Odontomas, the most prevalent mixed odontogenic tumors, can obstruct the eruption of adjacent teeth and cause functional difficulties in mastication. Management of tooth impaction associated with odontomas depends on the stage of root development and the tumor’s location within the alveolar bone. This case report aims to illustrate the outcomes of combined surgical and orthodontic management in growing patients with odontomas. Two pediatric patients—a 8-year-old boy and a 17-year-old girl—presented with sizable odontomas in the posterior maxilla. Radiographic examination revealed that the first molars on the affected sides were impacted due to the tumors. Treatment involved surgical excision of the odontomas. In the younger patient, the impacted developing molar erupted naturally into the oral cavity 14 months post-surgery, whereas the older patient required orthodontic traction to successfully guide the impacted molar into position. Large posterior odontomas can cause displacement, impaction, and root malformations of neighboring molars. Early detection and removal, prior to root completion, may allow for spontaneous eruption; otherwise, orthodontic intervention is necessary. Collaborative, interdisciplinary planning is crucial for optimal management of young patients with odontomas.
