PMC4860922_01
Intraoral examination showing missing 31 and 32
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F1
Clinical intraoral examination revealed normal complement of teeth in upper arch and missing 31, 32 in the lower arch [Figure 1].
Orthopantomogram showing irregular ill-defined calcified masses in the lower anterior region
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F2
The radiographic examination revealed an ill-defined mixed radio-opaque and radiolucent lesion in the region of 31, 32 of approximately 1 cm x 1.5 cm in size surrounded by a thin radiolucent band [Figure 2].
(a) Intraoperative view showing the placement of incision and reflection of full thickness flap which revealed few tooth-like structures immediately below the flap. (b) Intraoperative view after removal of tooth-like mass
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F3
Few tooth-like structures were seen immediately after raising the flap [Figure 3a]. The flap was sutured with 3-0 silk [Figure 3b].
Excised specimen revealing tooth-like structures
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F4
The excised tooth-like calcified masses [Figure 4] were sent for pathological evaluation.
(a) Photomicrograph of ground section of the tooth-like structures revealed pulpal space surrounded by dentin and cementum (Ground section, x40). (b) The coronal dentin-like structure is capped by enamel (Ground section, x40). (c) Higher magnification of enamel showing fish-scale pattern (Ground section, x100)
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F5
The radicular dentin-like portion was surrounded by cementum [Figure 5a], whereas coronal dentin-like component was capped by enamel which on closer examination revealed fish-scale pattern [Figure 5b and c].
(a) Photomicrograph of decalcified section revealed pulpal space surrounded by dentin. (b) The radicular component showing dentin with dentinal tubules surrounded by cementum (H&E stain, x40)
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F6
Hematoxylin and eosin stained decalcified sections of the tooth-like structures revealed pulpal space surrounded by dentin [Figure 6a], whereas the radicular dentin was surrounded by cementum [Figure 6b].
Photomicrograph of soft tissue revealed (a) fibrocellular connective tissue lined by 2-3 layers of nonkeratinized epithelium (H&E stain, x100), (b) areas of dystrophic calcification and odontogenic islands (H&E stain, x200), (c) areas of dentin-like structures with irregularly arranged dential tubules associated with globular masses of cementum (H&E stain, x100)
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F7
Soft tissue received along with the tooth-like structures revealed fibrocellular connective tissue lined by 2-3 layers of nonkeratinized epithelium [Figure 7a]. At areas, dystrophic calcifications and odontogenic islands were evident [Figure 7b]. At few areas, dentin-like structures with irregularly arranged dentinal tubules associated with globular masses of cementum were noticed [Figure 7c].