Diagnostic challenges in odontoma-induced pathological migration in periodontitis patient – a case report with 4-year post-operative outcome

Background. Odontomas are common odontogenic tumors, considered as developmental malformations rather than true neoplasms. They are typically detected during routine radiographic investigations and are composed of tissues resembling enamel, dentin, cementum, and pulp.

Case presentation. This report describes a case of a compound odontoma in the anterior maxilla of a 43-year-old female with chronic periodontitis. Initially, the spacing in the anterior teeth was attributed to pathological migration due to periodontitis. However, radiographs revealed a radiopaque mass between the left maxillary central and lateral incisors, identified as an odontoma. Odontomas are known to cause tooth malposition, diastema, and ectopic eruption, which explains the spacing observed in this case. The lesion was surgically treated using a full-thickness papilla preservation flap, and the resulting osseous defect was reconstructed. Four years of follow-up demonstrated a stable periodontium.

Conclusion. This case highlights the importance of comprehensive history-taking, precise radiographic interpretation, and considering unerupted odontomas or supernumerary teeth in cases of spacing associated with periodontitis.