Diagnostic Dilemma of Radiopaque Lesion: A Series of Two Cases of Complex Odontoma

Abstract

Complex odontomas are benign odontogenic hamartomatous lesions composed of enamel, dentin, cementum, and pulp tissue arranged in a disorganized pattern. They are usually asymptomatic and are commonly detected incidentally during routine radiographic examinations. However, erupting complex odontomas associated with pain, infection, cortical perforation, and impaction of adjacent teeth are uncommon and may present a significant diagnostic dilemma because of their resemblance to other mixed radiopaque lesions of the jaws. This case series presents two rare cases of erupting complex odontoma involving the mandibular posterior region in young patients aged 19 and 17 years. Both cases were associated with pain, swelling, and eruption disturbance of the mandibular second molar. Cone Beam Computed Tomography (CBCT) revealed large radiopaque masses associated with impacted teeth and close approximation to the inferior alveolar nerve. Surgical excision of the odontomas along with removal of the associated impacted molars was performed successfully under local anaesthesia. Histopathological examination confirmed the diagnosis of complex odontoma. Postoperative healing was satisfactory, with only minimal transient paraesthesia observed in one case. These cases highlight the importance of detailed radiographic evaluation, particularly CBCT, in establishing an accurate diagnosis and surgical plan for large radiopaque lesions of the jaws. Early diagnosis and timely intervention are essential to prevent complications such as cortical perforation, infection, pathological fracture, and nerve compression, thereby ensuring favourable functional and aesthetic outcomes.