PMC8257329_01
(a) Panoramic reconstruction of an initial CBCT showing a hypodense image (white arrow) in the region of a second molar suggesting the presence of a dental germ. (b) CBCT axial view showing the lesion expansion and cortical fenestration (white arrow). Foci of peripheral calcification in the lesion (in box).
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A cone-beam computed tomography (CBCT) showed the presence of a radiolucent image measuring <1 cm located between teeth 46 and 48, which was initially interpreted as a dental germ (Figure 1(a)). Additionally, an increasing volume with cortical expansion and fenestration was observed in a CBCT investigation (Figure 1(b)).
(a) Citrus yellow-colored liquid obtained after aspiration puncture of the lesion. Suggestive alteration of odontogenic nature. (b) Anatomopathological specimen obtained after biopsy. Presence of cystic cavity with fibrotic capsule in the lesion (black arrow).
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A straight incision was made in the alveolar ridge with flap detachment to facilitate access to the lesion, and an aspiration puncture was performed revealing a liquid content (Figure 2(a)). During surgery, the lesion was completely detached from the mandibular bone, allowing visualization of a capsule with a cystic aspect (Figure 2(b)).
(a) Photomicrograph stained by hematoxylin-eosin (200x) revealing features of a calcifying odontogenic cyst with presence of ghost cells (red arrow) associated with odontoma (asterisk). (b) Photomicrography showing a cystic lesion with a fibrous tissue capsule and lining of odontogenic epithelium of ameloblastic type loosely arranged with several amounts of ghost cells (200X). (c) Panoramic reconstruction of a control CBCT evidencing a new bone formation in the area (asterisk). Impacted first molar (white arrow).
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Therefore, the diagnosis of COC associated with odontoma was established (Figures 3(a) and 3(b)). CBCT revealed new bone formation in the region (Figure 3(c)). Currently, the patient is undergoing clinical and radiographic follow-up with pediatric dentistry specialists and orthodontists for adequate establishment of occlusal dynamics.