A 4-month-old boy was referred to the Pediatric Dentistry Emergency Unit at the University of Londrina-Brazil due to a nodular lesion in the anterior region of the right maxilla, present since birth. The lesion was pedunculated, measured approximately 0.5 cm in its largest diameter, had a smooth and intact surface with visible telangiectatic vessels, and was located on the anterior gingival ridge, palatal to the right. The patient was edentulous, born at term via cesarean section, with no systemic abnormalities. His weight gain was within the expected range, and he was bottle-fed and used a pacifier. The mother reported slight lesion growth and feeding interference. Complete excision was performed under topical and infiltrative anesthesia. The final diagnosis was a peripheral developing odontoma, a very rare entity, with fewer than 10 cases reported in the literature, all presenting a characteristic clinical appearance. It is characterized by tooth germs in various stages of development, found exclusively embedded in soft tissue without bone involvement. (Silva et al. 2009) Microscopic analysis of these cases, as well as the presented case, revealed developing tooth germs composed of ameloblasts, enamel matrix, odontoblastic layer, dentin, and dental papilla. (Silva et al. 2009). Odontogenic tumors are a heterogeneous group of benign and malignant lesions, characterized by varying clinical presentations and histopathological features (Vered and Wright 2022). In pediatric patients, they account for less than 10% of oral pathologies (Friedrich et al. 2010). Odontomas are the most common intraosseous odontogenic tumors of the maxilla and mandible, regarded as hamartomas of both ectodermal and mesodermal origin. They are often associated with permanent teeth and rarely with deciduous teeth (Mikami et al. 2013). Developing odontomas are classified as a subgroup that lacks the complete differentiation pattern of odontomas but appears more differentiated than ameloblastic fibro-odontoma. They are also rarer and primarily occur in children (Jones and Franklin 2006). The presence of peripheral tissues and eruption into the oral cavity in this pathology is an extremely rare occurrence (Contreras et al. 2018). Although there is no consensus regarding their origin, it is most commonly reported that peripheral odontomas originate specifically from the remnants of the dental lamina (rests of Serres) located in the gingiva. Another suggestion is that tooth-like structures arise from soft tissue remnants of the odontogenic epithelium through epithelial–mesenchymal interactions (Bilodeau and Collins 2017). The differential diagnosis of an alveolar ridge mass in a newborn should include congenital epulis, a benign soft tissue lesion that arises in the oral cavity, primarily in the maxillary alveolar ridge (Küpers et al. 2009). A conclusive diagnosis of odontogenic lesions in young children can be challenging. Although congenital odontomas and peripheral odontomas are rare, they should be considered when determining the most appropriate treatment approach. Microscopic view of the case showing a developing tooth germ covered by normal surface epithelium. (H&E, x25). The patient is following at the University of Londrina, in the Department of Oral Medicine and Dentistry for Children, every 3 months. After 1 year, clinical and photographic follow-up was carried out, which did not indicate recurrence. Gabriela Fleury Seixas: writing – original draft, investigation, supervision. Luciana Tiemi Inagaki: supervision, investigation. Gustavo Mortari Sales de Oliveira: writing – original draft. Ana Laura Navarro: writing – original draft. Paola Singi: writing – original draft. Mariella Padovese: supervision. Esther Ferreira Marques: writing – original draft. Tatiane Garcia: writing – original draft. Fabio Augusto Ito: formal analysis. Ademar Takahama-Junior: conceptualization, writing – review and editing, supervision, project administration. Fundação Araucária—Programa de Educação Tutorial (PET-Odontologia UEL). The patient's mother reported in this manuscript provided written informed consent for the publication of the case details. The authors declare no conflicts of interest.
SEIXAS et al. (Sun,) studied this question.