Eruption disturbance caused by an Odontoma & Step lesion exc
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A male patient aged 6 years and 8 months was referred to the pediatric dental clinic for hard‐tissue removal around the crown of an impacted maxillary right first molar. Panoramic radiography and cone‐beam computed tomography (CBCT) revealed that less than one‐fourth of the root was formed, and it was shorter than that of the corresponding left maxillary molar; additionally, the crown was covered by a radiopaque lesion (Figure 1). The differential diagnosis included odontoma, retention of the right maxillary first molar, and delayed root formation.

The treatment plan involved the removal of the lesion to facilitate the eruption of the molar. During the first surgical procedure, which was performed under local anesthesia, the hard tissue covering the tooth was exposed to the oral cavity; however, the lesion could not be separated from the tooth. In due course, the tooth gradually emerged along with the lesion attached to it.

A step lesion excavation was planned using an ultrasonic bone scalpel and diamond bur. The procedure was painless and repeated five times over a period of 9 months from the age of 7 years and 3 months. At 7 years and 8 months of age, the occlusal surface of the molar located beneath the gingiva demonstrated a chalky‐white appearance and was filled with carboxylate cement to prevent pulp infection.

At 8 years and 2 months of age, CBCT revealed remnants of the lesion, which appeared to be attached to the pulp (Figure 1). Therefore, the stepwise removal of the lesion was stopped, and an adhesive resin was applied to both the crown and the lesion as a protective measure. Accordingly, the lesion was diagnosed as an enamel‐like tissue‐dominant complex odontoma that was partially attached to the first molar.

To conclude it can be stated that despite the partial attachment of a complex odontoma to an impacted tooth, it is possible to guide the tooth to erupt normally and preserve it by step lesion excavation and the prevention of infection.

Source: https://onlinelibrary.wiley.com/doi/full/10.1002/ccr3.2523?af=R
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