Benign Odontogenic and Non-

odontogenic Tumors of the Jaws

Jahanzeb Chaudhry, BDS, DDS, MDSc
Dip. ABOMR
Associate Professor | HBMCDM | MBRU
 Neoplasms

Benign Malignant

Tumor
Odontogenic
Non-odontogenic

Reactive
Hyperplasia
Hamartoma
 General Characteristics
• Location
– Site predilection

• Borders
– Well defined ± Corticated
– Characteristics of BENIGN processes

• Density and Contents

– Range of densities depending on their potential
– Osteogenic: Radiopaque
– Osteolytic: Radiolucent/Mixed
Odontogenic Tumors
 Ameloblastoma
• Origin - Odontogenic
epithelium
• Malignant forms exist
• Most patients between 20
and 50
• Slow growing, few
symptoms
• Gradual increase in facial
asymmetry
• Radiographic Features
• Molar/ramus area of
mandible
• Maxillary lesions
develop in 3rd molar
area
• Root resorption
• Tooth displacement
• Cyst-like expansion
with thinning of cortical
plate
 Ameloblastoma
• Differential Diagnosis
• Lesions demonstrating internal septations
should be considered; especially:
– OKC
– CGCG
– Dentigerous cyst
 ADENOMATOID
ODONTOGENIC TUMOR
• Uncommon, non- Radiographic Features
aggressive tumor
– Well-defined, corticated
• Appear from age 5-50,
but 70% are identified or sclerotic border
during the second – 2/3rd develop internal
decade
radiopacities
• 2:1 female predilection
– Tooth displacement
Radiographic Features
- Maxillary canine-premolar – Resorption is rare
area
– Some expansion is
- Surrounds a greater
possible
portion of the root (usually a
canine)
White, S. C., Pharoah, M. J. (122013). Oral Radiology: Principles and Interpretation, 7th Edition.
[Elsevier 9.4.3]. Retrieved from vbk://9780323096331
• Differential Diagnosis
– Dentigerous cyst
– OKC
– Ameloblastoma
 CALCIFYING EPITHELIAL
ODONTOGENIC TUMOR
• Pindborg Tumor; • Radiographic Features
Ameloblastoma of
unusual type with – Predilection for
calcification mandible (2 : 1)

• Rare – Occur in molar -

premolar area
• Mineralized substance
within an amyloid-like – Usually associated
with an unerupted
material
tooth
• Slightly more male
– Tooth displacement
predilection - average
onset at 42 years
• Jaw expansion
• Differential Diagnosis
– Ossifying Fibroma
– Adenomatoid Odontogenic Tumor
 AMELOBLASTIC FIBROMA
• Soft Odontoma; Soft
Mixed Odontoma
• Neoplastic proliferation of
functional ameloblasts
• Enamel, dentin and
cementum not formed
• Occur between 5 and 20
years of age (avg. 15)
• Painless, slow growing,
expansile
• Radiographic Features
– Molar-premolar area
– Crest of follicle of
unerupted tooth or in an
area where a tooth failed to
develop
– Cortical expansion
– Inhibition of tooth eruption
– Apical displacement of
teeth
• Differential Diagnosis
– Unicystic ameloblastoma
– OKC
– Dentigerous Cyst
 ODONTOMA
• Compound Odontoma
– Usually unilocular
– Contains multiple (2 to 30) structures that resemble
miniature teeth

• Complex Odontoma
– Unilocular radiopaque mass
– Surrounded by a thin radiolucent zone
– Distinct line of cortication separates lesion from normal
bone
– Tooth-like structures are absent
Compound Odontoma Complex Odontoma
Benign Non-odontogenic
Tumors
 Hyperplasia of Bone
• Tori and Exostoses
– Etiology: Developmental

– Location(s): Midline hard palate, buccal cortical plate

of maxilla & mandible, lingual cortical plate of mand

– Clinical Features: Elevated bony hard projections

from the jaws; may occur centrally

– Radiographic Features: Radiopaque

 Hyperplasia of Bone
• Tori and Exostoses
– Microscopic Features: Compact bone

– Complications: Interfere with denture construction;

may be irritated during eating

– Treatment: Usually not treated; may be surgically

removed

– Prognosis: Excellent

– Pathogenesis: Unknown
Torus/Tori: Hyperplasia of Bone
• Mandible
– Premolar region
 Torus: Hyperplasia of Bone
• Maxilla
– Hard palate
Exostoses: Hyperplasia of Bone
• Buccal
– ??? Response to occlusal load
 Hyperplasia of Bone
• Enostosis; Dense bone Island; Idiopathic Osteosclerosis
– Common in mandibular premolar region
 Hyperplasia of Bone
• Differential Diagnosis
– Retained root fragment

– POD, Focal OD, Florid OD

– Hypercementosis and cementoblastoma

– Periapical sclerosing osteitis

– Osteoma
 Central Giant Cell Granuloma
(CGCG)
• Uncommon, benign process that occurs almost
exclusively within the jaw bones

• Unknown etiology

• Adolescents and Young adults

• Female/Male (2:1)

• More common in mandible (3:1)

• Painless expansion
 CGCG
• Solitary, uni or multilocular, well-defined, corticated,
radiolucent lesion
• Usually occurs anterior to molar teeth and mandibular
condyle areas
• Ill-defined, wispy septa
CGCG
 Bone Scar
• Etiology: Unknown

• Location(s): Either jaw; more common in mandible

• Clinical Features: None

 Bone Scar

• Radiographic Features: Well or ill-defined radiolucency

in region of extracted teeth
– Not to be confused with a radicular/residual cyst
 Neoplasms
Tumors

Ectodermal Mesodermal Mixed

Osteo
Neurilemoma
Neurofibroma

Neuroma Chondro

Neurofibromatosis
Vascular
 Mesodermal
• Osteoma
– Often Craniofacial

– Probably hamartomatous or reactive

– Histology resembles normal bone

 Mesodermal
• Osteoma
– Radiopaque

– Well defined
 Mesodermal
• Multiple Osteomas
– Related to Gardner’s Syndrome, Autosomal Dominant
– GI Polyps, Skin tumors, Increased risk for Colon
Adenocarcinoma
– Supernumerary teeth
 Mesodermal
• Central Hemangioma
– Vascular spaces lined with endothelial cells

– True neoplasm, developmental or traumatic origin

– 2:1 (female to male)

– High incidence at birth or 2nd decade

– Pulsating mass - “bruit”

 Mesodermal
• Central Hemangioma
– Honey comb, coap bubble, cystic, sun ray appearance
 WHEN HEMANGIOMA IS
SUSPECTED
• DEFINITIVE DIAGNOSIS
– SHOULD NOT BE BASED ON CLINICAL FINDINGS AND
PLAIN IMAGING ALONE

– BIOPSY IS CONTRADICTED; CAN BE LIFE THREATENING

– CT AND/OR MRI ARE REQUIRED

 Central Hemangioma
• Treatment

– Radiation Therapy

– Sclerosing Agents

– Induced Embolism

– Surgical Removal