Odontomas represent the most frequent type of mixed odontogenic lesions and can result in impaction of nearby teeth as well as difficulties in mastication. Management of tooth impaction associated with odontomas depends on the stage of root development and the lesion’s position within the alveolar bone. This case report aims to describe a combination of surgical and orthodontic interventions for growing patients with odontomas and to evaluate treatment outcomes. Two pediatric patients were included: an 8-year-old boy and a 17-year-old girl, each presenting with sizable odontomas in the posterior maxilla. The lesions were identified through radiographic imaging, which revealed impaction of the first molars on the affected sides. The therapeutic approach involved surgical excision of the odontomas. In the younger patient, the impacted molar erupted spontaneously approximately 14 months post-surgery. In the older patient, orthodontic traction was applied successfully to facilitate the eruption of the impacted molar. Large odontomas in posterior regions can displace and obstruct adjacent molars, sometimes affecting root morphology. Early detection and removal, before root formation completes, may allow spontaneous eruption; otherwise, orthodontic extrusion becomes necessary. Close collaboration between surgical and orthodontic disciplines is essential for effective management of odontomas in growing patients.
