Odontogenic cysts and neoplasms

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Odontogenic cysts and neoplasms
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Adenomatoid Odontogenic Tumor

• Enamel organ or dental lamina origin
• Young patients, females gt males, anterior maxilla
  and mandible
• Unilocular lucency, commonly (75) with unerupted
  tooth, may develop radiopacities
• Larger lesions may cause expansion

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Adenomatoid Odontogenic Tumor

• When associated with impacted teeth tendency for
  radiolucent margin to extend apically past the CEJ

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Adenomatoid Odontogenic Tumor

• Well-encapsulated
• Sheets of epithelial cells, cellular whorls and
  duct-like structures resembling glandular
  (adenomatoid) tissue

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Adenomatoid Odontogenic Tumor

• Enucleation
• Excellent prognosis

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Ameloblastic Fibroma

• Enamel organ or dental lamina with dental
  papilla-like connective tissue
• 1st and 2nd decades, mean age 12 yrs, posterior
  mandible
• Unilocular radiolucency, often with unerupted
  tooth (50), may become multilocular

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Ameloblastic Fibroma

• Strands and nests of odontogenic (ameloblastic)
  epithelium within a loosely cellular mesenchymal
  tissue that resembles primitive dental pulp

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Ameloblastic Fibroma

• Conservative excision, aggressive curettage
• Prognosis good
• Recurrence rate is probably rather low (lt15)
  highest reported (44) was an AFIP series
• Rarely, sarcomatous transformation

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Odontoma

• Hamartoma of odontogenic organ
• 1st and 2nd decades, mean age 14 yrs, frequently
  associated with unerupted tooth
• Types compound (usually anterior jaws) and
  complex (usually posterior jaws)

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Odontoma

• Compound tooth-like arrangements of dental hard
  tissues
• Complex haphazard mixture of dental hard tissues

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Odontoma

• Enucleation
• Excellent prognosis

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Ameloblastic Fibro-Odontoma

• Development of odontoma within background of
  ameloblastic fibroma
• 1st and 2nd decades, mean age 10 yrs, posterior
  mandible, usually associated with impacted tooth
• Well-defined radiolucency with variable
  radiopaque component

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Ameloblastic Fibro-Odontoma

• Odontoma portion is usually a complex odontoma
• Areas of ameloblastic fibroma are evident
• Relative amounts of each type of tissue vary from
  lesion to lesion

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Ameloblastic Fibro-Odontoma

• Conservative excision
• Excellent prognosis

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Central Odontogenic Fibroma

• Rare benign odontogenic tumor
• Adult patient, mean of 40 years
• Female predilection - 21 ratio
• Anterior maxilla posterior mandible

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Central Odontogenic Fibroma

• Painless swelling, maxillary lesions may
  demonstrate palatal depression
• Unilocular to multilocular lucency,
  displacement/resorption of adjacent roots
  commonly noted

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Central Odontogenic Fibroma

• Connective tissue stroma (fibroma) with variable
  amounts of odontogenic epithelium
• Scattered calcifications may be seen

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Peripheral Odontogenic Fibroma

• Uncommon, but not rare - may be confused with
  peripheral ossifying fibroma
• Firm, sessile gingival mass
• Most are less than 1 cm.
• Wide age range affected

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Central Odontogenic Fibroma

• Conservative excision
• Good prognosis, routine follow-up is recommended

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Odontogenic Myxoma

• Arises from dental papilla
• Young adults, mandible slightly more affected
  than maxilla
• Asymptomatic, larger lesions lead to painless
  swelling

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Odontogenic Myxoma

• Unilocular to multilocular
• Tooth displacement or resorption may be seen
• Cortical thinning and expansion may be dramatic

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Odontogenic Myxoma

• Loose, relatively acellular proliferation of
  stellate to spindle-shaped cells
• No capsule, lesion tends to infiltrate
  surrounding host bone

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Odontogenic Myxoma

• Smaller lesions aggressive curettage
• Larger lesions marginal or en bloc resection
• Overall 25 recurrence

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Benign Cementoblastoma

• Rare neoplasm that arises from PDL
• Young adults, posterior mandible, especially 1st
  permanent molar
• Pain and swelling often presenting features
• Opaque mass fused to root(s), thin lucent rim
  around mass

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Benign Cementoblastoma

• Cellular cementum with plump cementoblasts
• Often a periphery of radiating columns of
  calcified material
• May be mistaken for osteosarcoma

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Benign Cementoblastoma

• Conservative excision with tooth
• Root amputation and endodontic tx
• Good-excellent prognosis

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