Teeth are extraordinary structures when they form correctly. The orchestration of enamel, dentin, cementum, and pulp — all formed from their respective progenitor cells in precise spatial and temporal coordination — is one of the more elegant processes in human development. But occasionally, this process goes wrong. Not catastrophically, but in a way that produces something that is anatomically interesting and clinically significant: an odontome.
A 32-year-old woman came in after her OPG had been taken at another centre. She had been referred with the radiograph showing a mixed radiopaque-radiolucent lesion in her lower jaw. On intraoral examination, there was a visible lesion in the floor of the mouth region, associated with an abnormality in the tooth-bearing area.
This was a complex odontome — one of the more unusual developmental anomalies I encounter in practice.
What Is an Odontome?
The word comes from the Greek odonto (tooth) and the suffix -oma (tumour) — but odontomes are not true neoplasms. They are developmental anomalies, or hamartomas: a disorganised proliferation of normal tissue types in an abnormal configuration. Think of it as the blueprint for a tooth that got confused at the drafting stage.
There are two types. A compound odontome produces multiple small, recognisable tooth-like structures (called denticles). A complex odontome — as in this case — produces a disorganised, haphazard mass of all the tissues that would go into a tooth (enamel, dentin, cementum, pulp) but arranged in a completely irregular pattern. There is no recognisable tooth form. What you get instead is a calcified, irregular mass that sits within the jaw and occupies space that should either contain a normal tooth or healthy bone.
How Is It Diagnosed?
The OPG is typically the first investigation that raises suspicion. Complex odontomes appear on radiographs as a mixed density lesion — radiopaque areas (calcified dental tissues) surrounded by a radiolucent halo (the fibrous capsule). The appearance is not quite like anything else, which makes it relatively distinctive once you have seen a few. In this patient's case, the OPG from Phoenix Dentofacial Imaging Centre showed this characteristic mixed appearance clearly.
The patient was 32 years old — which is older than the typical odontome presentation. Odontomes are most commonly detected in the second decade of life, often incidentally on routine dental radiographs. A presentation at 32 suggests the lesion had been present for years without causing significant symptoms.
The Surgery
We approached the lesion intraorally, reflecting a full-thickness mucoperiosteal flap to expose the overlying bone. The lesion was exposed — visible as a calcified, irregular mass within the bone — and carefully removed in its entirety. Wound closure was completed in layers.
The excised specimen is one of the most visually characteristic findings in this case: multiple small calcified fragments — looking almost like irregular fragments of hard tissue — rather than a single mass. This is entirely characteristic of complex odontome, where the disorganised dental tissues produce an irregular, multi-fragment calcified mass.
Why Remove It?
The primary indications for odontome removal are prevention of complications. Odontomes can block the eruption of adjacent teeth (causing impaction), can become secondarily infected, can cause root resorption of adjacent teeth, and in rare cases can be associated with dentigerous cyst formation around the calcified mass. Additionally, the radiological differential for a mixed-density jaw lesion always includes odontogenic tumours — surgical removal both treats and definitively diagnoses in a single procedure.
The patient healed uneventfully. The adjacent tooth eruption potential was assessed, and she was followed up accordingly.
Complex odontomes are benign and curable with complete surgical removal. They do not recur.
— Dr. Hema | Oral & Maxillofacial Surgeon | Hyderabad
Let's talk about your case
Whether you're a patient researching options, a family member trying to understand a diagnosis, or a GP or dentist with a complex referral — reach out.
Let's talk about your case
Whether you're a patient researching options, a family member trying to understand a diagnosis, or a GP or dentist with a complex referral — reach out.
Let's talk about your case
Whether you're a patient researching options, a family member trying to understand a diagnosis, or a GP or dentist with a complex referral — reach out.