An unusual triad: Bilateral dilated odontoma, hypodontia and peg laterals
A 30-year-old female reported to the clinic with chief complaint of swelling and periodic pain in the maxillary right and left anterior region for several years. Medical, dental and family histories were non-contributory.\nExtra oral examination of the head and neck region structures was within normal limits and corresponded to normal growth and development for that age.\nIntra oral examination revealed maxillary permanent peg laterals on both the sides. The determination of the lateral incisor as a permanent was carried out after careful consideration of history, clinical examination and radiographic appearance. The swelling was localized to the labial aspect of peg lateral region [Figures and ]. Expansion of the buccal cortical plate without involving the lingual cortical plate was noticed. Affected teeth were not mobile. Overlying mucosa was slightly erythematous, hard and mildly tender on palpation.\nIntra oral examination also revealed the congenitally missing 13, 23 and 47 presented with clinically detectable pulpal exposure.\nA panoramic radiograph as well as intra oral periapical radiographs of 12 and 22 were ordered.\nIntra oral periapical radiograph in relation to 12 and 22 region revealed microdontic oval shaped lateral incisors. The coronal portion showed a small crown with normal radiopacity and the apical portion showed a dilated root with a central radiolucency surrounded by well-defined radiopacity [Figures and ].\nPanoramic radiograph showed an oval shape radiolucent interior delineated by a well-defined radiopaque band at the periphery in relation to 12 and 22 measuring 2.4 × 2 cm and 3.5 × 2.5 cm in diameter respectively. The nasal floor was elevated in relation to 22 [Figure and ].\nThe treatment plan included extraction of the peg laterals along with their root and subsequent prosthetic rehabilitation and the specimen was sent for hard tissue sectioning.\nHistopathological examination revealed dentin with dentinal tubules circumscribing immature enamel matrix and pulpal tissue. Disorganized matrix of immature dentin with enamel spaces noted within central area suggestive of dilated odontoma [].\nHistological assessment revealed a final diagnosis of dilated odontoma. Post-operative healing was uneventful.