Odontogenic tumors 2

1. MIXED
ODONTOGENIC
TUMORS
AND ODONTOGENIC
SARCOMAS

2. WHO CLASSFICATION 2005

4. Odontogenic epithelium with
odontogenic ectomesenchyme with or
without hard tissue formation

5. AMELOBLASTIC FIBROMA
Ameloblastic fibroma (AF) consists of odontogenic ectomesenchyme
resembling the dental papilla and epithelial strands and nests resembling
dental lamina and enamel organ.
No dental hard tissues are present…. WHO 2005

6. AMELOBLASTIC FIBROMA
SYNONYMS: Soft odontoma
 Soft mixed odontoma
 Fibroadmantoblastoma
 Granular cell ameloblastic fibroma
 PATHOGENESIS:
Neoplastic proliferation of epithelium(~dental lamina) + primitive
mesenchymal components (~dental papilla)
 Enamel, dentin and cementum…..not formed in this tumor

7. CLINICAL FEATURES
 Age: 5 to 20 yrs, av age 15 yrs
(corresponds to period of tooth form.)
 Gender: Males~ Females
 Clinically,
Painless, slow-growing expansion
Displacement of involved teeth
A/w missing tooth
 May be discovered in routine radiographs

8. HISTOPATHOLOGY Epithelial like islands/ strands
Peripheral columnar cells~
inner enamel epithelium
Spindle shaped epithelium~
stellate reticulum
Stroma 
Immature cell rich myxoid tissue
Epithelium ~ ameloblastoma, Stroma ~immature embryonic appearance

9. RADIOGRAPHIC FEATURES
LOCATION:
• Near alveolar crest(MC)
• In a follicular relationship with unerupted
tooth
• Arise where a tooth fails to develop
Premolar-molar area of mandible
From Ramus -> premolar-molar areaMolar area, extending into the ramus

10. RADIOGRAPHIC FEATURES
 PERIPHERY: Well-defined, corticated
(may be)
 INTERNAL STRUCTURE :
Unilocular, completely radiolucent
Multilocular with indistinct septa

11. RADIOGRAPHIC FEATURES
EFFECT ON SURROUNDING STRUCTURES:
If large  Displacement of teeth
Inhibition of eruption Cortical expansion with intact
borders with intact cortical plate

12. DIFFERENTIAL DIAGNOSIS
Features Ameloblastic
Fibroma
Central giant cell
granuloma
Ameloblasto
ma
Odontogenic
Myxoma
Age 5 to 20 yrs <20 young adults 10 to 90 yrs,
av 40
Young, 10- 30
yrs
Gender M~F - M>F F>M
Site Premolar-
molar region
Mand:max= 2:1
Mand- ant to first
molar
max- ant to cuspid
Older(post jaws)
Molar , ramus
region,
posterior
mandible
Premolar-
Molar Tooth
bearing area
>
Features Septa
infrequent,
fine
Septa granular, ill-
defined
Septa more
defined,
coarse
Few straight
septa
If small, unilocular, pericoronal ~ hyperplastic follicle and a dentigerous cyst

13. Ameloblastic Fibro-dentinoma
 Ameloblastic fibroma (AF) consists of odontogenic ectomesenchyme
resembling the dental papilla and epithelial strands and nests resembling
dental lamina and enamel organ
 If there is dentin formation, the lesion is referred to as ameloblastic
fibrodentinoma (AFD)

14. RADIOGRAPHIC FEATURES

15. Ameloblastic Fibro-odontoma
 Ameloblastic fibro-odontoma (AFO) is a tumour, which has the
histologic features of ameloblastic fibroma in conjunction with the
presence of dentin and enamel (IARC,2005)

16. Clinical Features
 Age: 5 to 20 yrs
 Gender: no particular sex predilection
 Associated with a missing tooth (take position of missing tooth occ)
Or
 An impacted tooth
 Site: Posterior aspect of mandible(MC)
 With epicenter occlusal to developing tooth/ towards alveolar crest

17. Radiographic Features
 PERIPHERY : well defined, corticated, unilocular(mostly),
multilocular

18.  INTERNAL STRUCTURE
Mixed appearance (radiolucent + radiopaque)
Smaller lesions  enlarged follicles with
1/ 2 discrete radiopacities
Larger lesions more extensive
Calcifications
In some  small calcifications
(enamel like margin)--- donut shape

19. EFFECT ON SURROUNDING STRUCTURES
 Inhibit eruption of the tooth May cause expansion

20. Histopathologically
Strands Islands
Dentin
Enamel Matrix
Odontogenic epithelium showing peripheral palisading and loosely arranged
central cells, identical to stellate reticulum embedded in myxoid cell-rich stroma
resembling the dental papilla

21. DIFFERENTIAL DIAGNOSIS
 If Unilocular, radiolucent
 Developing odontoma and Ameloblastic Fibroma  Difficult
to differentiate from
 Although more soft tissue component present in AFO
 Compound Odontoma more organised tooth like structure

22. DIFFERENTIAL DIAGNOSIS
Features AFO Complex odontoma
Age 5 to 20 yrs 2nd decade
Gender M~F F>M
Site Mandible>Maxilla Mandible> Maxilla
Site Molar region Molar region
Periphery Well-defined, corticated Well-defined, smooth or
irregular
Internal structure Majorly R/L , multiple r/o
,round pebble like, r/o
enamel like margin
Irregular mass of
calcified tissue(one
mass)
C/F Painless, jaw expansion Expansion if large
A/w unerupted tooth Most commonly associated Associated
Unilocular, mixed radiolucent and radiopaque

23. Treatment
 Enucleation

24. Coined by Paul Braco, 1867
And defined the term as tumors formed by the
overgrowth or transition of complete dental tissue

25. ODONTOMAS
 Most common types of odontogenic tumors
 Hamartomas
 # (Limited slow growth, well-differentiated tooth tissue)
 ”Odontoma ” a tumor that is radiographically and histologically
characterized by production of mature enamel, dentin, cementum
and pulp tissue
 Seen in various states of histo and morpho-differentiation
 Structural relationship of the components may vary- various forms

26. Important points
1. Limited and slow growth
2. Well-differentiated tooth tissue
3. Begin forming and mature while normal dentition is developing
4. Cease development while adjacent teeth complete their development
5. If left unerupted, persist, do not increase in size, may be discovered
late
6. During its maturation, an odontoma passes through the same stages
as a developing tooth, but dentin and enamel are laid down in an
abnormal pattern
7. Rarely erupt

27. Types
According to WHO, 2005
1. Complex odontoma/ complex composite odontoma
2. Compound odontoma/ composite compound odontoma
3. Dilated odontome
Clinically,
1. Central (intraosseous )odontomas
2. Peripheral odontomas
3. Erupted odontomas

28. COMPLEX ODONTOMA
 24% of all odontomas
 Odontoma, complex type (OC) is a tumour-like malformation
(hamartoma) in which enamel and dentin, and sometimes cementum, is
present….WHO(2005)
 GENDER: Females> Males
 AGE: Second decade

29.  Discovered when there is delayed eruption of adjacent teeth or
retained deciduous teeth
 Or incidentally later in life
 SITE: Mandible> Maxilla
First and second molar area >
 SIZE: very small to 6cm or larger in diameter
 C/M: large, expansion of jaw
COMPLEX ODONTOMA

30. RADIOGRAPHIC FEATURES
PERIPHERY: well defined (corticated) , smooth or irregular
Immediately inside soft tissue capsule
INTERNAL STRUCTURE:
irregular mass of calcified tissue
Degree of radiopacity >= adjacent tooth
May also vary from one region to another
reflecting amount of hard tissue
EFFECT ON SURROUNDING STRUCTURES:
Impaction, malpositioning, diastema, aplasia,
Malformation and devitalisation of the adj. tooth
Large: expansion with maintenance of boundary
COMPLEX ODONTOMA

31. HISTOPATHOLOGY
Enamel, dentin, and cementum-like
tissue are arranged in a hapha- zard
pattern, in contrast to the regular
structure encountered in compound
odontoma

32. Compound odontomas
 Compound : complex odontoma= 2:1
 A tumour like malformation (hamartoma) with varying numbers of
tooth-like elements (odontoids). ..WHO (2005)
 GENDER: Males = females
 AGE: Second decade

33.  Discovered when there is delayed eruption of adjacent teeth or
retained deciduous teeth
 Or incidentally later in life
 SITE: Maxilla> Mandible
Anterior region>
 SIZE: vary in size
 C/M: large, multiple, may then cause expansion of jaw
COMPOUND ODONTOMA

34. RADIOGRAPHIC FEATURES
PERIPHERY: well defined (corticated) , smooth or irregular
Immediately inside soft tissue capsule
INTERNAL STRUCTURE:
Initial stages: completely R/L
No of tooth like structures/ denticles
( deformed teeth)
Degree of radiopacity >= adjacent tooth
May also vary from one region to another
reflecting amount of hard tissue
EFFECT ON SURROUNDING STRUCTURES:
Impaction, malpositioning, diastema, aplasia,
Malformation and devitalisation of the adj. tooth
Large: expansion with maintenance of boundary
COMPOUND ODONTOMA

35. HISTOPATHOLOGY
Enamel and dentin
Pulp

36. DIFFERENTIAL DIAGNOSIS
 Multiple radiopacities inside a radiolucency
Features Complex
Odontoma
Cemento-
Ossifying
Fibroma
Periapical
cemental
dysplasia
Age 2nd decade Any age, young
adults>
Middle age, av 39
yrs
Site Mand> Max
1st and 2nd molar
area
Mand> Max
Mand: inf to PM &
M, sup to IAN
Max: canine
fossa, zygomatic
arch area
Mand> Max
Anterior teeth>
Gender F>M F>M F> M= 9:1

37. Featur
es
Complex
Odontoma
Cemento-Ossifying Fibroma Periapical Cemental
Dysplasia
Periphe
ry
Well defined
(corticated),
Immediately
inside soft
tissue capsule
Well defined, inside a R/L
line(fibrous capsule),
Surrounding bone-sclerotic
Well defined, R/l border of
varying width surrounded by
sclerotic bone
Irregular/oval/ round
Internal
Structur
e
1. R/L with lil calcification
2. Wispy(stretched tufts of
cotton)~FD
3. Flocculent pattern(large,
heavy snow flakes)~ FD
4. Solid amorphous
R/O(cementicle) ~ PCD
Early stage- R/L in
communication with PDL of
inv tooth
Mixed stage- amorphous,
irregular bone
swirling(cementicle)
Mature stage- totally R/O
Thin R/L may still be there
Effect
on
surroun
ding
strcs
Growth concentric within
bone, expansion of cortical
plates
Expansion into sinus
Displacement of teeth
Lamina dura lost,
Larger lesions- undulating
expansion,
Resorption of teeth (may) Resorption(may)

38. CALCIFYING CYSTIC ODONTOGENIC
TUMOR
 Calcifying cystic odontogenic tumour (CCOT) is a benign cystic
neoplasm of odontogenic origin, characterized by an ameloblastoma-like
epithelium with ghost cells that may calcify.

39. CALCIFYING CYSTIC ODONTOGENIC
TUMOR
 2% of all odontogenic pathologies
 Synonyms:
1. Calcifying odontogenic cyst
2. Calcifying epithelial odontogenic cyst
3. Gorlin cyst
In 1962, Gorlin decribed it as cyst – Gorlin Cyst

40. COC
PERIPHERAL
CYSTIC NEOPLASTIC
CENTRAL
CYSTIC NEOPLASTIC
In 1991, Buchner classified COC clinically :
CCOT

41. 1. Dualistic concept : lesion exist in two forms either as cyst or neoplasm
2. Monistic concept : consider lesion as tumor with a marked tendency
towards cystic architecture
 In 1981, Praetorius et al , gave classification on dualistic concept
CYSTIC
Type 1 – simple monocystic type
Type 2 odontome producing type
Type3- amelobalstomatous proliferating type
NEOPLASTIC
- Dentinogenic ghost cell tumor
CCOT

42. WHO follows monistic concept
In 1971- described lesion as non neoplastic cystic lesion , preferred to
use the term calcifying odontogenic cyst (COC)
In 1992- WHO classifies the lesion under odontogenic tumors but
continued to use the term COC
In 2005, WHO renamed the lesion as calcifying cystic odontogenic
tumor
CCOT

43.  AGE: 10 to 19 yrs, av 36 yrs, second peak at 7th decade
COC’s a/w odontomas younger patients
Neoplastic variants appear older patients
 GENDER: No gender predilection
 Site: Mandible = Maxilla
Anterior to first molar, cuspids, incisors
 May be a/w impacted tooth: pericoronal
CCOT

44. RADIOGRAPHIC FEATURES
PERIPHERY :
well defined, may be corticated,
Ill-defined, irregular
Curved, cyst like shape

45.  INTERNAL STRUCTURE:
Completely radiolucent
Small foci/ flecks of calcification
Small, smooth pebbles
Or larger amorphous masses
Multilocular(Rare)

46. Effect on surrounding structures
Expansion of cortical plates Root resorption
Displacement of tooth associated mostly canine Cortical plates perforation

47. DIFFERENTIAL DIAGNOSIS
 Peri-coronal, completely radiolucent
Indistinguishable from a dentigerous cyst
 Apical , radiolucent with calcification
Long standing cyst

48. DIFFERENTIAL DIAGNOSIS
 Mixed radiolucent radiopaque pericoronal lesions
Features CEOT CCOT AOT Ameloblastic
fibro-odotoma
Age 8 to 92 (av 42 yrs) Av 36 yrs, seventh
decade
5 to 50 yrs 8 to 92yrs
Gender Slightly M> F M~F M:F= 2:1 M~F
Site Mandible: Maxilla= 2:1 Mandible= Maxilla Maxilla>
mandible
Mandible>Maxilla
Site Premolar-molar area Anterior to first M
Cuspids, incisors
Incisor- Canine-
PM
Premolar-molar
Periphery Corticated/ ill defined Corticated/Ill defined Corticated/
Sclerotic border
Well-defined, corticated
Internal structure Radiopacities(Calcificati
ons ) close to the crown
of the embedded tooth
R/l or with flecks of
calcifications
R/l or with flecks
of calcifications
/like a custer
Majorly R/L , multiple r/o
,round pebble like, r/o
enamel like margin
C/F Painless, jaw expansion
with maintenance of
cortical boundary
Painless, jaw
expansion, cortical
perforation
Painless, jaw
expansion with
maintenance of
cortical boundary
Painless, jaw expansion
A/w unerupted
tooth
75% 52% 75% Most commonly
associated

49. ODONTOAMELOBLASTOMA
 Odontoameloblastoma (OA) combines features of
ameloblastoma with those of an odontoma.
Synonyms:
 Ameloblastic odontoma
 odontoblastoma

50.  Rare
 AGE: most cases diagnosed during first three decades
 SITE: Maxilla= Mandible
Posterior to canines>
CLINICAL SYMPTOMS/ SIGNS: Bone expansion,
 root resorption,
 tooth displacement
 occasional pain

51. RADIOGRAPHIC FEATURES
Unilocular, multilocular with varying degrees of radiopacity

52. RADIOGRAPHIC FEATURES
Resorption of teeth
• Displacement of teeth,
• Expansion of cortical plates if alrge

53. HISTOPATHOLOGY
Plexiform pattern
like ameloblastoma
Calcified material: dentin

54. Treatment and prognosis
 Odontoameloblastoma is a locally aggressive neoplasm
similar in behaviour and prognosis to conventional
ameloblastoma
 Tumor excision and partial resection of jaw depending on
involvement

55. Dentinogenic ghost cell tumour
 A locally invasive neoplasm characterised by ameloblastoma-like
islands of epithelial cells in a mature connective tissue stroma.
Aberrant keratinization may be found in the form of ghost cells in
association with varying amounts of dysplastic dentin.
 SYNONYMS:
Calcifying ghost cell odontogenic tumour
odontogenic ghost cell tumour
epithelial odontogenic ghost cell tumour, dentinoameloblastoma.
Dentinogenic ghost cell tumour (DGCT) (was considered a solid
variant of CCOt

56. CLINICAL FEATURES
 AGE: 2nd to 9th decade
 GENDER: Men> women
 SITE: maxilla= Mandible
 TYPES : intraosseous and extraosseous
 E/o variant : anterior part of the jaws>
 I/O variant: canine to first molar region>

57. RADIOGRAPHIC FEATURES
 Well defined borders
 Unilocular (Mostly)
 Resorption of adjacent teeth
 A/w impacted teeth
R/L to mixed appearance

58. HISTOPATHOLOGY
Ghost cells may be trapped in the
dysplastic dentin, which in some
areas may be mineralized
Epithelium ~ amelobastoma

59. TREATMENT
 I/O variant, aggressive- wide excision
 E/O - enucleation

60. Mesenchyme and /or ectomesenchyme
with/without odontogenic epithelium

61. ODONTOGENIC MYXOMA
 3 to 6 % of all odontogenic tumors
 An intraosseous neoplasm characterized by stellate and spindle-
shaped cells embedded in an abundant myxoid or mucoid
extracellular matrix…. WHO 2005
 Myxofibroma more collagen
SYNONYMS: Myxoma, Myxofibroma, Fibromyxoma

62. CLINICAL FEATURES
 AGE: 10 to 30yrs ( white and pharoh)
 GENDER: slightly female ( white and pharoh)
 SITE: Mandible: Maxilla= 3:1, only facial skeleton
 Mandible-> premolar-molar area (more common), ramus and condyle
(Rare)
 Maxilla -> alveolar process in premolar and molar region, zygomatic
process
 PATHOGENESIS: odontogenic ectomesenchyme
O. Myxoma

63. CLINICAL FEATURES
 SYMPTOMS: Asymptomatic, diagnosed on a routine radiograph
 Grows slowly, may/ may not cause pain
 Larger lesions, may cause swelling and asymmetry
 If maxilla is involved , it may obliterate maxillary sinus
 Sometimes a rapid growth ( accumulation of myxoid ground
substance in the tumor)
O. Myxoma

64. HISTOPATHOLOGICALLY
Randomly oriented stellate, spindle-shaped and round cells
with long cytoplasmic processes.

65. RADIOGRAPHIC FEATURES
 Periphery:
well defined , corticated (may be) Poorly defined (maxilla)
O. Myxoma

66.  INTERNAL STRUCTURE
 Unilocular appearance (rare)
O. Myxoma

67.  INTERNAL STRUCTURE
Curved, straight , coarse for fine
septa
Forming triangular,
quadrangular, or square-shaped
compartments (mc)
Characteristic: straight, thin etched septa
Tennis- racket like or step ladder
pattern(rare)
Multilocular appearance
One or two of the straight septa help in
identification
O. Myxoma

68. EFFECT ON SURROUNDING STRUCTURES
O. Myxoma
• Displaces / resorbs teeth(MC)
• Resorption (rare)
• Scallops around bone od adjacent teeth
• Tendency to grow along the involved bone
• When large,cause considerable expansion

69. DIFFERENTIAL DIAGNOSIS
Features O.myxoma Ameloblasto
ma
Central
hemangioma
Central giant
cell
granuloma
Age Young, 10- 30
yrs
10 to 90 yrs,
av 40
1st decade < 20 yrs
Site Premolar-
Molar Tooth
bearing area >
Molar , ramus
region,
posterior
mandible
Posterior body
and ramus ,
withing the Inf.
Alv canal
Mand>max=2:
1
Young:
Mand:ant to
1st m
Max:ant to
cuspid
Old:
Post aspect of
jaws
Gender F>M M>F F>M 2:1

70. Features O. Myxoma Amelobalsto
ma
Central
haemangioma
Central giant
cell
granuloma
Border Well-defined ,
corticated(poor
ly defined)
Well defined to
ill-defined
Well-defined/ ill
defined
Ill-
defined(MC),
well defined
Locules Multilocular,
tennis racket,
step-ladder
pattern
Spider-web,
Soap-bubble,
Honey-comb
Multilocular,
honeycomb
Multi-locular
Internal Septa Straight(1/2
mc), Coarse,
Curved
Straight,
Coarse,
Curved
Coarse, dense,
well-defined
Granular,
wispy, ill
defined septa
Cortical
expansion
A-P > B-L B-L Present but
less
B-L
Displacement
of teeth
Present Present(Comm
on)
Present
(common)
Present
Resorption of
teeth
Rare Present Present(often) Present

71. Features O.Myxoma Osteosarcoma Odontogenic
Fibroma
Age Young, 10- 30
yrs
4th decade 11 and 39 yrs
Site Premolar-Molar
Tooth bearing
area >
Mand>Max
Mand: post
mandible,
ramus , angle
Max: alv ridge,
antrum, palate
Mand>Max
Mand:
molar&pm
Max:
Gender F>M M:F= 2:1 F:M= 2.2:1
Clinical
sign/symptom
Asymptomatic,
may cause
pain,
Asymmetry if
large
Rapid swelling,
pain, loose
teeth,
ulceration,
epistaxis,
erythema,trismu
s,
exophthalmus
Asymptomatic,
or presence of
swelling

72. Additional imaging
 CT …. Establishing intraosseous extent
 MRI….. High tissue signal in T2 MRI (tumor extent and tumor
recurrence)

73. Treatment and Prognosis
 CLINICAL BEHAVIOR:
 Benign but very aggressive
 Little encapsulation and often extends through bone, with a propensity to
invade local soft tissues
 May appear to expand in thin layers into and through bone, as well as
into the adjacent soft tissues
Because of its histology and behavior, the treatment of choice has
become
 WIDE EN BLOC RESECTION RATHER THAN SIMPLE
ENUCLEATION.
 A tumor-free margin must be resected because of the tumor's local
invasiveness and its tendency to recur.
 A recurrence rate of 25% after curettage

74. CEMENTOBLASTOMA
 A cementoblastoma is characterized by the formation of
cementum-like tissue in connection with the root of a tooth

75. CLINICAL FEATURES
 AGE: 12 to 65 yrs, common towards the younger age group
 GENDER: Males>Females
 SITE: Mandible> Maxilla
 Premolar/molar area>
 Mostly a/w permanent tooth. May be a/w deciduous tooth(may be)
 SYMPTOMS AND SIGNS: slow growing, may displace teeth,
Involved tooth vital, often painful
Pain relieved by anti-inflammatory drugs

76. RADIOGRAPHIC FEATURES
PERIPHERY: Well defined radiopacity
 Well-defined radiolucent band
 Cortical border
• Maturing from centre to
Periphery
INTERNAL STRUCTURE:
Mixed, mostly r/o
Amorphous/ wheel spoke pattern
Density of cemental mass
obscures the root

77. RADIOGRAPHIC FEATURES
 EFFECT ON SURROUNDING STRUCTURES:
If root outline is apparent, external root resorption can be seen
Expansion with an
intact cortical plate

78. DIFFERENTIAL DIAGNOSIS
Features B.cemento
blastoma
Hypercem
entosis
Periapical
scleorisin
g osteitis
Dense bone
island
Cemental
dysplasia
Age 12 to 65y Middle age, av 39
yrs
Gender M>F Mand> Max
Anterior teeth>
Site Pm , molar F> M= 9:1
Symptom Pain irregular Not present
Shape Uniform,
circular
Undulating
Soft tissue
capsule
Better
defined and
uniform
Surrounded
by PDL
space,
Thinner
Not Not R/l border of
varying width
surrounded by
sclerotic bone
Resorption present Not Not Rare
Expansion Large,
present
Not Rare

79. ODONTOGENIC FIBROMA
 The odontogenic fibroma (OF) is a rare neoplasm
characterized by varying amounts of inactive-looking
odontogenic epithelium embedded in a mature,
fibrous stroma
 SYNONYMS:
1. Simple odontogenic fibroma
2. Central odontogenic fibroma

80. CLINICAL FEATURES
 AGE: 11 to 39 yrs
 GENDER: Females> Males= 2.2:1
 SITE: Mandible> Maxilla
Mandible: molar-premolar region
Maxilla: Anterior to first molar
 CLINICAL SYMPTOM/SIGN: Asymptomatic
Swelling
Mobility of teeth

81. RADIOGRAPHIC FEATURES
 PERIPHERY : well defined
 INTERNAL STRUCTURE: may be completely R/L, or multilocular
Smaller – unilocular Larger- multilocular

82. RADIOGRAPHIC FEATURES
 INTERNAL STRUCTURE:
If multi-locular.
Internal septa- fine, straight ~ O.myxoma
Internal Septa- coarse, granular ~ Giant cell granuloma
Few cases- internal calcification reported
EFFECT ON SURROUNDING STRUCTURES :
 Grow along the bone with minimum
expansion
 Tooth displacement (common)
 Root resorption (may be)

83. DIFFERENTIAL DIAGNOSIS
 Histological features (O.Fibroma ~ central desmoplastic
fibroma if epithelial rests are absent
Features Odontogenic
fibroma
Desmoplastic
fibroma
Aggressive Less More , may
invade the soft
tissue
Septa Fine, straight,
may be granular
Thick, straight,
angular
Radiographically, if it has fine straight septa ~O.myxoma
If granular ~ Central Giant Cell Granuloma

84. TREATMENT
 Simple excision
 Low recurrence rate
 Brazão-Silva, Marco T et al. “Central Odontogenic Fibroma:
A Case Report with Long-Term Follow-Up.” Head & Face
Medicine 6 (2010): 20. PMC. Web. 20 Mar. 2015.
 Hrichi, Radia et al. “Central Odontogenic Fibroma:
Retrospective Study of 8 Clinical Cases.” Medicina Oral,
Patología Oral y Cirugía Bucal 17.1 (2012): e50–e55. PMC.
Web. 20 Mar. 2015.

86. Ameloblastic Fibrosarcoma
 Ameloblastic fibrosarcoma (AFS) is an odontogenic tumour with a
benign epithelial and a malignant ectomesenchymal component. It is
regarded as the malignant counterpart of the ameloblastic fibroma (AF)
AGE: 3-89 years, av. 27.5 years
 AFS derived from a preexisting AF –> av 3 years
 de novo AFS  av 22.9 years
 GENDER : Males> Females
 SYMPTOMS/ SIGNS: Swelling
pain , Paraesthesia

87. RADIOGRAPHIC FEATURES
Expansile intraosseous radiolucency with
illdefined borders

88. Fibrodentinosarcoma/
Fibroodontosarcoma
 A tumour with histological features of ameloblastic
fibrosarcoma, together with dysplastic dentin (fibro-
dentinosarcoma) and/or enamel/enameloid and
dentin/dentinoid (fibro-odontosarcoma)
 Rare
 AGE: 12-83 years with a peak in the third decade
 SYMPTOM: painless jaw swelling

89. RADIOGRAPHIC FEATURES
Radiolucent, sometimes multilocular with poorly circumscribed
outlines. One or more dense opacities representing

90. SUMMARY

91. WHO CLASSFICATION 2005

93. 0-25 yrs More than 40
AOT CEOT
Ameloblastic Fibroma Ameloblastoma
Ameloblastic Fibro-odontoma SOT
Odontoma O.Myxoma
Ameloblastic Odontoma
Tumors Based on age predilection
Tumors Based on gender predilection
Male Females
Ameloblastoma AOT
Ameloblastic Fibroma SOT
Ameloblastic-Fibro-odontoma O.Myxoma
Ameloblastic Odontoma
CEOT

94. Tumors Based on Site of predilection
Mandible maxilla
Ameloblastoma AOT
Ameloblastic Odontoma CEOT
Odontogenic Myxoma Ameloblastic-Fibroodontoma
Calcifying odontogenic fibroma SOT

95. Unilocular , Radiolucenct, Pericoronal(a/w tooth)
Dentigerous cyst
Mural Ameloblastoma
Keratocystic Odontogenic tumor
Adenomatoid Odontogenic Tumor (early stage)
Amelobalstic Fibroma
Multilocular, Radilucenct, associated with teeth
Ameloblastoma
Keratocystic Odontogenic tumor
Odontogenic Myxoma

96. Odontoma(intermediate Stage)
Adenomatoid Odontogenic Tumor
CEOC
CEOT
Ameloblastic Fibro-odontoma
Ameloblastic odontoma
Amelobalstic Fibrodentinoma
Mixed radiolucent an dradiopaque associated with teeth

97. SOAP BUBBLE APPEARANCE
Hemangioma
Aneursymal Bone Cyst
Cherubism
Ameloblastoma
Giant cell Lesion of Hyperparathyroidsm
Central giant Cell granuloma
Keratocystic Odontogenic tumor
AV malformation
Honey Comb Appearance
Ameloblastoma
Central Hemangioma of bone
Driven Snow AppearanceTennis racket appearance
Odontogenic Myxoma Calcifying Odontogenic Tumor

98. References :
 Medline Plus .A service of the U.S National Library of
medicine . National Institutes of Health
 Dorland's Illustrated Medical Dictionary 32 (Version 2011)
 Textbook of Oral Medicine and radiology byRavikiran Ongole
 WHO 2005

99. Ameloblastic Fibro-odontoma
 De Souza Tolentino, Elen et al. “Ameloblastic Fibro-
Odontoma: A Diagnostic Challenge.” International Journal of
Dentistry 2010 (2010): 104630. PMC
 Buchner, Amos, Israel Kaffe, and Marilena Vered. “Clinical
and Radiological Profile of Ameloblastic Fibro-Odontoma: An
Update on an Uncommon Odontogenic Tumor Based on a
Critical Analysis of 114 Cases.” Head and Neck
Pathology 7.1 (2013): 54–63. PMC

100. CCOT
 Uchiyama, Y et al. “Calcifying Cystic Odontogenic Tumour:
CT Imaging.” The British Journal of Radiology 85.1013
(2012): 548–554. PMC. Web. 19 Mar. 2015.
 Balaji, S. M., and Thavarajah Rooban. “Calcifying
Odontogenic Cyst with Atypical Features.” Annals of
Maxillofacial Surgery 2.1 (2012): 82–85. PMC. Web. 19 Mar.
2015.

101. Ameloblastic fibroma
 De Castro, Jurema-Freire-Lisboa et al. “Ameloblastic
Fibroma: A Rare Case Appearing as a Mixed Radiographic
Image.” Journal of Clinical and Experimental Dentistry 6.5
(2014): e583–e587. PMC. Web. 18 Mar. 2015.
 Munde, Anita D, Ravindra R Karle, and Ujwala B Kale.
“Ameloblastic Fibroma in One-Year-Old Girl.” Journal of Oral
and Maxillofacial Pathology : JOMFP17.1 (2013): 149. PMC.
Web. 18 Mar. 2015.
 Pitak-Arnnop, Poramate et al. “Extensive Ameloblastic
Fibroma in an Adolescent Patient: A Case Report with a
Follow-Up of 4 Years.” European Journal of Dentistry 3.3
(2009): 224–228. Print.

102. Cementoblastoma
 Noffke, CEE et al. “Gigantiform Cementoma in a
Child.” Dentomaxillofacial Radiology 41.3 (2012): 264–
266. PMC. Web. 20 Mar. 2015.