Odontogenic

Tumors
 Odontogenic
Tumors

Epithelial Mixed Mesodermal

 Epithelial
Odontogenic
Tumors

Calcifying
Adenomatoid
epithelial
Ameloblastoma odontogenic
odontogenic
tumor
tumor
 Ameloblastoma

• This a true neoplasm of

odontogenic epithelium

• It is an aggressive
neoplasm the arises from
the remnants of the
dental lamina and dental
organ( odontogenic
epithelium)
 Ameloblastoma
• Benign, locally aggressive
odontogenic tumor. Usually it
slowly grows as painless swelling
of the affected site.

• It can occur at any age.

• Localized invasion into the

surrounding bone.

• 80-95% in the mandible (posterior

body, ramus region). In the maxilla
mostly in the premolar-molar
region.
 Ameloblastoma
• Unilocular (small lesions).
Multilocular (large discrete areas or
honeycomb appearance)

• Smooth, well-defined, well-

corticated margins

• Adjacent teeth are often displaced

and resorbed.

• It causes extensive bone

expansion.

• Incomplete removal can result in

recurrence.
Ameloblastoma
 Ameloblastoma

Usually presents as solid

opacification, in contrast to
characteristic multilocular and
radiolucent presentation of
gnathic ameloblastoma
Clinical appearance of the lesion shows •
extraction socket and alveolar swelling in
buccal aspect
Follicular islands of •
odontogenic epithelium
presenting follicular
ameloblastoma
Plexiform pattern of •
ameloblastoma showing
back-to-back anastomosing
cords of islands of
odontogenic epithelium. In
the center of the islands,
loosely organized cells
were found, resembling the
stellate reticulum of the
enamel origin.
 Prognosis
@ Slow growing tumor that may recur
locally
@ No tumor related deaths, metastasis or
malignant transformation reported
Terapy : Complete surgical excision is
treatment of choice
 Adenomatoid Odontogenic Tumor
("Adenoameloblastoma")

These are uncommon ,

nonaggressive tumors of
odontoginc epthilum.
Also called adenoameloblastoma
Relatively uncommon
70% in teens, remainder from 5 to
50 years, more common in
females
Associated with unerupted canine
tooth
Slow growing, few/no symptoms
 Adenomatoid odontogenic tumor
Features
• Benign. Relatively rare.

• It occurs in young patients (70% of

cases in patients younger than 20
years).

• Most common site: anterior maxilla.

• Often surrounds an entire unerupted

tooth (most commonly the canine).

• Usually well defined, well corticated.

Some tumors are totally radiolucent;
others show evidence of internal
classification.
 Groos/ macroscopis
Rounded, well defined fibrous capsule,
cystic with focal solid areas
Crown of tooth usually projects into cystic
cavity
 Adenomatoid odontogenic tumor
#Well circumscribed, central
proliferation of ductlike epithelium
surrounding small foci of
calcification
#Epithelium may have rosettes,
trabecular or cribriform patterns
Columnar type cells with basal
nuclei and clear cytoplasm may
resemble pre-ameloblasts
#Eosinophilic fibrillar material is
present between tumor cells and
within ductlike structures
Rarely melanin deposition
Terapy enuclease , do not
recure
 Calcifying epithelial odontogenic
tumor
Also called Pindborg tumor
Rare
Ages 30-49 years
May also occur within gingiva (peripheral
tumor)
May be invasive and recur locally, but less
aggressive than ameloblastoma
 Calcifying epithelial odontogenic
tumor (Pindborg tumor

• These are rare

neoplasms of the
tooth – producing
apparuts.
 Calcifying epithelial odontogenic
tumor (Pindborg tumor
• Rare benign neoplasm.
• It occurs more often in middle-
aged patients.
• Usually in mandible.
• Small lesions may be
radiolucent. In advanced
stages irregularly sized
calcifications may be scattered
in the radiolucency.
• It can cause displacement and
impaction of teeth.
 Calcifying epithelial odontogenic
tumor
Site
Premolar mandible
Often associated with
embedded tooth
Resembles
dentigerous cyst with
occasional small
radiopacities within
large radiolucent
area
 Calcifying epithelial odontogenic
tumor
Microscopis
Sheets of polyhedral, eosinophilic squamous
epithelial cells with focal psammoma bodies
Variable markedly pleomorphic cells with 2-3
nuclei
Amyloid bodies (containing degenerated keratin
filaments)
Often scanty stroma, although epithelium / stromal
ratio is variable between tumors
Clear cell variant has clear vacuolated cytoplasm
 Calcifying epithelial odontogenic
tumor
Calcifying epithelial •
odontogenic tumor is
characterized by
squamous epithelial
cells (note the
intercellular bridges),
calcifications (which
exhibit the Liesegang
ring phenomenon), and
abundant eosinophilic
deposits
 Mixed
Odontogenic
Tumors

Ameloblastic Ameloblastic
Odontomas
Odontomas
fibro-odontoma fibroma
Ameloblastic
odontoma
 Odontomas

• It is a tumor that is
radiogrphically and
histologically
characterized by the
production of mature
enamel , dentin ,
cementum and pulp
tissue .
• Compound # complex
 Odontoma
• Features
• Relatively common lesion.

• It usually occurs in young patients.

• Usually asymptomatic.

• Failure of eruption of a permanent tooth

may be the first presenting symptom.It is
commonly found occlusal to the involved
tooth.
 Odontoma
• Features

• Two types: complex and compound

odontoma.

• Complex odontoma is composed of

haphazardly arranged dental hard and
soft tissues.

• Compound odontoma is composed of

many small "denticles" .

• Well defined. The internal aspect is

very radiopaque in comparison to
bone.
 Epidemiology odontoma
Odontomas are thought to be the second
most frequent type of odontogenic tumor
worldwide after ameloblastoma accounting
for about 20% of all cases within this
relatively uncommon tumor category which
shows large geographic variations in
incidence
 Odontoma
Arises from •
epithelium
Shows extensive •
deposits of enamel
and dentin (has
tubular appearance)
forming small,
irregular teeth or an
irregular mass of
tooth tissues
(cementum, dentin,
enamel)
 Compound odontoma
A compound odontoma still
has the three separate dental
tissues (enamel, dentin and
cementum), but may present
a lobulated appearance
where there is no definitive
demarcation of separate
tissues between the individual
"toothlets" (or denticles). It
usually appears in the
anterior maxilla.
 Compound odontoma
A compound odontoma still
has the three separate dental
tissues (enamel, dentin and
cementum), but may present a
lobulated appearance where
there is no definitive
demarcation of separate
tissues between the individual
"toothlets" (or denticles). It
usually appears in the anterior
maxilla
 Compound odontoma
Photomicograph •
shows pulpal tissue
adjacent to predentin
and mature dentin.
The relationship is
similar to that of
normal teeth
Compound odontoma
Odontoma complex tipe
The complex type is
unrecognizable as
dental tissues,
usually presenting as
a radioopaque area
with varying
densities. It usually
appears in the
posterior maxilla or
mandibula.
 Ameloblastic fibroma
• These are benign mixed
odontogenic tumors .

• They are characterized

by neoplastic proliferation
of maturing and early
functional ameloblasts as
well as the primitive
mesnchymel components
of the dental papilla
 Ameloblastic fibroma
• Benign Rare. Occurs in children and
adolescents.

• Most common site: mandible posterior

region.

• Often associated with an unerupted

tooth.

• Well defined, well corticated. Small

lesions are monolocular. Large lesions
are multilocular.

• It may cause displacement of adjacent

teeth. Large lesions cause
buccal/lingual expansion.
Ameloblastic fibroma
 Ameloblastic fibroma
Small islands and cords
of markedly attenuated
ameloblastic epithelium
two cells thick within
dense collagenous
stroma that is often
immature
Occasional dentin or
cementum production
and stellate reticulum
Also granular cell variant
Ameloblastic fibroma
 Ameloblastic
fibro-odontoma
• This is an extremely
rare lesion. It
consists of elements
of ameloblastic
fibroma with small
segments of enamel
and dentin.
Ameloblastic fibro- •
odontoma exhibiting
(1) odontogenic
epithelium
(2) hard tissue •
 Mesodermal
Odontogenic
Tumors

Odontogenic
Cemento- Odontogenic
myxoma
blastoma fibroma
(myxofibroma)
 Odontogenic myxoma (myxofibroma)

• They are benign,

intraosseous
neoplasms that arise
from the
mesenchymal portion
of the dental papilla.
 Odontogenic myxoma (myxofibroma)
• Features

• It represents approximately 3 - 6%
of all odontogenic tumors. It is
painless and grows slowly.

• It can occur at any age but most

commonly in the second and third
decades of life.

• More often affect the mandible

(molar/premolar region).
 Odontogenic myxoma (myxofibroma)
• Features

• Typically multilocular (internal

septa- strings of a tennis racket or
honeycomb appearance). Large
lesions can have the sun ray
appearance of an osteosarcoma.

• Often well-defined.

• Adjacent teeth can be displaced

but rarely resorbed. It causes less
bone expansion than in other
benign tumors.
Odontogenic myxoma (myxofibroma)
Cystlike
lesion with
soap bubble
appearance
 Odontogenic myxoma (myxofibroma
Loose bland stellate cells with
long, branching cytoplasmic
processes
Occasional rests of Malassez
Called myxofibroma or
fibromyxoma if prominent
collagen
Frequent residual bony
trabeculae present
No/minimal odontogenic
epithelium
 Cementoblastoma
• This is a slow growing
mesenchymal
neoplasms composed
principally of
cementum.
 Cementoblastoma
• Features

• Benign neoplasm. Most commonly

in the second and third decade.

• Site: usually mandibular premolar

and molar regions.

• Attached to the root of the affected

tooth. Tooth displacement,
resorption are common.

• Pain in 50% of the cases,

swelling.

• When radiopaque is usually

surrounded by a thin radiolucent
halo.
 Radiographic Features
• Location:

• Periphery: well defined RO

with RL hallo surrounding the
calcified mass.

• Internal structure: mixed RL-

RO leseions may be
amorphous

• Effect on surrounding tissues:

expansion, external root
resorption
Cementoblastoma
 Cementoblastoma

Large cementicles
(globules) fused to form
a mass within
proliferative fibrovascular
stroma
Trabeculae lined by
plump osteoblasts
Cementoblastoma
and residual
cementoblastoma
revealed the same
histological
appearance: dense
mineralized
acellular trabeculae
of basophilic tissue
cement-like, devoid
of vessels,
adhering to the root
of the tooth.
 Therapy
Surgical excision of the lesion is done, and
depending upon the clinical circumstances,
this may or may not involve removal of the
involved tooth. With incomplete removal,
recurrence is common; some surgeons
advocate curettage after extraction to
decrease the overall rate of recurrence.
 Odontogenic fibroma
benign
odontogenicfibroma
tumor. It is more
common in adults, with
the average age being
40. It is twice as likely
to affect women than
men. It is usually found
either in the anterior
maxilla or the posterior
mandible.
 Odontogenic fibroma
Radiographically it
presents with either
radiolucency or
mixed
radiolucency/opaque
.. Treatment is by
surgical removal
 Odontogenic fibroma
The simple type is
characterized by
delicate fibrillar stroma
of collagen containing
fibroblasts; the WHO
type is characterized
by more mature fibrillar
stroma of collagen.
Treatment is by
surgical remova
 Malignant odontogenic tumor

Malignant ameloblastoma •

Primary intraosseous carcinoma

 Malignant ameloblastoma

It is considered to be the most common

odontogenic tumor. It is a tumor of the
enamel organ without formation of enamel.
Robinson has defined it as: Unicentric,
nonfunctional, intermittent in growth,
anatomically benign and clinically
persistent.
The importance of this tumor lies in its
common occurrence, locally invasive
behavior which causes marked deformity
and serious debilitation. They also
demonstrate increased recurrence rate after
surgery.
Ameloblastoma arise from remnants of
odontogenic epithelium i.e. from rests of dental
lamina.
If these rests are situated outside the bone in the
soft tissues of gingiva or alveolar mucosa may give
rise to peripheral ameloblastoma.
Other possible sources of origin include gingival
surface epithelium and lining of odontogenic cysts.
 There are six histopathologic subtypes which •
have been identified for ameloblastoma i.e.
follicular, plexiform, acanthomatous, basal •
cell, unicystic and desmoplastic
ameloblastoma.
Mixtures of different patterns are commonly •
observed and the lesions are usually classified
based on the predominant pattern present.
 follicular,
plexiform,
acanthomato
us, basal cell,
unicystic and
desmoplastic
ameloblasto
ma
Primary intraosseous carcinoma

May arise from epithelial lining of an odontogenic cyst or

de novo from intraosseous odontogenic rests
Mean age is 52 years (range 4 to 76 years); 70% occur
in men (Int J Oral Maxillofac Surg 2001;30:349); most
tumors (92%) occur in mandible
Progressive swelling of the jaw, pain and loosening of the
teeth
Cervical nodal metastases are common
Aggressive behavior (4 year survival is 40%)
 Radiology
Radiolucent cystic- •
like pattern of bone
destruction, but
with well-defined
margins
Usually squamous cell
carcinoma, high grade
 therapy

Aggressive surgical excision

Possibly with post-operative •
radiotherapy •
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