BEN IG N O D O N TO G EN I C TU M O R S O F J AW S

( A M EL O BLA STO M A , O D O N TO M A , O D O N TO G E N O U S
FI B R O M A ) : C LA S S I FI C ATI O N , M O R PH O LO G I C A L
C O N S TITU TI O N , SY M PTO M S A N D SI G N S ,
D I A G N O ST IC S , M ED I C A L T R EAT M E N T, A N D Topic 3
P R E V EN T I V E M EA S U R ES .
B EN IG N N O N O D O N TO G EN I C TU M O R S O F J AWS
( O S TE O C LA STO M A , O STE O M A , C H O N D R O M A ,
FI B R O M A , E PU L I S ) .
INTRODUCTION

• Odontogenic tumors comprise a complex group of lesions with varied histopathological

and clinical features.
• Some tumors are true neoplasms, while some are hamartomas (developmental
malformations).
• Some are composed only of odontogenic epithelium, while many are mixed i.e. both
epithelium and mesenchyme, while some are composed only of mesenchyme
ODONTOGENIC TUMORS ARE A GROUP OF
NEOPLASTIC GROWTHS THAT ORIGINATE
FROM THE TISSUES RESPONSIBLE FOR
TOOTH FORMATION AND THE
PERIODONTAL APPARATUS OF THE JAW
CLASSIFICATION
 A. TUMORS OF ODONTOGENIC
EPITHELIUM:
1. Ameloblastoma
2. Calcifying epithelial odontogenic tumor
3. Adenomatoid odontogenic tumor
4. Squamous odontogenic tumor
5. Clear cell odontogenic tumor
 B. TUMORS OF ODONTOGENIC
EPITHELIUM & MESENCHYME WITH /
WITHOUT DENTAL HARD TISSUE
FORMATION: 
1. Ameloblastic fibroma & Ameloblastic fibrosarcoma.
2. Ameloblastic fibro odontoma
3. Odontoameloblastoma
4. Odontoma – Compound & Complex
 C. TUMORS OF ODONTOGENIC
MESENCHYME WITH / WITHOUT
DENTAL HARD TISSUE FORMATION:
1. Odontogenic fibroma
2. Odontogenic myxoma
3. Cementoblastoma
4. Granular cell odontogenic tumor
AMELOBLASTOMA
-MOST COMMON ODONTOGENIC NEOPLASM,
DERIVED FROM ODONTOGENIC EPITHELIUM
-SLOWLY GROWING, LOCALLY AGGRESSIVE,
BENIGN NEOPLASM
-OCCURS IN 3 DIFFERENT TYPES WITH
DIFFERING CLINICAL, RADIOLOGICAL AND
HISTOLOGICAL FEATURES
1. CONVENTIONAL / MULTICYSTIC
2. UNICYSTIC
3. PERIPHERAL
AMELOBLASTOMA - CONVENTIONAL
CLINICAL FEATURES:
Age incidence: 3rd & 4th decades
Sex incidence: Slightly more in males
Site predilection: 80% ameloblastomas occur in
posterior mandible, followed by maxillary molar region
 SIGNS & SYMPTOMS: 
Slowly growing, painless, hard bony
swelling or expansion of jaw
Thinning of cortical plates produces
“Egg shell crackling”
Other symptoms – Tooth mobility root
resorption and paresthesia if inferior
alveolar nerve is affected.
 RADIOLOGICAL FEATURES

 Typicallyrounded, well defined

multilocular radiolucency with
scalloped margins
When loculations are large, the
appearance is called as “SOAP
BUBBLE” appearance.
When loculations are smaller, the
appearance is called “HONEY
COMBED” appearance
Buccal & lingual cortical plates
are expanded
Roots of adjacent teeth displaced
/ resorbed
As it spreads through medullary
spaces, radiographic margins are
not accurate indication of bone
involvement.
 DIFFERENTIAL DIAGNOSIS: 

1. ODONTOGENIC KERATOCYST
2. FIBROUS DYSPLASIA
3. OSSIFYING FIBROMA 4. CENTRAL GIANT CELL
GRANULOMA.
 HISTOPATHOLOGICAL FEATURES:
 Many subtypes are seen.
1. FOLLICULAR
2. PLEXIFORM
3. ACANTHOMATOUS
4. GRANULAR CELL
5. DESMOPLASTIC
6. BASAL CELL TYPE
7. CLEAR CELL TYPE
AMELOBLASTOMA (FOLLICULAR)
•Islands of epithelium resemble dental organ
surrounded by mature connective stroma.
•Individual follicles show central mass of
stellate reticulum like cells surrounded by a
single peripheral layer of ameloblast like cells.
•Nuclei of peripheral cells are reversely
polarized.
•Within the islands, cyst formation is common.
 AMELOBLASTOMA (PLEXIFORM) 

Instead of islands, long, anastomosing

cords and occasional sheets of epithelial
cells bounded by columnar / cuboidal cells.
Cells within cords are more loosely
arranged than peripheral cells.
Supporting stroma is loose and vascular.
Cyst formation occurs, not inside
follicles, but in surrounding stroma.
AMELOBLASTOMA (ACANTHOMATOUS)
Central area of follicles show
extensive squamous metaplasia, often
associated with keratin formation.
DOEAS NOT INDICATE A MORE
AGGRESSIVE COURSE OF
TUMOR.
Can be confused with squamous
cell carcinoma.
 AMELOBLASTOMA (GRANULAR CELL)
Follicles / sheets of cells show
granular cell change.
These cells have abundant
cytoplasm filled with eosinophilic
granules.
Seen in younger persons and
appears to be more aggressive
clinically.
AMELOBLASTOMA (DESMOPLASTIC) 
This variant is composed of small
islands / cords of odontogenic epithelial
cells surrounded by a dense, collagenized
stroma.
Peripheral ameloblast like cells are
missing / inconspicuous around the islands
/ cords.
Occurs in anterior jaw and radiologically
looks like a fibro-osseous lesion due to
mixed opacity & lucency.
AMELOBLASTOMA (BASAL CELL) 
Least common type.
Composed of nests / sheets of
hyperchromatic basaloid cells.
No stellate reticulum present
centrally and peripheral cells
tend to be cuboidal rather than
tall columnar.
TREATMENT:
Can vary from simple enucleation to curettage to en
bloc resection.
As lesion spreads through medullary spaces, simple
enucleation can leave islands of tumor within the jaws,
leading to recurrence.
Marginal resection is the optimal method.
Rarely can undergo malignant transformatio n.
ODONTOMA
Most common odontogenic tumor.

Considered hamartomas, rather than neoplasm.

In a fully developed odontoma, mainly enamel

and dentin along with variable amounts of pulp
and cementum are seen.
CLASSIFICATION
Odontomas are further sub classified into
•COMPOUND ODONTOMA
•COMPLEX ODONTOMA
Both occur with equal frequency.
Compound – composed of multiple, small, tooth like
structures.
Complex – composed of conglomerate mass of enamel
and dentin with no anatomic relationship to tooth.
CLINICAL FEATURES
Age incidence: First 2 decades.
Sex incidence: None.
Site predilection: Anterior maxilla.
Signs & symptoms:
•Mostly asymptomatic, small, seldom exceeding the size
of tooth missing in the region.
•Larger lesions may cause jaw expansion.
ODONTOMA (COMPOUND) 
Gross pathological
specimen showing a
mass of more than 20
tooth like malformed
structures.
ODONTOMA (COMPOUND)
RADIOLOGICAL FEATURES:
This type is composed of multiple,
small tooth like structures.
The entire mass appears
surrounded by a radiolucent rim.
An unerupted tooth is usually
associated with both types of
odontomes which impedes normal
eruption of the tooth.
ODONTOMA (COMPLEX)
RADIOLOGICAL FEATURES: 
Complex odontoma comprises of
a single conglomerate mass of tooth
like material.
It bears no anatomic resemblance
to any tooth.
Appears as a ‘opaque mass
surrounded by a narrow ‘lucent rim.
ODONTOMA (COMPOUND)
HISTOLOGICAL FEATURES :
Microscopically, it shows
discrete tooth like denticles in a
fibrous stroma.
Being a decalcified specimen,
enamel appears as spaces around
normal looking dentin and pulp
which bear normal anatomic
relationship to each other.
ODONTOMA (COMPLEX)
HISTOLOGICAL FEATURES:
Consist of largely tubular dentin
enclosing clefts / hollow circular
spaces that contained enamel
prior to decalcification.
Thin layer of cementum
sometimes may be present at the
periphery.
ODONTOGENIC FIBROMA (CENTRAL)
CLINICAL FEATURES
Fewer than 50 cases have been reported in the English
literature.
Patient Age: Patients have ranged in age from 980 years
old with a mean of 40 years.
Gender Predilection: Females, 7.4 : 1 in one study.
Location: 60% Sixty percent occur in the maxilla where
most are located anterior to the first molar. When in the
mandible, approximately 50 % occur in the posterior jaw.
ODONTOGENIC FIBROMA:
RADIOGRAPHIC APPEARANCE 
The odontogenic fibroma usually appears as a well-
defined, unilocular radiolucency. It is often associated
with the apical area of an erupted tooth.
Larger lesions are often multilocular.
Many odontogenic fibromas have sclerotic borders. root
resorption is common.
ODONTOGENIC FIBROMA.
Relative distribution of odontogenic fibroma in the
jaws.
ADDITIONAL FEATURES

Small odontogenic fibromas are usually asymptomatic.

The larger lesions may be associated with localized
bony expansion of the jaw or with the loosening of
adjacent teeth.
ODONTOGENIC FIBROMA:
HISTOLOGIC FEATURES
Some authors have described two separate types of
odontogenic fibromas.
The simple odontogenic fibroma is composed of stellate
fibroblasts arranged in a whorled pattern with fine collagen
fibrils and a lot of ground substance.
Foci of odontogenic epithelium may or may not be present.
Occasionally, foci of dystrophic calcification may be
present.
ODONTOGENIC FIBROMA:
HISTOLOGICAL FEATURES
The WHO type odontogenic fibroma appears as a fairly
cellular fibrous connective tissue with collagen fibers
arranged in interlacing bundles.
Odontogenic epithelium in the form of long strands or
isolated nests is present throughout the lesion.
Calcifications composed of cementoid and/or dentinoid
may be present.
ODONTOGENIC FIBROMA:
TREATMENT AND PROGNOSIS
The odontogenic fibroma is usually treated by
enucleation and curettage.
There have been few recurrences, this the prognosis is
good.
BENIGN NONODONTOGENIC
TUMORS OF JAWS
CLASSIFICATION BENIGN NON-
ODONTOGENICTUMORS
Benign tumors of Epithelial tissue origin
Benign tumors of Connective tissue origin:
•Benign tumors of Muscle tissue origin
•Benign tumors of Nerve tissue origin
•Benign tumors of Salivary gland origin
•Benign tumors of Bone
•Angiogenic Benign tumors
•Lymphatic Benign tumors
FIBROMA
Most common benign soft tissue tumor in the oral
cavity.
Most of these lesions are infact hyperplasia or
reactive proliferation of fibrous tissue.
CLINICAL FEATURES:
It can occur at any age but it is common in 3rd 4th and 5th
decades.
Female predilection.
Site : it occurs on gingiva, tongue, buccal mucosa and
palate.
Appearance : it is most often sessile dome shaped or
slightly pedunculated with smooth contour.
Consistency : it can range from soft and myxomatous to
firm and elastic.
FIBROMA
DIFFERENTIAL DIAGNOSIS

Myxofibroma – it is softer on palpation when compared

to fibroma
Neurofibroma
Neurilemoma
Giant cell fibroma
Minor salivary gland tumors
TREATMENT :

Conservative surgical excision

Recurrence is extremely rare
OSTEOCLASTOMA
It is a well described benign hyperplastic lesion of oral
mucosa.
First described by Weathers and Callihan in 1974.
Clinical features:
•It occurs at any age
•It is common in gingiva followed by tongue, palate, buccal
mucosa and lips
•Asymtomatic
•It appears usually small, raised, peduculated, papillary
lesion less than 1cm in diameter
DIFFERENTIAL DIAGNOSIS

squamous papilloma
irritation fibroma
pyogenic granuloma
TREATMENT

Surgical excision
Recurrence is rare
OSTEOMA
Benign neoplasm characterized by a proliferation of
either compact or cancellous bone, usually in the
endosteal or periosteal location. 
CLINICAL FEATURES:
It is an uncommon lesion in the oral cavity.
It can occur at any age mostly in young adults.
The tumor of periosteal origin manifests itself as a circumscribed swelling of the
jaw.
It is a slow growing tumor.
The tumor of endosteal origin is slower topresent clinical manifestations, since
considerable growth must occur before there is expansion of the cortical plates.
Multiple osteomas of the jaws as well as long bones and skull are characteristic
manifestations of Gardner’s syndrome.
Rarely, pain is associated with this tumor. 
RADIOGRAPHIC FEATURES
The central lesion usually appears with in the jaw as a
well- circumscribed radiopaque mass.
Sometimes., this may be diffuse,then it must be
differentiated from chronic sclerosing osteomyelitis.
Periosteal form of the disease is manifested as a
sclerotic mass. 
TREATMENT 
Surgical excision if the tumor if it is causing difficulty
or if a prosthetic appliance is to be constructed,
particularly when the tumor lies close to the surface of the
alveolar bone.
Recurrence is extremely rare.
CHONDROMA
Chondroma Benign neoplasm of chondrocytes and
hyaline cartilage
GAL:
•None
•Third and fourth decades
•Anterior maxilla, condyle
•Usually hands and feet
CHONDROMA HISTOPATHOLOGY
Mature hyaline cartilage
Encapsulated
Small chondrocytes
Well-formed lacunae
1 cell/lacuna
CHONDROMA
•Well demarcated radiolucency with scattered globular radiopacities
•Asymptomatic
•Cortical expansion
•Slow enlargement
•Rx: conservative surgical excision or curettage
•Low-to-no recurrence
•Recurrence should be suspected as low-grade chondrosarcoma
•Special diseases:
• Ollier disease
- Multiple chondromas
• Maffucci syndrome
- Multiple chondromas
- Soft tissue angiomas
EPULIS
CONGENITAL EPULIS OF THE NEW BORN

Congenital epulis of the newborn is a rare non-neoplastic reactive

or degenerative lesion probably arising from mesenchymal cells. It
appears in newborn infants, exclusively on the alveolar ridges of
the maxilla and mandible. The lesion develops commonly on the
maxilla and occurs about ten times more frequently in female than
male babies.
CLINICAL PICTURE.
Clinically, it is present at birth, and it appears as an
asymptomatic solitary pedunculated tumor of red or
normal color, which ranges from a few millimeters to a
few centimeters in diameter
THE DIFFERENTIAL DIAGNOSIS

 includes the melanotic neuroectodermal tumor of

infancy
 pyogenic granuloma
 fibroma.
LABORATORY TEST.
Histopathologic examination is essential for the
diagnosis.
TREATMENT

Surgical excision, although spontaneous regression has

been reported.
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