Odonto calcifying cyst
A 13-year-old boy reported with the chief complaints of space in the maxillary front tooth region since 1 month [].\nHistory reveals that the patient visited a dentist for improper arrangement of the maxillary front tooth region and had undergone uneventful extraction. On clinical examination, extra orally there was no obvious facial asymmetry.\nIntra oral examination showed an ill-defined swelling of the buccal gingiva in the region of right maxillary central and lateral incisors measuring 1.5 cm × 1 cm in size. The swelling was slightly obliterating the labial vestibule; surface over the swelling was smooth, normal in color and texture. On palpation, the swelling was bony hard in consistency and non-tender [].\nOn correlating the patient's complaint, with the history and clinical examination a provisional diagnosis of benign tumor of maxilla was made.\nOn radiographic examination, IOPA Intra Oral Periapical Radiograph showed radiopaque mass with multiple teeth like structures present in relation to 11, 12, 13 measuring 0.5 cm in size. Occlusal radiograph showed expansion and thinning of the labial cortical plate []. OPG Ortho Pan Tomography shows a tooth like radio opaque mass in relation to right central and lateral incisor surrounded by a well-defined radiolucent rim towards the inferio-left lateral aspect of the mass [].\nThe radiographic differential diagnosis that were considered are odontome, cystic odontoma, multiple supernumerary teeth, COC, Adenomatoid odontogenic tumour, ameloblastic fibro-odontoma.\nThe patient was admitted, and enucleation of the lesion was done under local anesthesia. The lesion was easily detached from the surrounding bone and was removed together with hard tissue. The excised specimen consisted of a cystic sac approximately 2 cm in diameter; the odontoma-like hard tissue was attached to the cystic wall.\nMicroscopically, the histopathological section of the specimen showed odontogenic lining epithelium which was single layered in one area and two to three layers in the remaining areas lyning the cystic cavity []. Above the odontogenic epithelium stellate reticulum like cells were arranged. Eosinophilic masses suggestive of ghost cells were seen. A fibrous connective tissue wall was also present [].\nThe decalcified section of the hard tissue showed enamel and dentin like material arranged in disorganized fashion []. The histopathologic features were suggestive of COC associated with complex composite odontoma.