Odontogenic lesions in opercula of permanent molars delayed in eruption

Opercula of permanent first and second molars delayed in eruption were investigated histologically to detect possible causes of eruption failure. The material comprised operation specimens from exposure of 74 non-erupted molars in 63 young individuals (34 boys, 29 girls). Eighteen of the 74 specimens (or 24.3%) were diagnosed as "classical" odontogenic tumors belonging to the following entities: ameloblastic fibroma (seven), ameloblastic fibrodentinoma (six), ameloblastic fibro-odontoma (four) and complex odontoma (one). Twenty-two specimens (or 29.7%) showed a hitherto unrecognized odontogenic lesion of hamartomatous character, termed odontogenic giant cell fibromatosis (OGCF). Thus, 54.1% of the specimens could be diagnosed as odontogenic tumors or hamartomas. Histomorphologic changes could not be detected in the remaining 34 specimens (45.9%). Odontogenic tumors were associated with unerupted first molars much more frequently than with second molars (ratio 8:1). The OGCF had a strong association with unerupted mandibular molars. Further, opercula of mandibular first molars frequently revealed odontogenic lesions whereas tissue overlying the crown of unerupted maxillary second molars often was reported as normal operculum.