soft and hard

1. Lesions of jaws
Presented by : Dr.A.K.Zalan
Postgraduate Resident MDS
Pediatric Dentistry, Children Hospital,
PIMS, Islamabad.

2. Odontogenic tumors:
They are named because of their origin from tissues derived
from the developing odontogenic elements, that is ,
epithelium ultimately derived from dental lamina.

3. Ameloblastoma
 Common odontogenic neoplasm
 Aggressive benign neoplasm of ectodermal orgin.
 Usually asymptomatic lesion, initial presentation
may be facial swelling.
 May present with pain and lip/facial numbness.
 Maybe diagnosed radiographically or may show
features such as bony expansion, mobility or
divergence of teeth.
 Commonly present in mandible with the common
site is molar-ramus area.

4.  Unicystic ameloblastoma commonly occurs in young
age.
 Majority of them mimicking dentigerous cyst.

7. Radiographically :
Maybe unilocular or multilocular radiolucent lesions,
with or without bony expansion.
Unicystic occurs almost exclusively in mandible,
predominantly in posterior part.
Most commonly found in association with crowns of
impacted teeth, unicystic ameloblastoma may be seen
inter-radicularly, periapical or edentulous regions.

8. Treatment :
Surgical removal, the method of which varies according to
the location and clinical and radiographic extent.
Recurrence rate is 55 to 90% if treated by curettage.

9. Adenomatoid odontogenic tumor:
Benign, probably hamartomatous, epithelial tumor
that occurs in two intraosseous forms ( Follicular and
extrafollicular) as well as peripheral.
It is also known as adenoameloblastoma, which is
misleading because it behaves different clinically then
ameloblastoma.
AOT can be subclassified into three variants based on
clinical and radiologic findings.
Two of these are central or intra-osseous variants.

10.  Follicular ( dentigerous) type, in which the tumor is
found in association with the crown of an impacted
tooth, with the provisional diagnosis being that of
dentigerous cyst.
 The second and less commonly reported intraosseous
variant is the extrafollicular type, in which there is no
association with the crown of an impacted tooth with
the provisional diagnosis being that of residual,
radicular , globulomaxillary, or lateral periodontal
cyst, depending upon its location.

11.  The third variant is peripheral or extraosseous ,
which may appear clinically as fibroma.
 Most of the AOT are intraosseous ,with follicular
being the common type.
 These are commonly asymtomatic, but can cause
painless swelling, exhibiting slow but progressive
growth.
 Common in 2nd decade of life.
 Females involves twice as males.
 Twice common in maxilla then mandible with
predilection for occurrence in canina and incisor
region.
 Peripheral type is usually present in anterior maxilla

13. Radiographic Examination:
 Radiographically it may present as unilocular
radiolucent lesion , which may appear as dentigerous
cyst or residual, radicular, globulomaxillary or
lateral periodontal cyst depending upon the
location.
 Radiopacity of varying size and density are often
present.
 Root divergence and displacement of teeth.

15. Treatment:
 Because of its encapsulated nature and benign
biological behavior , conservative surgical
enucleation and curettage is the treatment if choice.
 No propensity for recurrence.

17. Odontogenic myxoma:
 Uncommon benign mesodermal neoplasm of jaws,
thought to arise from odontogenic ectomesenchyme
or undifferentiated mesenchymal cells in the
periodontal ligament.
 Mandible is more involved then maxilla.
 Usually painless, slow growing lesions that can
attain considerable size before manifesting signs and
symptoms such as swelling or mobility or divergence
of teeth.

18.  Several cases occurs in which the lesion is associated
with impacted tooth.
 Some cases noted to occur in non-tooth-bearing area,
such as ramus and condyle.

19. Radiographic Examination:
 Maybe unilocular or multilocular, causes expansion,
thinning and destruction of the cortical plates of bone
and displacement of teeth.
 Multilocular lesions exhibit a mottled, soap-bubble
or honey comb appearance.
 Pediatric patients unilocular lesion with bony
expansion and tooth displacement is common.

20.  Because of the variable nature of radiographic
appearance of odontogenic myxoma, D/Ds should
include odontogenic lesions such as dentigerous cyst,
OKC, ameloblastoma.
 In non-odontogenic lesions D/Ds should include
CGCG, central hemangioma, traumatic bone cyst and
aneurysmal bone cyst.

21. Treatment
 Complete surgical excision, which may prove
difficult because of infiltration and expansion of
tumor into bone and absence of true capsule.
 Follow up is necessary to check for the recurrence.

22. Ameloblastic fibroma:
 True mixed neoplasm of odontogenic origin
characterized by proliferation of both odontogenic
epithelium and mesenchymal tissue without the
formation of enamel and dentin.
 Less aggressive then ameloblastoma
 Slightly more common in males.
 Mostly occurs in mandible with a predilection to
second primary or second premolar region.
 Initial clinical presentation is swelling but maybe
asymptomatic and found in routine radiographic
examination.

23.  Maybe unilocular or multilocular radiolucent lesion,
usually with well-defined, often sclerotic borders,
and maybe associated with unerupted or displaced
teeth.
 Malignant transformation of amelobastic fibroma to
ameloblastic fibro-sarcoma has been reported

25. Treatment :
 Surgical removal that is complete but less aggressive
then ameloblastoma.
 Recurrence rate is 33%
 Long follow up is needed.

26. Ameloblastic fibro-odontoma:
 Lesion similar to ameloblastic fibroma but also show
inductive changes that lead to the formation of both
dentin and enamel .
 But these lesions are different from Ameloblastic
fibroma.
 Average age of occurrence is 9.4 years
 Mandible is more common.
 Painless, slow-growing but can be rapidly growing.

27.  Radiographic examination :
 Well-circumscribed , unilocular, mixed density,
radiolucent-radiopaque lesion associated with
displaced or unerupted teeth , clinical manifestation
of which leads to its diagnosis.
 While it is generally agreed that AFO is a
hamartomatous lesion that is a stage preceding the
development of complex odontoma, but AFO should
be classified as neoplasm.
 This is because of local destruction , rapid and
continued growth and its malignant transformation
to ameloblastic fibro-odontosarcoma.

28. Treatment:
 Recurrence of 7.4%
 Conservative surgical removal with associated teeth
has been recommended.

30. Odontoma
 Mixed odontogenix tumors , in which both epithelial
and mesenchymal components have undergone
functional differentiation to the point that both
enamel and dentin are formed.
 Believed to be hamartomatous mass rather then
neoplasm
 WHO classified it into two types depending on
their morphodifferentiation
1- Complex odontome.
2- Compound odontome.

31. Compound odontoma:
 All dental tissues are represented in an orderly
fashion so that there is at least superficial anatomic
resemblance to teeth.
Complex odontoma:
All dental tissues are represented , they are formed in
such a rudimentary fashion that there is little or no
morphologic similarity to normal tooth formation.

32.  Compound odontoma mostly occurs in anterior
maxilla while complex odontoma usually occurs in
posterior mandible.
 Mean age of occurrence of compound odontoma is
14 years while for complex odontoma it is 20.3 years.
 Some say that complex odontoma are the terminal
stage in the series of hamartomatous lesions,
inlcuding ameloblastic fibro-dentinoma, AFO, and
ameloblastic fibroma.

35.  Some believes that compound odontoma is the
histodifferentiation similar to the process producing
supernumerary teeth. “ multiple schizodontia”
 Or locally conditioned hyperactivity of the dental
lamina.
 Usually asymptomatic but can cause impaction or
retention of primary teeth.
 Maybe found in conjunction with dentigerous cyst.

36. Radiographic findings:
 Found on routine radiographic examination
 Irregular radiopaque mass or as small, tooth-like
structures with the most frequent presenting
complain maybe lack of eruption of permanent teeth
or bony expansion or swelling.

37. Treatment
 Surgical excision
 No propensity for recurrence.

38.  THANK YOU
 True power is within , and it is available now
( The power of now)