12-ODONTOGENIC Tumours 3

BENIGN
MESENCHYMAL
ODONTOGENIC
TUMOURS
1. ODONTOGENIC FIBROMA
2. ODONTOGENIC MYXOMA/MYXOFIBROMA
3. CEMENTOBLASTOMA
4. CEMENTO-OSSIFYING FIBROMA
CEMENTOBLASTOMA
TRUE CEMENTOMA
CEMENTOBLASTOMA
A BENIGN, WELL CIRCUMSCRIBED NEOPLASM OF CEMENTUM LIKE TISSUE GROWING IN
CONTINUITY WITH THE APICAL CEMENTAL LAYER OF A MOLAR OR PREMOLAR THAT PRODUCES
EXPANSION OF CORTICAL PLATES AND PAIN
CEMENTOBLASTOMA
• Cementoblastoma is an odontogenic neoplasm of cementoblasts, and

represents the only true neoplasm of cementum.
CEMENTOBLASTOMA
CLINICAL FEATURES
• <1% of all odontogenic tumors.
• > 75% in the mandible,
• 90% arising in the molar and premolar region.
• 50% involve the first permanent molar.
• Rarely affect deciduous teeth.
• no gender predilection.
• predominantly in children and young adults, (50% arising before the age of 20 years )
• Pain and swelling in approximately two thirds of reported patients.

CEMENTOBLASTOMA
CLINICAL FEATURES
• Signs of locally aggressive behavior may be observed, including

• Bony expansion,
• Cortical erosion,
• Displacement of adjacent teeth,
• Envelopment of multiple adjacent teeth,
• Maxillary sinus involvement, and
• Infiltration into the pulp chamber and root canals.

CEMENTOBLASTOMA
RADIOGRAPHIC FEATURES
• Radiopaque mass that is fused to one or more tooth roots and is surrounded
by a thin radiolucent rim
• The outline of the root or roots of the involved tooth is usually obscured as a
result of root resorption and fusion of the tumor with the tooth.
CEMENTOBLASTOMA
CEMENTOBLASTOMA
CEMENTOBLASTOMA
CEMENTOBLASTOMA
CEMENTOBLASTOMA
HISTOPATHOLOGIC FEATURES
• Sheets and thick trabeculae of mineralized material with
• Irregularly placed lacunae and
• Prominent basophilic reversal lines.
• Multinucleated giant cells often are present
• Prominent blastlike cells frequently line the mineralized trabeculae
• Cellular fibrovascular tissue is present between the mineralized trabeculae

CEMENTOBLASTOMA
• The periphery of the lesion is composed of uncalcified matrix arranged in radiating columns.
• May infiltrate the pulp chamber and root canals of the involved tooth.
CEMENTOBLASTOMA
CEMENTOBLASTOMA
CEMENTOBLASTOMA
CEMENTOBLASTOMA
CEMENTOBLASTOMA
CEMENTOBLASTOMA
CEMENTOBLASTOMA
CEMENTOBLASTOMA
D/D
• Osteoblastoma
CEMENTOBLASTOMA
TREATMENT AND PROGNOSIS
• Surgical extraction of the tooth together with the attached calcified mass.
• Recurrence rate as high as 22%.
• Progressive growth of the tumor after extraction of the involved tooth and incomplete
removal of the mass has been documented.

BENIGN MIXED
EPITHELIAL &
MESENCHYMAL
ODONTOGENIC
TUMOURS
1. AMELOBLASTIC FIBROMA
2. ODONTOMA
1. Odontoma, compound type
2. Odontoma, complex type
3. PRIMORDIAL ODONTOGENIC TUMOUR
4. DENTINOGENIC GHOST CELL TUMOUR
BENIGN MIXED
EPITHELIAL &
MESENCHYMAL
ODONTOGENIC
TUMOURS
2. ODONTOMA
AMELOBLASTIC FIBROMA
• A circumscribed lesion, located over unerupted molars in young patients; the

epithelium and connective tissue recapitulate the cap and bell stages of
odontogenesis
• Considered to be true mixed tumor in which the epithelial and mesenchymal tissues are both
neoplastic.
• Uncommon
CLINICAL AND RADIOGRAPHIC FEATURES
• Younger patients;(1st two decades; avg. 14 years) but also seen up to 40years.
• Males > females.
• Small are asymptomatic;
• Larger tumors are associated with swelling of the jaws.
• Commonest location is posterior mandible (70%)
• Unilocular or multilocular radiolucent

• Radiographic margins tend to be well defined/ sclerotic.
• An unerupted tooth is associated with the lesion in about 75% of cases
• May grow to a large sizeinvolving body and ascending ramus of the mandible
• GTOSS:
• solid, soft tissue mass with a smooth outer surface; with or

without capsule
• The tumor is composed of a cell-rich mesenchymal tissue

resembling the primitive dental papilla admixed with proliferating
odontogenic epithelium (cords or islands).
• EPITHELIUM
• 1. Long narrow cords:
• most common epithelial pattern
• Often present in an anastomosing arrangement.
• usually only two cells in thickness and
• composed of cuboidal or columnar cells

• EPITHELIUM (both patterns are seen):

2. Islands (follicles)
• Small, discrete islands that resemble the follicular stage of the developing enamel
organ.
• Peripheral columnar cells, which surround a mass of loosely arranged epithelial cells
that resemble stellate reticulum.
• Seldom demonstrate microcyst formation (in contrast to ameloblastoma)

• Mesenchyme:
• Plump stellate and ovoid cells in a loose matrix, which closely resembles the
developing dental papilla.
• Collagen formation is inconspicuous.
• Juxtaepithelial hyalinization of the mesenchymal portion of the tumor (may be

diffuse)
• In recent years, a few examples of ameloblastic fibroma occurring in

conjunction with calcifying odontogenic cyst have been reported.
• Conservative initial therapy for ameloblastic fibroma.
• More aggressive surgical excision for recurrent lesions.
• Approximately 45% of the cases of the rare ameloblastic fibrosarcoma

develop in the setting of a recurrent ameloblastic fibroma.
BENIGN MIXED
EPITHELIAL &
MESENCHYMAL
ODONTOGENIC
TUMOURS
2. ODONTOMA
ODONTOMA
• A usually hamartomatous lesion commonly found over unerupted teeth and

containing enamel, dentin, pulp and cementum in either recognizable tooth
shapes (compound) or as solid gnarled mass
ODONTOMA
EPIDEMIOLOGY
• Most common odontogenic tumor (70% of all OT)
• Prevalence exceeds that of all other odontogenic tumors combined.
• Odontomas are considered to be developmental anomalies (hamartomas), rather than true

neoplasms.
• When fully developed, odontomas consist chiefly of enamel and dentin, with variable
amounts of pulp and cementum.
• In their earlier developmental stages, varying amounts of proliferating odontogenic

epithelium and mesenchyme are present.
ODONTOMA
TYPES
• COMPOUND ODONTOMA
• composed of multiple, small toothlike structures.
• COMPLEX ODONTOMA
• consists of a conglomerate mass of enamel and dentin, which bears no anatomic
resemblance to a tooth.
• Compound odontomas > Complex odontomas
• Occasionally, odontomas may show features of both compound and complex

odontoma.
ODONTOMA
CLINICAL FEATURES
• 1st & 2nd decades of life (mean age at the time of diagnosis is 14 years)
• Asymptomatic,
• Typically relatively small and seldom exceed the size of a tooth in the area where they are
located.
• Large odontomas up to 6 cm or more in diameter can cause expansion of the jaw.
• Maxilla > mandible.

• Compound type: anterior maxilla;
• Complex odontomas: molar regions of either jaw mostly mandible
• Occasionally, an odontoma will develop completely within the gingival soft tissues.
ODONTOMA
ODONTOMA
RADIOGRAPHIC FEATURES (COMPOUND)
• Unilocular lesion containing collection of toothlike structures (miniature teeth) surrounded

by a narrow radiolucent zone
• Frequently associated with unerupted tooth
• Some small odontomas are present between the roots of erupted teeth
• The miniature tooth like structures may range from 2-3 up to 20-30 in number
ODONTOMA
ODONTOMA
ODONTOMA
ODONTOMA
ODONTOMA
ODONTOMA
RADIOGRAPHIC FEATURES (COMPLEX)
• Calcified mass (may exhibit nodularity) with the radiodensity of tooth

structure, surrounded by a narrow radiolucent rim.
• Unilocular and separated from normal bone by a distinct line of cortication.
• Absent individual tooth like structures

ODONTOMA
ODONTOMA
ODONTOMA
ODONTOMA
ODONTOMA
ODONTOMA
ODONTOMA
RADIOGRAPHIC FEATURES D/D
• A developing odontoma may show little evidence of calcification and appear as a

circumscribed radiolucent lesion and simulate many odontogenic cysts and tumours.
• A complex odontoma may be radiographically confused with an osteoma or some other

highly calcified bone lesion.
ODONTOMA
HISTOPATHOLOGIC FEATURES (COMPOUND)
• Multiple structures resembling small, single-rooted teeth, contained in a loose fibrous matrix
• The mature enamel caps of the toothlike structures are lost during decalcification, but
varying amounts of enamel matrix are often present.
• Pulp tissue may be seen in the coronal and root portions of the toothlike structures.
• In patients with developing odontomas, structures that resemble tooth germs are present.
ODONTOMA
HISTOPATHOLOGIC FEATURES (COMPLEX
• Consist largely of mature tubular dentin.
• This dentin encloses clefts or hollow circular structures that contained the mature enamel
• The spaces may contain small amounts of enamel matrix or immature enamel
• Small islands of eosinophilic-staining epithelial ghost cells are present in about 20% cases
• A thin layer of cementum is often present about the periphery of the mass.
• Occasionally, a dentigerous cyst may arise from the epithelial lining of the fibrous capsule of a
complex odontoma.
ODONTOMA
ODONTOMA
ODONTOMA
ODONTOMA
HISTOPATHOLOGIC FEATURES (COMPLEX)
ODONTOMA
ODONTOMA
ODONTOMA
ODONTOMA
HISTOPATHOLOGIC FEATURES (PERIPHERAL)
ODONTOMA
• Odontomas are treated by simple local excision, and the prognosis is

excellent.
AMELOBLASTIC FIBRO-ODONTOMA
• The ameloblastic fibro-odontoma is defined as an expansile lesion in young patients that

contains soft tissue component of an ameloblastic fibroma and hard tissue component of
complex odontoma.
• They represent part of the spectrum of histological changes seen in a developing odontoma
CLINICAL FEATURES
• Children with an average age of 10 years.
• Posterior regions of the jaws
• No gender predilection.
• Asymptomatic
• Large examples may be associated with a painless swelling of the affected bone.
• Well-circumscribed unilocular or, rarely, multilocular radiolucent defect that contains a

variable amount of calcified material with the radiodensity of tooth structure.
• The calcified material within the lesion may appear as multiple, small radiopacities or as a
solid conglomerate mass
• An unerupted tooth is present at the margin of the lesion, or the crown of the unerupted
tooth may be included within the defect.
• Some contain only a minimal amount of calcifying enamel and dentin matrix and appear
radiographically as radiolucent lesions
• These cannot be differentiated from the wide variety of unilocular radiolucencies that may involve
the jaws.
• Some appear as largely calcified masses with only a narrow rim of radiolucency about the
periphery of the lesion.
• Narrow cords and small islands of odontogenic epithelium in a loose connective tissue that resembles
the dental papilla.
• The calcifying element consists of
• foci of enamel & dentin matrix formation in close relationship to the epithelial structures (Fig. 15-104).
• The more calcified lesions show mature dental structures in the form of rudimentary small teeth or
conglomerate masses of enamel and dentin.
• When only dentin matrix and dentinoid material as ameloblastic fibro-dentinoma.

HISTOPATHOLOGIC FEATURES D/D
• Ameloblastic fibroma
• Odontoma
• Odontoameloblastoma
GROSS FEATURES
AMELOBLASTIC FIBRO-
ODONTOMA
HISTOPATHOLOGIC
FEATURES
A. Area similar to ameloblastic fibroma,

B. Ameloblastic differentiation was
evident
C. Components of AFO: dentinoid
(arrowhead), enamel matrix (white
arrow), and adjacent cords of
odontogenic epithelium (black arrow),
all lying in the mesenchymal stroma
D. Irregular mass of dentinoid material

presenting tubules
• Conservative curettage,
• The tumor is well circumscribed and does not invade the surrounding bone.
• The prognosis is excellent, and recurrence after conservative removal is

unusual.
• Extremely rarely, development of an ameloblastic fibrosarcoma is reporteds

ODONTOAMELOBLASTOMA
• “An extremely rare odontogenic tumor that contains an ameloblastomatous

component and odontoma-like elements”
• Deleted in 2017 WHO Classification
• Because there is no real evidence that it is a true mixed neoplastic tumour
• Represent a conventional ameloblastoma that arise in association with an odontoma.
ODONTOAMELOBLASTOMA
CLINICAL FEATURES
• Younger patients,
• Either jaw can be affected.
• Pain,
• Delayed eruption of teeth
• Expansion of the affected bone may be noted.
ODONTOAMELOBLASTOMA
CLINICAL FEATURES
ODONTOAMELOBLASTOMA
• Radiolucent, destructive process that contains calcified structures.
• These have the radiodensity of tooth structure and may resemble miniature
teeth
• May occur as larger masses of calcified material similar to a complex

odontoma.
ODONTOAMELOBLASTOMA
ODONTOAMELOBLASTOMA
• The proliferating epithelial portion of the tumor has features of an
ameloblastoma
• Plexiform or
• Follicular pattern.
• Immature or more mature dental tissue

• In the form of developing rudimentary teeth, which is similar to compound odontoma, or
• Conglomerate masses of enamel, dentin, and cementum, similar to complex odontoma.

ODONTOAMELOBLASTOMA
ODONTOAMELOBLASTOMA
ODONTOAMELOBLASTOMA
ODONTOAMELOBLASTOMA
ODONTOAMELOBLASTOMA
ODONTOAMELOBLASTOMA
ODONTOAMELOBLASTOMA
• Multiple recurrences have been reported after local curettage, and it appears
that this tumor has the same biologic potential as the ameloblastoma.
• Treat as that of ameloblastoma

BENIGN MIXED
EPITHELIAL &
MESENCHYMAL
ODONTOGENIC
TUMOURS
2. ODONTOMA
PRIMORDIAL ODONTOGENIC TUMOUR
PATHOGENESIS
• New entity with only seven reported cases.
• Arises from the dental primordium—that is an abortive tooth germ that fails
to develop into a dental organ.
RADIOGRAPHICAL FEATURES
• All lesions so far reported have presented as a well-demarcated radiolucency

in a dentigerous relationship with an unerupted tooth ___ most often a third
molar.
RADIOGRAPHICAL FEATURES
HISTOPATHOLOGICAL FEATURES
• It is a benign tumour composed of odontogenic mesenchyme with loosely

arranged fusiform or stellate fibroblasts resembling dental papilla
• The lesion is surrounded by a layer of cuboidal epithelial cells resembling the

internal enamel epithelium.
HISTOPATHOLOGICAL FEATURES

12-ODONTOGENIC Tumours 3

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12-ODONTOGENIC Tumours 3

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BENIGN

• Cementoblastoma is an odontogenic neoplasm of cementoblasts, and

• > 75% in the mandible,

• 90% arising in the molar and premolar region.

• 50% involve the ﬁrst permanent molar.

• Rarely affect deciduous teeth.

• Pain and swelling in approximately two thirds of reported patients.

• Signs of locally aggressive behavior may be observed, including

• Displacement of adjacent teeth,

• Envelopment of multiple adjacent teeth,

• Maxillary sinus involvement, and

• Inﬁltration into the pulp chamber and root canals.

• Sheets and thick trabeculae of mineralized material with

• Irregularly placed lacunae and

• Prominent basophilic reversal lines.

• Multinucleated giant cells often are present

• Prominent blastlike cells frequently line the mineralized trabeculae

• Cellular ﬁbrovascular tissue is present between the mineralized trabeculae

• Recurrence rate as high as 22%.

removal of the mass has been documented.

• A circumscribed lesion, located over unerupted molars in young patients; the

• Unilocular or multilocular radiolucent

• solid, soft tissue mass with a smooth outer surface; with or

• The tumor is composed of a cell-rich mesenchymal tissue

• Often present in an anastomosing arrangement.

• usually only two cells in thickness and

• composed of cuboidal or columnar cells

• EPITHELIUM (both patterns are seen):

• Seldom demonstrate microcyst formation (in contrast to ameloblastoma)

• Collagen formation is inconspicuous.

• Juxtaepithelial hyalinization of the mesenchymal portion of the tumor (may be

• In recent years, a few examples of ameloblastic ﬁbroma occurring in

• Conservative initial therapy for ameloblastic ﬁbroma.

• More aggressive surgical excision for recurrent lesions.

• Approximately 45% of the cases of the rare ameloblastic ﬁbrosarcoma

• A usually hamartomatous lesion commonly found over unerupted teeth and

• Prevalence exceeds that of all other odontogenic tumors combined.

• Odontomas are considered to be developmental anomalies (hamartomas), rather than true

• In their earlier developmental stages, varying amounts of proliferating odontogenic

• Compound odontomas > Complex odontomas

• Occasionally, odontomas may show features of both compound and complex

• Large odontomas up to 6 cm or more in diameter can cause expansion of the jaw.

• Maxilla > mandible.

• Complex odontomas: molar regions of either jaw mostly mandible

• Unilocular lesion containing collection of toothlike structures (miniature teeth) surrounded

• Frequently associated with unerupted tooth

• Calciﬁed mass (may exhibit nodularity) with the radiodensity of tooth

• Unilocular and separated from normal bone by a distinct line of cortication.

• Absent individual tooth like structures

• A developing odontoma may show little evidence of calciﬁcation and appear as a

• A complex odontoma may be radiographically confused with an osteoma or some other

• Consist largely of mature tubular dentin.

• Odontomas are treated by simple local excision, and the prognosis is

• The ameloblastic ﬁbro-odontoma is deﬁned as an expansile lesion in young patients that

• Children with an average age of 10 years.

• Posterior regions of the jaws

• Well-circumscribed unilocular or, rarely, multilocular radiolucent defect that contains a

• The calcifying element consists of

• When only dentin matrix and dentinoid material as ameloblastic ﬁbro-dentinoma.

A. Area similar to ameloblastic fibroma,

D. Irregular mass of dentinoid material

• The prognosis is excellent, and recurrence after conservative removal is

• Extremely rarely, development of an ameloblastic ﬁbrosarcoma is reporteds