A 54-year-old female patient came to the consultation after suffering an acute inflammatory state in the left posterior sector of the lower jaw.
The patient reported having consulted a dentist a month ago, remembers that he underwent an intraoral radiographic examination and told him not to have any visible pathology due to the absence of pieces.
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A thorough clinical study of absences of lower molars in the left sector is performed and a good oral health condition is observed.
From there, it was decided to perform a panoramic extraoral radiography in order to observe the area in question more broadly.
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Radiography shows a rounded radiopaque image with net limits in the left inferior molar sector at the level of the inferior dental canal in the area.
When performing the anamnesis, the patient reported that during a state of infection that had suffered days before, she had paresthesia in this area, which determines that something happened in relation to the inferior dental nerve.
It is discarded whether it is a root remnant of some anterior teeth extractions due to their location and the size and shape of the object of study.
This is observed of larger size to what could be a root rest of a tooth still in transverse position.
After performing all the relevant studies, it was decided its surgical treatment.
Photographs of the different operative steps are presented.
It was decided to perform enucleation of this pathology for which a linear incision was used on the edentulous ridge cavity with discharge at level 33, after osteotomy of the area where the lesion was believed.
A delicate maneuver raises the inferior dental nerve.
Immediately behind, a small solid surface appears, which is removed in a very small diphtheubic fashion, as the space was aimed at not injuring the inferior dental nerve in its canal.
Figure 3 shows the remaining cavity, surged from left to right by the neurovascular bundle.
Figure 4 shows the suture already performed and Figure 5 shows the extracted material sent for anatomopathological studies at the Pathology Department of the School of Buenos Aires.
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Figure 8 shows a periapical X-ray taken one year later.
In the location where the odontoma is located, an area with tendency to increase bone density is observed, and we can see the path of the dental canal through its superior and inferior cortical bones.
Clinically, the patient completely felt sensitivity.
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The anatomopathological report informed us that a fragment of hard cydrical tissue measuring 0.7 x 0.4 x 0.3 cm was macroscopically found and three fragments of soft tissue, white after the cut were not particular.
Microscopically, it consists of fragments of dental tissues, sclerotic bone tissue and fibrogranulomatous reaction with lymphoplasmacytic inflammatory infiltrate.
The diagnosis corresponds to dental tissues included with chronic inflammatory reaction, that is, its diagnosis is compatible with that of an odontoma.
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Discussion and conclusion
Tumors of odontogenic origin cover 4% of all lesions of the oral cavity and jaws, cysts usually have 13% and the rest of the pathologies cover the remaining 83% according to the literature consulted.
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It can be established that odontoma is the most frequent dental tumor according to the criteria of different authors, with a high prevalence over other tumors.
Statistically, complex odontoma comprises 37%, compound 30% above the ameloblastoma which has 14% and myxoma found in 7%.1,17-19
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The incidence indicates a predisposition of males 60.5% over females (39.5%) according to the consulted literature 1.2.20-22
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The patient treated is female, in the sixth decade of life.
The lesion was found in the lower jaw in the posterior zone of the left side, noting prevalence in both age, sex and location the lesion according to the bibliography consulted.1,23
It is corroborated that the panoramic technique is the appropriate conventional radiographic study to diagnose this type of affections by the complete visualization of the jaws and adjacent structures as for their low gonodal exposure.29
From the above it is demonstrated the importance of requesting the appropriate radiographic study to obtain a correct presumptive diagnosis either by location, shape and size of the lesion.
Strict compliance with biosafety standards and proper follow-up of operative steps in surgical treatment to avoid possible complications after surgery.
The corroboration through histopathological studies is essential for the resolution of the case and follow-up through radiographic controls in the short, medium and long term.
