Diagnostic tools in the assessment of an impacted canine caused by an odontoma

Background: The odontoma is frequently the cause of dental inclusion through a mechanism of spatial competition.The aim of the present work is to propose a diagnostic procedure in the evaluation of an impacted canine caused by an odontoma. This diagnostic procedure has been applied to a clinical case: the inclusion of an upper canine, caused by an oversized Compound Odontoma. Methods: The first diagnostic tool is the clinical evaluation.The patient, 22 years old, showed persistence in the arch of the deciduous element 5.3; the inclusion of the permanent element 1.3 was suspected. The second step is the X-ray examination. The OrthoPanTomography (OPT), performed as radiographic analysis of 1st level; highlighted the inclusion of the element 1.3 and an area of multifocal radiopacity in contiguity to his crown and allowed to identify the probable cause of inclusion of canine: an oversized Compound Odontoma. The prognostic evaluation, according to the technique of Ericson and Kurol performed on OPT, allowed to define numerically the position of the impacted canine and oriented toward a single surgical act: removal of the impacted canine and the odontoma. A Cone-Beam Computer Tomography (CBCT) of the upper jaw, performed as examination of 2nd level, and 3D reconstruction showed the presence of nine radiopaque denticular structures of various sizes, allowed to analyze in detail the involved anatomical region and directed the clinician towards palatal surgical approach.Finally, an histological examination should be performed. Results: As result of this diagnostic process, a single surgical act was performed: removal of the deciduous canine, the impacted canine and the odontoma. The surgical act confirmed the excellent correspondence between the 3D digital reconstruction of the maxillary region and the real anatomical structure. The surgical findings of the odontoma confirmed all that was radiographically highlighted: 9 denticular structures with variable size and shape. The postoperative CBCT confirmed the total removal of the lesion. Histological examination confirmed the diagnostic hypothesis: denticles surrounded by fibrous tissue with structure similar to the follicular sac. Conclusions: The 3D reconstruction provides more realistic and friendly images, useful both in dentist-patient communication both in the choice of the therapeutic approach.