Odontogenic tumors v / dental implant courses by Indian dental academy

Odontogenic Tumors
INDIAN DENTAL
ACADEMY
Leader in continuing
Dental Education
www.indiandentalacademy.com

LEARNING
OBJECTIVES
• At the end of the lecture student should be able to
• Describe etiology,
• Enlist clinical features,
• Enlist radiological features,
• Enlist histopathological features of Ameloblastic
fibroma, Ameloblastic fibro-odontoma & Odontoma

• True mixed tumor characterized by the simultaneous
neoplastic proliferation of the mesenchymal and
epithelial components.
• WHO defined it as ‘‘neoplasm composed of proliferating
odontogenic epithelium embedded in a cellular
ectomesenchymal tissue that resembles the dental
papilla, and with varying degrees of inductive change
and dental hard tissue formation’’

• Lesions composed of similar elements, but in which
inductive change has resulted in the deposition of dentin
alone or dentin plus enamel, are termed ameloblastic
fibrodentinoma (AFD) & ameloblastic fibro-odontoma
(AFO), respectively.
• It represents only about 2% of odontogenic tumors.

Ameloblastic Fibroma
Clinical features
• Occur predominantly in children and young adults usually
within an age range of 6 months to 42 years (average age,
14.6–15.5 years). with no gender predilection
• The posterior mandible is the most common site, & about
80% of cases are located in the first permanent molar and
second primary molar area followed by posterior maxilla
and rarely in the anterior regions of the jaws
• Painless, slow-growing, & expansile neoplasm.

• About 20% of the lesions are discovered on routine
radiography. Does not tend to infiltrate bone.
• It enlarges by gradual expansion so that the periphery of
the lesion often remains smooth.
• Initial presentation may include pain, tenderness, or mild
swelling of the jaw. The tumor is associated with an
impacted tooth in about 75% of the cases

Radiographic
features
• A well-defined, unilocular or
multilocular radiolucency with a
smooth outline and often with a
sclerotic opaque border
• Large mandibular lesions are
multilocular, whereas smaller
lesions are typically unilocular
• May range in size from 1 to 8
cm
• It may mimic a dentigerous cyst
when associated with
unerupted teeth.

Histopathology
• Epithelial component is
characterized by proliferating
islands, cords, and strands of
odontogenic epithelium exhibiting
a peripheral layer of cuboidal or
columnar cells, & the central area
resembles the stellate reticulum

• The ectomesenchymal
component is that of an
embryonic, cell-rich
mesenchyme mimicking
dental papilla.
• A cell-free zone or a zone of
hyalinization may be found
around the epithelial-
connective tissue interface.

Treatment & prognosis
• AFs tend to separate readily from their bony walls and do not
recur
• Conservative excision seems to be the treatment of choice. A
modified block resection, rather than a curettage or simple
excision, has been suggested.
• Large tumors may require a more aggressive approach.

Ameloblastic
Fibrodentinoma
• Very rare
• 1st to 2nd decade, M>F
• Varying degree of radiopacity
• Ectomesenchymal component is that of an embryonic, cell-
rich mesenchyme mimicking dental papilla
• Dentinoid/Osteodentin is seen
• Important due to occurrence of ameloblastic
fibrodentinosarcoma

Ameloblastic fibro-
odontoma
• The WHO classification defines AFO as ‘‘a lesion similar to
ameloblastic fibroma, but showing inductive changes that lead
to formation of dentin and enamel’’.
• The lesion represents approximately 1% to 3% of odontogenic
tumors ; however, if patients younger than 16 years are
considered, AFO comprises about 7% of odontogenic tumors.

Clinical features
• AFO usually is diagnosed in the first 2 decades of life,
and about 98% of the tumors occur before the age of 20
• There is a slight male predilection.
• Most tumors are found in the posterior mandible; the
second most common location is the posterior maxilla.
This tumor remains an exclusively central or intraosseous
lesion.
• It usually presents as a painless, slow-growing, expansile
lesion and often presents with swelling and failure of
tooth eruption. Most AFOs are associated with an
unerupted tooth

Radiographic Features
• AFO presents as a well-
circumscribed expansile
radiolucency that generally
contains solitary or multiple
small radiopaque foci which
represent the calcified
product in the lesion.
• Most lesions are relatively
small when first detected and
are not more than 1 to 2 cm
in size.

• Composed of strands,
cords, and islands of
odontogenic epithelium
distributed in a cell-rich,
dental papilla-like
ectomesenchymal stroma
• Varying amounts of
osteodentin or dentin like
material and occasionally
enamel matrix can be
identified
Histopathology

• The odontogenic epithelium adjacent to the enamel
matrix seems to be pre- ameloblast like.
• More-calcified lesions exhibit mature dental hard tissues
that resemble rudimentary teeth or a conglomerate of
enamel and dentin.

Treatment and
prognosis
• Conservative surgical enucleation is considered
to be the treatment of choice with concurrent
removal of the associated unerupted tooth.
• When the hard tissue component in the tumor is
minimal, the lesion should be removed
conservatively without removal of the impacted
tooth

Odontoma
• Broca first coined the term ‘‘odontome’’ in 1866. He defined
it as a tumor formed by an overgrowth of complete dental
tissue
• Thoma and Goldman narrowed the term ‘‘odontoma’’ to
include tumors that were composed of well-differentiated
tooth structure.
• Shafer and Gorlin defined odontoma as a tumor that has
developed and differentiated enough to produce enamel and
dentin.

• Hamartomas.
• Complex odontoma -A malformation in which all of the
dental tissues are represented, & individual tissues
mainly are well formed but occur in a disorderly pattern
• The compound odontoma -A malformation in which all
of the dental tissues are represented in a more orderly
pattern than in the complex odontoma so that the lesion
consists of many tooth-like structures.

• Ameloblastic fibroma Ameloblastic fibrodentinoma 
Ameloblastic fibroodontoma Complex Odontoma.
• The compound odontoma is more differentiated, and its
pathogenesis more closely is related to the creation of
supernumerary teeth, especially mesiodens.
• This hypothesis is strongly supported by the
preponderance of compound odontomas in the anterior
maxilla and by predisposition of supernumerary teeth for
the same location

Incidence
• Odontomas are commonest odontogenic tumor.
• Most odontomas occur in the second decade of life
• 20% of these lesions occur in patients aged 0 to 9 years.
• The most common location for compound odontomas is
the anterior maxilla. There is general agreement that most
cases of complex odontomas are found in the posterior
mandible and that the second most common site is the
anterior maxilla. Occur with equal frequency in both sexes.
• Odontomas are associated mostly with permanent teeth
and rarely with deciduous teeth.
• When they occur in the deciduous dentition, they are more
common in the incisor canine area

Clinical features
• Odontomas usually form hard, painless masses and are small,
rarely exceeding the diameter of the associated impacted tooth.
• Most lesions are discovered as an incidental radiographic
finding; however, they can be associated with significant signs
and symptoms.
• The most common symptom is an impacted permanent tooth or
a retained deciduous tooth.
• Swelling is the second most common complaint (<10% of
cases), & it is common in subjects with odontomas associated
with dentigerous cysts
• Odontomas, especially complex odontomas, may become large
and produce expansion of bone and facial asymmetrywww.indiandentalacademy.com

Radiographic features
•Densely opaque masses of varying size, usually associated with
unerupted or impacted teeth.
• Opaque masses are almost invariably surrounded by a
radiolucent line.
• Compound odontomas contain a collection
of tooth-like structures of varying size and shape
•Confused with osteomas.
•May show little calcification and appear only as well-
circumscribed radiolucencies.
•The number of teeth found in these lesions can vary

Histologic features
• Odontomas contain varying amounts
of enamel, pulp tissue, enamel organ,
and cementum
• The dental tissues, for the most part,
have normal histomorphology but are
arranged abnormally.
• Spherical dystrophic calcifications,
enamel concretions, and sheets of
dysplastic dentin and cementum also
may be found.

• A few odontomas have a mixture of
compound and complex elements
that consists of miniature well-formed
teeth associated with disorganized
sheets of tooth structure.
• Immature odontomas may lack all
but rudimentary calcifications.

• Ghost cells often are seen in
odontomas, especially complex
odontomas
• Ghost cells have no prognostic
significance. Ghost cells are
more common in complex
odontomas.
TREATMENT AND PROGNOSIS
Conservative surgical excision is
the treatment of choice for
odontomas, because such
treatment results in little to no
chance of recurrence. www.indiandentalacademy.com

Summary
• Etiology, Clinical features, Radiological features,&
Histopathological features of
• Ameloblastic fibroma
• Ameloblastic fibro-odontoma
• Odontoma

BIBLIOGRAPHY
• Text book of oral pathology Shafer's, 5 & 6th edition
• Odontogenic Tumors & Allied Lesions Reichart/
Philipsen Ist edition
• Color Atlas of Oral Diseases Cawson, R. 2nd edition
• Oral and Maxillofacial Pathology Neville, Brad W. 2nd
• Lucas’s Pathology Of Tumor’s of the Oral Tissues
• Cawson, R. A., Bennie, W. H 5th edition

Odontogenic tumors v / dental implant courses by Indian dental academy

Recommended

Recommended

More Related Content

What's hot

What's hot (19)

Viewers also liked

Viewers also liked (12)

Similar to Odontogenic tumors v / dental implant courses by Indian dental academy

Similar to Odontogenic tumors v / dental implant courses by Indian dental academy (20)

More from Indian dental academy

More from Indian dental academy (20)

Recently uploaded

Recently uploaded (20)

Odontogenic tumors v / dental implant courses by Indian dental academy