The document discusses several odontogenic tumors including: Ameloblastic fibroma is a mixed tumor of odontogenic origin composed of neoplastic epithelium and connective tissue that commonly occurs in children and teenagers. It is often associated with an impacted tooth. Ameloblastic fibro-odontoma is similar to ameloblastic fibroma but contains neoplastic epithelium, neoplastic myxomatous connective tissue, and foci of enamel and dentin formation. Odontoma is the most common odontogenic tumor and is considered a hamartoma. It has two types, compound and complex, which are composed of enamel and dentin laid down in an abnormal pattern

1. GUIDED BY:
Dr. PRATIBHA POUDEL
Dr. BHOJ RAJ ADHIKARI
PRESENTED BY
Ashim Upadhyaya
Amod kumar Yadav

2. CONTENT
1. Classification
2. Ameloblastic fibroma
3. Ameloblastic fibro- odontoma
4. Odontoma
5. Ameloblastic odontoma
6. Calcifying cystic odontogenic tumor
and dentinogenic ghost cell tumor
7. Primordial odontogenic tumor

4. 1.AMELOBLASTIC FIBROMA
 Also known as –Soft mixed odontogenic tumor
-Soft mixed odontoma
-Fibroadamantoblastoma

5. Introduction
Ameloblastic fibroma is
considered to be a true mixed
tumor in which there is
simultaneous proliferation
of both epithelial and
mesenchymal tissue without
formation of enamel and
dentin.
 Uncommon
 Origin: From inner enamel
epithelium and dental papilla

6. Some investigators suggested that:
Ameloblastic fibroma
left undisturbed
Matures to form ameloblastic fibro- odontoma
Eventually into completely differentiated
odontoma
* But this concept is contraindicated

7. Clinical features
 Younger patients(firsts two decades)
 Male > female
 Commonly mandible(70%)
• Molar regions, ramus of mandible

8. Clinical presentation
 Asymptomatic
 90% associated with
impacted tooth
 Slow clinical growth
 Accidental discovery during
radiography
• If not patient visits with
pain, tenderness and mild
swelling.

9. Radiographic features
 Well circumscribed
radiolucency(1-8.5cm diameter)
 Sclerotic margin
 Unilocular or multilocular
 Associated with impacted
tooth (75%)
 Bulging of bone

10. Histological features
components
1.Proliferating
Odontogenic
Epithelial
2.Cell rich
Mesenchymal
tissue

11. Epithelial component
 Shows various patterns like: rosettes,
strands, islands, nest, cords.
 Line by columnar or cuboidal cells
 Two cell thickness
 Stellate reticulum like cells surrounded by
peripheral columnar cells
 Resembles follicular stage of dental lamina

12. Mesenchymal component
 Made up of primitive connective tissue
 Closely intertwining fibrils
 Spindle shaped mesenchymal cells
 Juxtaepithelial hyalinization
 Less blood vessels
 Resembles dental papilla

14. Differential diagnosis
 Ameloblastoma(follicular)
 Dentigerous cyst
 Central giant cell granuloma
 Odontogenic myxoma
 Histiocytosis

15. Treatment
 Conservative resection , if incomplete 18.3%
(Zallen) chances of recurrence.
 Repeated recurrence may develop
ameloblastic fibrosarcoma.

16. 2. Ameloblastic fibro - odontoma
 Before Slootweg represented as hamartoma as
immature complex odontoma
 But WHO defined AFO as:
‘A neoplasm composed of proliferating
odontogenic epithelium embedded in a cellular
ectomesenchymal tissue that resembles dental
papilla with varying degree at inductive change
and dental hard tissue formation.’

17. Clinical features
 Age : 0.5 – 39 years, more under 11.5 years
 Sex : Male > Female
 Site : Maxilla = Mandible (posterior region)
 Especially impacted tooth

18. Clinical presentation
 No clinical manifestation.
 Accidentally discovers during radiography.
 Patients may visits with swelling and failure of
tooth eruption.

19. Radiographic features
 Well circumscribed lesion
 Expansile radiolucency
 Solitary or small multiple
radio-opaque masses.
 Size of 1-2 cm in diameter, but
 Larger ones extends up to
body and ramus of mandible.

20. Histological features
 Identical as Ameloblastic fibroma
 Epithelial:
- cords, strands fingers and rosettes of
odontogenic epithelium
- Lined by cuboidal and columnar cells
- Resembles dental lamina

21. • Mesenchymal:
- Is embryogenic fibrous connective tissue
- With delicate fibrils, interspersed by primitive
fibroblasts
- Resembles dental papilla
*Foci of enamel and dentin matrix formation
(composite odontoma)

22. Differential diagnosis
1.Calcyfying odontogenic cyst
2.Calcfying epithelial odontogenic
tumor
3.Developing odontoma
4.Adenomatoid odontogenic tumor

23. Treatment
 Conservative curettage
 Recurrence rate is about 7%
 Rarely develops into Ameloblastic
fibrosarcoma
#Ameloblastic fibro dentinoma: calcifying
component consists only of dentin matrix
and dentinoid.

24. 3.ODONTOMA
-Most common odontogenic tumor.
-Epithelial and mesenchymal cells
-Exhibit complete differentiation
-Form enamel and dentin
-Laid down in an abnormal pattern.

25. -Odontoma is a hamartomatous malformation:
•Disorganized mass of cells
•Limited growth potential
•Limited recurrance

26. Odontoma also called as Composite Odontoma.
•Because of more than one type of tissue.
-Two types:
•Compund composite odontoma
•Complex composite odontoma

27. -Compound Odontome:
•Dental tissues arranged in orderly pattern.
•Anatomic resemblance to normal teeth.
-Complex Odontome:
•Arranged in disorganized pattern.
•No resemblance.

28. ETIOLOGY
-Unknown
-Local trauma
-Infection
-Genetic mutation

29. Clinical Features
-Age
•Young
•Second decade of life
•Mean age =14.8
-Sex
•Male(59%)
•Female(41%)

30. -Site
•Maxilla >Mandible (3:1)
1.Compound Odontoma
•Anterior maxilla
2.Complex odontoma
•Molar region of either jaw.

31. Clinical Presentation
-Asymptomatic and small
-Occassionally signs and symptoms
•unerrupted or impacted teeth
•Retained deciduous teeth
•Swelling
•infection
-Cyst formation mostly dentigerous cyst.

32. Radiographic Features
1.Compound
Odontoma
Collection of tooth
like structures
Surrounded by
Radiolucent zone

33. -Compound Odontome
Calcified mass
Radiodensity of tooth
structure
Surrounded by
Radiolucent rim.

34. Histopathology
-Compound
Odontome
Enamel,dentin,pulp
orderly arranged
Denticles embedded
in Connective tissue
.Have a fibrous
capsule

35. -Ghost cells

36. COMPOUND ODONTOMA COMPLEX ODONTOMA
1.Dental tissues orderly pattern 1.Dental tissues disorderly
pattern
2.Multiple small tooth like
structures
2.Mass of enamel and dentin
3.More common 3.Less common
4.Majority cases before age 20 4.Before age 30
5.Common site: Maxillary
anterior
5.Mandibular molar of either
jaw

37. 6.Clinical presentation:
.painless
.Non aggressive lesion
.More limited potential growth
.Associated with unerupted
tooth
6.Clinical presentation:
.Painless
.Expanding lesion
.Slow growing
.unerupted teeth
7.Radiologically
•Collection of tooth like
structures
•Surrounded by radiolucent zone
7.Radiologically
•Calcified mass
•Radio density of tooth structure
•Narrow radiolucent rim
8.Histologically,
•Denticles embedded in loose
fibrous matrix
•Varying amount of enamel
matrix
8.Histologically,
•Large mature tubular dentin
•Small amount of enamel matrix

38. Differential diagnosis
-Calcifying epithelial odontogenic tumor
-Ameloblastic fibrodentinoma
-Ameloblastic fibro-odontoma
-Osteoma
-Odontoameloblastoma
-Focal sclerosing osteomyelitis

39. Treatment
Surgical removal
Prognosis is excellent

41. 4.Ameloblastic Odontoma
(odontoameloblastoma)
 characterized by:
-Simultaneous occurance of :
Ameloblastoma and composite odontoma
Extremely rare odontogenic tumor

42. Clinical Feature
Age : between 6 month and 40 years of age
sex : male
Site : Mandible>Maxilla,molar and premolar region
-Pain
-Delayed eruption of teeth
-Expansion of the effected bone
Clinical presentation

43. Radiographic Features
-Single
-Irregular radiopaque mass of calcified
tissue

44. Histopathology
-Has features of Ameloblastoma
Plexiform or follicular pattern.
-Has features of odontoma
Compound or Complex

45. Treatment and Prognosis
-Surgical excision
-curettage

46. 6.Calcifying cystic odontogenic tumor
and Dentinogenic ghost cell tumor
Q. Is the calcifying cystic odontogenic tumor
a cyst or is it a tumor ?

47. Praetorius in 2006 classified it as cystic, benign and malignant
neoplasm
In 2005 WHO classified lesion as odontogenic tumor as Calcifying
cystic odontogenic tumor (CCOT) and dentinogenic ghost cell tumor
(DGCT) as its variant.
Later, Kurt Thoma and Henry Goldman considered lesion to be
odontogenic tumor of ectodermal and mesodermal origin.
In 1963 Gold termed COC as keratinizing and calcifying odontogenic
tumor.
In 1962 Gorlin described COC as distinct clinicopathologic entity
Also, he with his associates suggested COC might be oral analogue of
‘ calcifying epithelioma of Malherbe.’

49. But WHO in 2017 classified the lesion as calcifying odontogenic cyst
as in most of the case there was cyst formation.

50. Introduction
Back in 2005:
 WHO defined calcifying cystic odontogenic tumor as a
‘ benign cystic neoplasm of odontogenic origin
characterized by ameloblastoma like epithelium with
ghost cells that may calcify’.
 WHO then defined dentinogenic ghost cell tumor as a
‘ benign neoplasm characterized by ameloblastoma
like islands of epithelial cells in mature connective
tissue stroma.

51. Clinical features and presentation
1.CCOT
• Age: 2nd decade of life
• Sex: male = female
• Site : maxilla=mandible
(mostly in anterior jaw)
Presentation:
• Can present centrally and peripherally
• Central lesion usually aymptomatic
• Slow growing
• produces hard swelling
• Peripheral lesion are sessile and pedunculated

52. Condt…
2. DGCT
• Age: 2nd and 3rd decade of life
• Sex : male = female
• Site: Maxilla = mandible ( mostly between canine and
1st molar)
Presentation
• Asymptomatic
• Pain
• discomfort

53. Radio graphical features
Both shows same feature:
• Well defined radiolucent or radiopaque lesion.
• Unilocular or multilocular.
• Bicortical expansion on occlusal radiographs.
• Ocasssionally, root resorption or an impacted teeth
may be seen.

54. Histological features
• Fibrous capsule is lined by 4-10 cell thickness
• Basal cells are cuboidal or columnar with polarized nuclei
• Within epithelial component presence of
characterstic “ Ghost cells” undergoing keratinization
• Ghost cell are eosinophilic epithelial cells that lacks nuclei
with preservation of outline
• Ghost cell have potential to calcify
• Interspersed of dentinoid among epithelium and ghost cells
is called Dentinogenic ghost cell tumor

55.  Under Van Geison’s stain Ghost cell appears yellow and
dentinoid as red.
 In H and E stain ghost cell appears shadowy
Treatment
 Enucleation for calcifying cystic odontogenic tumor
 Surgical excision for dentinogenic ghost cell tumor
 Recurrence has been reported

56. 7. Primordial odontogenic tumor
 Rare recently described odontogenic tumor.
 Mostly associated with unerupted tooth.
Clinical features
• Age: children and adolscents
• Site: mostly posterior mandible
Clinical presentation
• Asymptomatic, slow growing
mass, causing facial asymmetry

57. Radio graphically
• Large expanding radiolucency area are seen
• Appears as dentigerous cyst
Histologically
• Tumor resembles gaint solid mass of dental papilla
• Thin layer of ameloblasts around periphery
• But no odontoblast, dentin or enamel matrix
Treatment
• Surgical removal
• No recurrence

58. Summary
 Ameloblastic Fibroma Mixed tumor of odontogenic origin
that mostly occurs in children and teenagers,Often
associated with an impacted tooth,Composed of neoplastic
epithelium and neoplastic connective tissue , which can be
treated by curettage or excision and has rare malignant
conterpart.
 Ameloblastic Fibro- odontoma same as Ameloblastic
fibroma but composed of neoplastic epithelium and
neoplastic myxomatous connective tissue.

59. Summary
 Odontoma is the most common odontogenic tumor but
regarded as a hamartoma rather than a neoplasm mostly
occuring in children and are usually asymptomatic, have
two type ie complex and compound odontoma, which can
be treated by enucleation .
 Ameloblastic odontoma is extremely rare mixed tumor of
odontogenic origin having characters of ameloblastoma and
composite odontoma.

60. Summary
 Calcifying cystic odontogenic tumor is a rare odontogenic
cyst that occurs mostly in anterior part of jaw in which there
is a proliferation of odontogenic epithelium and scattered
nest of ghost cells and calcification present as a solid mass.
 Primordial odontogenic tumor rare new tumor mostly
associated with unerupted tooth and are asymptomatic
resembling the solid mass of dental papilla which can
surgically removed.
 Dentinogenic ghost cell tumor is a benign tumor of
odontogenic origin which is regarded as solid variant of
CCOT have most of the characteristics common as CCOT
with extra dentinoid formation.

61. MCQs
1. Ameloblastic fibroma originates from:
a) Inner enamel epithelium and dental papilla
b) Rest of Malassez
c) Reduced enamel Epithelium
d) Rest of serres
2.Which is the most common odontogenic tumor?
a) Ameloblastoma
b) Odontoma
c) Adenomatoid odontogenic tumor
d) Squamous cell carcinoma

62. 3. Cyst mostly associated with odontoma is:
a) Radicular cyst
b) Odontogenic keratocyst
c) Dentigerous cyst
d) Glandular cyst
4.In Odontoameloblastoma there is simultaneous occurrence
of:
a) Ameloblastoma and dentigerous cyst
b) Odontoma and dentigerous cyst
c) Odontoma and ameloblastic fibroma
d) Ameloblastoma and odontoma

63. Reference
 Shafer, Hine, Levy. Shafer's textbook of oral pathology.
8th edition. New Delhi: Elsevier; 2019
 Neville Brad W. Damm Douglas D. Allen Carl M. Chi
Angela C. Oral and Maxillofacial Pathology. 4th
edition. Missouri: Elsevier; 2016
 E.W. odell. Cawson’s essentials of oral pathology and
oral medicine. 9th edition. London; Elsevier; 2017
 Swapan Kumar Purkait. Essentials of oral pathology.
3rd edition. New Delhi; Jaypee; 2011

64. Past Questions
Q. Short notes on Odontoma.
Q. Describe the etiology, clinical features, radio
graphical features and histology of odontoma.
Q. Define and classify odontomes.

65. THANK YOU