Title Extirpation of odontoma reg. 4+
Description This video illustrates a 13 year old boy, who’s left canine is not erupting as the right canine. Panoramic x-ray shows a radiopacity obstructing eruption of the left canine. Intraoral x-ray shows a radiolucency – similar to a periodontal membrane – surrounding the radiopaque area, which seems divided into two or more separate tooth-like structures. However, it is not possible at this stage to decide, whether this would be a compound or a complex odontoma.
Authors Anders Nattestad og Birgit Kenrad
Length 9:16


Introduction and x-ray
This video illustrates a 13 year old boy, who’s left canine is not erupting as the right canine. Panoramic x-ray shows a radiopacity obstructing eruption of the left canine. Intraoral x-ray shows a radiolucency – similar to a periodontal membrane – surrounding the radiopaque area, which seems divided into two or more separate tooth-like structures. However, it is not possible at this stage to decide, whether this would be a compound or a complex odontoma. Klik i billedet for at se dette klip i bedste kvalitet


Local anaesthesia
The facial mucosal surface is anaesthetized by analgetic gel for one minute and dried by use of a gauze tamponade. Local infiltration is performed by injecting lidocaine containing adrenaline. In the palate, analgetic gel is applicated, a finger is pressed hard against the incisive papilla, and injection is done to the incisal foramen and the palatal mucosa. Klik i billedet for at se dette klip i bedste kvalitet


03-incision
A facial marginal incision is done from tooth no. +6 or 26 to tooth no. +2 or 22. An oblique releasing incision is made from the buccal mucosa to the marginal gingiva of +2. Note the finger establishing support by resting on the left incisor! Klik i billedet for at se dette klip i bedste kvalitet


Raising the flap
The mucosal flap is released from the underlying bone by use of a periosteal elevator, beginning at the releasing incision and moving backwards beneath the marginal incision. The flap is then easily separated from the alveolar bone in a cranial direction, and S?rhage the retractor is being placed. A lingual marginal incision is made along the two aligning teeth and this minor flap is released and retracted by the periosteal elevator. After rinsing with sterile physiological saline, the most superficial part of the tumour tissue is visible penetrating the top of the alveolar crest. Klik i billedet for at se dette klip i bedste kvalitet


Bone removal
The penetration is extended using the bur, - constantly supplied by sterile physiological saline to keep the bone cool and moist. Very thin fragments of bone may be removed by a pean in stead of by bur, protecting the underlying structures. Klik i billedet for at se dette klip i bedste kvalitet


Extirpation of tumor
The incisal edge of the permanent left canine is now visible surrounded by soft follicular tissue. Further exposition of the tumour tissue is done, and the separate structures are removed one by one, each of them more or less resembling a tooth. Klik i billedet for at se dette klip i bedste kvalitet


Suturing
The wound is carefully trimmed by removing soft tissue from the tumour site, removing sharp bone edges – if any – and rinsing with saline. To stabilize the flap, the first suture is placed in the mucosal flap at the corner between the marginal and the releasing incisions, and then through the palatal marginal mucosal flap. A piece of finesse is to lead the needle back through the tip of the facial flap a few milimeters from the first insertion. When tightening the suture, this leads the flap back to the in situ position without forcing the interdental papilla to one of the two sites. Then the releasing incision is sutured by single sutures. Note, that the needle is guided through the tissue respecting the curve of the needle. The ends of the sutures are cut at a length not hampering the patient, however long enough to catch hold of, when removing the sutures 5 to 7 days after the operation. Klik i billedet for at se dette klip i bedste kvalitet


Histopathology
The removed tooth-like structures are seen related to a scale. They are immidiately placed in 10 % formalin and after the operation send for histological preparation and examination together with a written formular. The histological diagnose was Compound odontoma, which is a benign odontogenic consisting of several tooth-like elements. This diagnosis harmonized well to the clinical appearance. A complex odontoma would consist of all the odontogenic tissues in a pattern not similar to tooth structure.