1. Odontogenic tumors are a group of neoplasms or tumor-like malformations arising from cells of the odontogenic apparatus or their remnants. 2. Benign odontogenic tumors are generally classified based on whether they contain odontogenic epithelium with or without odontogenic ectomesenchyme. 3. The most common odontogenic tumor is the ameloblastoma, which typically presents as a painless swelling in the mandible and demonstrates a multilocular radiolucent appearance with tooth resorption. Complete surgical excision is required due to the high recurrence rate.

1. Odontogenic
Tumor
dr MIRZA MUQEEM BAIG

2. • What is a tumor?
 Tumor or neoplasm is an abnormal new, uncoordinated growth in the body, which
results from excessive, autonomous, purposeless proliferation of cells, which
continues its growth, even after cessation of stimuli
 Odontogenic tumor
A group of neoplasm or tumor like
malformations arising from cells of odontogenic apparatus or
their remnants.

3.  Classification of benign odontogenic tumour
A. Odontogenic epithelium without odontogenic ectomesenchyme
1. Ameloblastoma
2. Calcifying epithelial odontogenic tumour [CEOT] , Pindburg tumour
3, clear cell odontogenic tumour
4.Squamous odontogenic tumour

4. B. Odontogenic epithelium with odontogenic ectomesenchyme, with or
without dental hard tissue formation
Ameloblastic fibroma
Ameloblastic fibrodentinoma (dentinoma)
Odontoameloblastoma
Adenomatoid odontogenic tumor (AOT)
Complex odontome
Compound odontome

5. C. Odontogenic ectomesenchyme with or without inclusion of odontogenic
epithelium
Odontogenic fibroma
Myxoma (odontogenic myxoma, myxofibroma)
Benign cementoblastoma (true cementoma)

6. A. Odontogenic epithelium without odontogenic
ectomesenchyme
 Ameloblastoma
• Most common odontogenic tumour of jaw.
• ameloblastoma ; Amel – enamel & blastos – germ
• HISTORY
• First reorganised by Cuzack in 1827.
• It was named Adamantinoma by luis Charles malassez in 1885.
• Ivy and Churchill coined term Ameloblastoma in 1934.
• In 1992 WHO categorized ameloblastoma as locally invasive epithelial
odontogenic neoplasm .

7.  etiology
• Early embryonic sources
• Basal cells of surface epithelium of oral mucosa
• Secondary developmental sources
• Hetertropic epithelium
• Late developmental sources

8.  Classification
 Multicystic ameloblastoma - follicular & plexiform type
 unicystic ameloblastoma – luminal , intraluminal & mural type

9.  Clinical features
 Incidence : Approx 1% of all tumour and 18% of
odontogenic tumour is ameloblastoma.
 Age : during second third fourth and fifth decade
of life.
 no sex predilection.
 Site: most involved site is mandible, ratio of
mandible : maxilla is 5:1.
 Asymptomatic & undiscovered till lesion produce
jaw swelling
 Facial asymmetry is seen.

10. Pt. complain slow growing, painless, hard,
nontender swelling which gradually increases in
size.
Mobility of teeth, avulsion, ill fitting denture
Nerve involvement in late stages.
More prone to secondary infection.
Root resorption is seen
Swelling may lead to airway obstruction,
dysphagia.
 egg shell cracking because of thinning of
bone.

11.  Radiographic features
 Lesion are radiolucent with sharp borders.
 Honey comb or soap bubble appearence

12.  Histologic features
Two main pattern are seen :
1. follicular type – resemble tooth follicle ,
2. plexiform type –interlacing strands.
Subtype of follicular ameloblastoma:
. Acanthomatous type
. Basal cell type
. Granular type
. Desmoplastic type
. Mural ameloblastoma

13.  Management
 Complete eradication of lesion
 Reconstruction of the resultant defect
 Recurrence rate in multicystic is 50-100% after curettage.

14. For Intraosseous, Solid/Multicystic
Ameloblastoma
 En bloc resection or marginal RsCD
 Segmental RcwCD:
o If cortical bone is resorbed and penetrated, the resection should include periosteal layer
o A thin inferior border of the mandible in the first procedure may fracture, if a reconstruction
plate is not used to span and support the segment.
o If the complete excision of the tumor is ascertained by clinical and radiographic examination of
specimen then immediate reconstruction can be undertaken
o If there is uncertainty about resection margins, recon struction should be delayed until No
recurrence is seen.
o Adequate soft tissue coverage should be available, if immediate reconstruction is planned
o Immediate reconstruction can be done by using an autogenous free bone grafts

15.  Reconstruction plate with or without condylar prosthesis can be used in
very old patients, or where adequate soft tissue coverage is not Available.
 If sufficient soft tissue is not available locally, a vascularized pedicle graft of
bone can be used
 In maxilla—aggressive resection is carried out

16. • Jackson and Callon Forte (1996) guide
lines:depending upon anatomical
extents:
■Tumor confined to maxilla without orbital floor
involvement— partial maxillectomy
■ Tumors involving the orbital floor, but not the
periorbital area—total maxillectomy.
■ Tumor involving orbital contents—total
maxillectomy with orbital exenteration
■ Tumor involving the skull bone—along with skull
base resection—neurosurgical procedure.
• Recurrence The multicystic ameloblastoma
has a recurrence up to 50% during the first 5 years
postoperatively.
* Long-term follow-up is a must.

17. Calcifying epithelial odontogenic tumour
(pindborg tumour)
 Described by pindborg in 1955
 Origin: cells of enamel organ or remnants of dental lamina.

18. Clinical features
 Incidence: 1% of all odontogenic tumour
 No sex predilection
 Age: middle age 30-50
 Site: mandible most common
 50% cases with unerupted teeth
 Painless, slow growing mass with Bony had swelling & Facial
asymmetry
 Maxillary lesion may cause airway obstruction , epistaxis

19.  Radiographic features
 Unolocular or multilocular radiolucency is seen
 Honey comb appearwne withirregular bony
trebaculae
 Driven snow appearance and tree ring pattern
of calcification can be seen
 Histologic features
 Liesegang rings are seen due to calcification.

20.  Management
 Careful excision of tumour with margin of normal tissue
& follow up
 Recurrence rate is 15%.

21.  Clear cell odontogenic tumour [CCOT]
 rare slow growing lesion
 first Described by Waldron in 1984
 Clinical features
 Age : above 50yr
 No sex predilection
 Site :70%in mandible 25%in maxilla

22.  Radiographic features
 Radiolucent unilocular or multilocular lesion I seenwith
poorly irregular borders
 Bone destructon& root resorption is seen
 Histologic features
 Sheet and island of uniform vacuolayed and clear cells
are seen
 Management
 Strong potential for aggression so treated radically.

23.  Squamous odontogenic tumour
 Rare benign tumour
 Etiology
 Remnants of dental lamina
 Cell rest of malassez
 Clinical features
 Age; range from 11-67
 No sex predilection
 Site: maxilla:mandible – 1:1
 Asymptomatic lesion with Mild pain and discomfort
 Loosening of teeth

24.  Radiographic features
 Appear as semilunar or triangular radiolucency with
well define borders
 Lesion are seen near root
 Root resorption is usually absent
Histological features
 Island of mature squamous epithelium without
peripheral columnar layer is seen
 Management

 conservative local excision is done

25.  Odontogenic epithelium with odontogenic ectomesenchyme, with or without
dental hard tissue formation
 Ameloblastic fibroma
 Rare benign tumour
 Clinical features
 Age-seen in first two decades
 Sex – both male and female are equally affected
 Site – seen more in mandible
 Slow growing painless bony hard swelling of jaw,
mostly asympyomatic
 Mobility of teeth is seen
 More associated with impacted tooth.

26. Radiographic features
 Lesion maybe uni or multilocular with sclerotic border
 Finger like projection are seen extending into bone
Histologic features
 Mushroom like proliferation is seen
 diffuse area of hyalinized acellular tissue is seen
 Management
 Surgical enucleation with follow-up
 Recurrence rate is 20%

27. Ameloblastic fibro-odontoma
 Mixed tumour containing both enamel and dentin
Clinical features
 Age – first and second decade
 Sex – more common in males
 Site – mandible
 Asymptomatic jaw enlargement
 Lesion often associated with missing teeth.

28. Radiographic features
 It shows unilocular (rarely multilocular)radiolucency with well
defined sclerotic border with radiopacity in center
 Histological features
 Multiple foci of enamel and dentin matrix are found near
epithelial components.
 Management
 Conservative management with enucleation.

29. Ameloblastic fibrodentinoma
 Similar to ameloblastic fibroma
 Rare, benign odontogenic tumour
Clinical features
 Site –more seen in mandible than maxilla
 Sex –more in males 2:1
 Age –in children – associated with unerupted teeth
in adults – seen In posterior region of jaw

30.  Radiographic features
 Radiopacity throughout the lesion
 Histological features
 Poorly mineralised dentin
 Various stages of dentin can be seen such as , dentin,
osterodentin & tubular dentin
Management
 Complete excision of lesion

31.  Adenomatoid odontogenic tumor
 Uncommon tumour of jaw
 Tumour arises from reduced enamel epitheliam
 Clinical features
 Age – 10-20 yrs(73%) rarely above 30 yrs
 Sex – more predilection in females
 Site- more common in maxilla and involve anterior region
 Slow enlarging but bony hard in nature
 Elevation of upper lips and change in facial profile

32.  Radiographic features
 Unilocular radiolucency around the crown of
impacted teeth
 Radiolucency show fine calcification (Snow flake
calcification )
 Histological features
 AOT reveal spindle shape neoplastic cell
proliferating in duct like pattern.
 Dentioid like material is observed
 Lesion surrounded by thick fibrous capsule
 Management
 Conservative excision or enucleation
 Recurrence is rare with good prognosis

33. Odontoma
 It is not a true neoplasm
 This is consider more of a developmental anomaly or
composite lesion
 Types
1. Compound odontoma
2. Compled odontoma

34. Compound odontoma
 Consist of numerous small calcified tooth like structure
or miniature dwarfed teeth
 Site-more common in maxilla
 Age- second decade of life
 Sex-both are equally affected
 Generally asymptomatic
Radiographic features
 Appear as mass of calcified structure with similarity to
normal teeth
 Seen as pocket of dwarf teeth
 They give a Bag of marble appearance

35.  Histological features
 The compound odontoma show a connective tissue
capsule
 Lesion is composed of small wekk formed teeth with
enamel,dentin,pulp & cementum.
 Management
 Completely calcified compound odontoma is inert and
can left alone
If infection, excision is done

36. Complex odontoma
 Consist of disorganised and diffused mass of
odontogenic tissue with haphazard arrangement of
calcified dental structure
 Clinical features
 Age-first and second decade of life
 Sex- equally in both
 Site-occur in both jaw, especially in posterior region
 Facial asymmetry in advance stages

37. Radiographic features
Appear as irregular ovoid smooth densly
radiopaque mass often surrounded by thin
radiolucent zone
 Sunburst like appearance
 Histologic features
 Hapazardly arranged dental tissue bound
together in mass of cementum and often
surrounded by thin connective tissue capsule.
 Management
 Completely calcified odontma is inert and can
be left alone.
 But,in case of pain or facial asymmetry
excision is done

38.  Odontogenic ectomesenchyme with or without inclusion of
odontogenic epithelium
 Odontogenic fibroma
 Seen as : Intraosseously— central odontogenic fibroma
: Extraosseously— on the gingiva.

39.  Central Odontogenic fibroma
 Clinical features
 Slow persistent growtH and cortical expansion
 Site – most commonly in Mandible
 Sex – males are more effected
 Age – mean age 37 yrs

40.  Radiographic features
• Multiloculated radiolucency with well-defined
sclerotic margin
• Root resorption is also seen
• Maybe associated with third molar
 Histological features
• Connective tissue stroma shows a whorling or
interlacing dense collagen matrix with fairly cellular
uniform fibroblasts.
• Ocassion some dentanoid like calcification can be
seen.
 Management
• Enucleation and curettage.

41.  Peripheral Odontogenic Fibroma
 Site – seen more on mandible mostly anterior to second molar
 Size – 1-3cm
 The lesions are attached on the gingiva Maybe pedunculated or sessile
 Sex- equally in both
 Treatment
 excision with a margin of uninvolved tissue.

42.  Myxoma (Odontogenic Myxoma or
Myxofibroma)
 Etiology
 Derived from the mesenchymal portion of the tooth germ,
either the dental papilla or the follicle, or the periodontal
ligament.
 Clinical features
 Slowly growing, locally infiltrative tumor of the jaws, which
expands the bone and causes destruction of the cortex,
 Unilateral Lesion , may cross midline
 Facial asymmetry
 Female are more affected

43.  Radiolographic features
• Honey comb , soap bubble & tennis racket
appearance with irregular Scalloped
margins
Histological features
• Well differentiated fibroblast (30–40%),
which appears spindle like on longitudinal
section and stellate on cross section
• Myxoblastic cell (10%)

44.  Management
• Extensive lesions— excision by RsCD or RcwCD
including a perimeter margin of tumor-free bone.
• Recurrence rate is 33%
• Long. Term follow up

45.  Benign Cementoblastoma
(Cementoblastoma, True Cementoma
 It is a rare tumor of connective tissue, forming
cementum like calcification, fused to a tooth
root.
 Clinical features
 Age— 10–20 years
 No sex predilection
 Slow growing lesion with clinical expansion of
the jaw,
 No discomfort or pain , affected tooth is
Mostly vital.

46. • Radiolographic features
Well-defined, round, oval radiopaque mass with a
radiolucent periphery is seen which is fused to a single or
multiple roots of a vital tooth.
• Histological features
■ Main bulk consists of a dense cementum or
osteocemental mass
■ Numerous reversal lines forming a calcified mosaic
pattern is seen occupying the central area of the lesion

47. • Management
small Lesion if size 1-3cm can be enucleated Directly
Large lesion Can be cut into segment for enucleation.
Tooth attached to lesion should be extracted.