3. INTRODUCTION
• Odontogenic tumors present cellular proliferations with a
wide range of biological potentials & behaviors
• They may be hamartomas ,benign or malignant neoplasms
• Hamartomas -dysmorphic cellular proliferations native to an
organ in which they arise ,gain certain size before ceasing
proliferation Treatment is enucleation or curettage
• Benign neoplasms- dysmorphic cellular proliferations native to
an organ in which they arise , which also elaborate cytokines
necessary for tissue invasion but not those for metastasis
4. • Treatment is curative surgery or en-bloc
resection
• Malignant neoplasms- dysmorphic cellular
proliferations native to an organ in which they
arise , which also elaborate cytokines
necessary for tissue invasion and those for
metastasis
• This requires en-bloc resection ,chemotherapy
and/radiotherapy
5. CLASSIFICATION
• A) BENIGN
1)ODONTOGENIC EPITHELIUM WITHOUT
ODONTOGENIC ECTOMESENCHYME
-AMELOBLASTOMA
-SQUAMOUS ODONTOGENIC TUMOR
-CALCIFYING EPITHELIAL ODONTOGENIC TUMOR
-ADENOMATOID ODONTOGENIC TUMOR
2)ODONTOGENIC EPITHELIUM WITH ODONTOGENIC
ECTOMESENCHYME WITH OR WITHOUT HARD TISSUE
FORMATION
- AMELOBLASTIC FIBROMA
-AMELOBLASTIC FIBRODENTINOMA
-AMELOBLASTIC FIBRO-ODONTOMA
6. -ODONTOAMELOBLASTOMA
-CALCIFYING ODONTOGENIC CYST
-COMPLEX ODONTOMA
-COMPOUND ODONTOMA
3) ODONTOGENIC ECTOMESENCHYME WITH OR
WITHOUT INCLUDED ODONTOGENIC EPITHELIUM
-ODONTOGENIC FIBROMA
-MYXOMA
-CEMENTOBLASTOMA
B) MALIGNANT
1)ODONTOGENIC CARCINOMAS
-MALIGNANT AMELOBALSTOMA
-PRIMARY INTRAOSSEOUS CARCINOMANI
-CLEAR CELL ODONTOGENIC CARCINOMA
- GHOST CELL ODONTOGENIC CARCINOMA
10. • The tumors are more common in the
mandibular molar area
• can occur anywhere in either jaw
• no sex predilection, produces some enamel but
mostly dentin.
• present as an asymptomatic jaw expansion
• may resorb tooth roots, displace developing
teeth, and displace the inferior alveolar canal.
11. Radiographic features
• Location : occur in posterior aspect of
mandible
epicenter is usually occlusal to developing
tooth or toward the alveolar crest.
Periphery : tumor is usually well defined and
sometimes corticated
Internal structure : mixed majority radiolucent.
Small lesions may appear as enlarged follicles
with only one or two small discrete
radioopacities.
14. AMELOBLASTIC FIBRO-
DENTINOMA
• It ia a tumor similar to that of ameloblastic
fibroma in which the calfying component
consists only of dentin matrix and dentinoid
maerial.
15. ODONTOMA
• PATHOGENESIS
• Odontomas are actually mixed odontogenic
hemartomas of aborted tooth formation
• Odontomas represent an attempt to duplicate tooth
formation but in a distorted fashion
• They arise from both odontogenic epithelium, which
produces enamel, and odontogenic mesenchyme,
which produces dentin via odontoblast differentiation.
16. Clinical & radiographic features
• two general types.
• which forms multiple small toothlike structures, is called the
compound odontoma. occur slightly more often anterior to the
mental foramen
• forms an amorphous calcified mass and is called the complex
odontoma occur more often posterior to the mental foramen
• Most are incidental radiographic findings observed on a dental
examination.
• Or radiographic findings discovered when a tooth fails to
erupt, a primary tooth fails to exfoliate, or an expansion of
bone is observed
• Most occur in children and young adults
17. Radiography
• Location : compound odontoms occur in
anterior maxilla in association with the crown
of an unrupted canine. complex odontomas
found in mandibular first and second molar
area.
• Periphery : borders are well defined and may
be smooth or irregular. Lesions may have
corticated border and immediately inside and
adjacent to cortical border in a soft tissue
capsule.
18. • Internal structure : lesions are largely
radioopaque.compound odontomas have a
number of tooth like structures or denticles
that look like deformed teeth.
• Complex odontomas contain a irregular mass
of calcified tissue
• Dilated odontoma has a single calcified
structure with a more radiolucent central
portion that has an overall form like a donut.
19. • Effect on surrounding structures : can
interfere with normal eruption of teeth. Mostly
associated with abnormalities such as
impaction, malpositioning, diastema , aplasia
,malformation devitilization of adjacent teeth.
• Large complex odontomas may cause
expansion of the jaw with maintainence of
cortical boundary.
• Differential diagnosis : cemnto osseous
fibromas, periapical cemental dysplasia
20. Treatment
• The odontoma and the lesions on its usual differential
list are curable with enucleation and curettage
• calcified masses are not adherent to bone and can be
enucleated from the bony cavity with hand curettes.
• In larger compound or complex odontomas - take an
intraoperative radiograph to ensure that all of the
small calcified masses have been removed.
• Spontaneous osteogenesis in these young patients will
result in bone regeneration in 9 to 12 months.
25. AMELOBLASTIC ODONTOMA
• Simultaneous occurrence of ameloblastoma
and composite odontoma
• Any age
• Mostly children
• Mostly mandible
• Expansible lesion of bone produces facial
deformity
• Mild pain , delayed eruption
26. Radiographic features
• Central destruction of bone with expansion of
cortical plates
• Presence of numerous radioopaque masses
with no resemblance to formed teeth
• Otherwise single radioopaque
• Treatment : resection of jaw preserving
inferior border of mandible.
27. CALCIFYING ODONTOGENIC
CYST
• Both cystic and neoplastic variants
• Less common lesion
• They occupy a spectrum ranging from a cyst to odontogenic
tumor , with characteristics of cyst alone or those of a solid
neoplasm
• WHO presently classify it as benign tumor.
• Lesion may manuacture calcified tissue identified as dysplastic
dentin and in some instances associated with an odontoma.
• Peaks at 10 to 19 yrs mean age 36 yrs
• Usually appears slow growing painless swlling o the jaw
28. • In some cases the expanding lsion may destroy
the cortical plate and the cystic mass may
become palpable as it extends into soft tissue.
• Aspiration often yields a viscous granular,
yellow fluid.
29. Radiographic feature
• Location : 75% in bone with equal distribution
between the jaws.
• Mostly anterior to first molar , especially
associated with cuspids and incisors, where the
cyst manifest as a pericoronal radiolucency.
• Periphery and shape : well defined corticated
with acurved cyst like shape to illdefined and
irrgular.
30. • Internal structure: may be completely
radiolucent , may show evidence of small foci
of calcified material that appears as white
flecks or small smooth pebbles., or it may
show even larger solid amorphous masses.
• Effects on surrounding structures :
associated with atooth and impedes its eruption
• Displacement of teeth and resorption of roots
may occur
• Perforations of cortical paltes may be seen
radiographically with enlarging lesions.
32. REFERENCES
• Shafer’s textbook of oral pathology
• White & Pharoah , oral radiology principles
and interpretation.
• Textbook of oral medicine and oral diagnosis
and oral radiology
Ravikiran ongole, praveen B N.
