PMC6880268_01
The radiographical diagnosis of complex odontoma.. 
A) and
B) panoramic and periapical radiography showing radiopaque lesion in the upper right incisors region;
C) tomographic image of the sagittal section showing the relation of the lesion with the apex of the upper right central and lateral incisors;
D) axial reconstruction of odontoma.
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Panoramic radiographic examination revealed a radiopaque bone-like structure but with a greater density than bone, circumscribed by a thin radiolucent margin in the apical region of teeth 11 and 12 presenting features of complex odontoma ( Figure 1).
Surgical approach for total excision of the complex odontoma.. 
A) Osteotomy;
B) total excision of the odontoma;
C) repositioning of flap and intra-sulcular suture;
D) enucleated complex odontoma.
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A bone regularization procedure was carried out, followed by cleaning of the surgical cavity by irrigation with saline solution ( Figure 2).
Clinical approach to retro-obturation with five mineral oxides (5MO).. 
A) Image of the surgical access after washing and polishing the rigid structures with curette;
B) creation of a niche in the apical third for des-obturation;
C) placement of 5MO cement in the retro-obturation.
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Tooth 12 demonstrated external apical resorption; thus, an apicectomy was performed, which was then retro-filled with 5MO (SHAM Dentico, Oman) ( Figure 3).
Histopathological analysis of the odontoma.. 
A) Connective tissue around the tumor showing bundles of collagen representing mineralized areas (green arrows) and an island of odontogenic epithelium (blue arrow);
B) pulpal tissue-like area, demonstrating delicate collagen fibers, a columnar layer of odontoblasts (blue arrows) related to the pre-dentin (yellow arrow) and the dentin matrix showing dentinal tubules (green arrow);
C) enamel matrix;
D) mineralized tissue similar to cement, presenting basophilic reverse lines (green arrows).
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Histopathological examination confirmed the diagnosis of complex odontoma ( Figure 4).
Radiographic preservation.. 
A) Periapical radiography of the endodontic treatment before surgery;
B) radiographic examination after excision of the odontoma and performing the apical retro-obturation of tooth 12;
C) 30 days after surgery;
D) and
E) 12 months after removal of the odontoma.
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The periapical radiograph was taken using a radiographic positioner ( Figure 5).