dentigerous cysts present often as unilocular radiolucent lesions surrounding an unerupted tooth which starts at the cemento-enamel junction.8, 9
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