INDEX

1 . Definition
2. Classification
3. Ameloblastoma
4. Malignant ameloblastoma
5. Adenomatoid odontogenic tumor
6. Calcifying epithelium odontogenic tumor
7. Odontoma
8. Calcifying odontogenic cyst
9. Ameloblasic fibroma
DEFINITION:
Odontogenic tumors are the lesions derived from cellular elements that
are forming the tooth structure.
NEOPLASM
A). Benign
1). Odontogenic epithelium

(i). Ameloblastoma
(ii). Squamous odontogenic tumor
(iii). Calcifying epithelial odontogenic tumor

(iv).Clear cell odontogenic tumor

(Pindborg’s tumor)
2). Odontogenic epithelium with odontogenic ectomesenchyme
(i). Ameloblastic fibroma
(ii). Ameloblastic fibro dentinoma and ameloblastic fibro odontoma
(iii). Odontoameloblastoma
(iv). Adenomatoid OdontogenicTumor
(v). Calclifying odontogenic cyst
(vi). Complex odontoma
(vii). Compound odontoma

3). Odontogenic ectomesenchyme

(i). Odontogenic fibroma

(ii). Myxoma / Odontogenic myxofibroma
(iii). Benign cementoblastoma (True Cementoblastoma)
B). Malignant
1). Odontogenic carcinomas
(i). Malignant Ameloblastoma
(ii). Primary intraosseous carcinoma
(iii). Malignant variant of other odontogenic epithelial tumor
(iv). Malignant changes in odontogenic epithelial tumors
(v). Malignant changes in odontogenic epithelial cyst

2). Odontogenic sarcomas

(i). Ameloblastic fibrosarcoma (Ameloblastic sarcoma)

(ii). Ameloblastic fibrodentine sarcoma & Amleoblastic fibro
odontosarcoma

3). Odontogenic carcinosarcoma

 AMELOBLASTOMA

Definition
An epithelial tumor arising from the odontogenic apparatus or from cells
with a potentiality for forming tissues of the enamel organ.

WHO Defined it as
Unicentric, non functional, intermittent in growth, anatomically benign
and clinically persist

Origin of the ameloblastic cells

1). Odontogenic epithelium
a). Remenants of Dental lamina
b). Reduced enamel epithelium
c). Rests cells of malassez
2). Basal cell layer o overlying surface epithelium
3). Epithelial lining of odontogenic cyst

Three clinical subtypes

1). Common polycystic Ameloblastoma (80% of all cases)
2). Unicystic Ameloblastoma (13% of all cases)
3). Peripheral (Extraosseous) Ameloblastoma (1% of all
cases)
 1). Common polycystic ameloblastoma

Also called conventional, Intraosseous , Multicystic

Clinical features
wAge - 20 to 40yrs
 Site - mandible > maxilla
 slow growing, painless, bony expansion
 initially Tennis ball like consistency

 “Egg shell” like cracking

Radiographic features
Round cyst like radiolucency
Honey comb (if small loculations)
wor soap bubble like consistency(if large loculations)
Histopathology:

(Vicker’s and Gorlins criteria).

1). Hyperchromatism
2). Palisading cells
3). Vacuolization
4). Hyalinization
Histopathological variants
1). Follicular ameloblastoma
2). Plexiform ameloblastoma
3). Plexiform unicystic ameloblastoma
4). Acanthomatous ameloblastoma
5). Papilliferous keratoameloblastoma
6).Granular cell ameloblastoma
7). Desmolytic ameloblastoma
8). Basal cell ameloblastoma
9). Clear cell Ameloblastoma

Follicular Ameloblastoma
Consists of different shapes & sizes of epithelial islands in the form of
epithelial nests or follicles.
Plexiform ameloblastoma
Consists of interlacing strands of odontogenic epithelial trabeculae

Acanthomatous Ameloblastoma
central epithelial cells squamous cell metaplasia keratin deposition.

Desmoplastic Ameloblastoma
Small epithelial islands widely separated by dense, scar like fibrous tissue.

Granular cell Ameloblastoma

central cells appears swollen & densely packed with eiosinophillic granules.
Basal cell pattern
Islands of uniform basaloid cells.

Treatment options
1). Simple Curettage - high recurrence rate. In mandible, wide marginal
resection leaving compact bone of lower border intact provided the lower
border is not involved radiographically
Large tumors invading lower border of mandible, segment resection using
bone grafts. In maxilla, wide excision is treatment of choice

b).Unicystic Ameloblastoma
Definition :
Is defined as a single unicystic cavity that shows ameloblastomatous
differentiation in the lining.
origin - a). De-novo as a neoplasm
b). Result of neoplastic transformation.
Clinical features
 age - 16 to 20yrs (younger patients).
 Site - mandible > maxilla
 Large lesions painless swelling in the jaw.
Radiographic features
Well-circumscribed, radiolucent area that surrounds the crown of an
unerupted molar.

3 histopathological variants.
1). Luminal unicystic
2). Intaluminal unicystic
3). Mural unicystic

Differential diagnosis
(1). Dentigerous cyst
(2). Residual cyst

Treatment and prognosis

(1). Enucleation and curettage (recurrence rate - 10% to 20%) less
recurrence as surrounding fibrous connective tissue limits the lesion.
(2). If the lesion extends into fibrous cyst wall prophylactic measure Local
resection of the area

c). Peripheral or Extraosseous

Incidence - 1%
origin - a). Remnants of dental lamina beneath the oral mucosa
b). Basal epithelial cells of surface epithelium
Clinical features
 Age - middle age
 site - posterior gingival &
 alveolar mucosa Mandible > maxilla
 Painless, nonulcerated, sessile or pedunculated gingival or alveolar
mucosal
Histopathology:
bear islands of ameloblastic epithelium occupying lamina propria
underneath surface epithelium.
Treatment & prognosis
Surgical excision (Recurrence rate - 15 to 20%).

MALIGNANT AMELOBLASTOMA
Benign tumor that in the typical intraosseous form has a tendency to
infiltrate cancellous bone

AMELOBLASTIC CARCINOMA

Ameloblastoma that has a cytologic evidence of malignancy.

Clinical features:
 swelling, pain and inflammation
 Ulceration of mucosa & loosening of teeth
 Epitaxis & nasal obstruction.

Radiographic features
unilocular or multilocular radiolucency, soap bubble appearance.
Treatment
Simple curettage (high recurrence rate). In mandible, wide marginal
resection leaving compact bone of lower border is not involved
radiographically.
Large tumors - segmental resection followed by reconstruction using bone
graft

.
 ADENOMATOID ODONTOGENIC
TUMOR
Origin - Tumor cell derived from
a). Enamel organ epithelium
b). Remnants of dental lamina
Clinical features
 Age - younger patient (10 to 19yrs)
 Site - anterior portion of the jaw maxilla > mandible
 Asymptomatic, painless, slow growing. large lesions causes
expansion

AOT variants
Central Peripheral
(intraosseous) (extraosseous)

1). Follicular type rare, small

involves crown of sessile masses on
an unerupted tooth facial gingiva of
maxilla
2). Extrafollicular type DD: Gingival
located b/w roots fibrous lesion
of erupted toothRadiographic features
Usually unilocular with well defined corticated border
 may or may not contain a tooth
 often contains fine calcifications.
 tubular or duct like structures

Histopathology:
surrounded by fibrous capsule
Spindle shaped epithelial cells forming sheets, strands or whorled masses of
epithelial cellsCalcification- small foci as well as larger areas.

Treatment : Surgical enucleation (recurrence is rare).

 CALCIFYING EPITHELIUM ODONTOGENIC
TUMOR
( Pindborg’s tumor )

Definition:
It is a locally aggressive tumor consist of sheets & strands of polyhedral
cells in fibrous stroma with no inflammatory component & are often
accompanied by spherical calcifications & amyloid staining hyaline
deposits.
Origin

 Rest of dental lamina

 Reduced enamel epithelium1% of all odontogenic tumor

Clinical features
CEOT

Central Peripheral

(intraosseous) (extraosseous)
age - 40yrs site - anterior gingiva
rd
site - 2/3 of appears as superficial
lesions in mandible soft tissue swelling
slow growing. of gingiva in a tooth
painless mass. bearing area or
edentulous area of jaw

Radiographic features:
Early lesions - unilocular, old lesions - multilocular or honey comb
appearance. Scalloped margins entire radiolucency with calcified structures
of varying size & density “Snow driven” appearance.
Histopathology:
sheets of polyhedral epithelial cells on fibrous stroma
cells show pleomorphism, prominent nucleoli & hyperchromatism.
Liesegang ring calcifications

ODONTOMA

Most common type of odontogenic tumor

Definition:
A non-neoplastic developmental anomaly or malformation that contains
fully formed enamel and dentin.
Types:
1). Invaginated odontome (Dens invaginatus, Dens in dente)
2). Evaginated odontome
3). Enamel pearl
4). Germinated odontome
5). Complex odontome
6). Compound odontome

Clinical features:
 Age- 10 to 20yrs
 Site - Maxilla > mandible
 Slow growing , hard , painless mass
 GARDNER’S Syndrome is associated with it
(a). Multiple odontomas
(b). Multiple osteomas
(c ). Intestinal polyps
(d). Epidermoid cyst
(e). Dermoid tumor(fibrous)
2 Types
(1). Complex
(2). Compound

(1). Compound odontoma

site - anterior part of maxilla
 origin - repeated divisions of tooth germs. By overgrowths multiple
budding of dental lamina with formation of multiple tooth germ.

Radiographically -
Dense opacity with radioluscent rim surrounding it. Collection of tooth like
structures of varying size & shape surrounded by narrow radioluscent zone.
Histolopathology:
Numerous denticles having structures of normal teeth embedded in fibrous
connective tissue.

(2).Complex odontoma
site - posterior part of maxilla
Consist of congomerated mass of enamel & dentin which bears no anatomic
resemblence to a tooth.Cauliflower like mass of hard tissues.
Radiographically:

Calcified mass with the radiodensity of tooth structures

Histolopathology:
Mass consist of enamel, mature tubular dentine, cementum together with
pulp & PDL members in varying amount

CALCIFYING ODOTOGENIC CYST

(Odontogenic ghost cell cyst)
Definition:
A rare well circumscribed solid or cystic lesion derived from odontogenic
epithelium that resembles follicular ameloblastoma but consists ghost cells
& spherical calcifications.
Cutaneous counterpart- Benign calcifying epithelioma of MALHERBE/
Pilomatrixoma
Clinical features
Origin - remnants of dental lamina
Site - areas anterior to molar
Age - most common in 2nd decade
painless asymptomatic slow growing hard lesion causes expansion of buccal
cortical plate.

TYPES

Extaosseous Intraosseous

Focal localized generalized

swelling expansion of buccal cortical plates

DD. gingival fibroma Dentigerous cyst

peripheral giant Ameloblastoma
Gingival cyst Adenomatoid odontogenic

Radiographic feature:
Well circumscribed unilocular radiolucency containing.
Flecks of indistinct radiopacities.

Histolopathology:
Epithelium lining a cystic space. Epithelium consist of pallisaded columnar
cells with reverse polarity of nuclei. Inner layer of stellate reticulum.
GHOST cells present.
Multiple spherical & diffuse calcification.
Deposites of hyaline material.

TREATMENT
1). Curettage
2). Recontouring
3). Resection with or without loss of continuity.

Curettage
Scrapping of the tumor tissue away from bone. Tumor usually comes out in
Ameloblastic fibroma
painless mixed tumor occurring in younger patients in the premolar and
molar region.
Sharply demarcated radiographic borders.
Microscopically epi. Cells lie in conn. Tissue stroma. Enucleation and
curettage
Ameloblasticfibro – odontoma
Tumor with features of ameloblastic fibroma but that also contains enamel
and dentin.histologically epi. Islands in conn. Tissue stroma
.Radiographically well circumscribed unilocular. Treated by enucleation.
Ameloblastic fibrosarcoma
wMalignant counterpart of ameloblastic fibroma. Radiographically ill
defined destructive radiolucency.
wCellular mesenchyme shows hyperchromatism and atypical cells with
island of ameloblastic epithelium