BENIGN ODONTOGENIC TUMORS OF MAXILLOFACIAL REGION/endodontic courses

BENIGN ODONTOGENICBENIGN ODONTOGENIC
TUMORSTUMORS
OFOF
MAXILLOFACIAL REGIONMAXILLOFACIAL REGION
INDIAN DENTALACADEMY
Leader in continuing Dental
Education
www.indiandentalacademy.com

Classification (Modified WHO)Classification (Modified WHO)
BENIGN
◦ Odontogenic epithelium without odontogenic
ectomesenchyme
1.Ameloblastoma
2.Squamous Odontogenic Tumor
3.Calcifying Epithelial Odontogenic Tumor
(Pindborg tumor)
4.Adenomatoid Odontogenic Tumor

Odontogenic EctomesenchymeOdontogenic Ectomesenchyme
with or without includedwith or without included
Odontogenic EpitheliumOdontogenic Epithelium
1.Odontogenic Fibroma
2.Myxoma (Myxofibroma)
3.Cementoblastoma
(Benign Cementoblastoma, True Cementoma )

Indian Dental academy
• www.indiandentalacademy.com
• Leader continuing dental education
• Offer both online and offline dental courses

Odontogenic EpitheliumOdontogenic Epithelium
with Odontogenic Ectomesenchymewith Odontogenic Ectomesenchyme
with or without hard tissue formationwith or without hard tissue formation
1.Ameloblastic Fibroma
2.Ameloblastic Fibro Dentinoma
3.Ameloblastic Fibro-Odontoma
4.Odonto Ameloblastoma
5.Calcifying Odontogenic Cyst
6.Complex Odontoma
7.Compound Odontoma www.indiandentalacademy.com

MalignantMalignant
Odontogenic carcinomas
1.Malignant Ameloblastoma
2.Primary Intra Osseous Carcinoma
3.Clear Cell Odontogenic Carcinoma
4.Ghost Cell Odontogenic Carcinoma

Odontogenic SarcomasOdontogenic Sarcomas
1.Ameloblastic Fibrosarcoma
2.Ameloblastic Fibro Dentinosarcoma
3.Ameloblastic Fibro-Odontosarcoma

AMELOBLASTOMAAMELOBLASTOMA
The ameloblastoma is a true neoplasm of
enamel organ- type tissue which does not
undergo differentiation to the point of
enamel formation.

PathogenesisPathogenesis
The tumor conceivably may be derived from
1)Cell rests of the enamel organ
 Remnants of the dental lamina
 Remnants of hertwig’s sheath
 The epithelial rests of malassez

PathogenesisPathogenesis
2)Epithelium of odontogenic cysts
Ex. Dentigerous cyst, Odontomas
3)Disturbances of the developing enamel organ
4)Basal cells of the surface epithelium of the jaws
5) Heterotopic epithelium in other parts of
body,
especially the pituitary gland

Peripheral(Extraosseous)AmeloblastomaPeripheral(Extraosseous)Ameloblastoma
 Histologically resembles I.O. Ameloblastoma
but
occurs in the soft tissue outside the jaw bones
This tumor appears to originate from either
Surface epithelium or remnants of dental lamina.

C/FC/F
Slight Predilection for occurrence in males,
M:F Ratio =13: 8
Mandible : Maxilla= 2:1 Ratio
The lesions appear as nodules on the gingiva,
varying in size 3 mm to 2cm in diameter.

Differences with Intra OsseousDifferences with Intra Osseous
Relatively innocuous,
Not persistent
Non invasive
Has very limited recurrence.
May be excised locally

Pituitary ameloblastomaPituitary ameloblastoma
Peak incidence between 13 and 23 years
The pituitary ameloblastoma
is the most common tumor of
childhood and adolescence.
Clinical Features.
No Sex Predilection

occur between the ages of 20 and 40
years.
The ameloblastoma originates in the
mandible in 80 per cent of the cases,and
nearly three-fourths of these occur in the
molar-ramus area.
The less common lesions in the maxilla
are found most frequently in the molar
area, antrum and floor of the nose.

Roentgenographic FeaturesRoentgenographic Features
The ameloblastoma has been described classically
as a multilocular cyst like lesion
Compartmented appearance with septa of bone
extending into the radiolucent tumor mass.
In the advanced lesion producing jaw expansion,
thinning of the cortical plate

Periphery:
The ameloblastoma is well defined and
frequently delineated by a cortical
border.
The border is curved, and in small lesions
the border and shape may be
indistinguishable from a cyst.
The periphery of lesions in the maxilla is
more ill defined.

Location:
Molar – ramus region of the mandible
Third molar area of the maxilla
Periphery:
Well defined and frequently delineated by
a cortical border.
Internal structure:
Honey comb ( numerous small
compartments or loculations)

Soap bubble (larger compartments of
variable size) patterns
Effects on surrounding structures:
Extensive root resorption
Tooth displacement

AMELOBLASTOMAAMELOBLASTOMA

Treatment and PrognosisTreatment and PrognosisRadical and conservative surgical
excision
Curettage
Chemical and electrocautery
Radiation therapy
Combination of surgery and radiation

CALCIFYING EPITHELIALCALCIFYING EPITHELIAL
ODONTOGENIC TUMORODONTOGENIC TUMOR
Occurs most frequently in middle age.
Predilection for mandible over maxilla 2:1.
Prevalence in molar region is thrice of bicuspid

Roentgenographic Features.
Diffuse or a well-circumscribed unilocular RL
Combined pattern of RL & RO
Many small, irregular bony trabeculae
traversing the radiolucent area in many
directions ,
Producing a multilocular or honey comb
pattern.

Scattered flecks of calcification
throughout the radiolucency have given
rise to the descriptive term of a “driven
snow” appearance.

Location:
Mandible : Maxilla = 2:1
Premolar- molar area
Periphery:
Border have well defined cyst like cortex.
Internal structure :
Appearance of radiopacities close to the
crown of the embedded tooth

Displace a developing tooth or prevent
its eruption.

CALCIFYING EPITHELIALCALCIFYING EPITHELIAL

ADENOMATOIDADENOMATOID
AOT chtzed. by the formation of duct like
structures
Occurrence in maxilla (65%), mandible(35%)

Destructive lesion of the jaw which may or
may not be well circumscribed
Majority of reported cases, resembles a
dentigerous cyst.
 The majority of tumors of this variety are
treated by conservative surgical excision.

Location:
Incisor – canine – premolar region of the
maxilla
Periphery:
Well defined corticated or sclerotic
border.

Internal structure radiographically:Internal structure radiographically:
Completely radiolucent
RL with faint radiopaque foci
Dense clusters of ill- defined radiopacities
occasionally calcifications are small with well-
defined borders like a cluster of small pebbles
Displacement of adjacent teeth

ADENOMATOIDADENOMATOID

PERIPHERAL ODONTOGENIC FIBROMAPERIPHERAL ODONTOGENIC FIBROMA
Clinical Features.
Slow growing, present for a number of years.
Described as a solid, firmly attached gingival
mass
Sometimes arising between teeth and some
times displacing teeth.

Radiographic FeaturesRadiographic Features
Mostly mandible Molar - premolar
region
Anterior to the first molar in the maxilla.
Periphery: Well defined.

Internal structure:Internal structure:
Smaller lesions usually are unilocular
Larger lesions have a multilocular pattern
Effect on surrounding structures:
Tooth displacement is common
 Root resorption has been reported.

TreatmentTreatment
Surgical excision

PERIPHERAL ODONTOGENICPERIPHERAL ODONTOGENIC
FIBROMAFIBROMA

ODONTOGENIC MYXOMAODONTOGENIC MYXOMA
Odontogenic myxoma is a tumor of jaws
Apparently arises from the mesenchymal
portion of the tooth germ:
 dental papilla,
 dental follicle
 periodontal ligament.
Occurs most frequently in 2nd
or 3rd decade

 Central lesion of the jaws expands bone and
may cause destruction of the cortex.
Roentgenographic Features.
◦ Mottled
◦ Honey combed appearance
◦ Destructive, expanding radiolucency with
multilocular pattern.

Location:
Mandible : Maxilla = 3:1
Premolar and molar areas in the
mandible
Periphery:
Well defined
 Corticated margin is poorly defined.
Mixed radiolucent – radiopaque internal
pattern. www.indiandentalacademy.com

Tennis racket- like or step ladder like
pattern.
A characteristic septa identified with this
tumor is a straight, thin – etched septa.
Tooth displacement and loosening when the
tumor grows in a tooth bearing area.

ODONTOGENIC MYXOMAODONTOGENIC MYXOMA

Treatment.Treatment.
Surgical excision,followed by cautery.

PERIAPICAL CEMENTALPERIAPICAL CEMENTAL
DYSPLASIADYSPLASIA
Occurs in & near the PDL usually around
the apex of a mandibular incisor.
The earliest stage in its development is the
formation of a circumscribed area of
periapical fibrosis accompained by localized
destruction of the bone.

This initial step has been called the
osteolytic stage.
2nd
stage is the beginning of calcification in
the radiolucent area of fibrosis.
Described as increased cemento blastic
activity with the deposition of spicules of
cementum or cementicles
Is referred to as the cementoblastic stage.

3rd stage is the mature stage
 Excessive amount of calcified material is
deposited in the focal area
Appears as a well defined R.O. that is usually
bordered by a thin R.L. line or band.

Location:
Predilection for the periapical bone of
the mandibular anterior teeth.
Periphery and shape:
Well defined periphery.
Sclerotic bone represents a reaction of
the immediate surrounding bone.

In the early stage, normal bone is
resorbed and replaced with fibrous tissue
that usually is continuos with the
periodontal ligament.(causing loss of the
lamina dura)
In the mixed stage, radiopaque tissue
appears in the radiolucent structure.

In the mature stage, the internal aspect
may be totally radiopaque without any
obvious pattern.
Effects on surrounding structure:
The normal lamina dura of the teeth
involved with the lesion is lost, making
the periodontal ligament space either less
apparent or giving it a wider appearance.

PERIAPICAL CEMENTALPERIAPICAL CEMENTAL
DYSPLASIADYSPLASIA

BENIGN CEMENTOBLASTOMABENIGN CEMENTOBLASTOMA
The benign cementoblastoma is a true
neoplasm of functional cementoblasts
which form a large mass of cementum or
cementum-like tissue on the tooth root.
◦ The mandible is affected three times more
frequently than the maxilla.
◦ The associated tooth is vital.

The lesion is slow- growing and may cause
expansion of cortical plates of bone.
Tumor mass is attached to the tooth root
Appears as a well-circumscribed dense RO
mass surrounded by a thin, uniform RL line.

Location:
Most commonly on a premolar or first
molar of the mandible.
Periphery:
Well- defined radiopacity with a cortical
border and then a well- defined
radiolucent band just inside the cortical
border.

Mixed radiolucent- radiopaque lesions
where the majority of the internal
structure is radiopaque.
External resorption is seen.
Expansion of the mandible with an intact
outer cortex.

BENIGN CEMENTOBLASTOMABENIGN CEMENTOBLASTOMA

AMELOBLASTIC FIBROMAAMELOBLASTIC FIBROMA
◦ It arises most commonly in the molar region
of the mandible.
◦ Pain, tenderness or mild swelling of the jaw
may induce the patient to seek aid from the
dentist,however.

Unilocular or multilocular radiolucent
lesion.

Location:
Premolar- molar area of the mandible.
Periphery:
Well defined and often corticated in a
manner similar to that of a cyst.
Unilocular (totally radiolucent ) – more
common

Multilocular with indistinct curved
septa.
If the lesion is large, there may be
expansion with an intact cortical plate.

AMELOBLASTIC FIBROMAAMELOBLASTIC FIBROMA

ODONTOMAODONTOMA
The complex form of odontoma is less
common than the compound type.
◦ Of all odontomas combined, 67 per cent
occurred in the maxilla and 33 per cent in the
mandible.
◦ Occasionally it does become large and may
produce expansion of bone with facial
asymmetry.

Location:
Compound type - occurs in the anterior
maxilla in association with the crown of
an unerupted canine
Complex odontomas – Mandibular first
and second molar area.
Periphery:
Borders are well defined and may be
smooth or irregular.

Compound odontomas have a number of
tooth like structures or denticles that
look like deformed teeth.
Complex odontomas contain an irregular
mass of calcified tissue.
Interfere with normal eruption of teeth.

Treatment.Treatment.
Surgical removal.

ODONTOMAODONTOMA

AMELOBLASTIC ODONTOMAAMELOBLASTIC ODONTOMA
◦ More common in mandible than in maxilla.
◦ It is a slowly expanding lesion of bone.
◦ Considerable destruction of bone occurs.
◦ Central destruction of bone with expansion
of the cortical plates is prominent.

Location:
Posterior aspect of the mandible.
Periphery:
Well defined.
Mixed, with the majority of the lesion
being radiolucent.

TREATMENTTREATMENT
Conservative curettage
Enucleation

AMELOBLASTIC ODONTOMAAMELOBLASTIC ODONTOMA

REFERANCEREFERANCE
Shafer’s text book of oral pathology
Oral radiology – White and Pharoah

THANK YOU

BENIGN ODONTOGENIC TUMORS OF MAXILLOFACIAL REGION/endodontic courses

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Viewers also liked

Viewers also liked (20)

Similar to BENIGN ODONTOGENIC TUMORS OF MAXILLOFACIAL REGION/endodontic courses

Similar to BENIGN ODONTOGENIC TUMORS OF MAXILLOFACIAL REGION/endodontic courses (20)

More from Indian dental academy

More from Indian dental academy (20)

Recently uploaded

Recently uploaded (20)

BENIGN ODONTOGENIC TUMORS OF MAXILLOFACIAL REGION/endodontic courses