They can occur at any age, although typically are diagnosed in the 2nd decade of life. They are divided histologically into: complex odontoma : irregular calcified lesions with no distinct tooth components compound odontoma : identifiable tooth components Associations Approximately half will be associated with an unerupted tooth, the rest being diagnosed both before or after tooth eruption. Radiographic features Initially, the tumor is lucent, but with time, it develops small calcifications which eventually coalesce to form a radiodense lesion with a lucent rim. Epithelial components may occasionally give rise to a dentigerous cyst.
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Figure 3 Cone-beam tomography panoramic reconstruction showing a well-circumscribed calcified mass in intimate contact with the alveolar inferior nerve. Considering the clinical and radiographic examinations, our presumptive diagnosis was complex odontoma. The patient underwent enucleation of the lesion and careful curettage of the surgical cavity under general anesthesia. Light microscopic examination of sections stained with hematoxylin and eosin revealed strands and islands of odontogenic epithelium showing peripheral palisading and loosely arranged central cells, identical to stellate reticulum, embedded in a myxoid cell-rich stroma resembling the dental papilla Figure 4.
Dentin and enamel were also present Figure 5. The final diagnosis was AFO. The patient is being followed up postoperatively and there is no sign of recurrence. Figure 4 H. Figure 5 H. Discussion In the present case, the patient presented to our department with previous examinations, including panoramic, helical and cone-beam computed tomography. While these radiographic examintions were given a presumptive diagnosis of odontoameloblastoma by the examinaing radiologists, we believed that the findings were more common in this region.
Odontoameloblastoma, also known as ameloblastic odontoma, has a more aggressive behavior, similar to an ameloblastoma rather than an odontoma [ 9 ]. The histogenesis of this lesion is controversial. AFO is a benign tumor that exhibits the same benign biologic behavior as that of ameloblastic fibroma, showing inductive changes that lead to the formation of both dentin and enamel [ 1 ]. This is in contrast to the ameloblastoma.
According to the revised World Health Organization WHO classification [ 10 ], ameloblastic fibroma and AFO are believed to be stages of complex odontoma formation [ 1 ]. This means that the aforementioned lesions should not be considered as distinct entities [ 11 ]. Cahn and Blum [ 13 ] postulated that ameloblastic fibroma the histologically least differentiated tumor develops first into a moderately differentiated form, following AFO and eventually into a complex odontoma.
However, the concept that these lesions represent a continuum of differentiation is not widely accepted, with other researchers suggesting that they are separate pathologic entities [ 12 — 15 ]. In some studies, the term AFO represents a histological combination of ameloblastic fibroma and complex odontoma [ 12 , 16 ]. The majority now agrees that AFO exists as a distinct entity, but it can be histologically indistinguishable from immature complex odontoma.
The arrangement of the soft tissues and the development stage of the involved tooth are useful criteria for diagnosis [ 3 ].
Despite numerous efforts, however, there is still considerable confusion concerning the nature of these lesions [ 17 ].
This lesion usually occurs in people less than 20 years old, and age is thus an important characteristic in the differential diagnosis. This lesion is usually found in the molar area [ 6 , 12 ], and the distribution is roughly equal between the maxilla and mandible [ 6 , 12 ].
Many authors reported that AFO can be treated adequately through a surgical curettage without removal of the adjacent teeth [ 1 , 4 , 5 , 7 , 8 ]. As noted in the literature, not all lesions previously classified as AFO are, in fact, aggressive lesions. If there is a recurrence accompanied by a change of the histological pattern toward a more unorganized fibrous stroma with displacement of the epithelial component, then more extensive treatment procedures appear to be indicated [ 19 ].
Determination of a case-dependent treatment plan may provide an optimum outcome. Long-term follow up with short intervals should be maintained in the management of AFO. References J. Hamner III and M. View at: Google Scholar P. Hawkins and E. Wu and K. View at: Google Scholar F. Okura, H. Nakahara, and T. View at: Google Scholar S. View at: Google Scholar N. Choukas and P. Jacobsohn and J. View at: Google Scholar R. De Pedro Marina, and L. View at: Google Scholar Y. Takeda and C.
View at: Google Scholar D. Dolanmaz, A. Pampu, A. Kalayci, O. View at: Google Scholar L. Cahn and T. Eversole, C. Tomich, and H. View at: Google Scholar H. Chang, D. Precious, and M. View at: Google Scholar G. De Riu, S. Meloni, M. Contini, and A.
Daley, G. Wysocki, and G. View at: Google Scholar A. Oghli, I. Scuto, C. Ziegler, C. Flechtenmacher, and C. E34—E37, This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Ameloblastic Fibro-Odontoma: A Diagnostic Challenge
Abstract Background: Odontogenic tumors such as ameloblastic fibro-odontoma AFO are rare conditions in children and are often asymptomatic. AFOs are found by routine clinical and radiological examination or when they cause obvious intra- or extra-oral swelling. Materials and Methods: A case of an AFO in a 7-year-old girl is described, and cases from the literature and this report are analyzed. Results: The total of cases revealed the average age at presentation of AFO to be 6.
Picture : Odontoma Symptoms of Odontoma There are many symptoms of Odontoma but they are often overlooked or misdiagnosed. One that is serious is difficulty with swallowing. If a tooth is delayed when it ought to be erupting, that is another sign that something is not right. If you have a lump in your gum that could be a symptom of odontoma. Some may be confused initially with an impacted wisdom tooth.