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Dx: Ameloblastic Fibro-odontoma

KEY FACTS

Terminology Ameloblastic fibro-odontoma (AFO) Definition: Mixed ectodermal-mesenchymal tumor similar to ameloblastic fibroma but with scattered collections of enamel and dentin Imaging Well-defined, sometimes corticated, lucent area with specks of tooth-density material within Calcifications may be doughnut-shaped with rim of enamel density Associated with missing tooth or unerupted tooth Most common in posterior mandible pericoronal to developing tooth May appear as small as enlarged tooth follicles or few cm in diameter Larger lesions have more calcified material CBCT will show buccolingual expansion Top Differential Diagnoses
Ameloblastic fibroma Odontoma Adenomatoid odontogenic tumor Calcifying cystic odontogenic tumor Calcifying epithelial odontogenic tumor

Pathology Islands of odontogenic epithelium in loose primitive connective tissue resembling dental papilla Clinical Issues Age: 2nd decade M=F Large lesions may present as painless bony swelling Treatment: Enucleation, recurrence rare Development of ameloblastic fibrosarcoma after curettage has been reported but is very rare
TERMINOLOGY

Abbreviations Ameloblastic fibro-odontoma (AFO) Definitions Mixed ectodermal-mesenchymal tumor similar to ameloblastic fibroma but with scattered collections of enamel and dentin
IMAGING

General Features Best diagnostic clue: Largely radiolucent area with specks of tooth density material within it associated with missing tooth or tooth that has not erupted Location: Most common in posterior mandible occlusal or pericoronal to developing tooth Size: May appear as small as enlarged tooth follicles or a few cm in diameter Morphology Well defined

May or may not be corticated Mixed density internal structure but mostly radiolucent Larger lesions have more calcified material Calcifications may be doughnut-shaped with rim of enamel density Calcifications do not resemble teeth Unilocular; rarely multilocular Imaging Recommendations Best imaging tool CBCT will show buccolingual expansion if present and relationship of related tooth to vital structures (inferior alveolar nerve canal or maxillary sinus) Periapical or panoramic radiography may be 1st diagnostic imaging to determine cause of unerupted tooth
DIFFERENTIAL DIAGNOSIS

Ameloblastic Fibroma

Entirely radiolucent Histology may show small foci of calcified material indicating AFO
Odontoma

Larger amount of calcified material If odontoma is still developing, may look like AFO AFO calcified material never resembles teeth Odontoma is usually self limiting, stops growing after teeth development ends
Adenomatoid Odontogenic Tumor

"Snow flake" or fine calcifications Mostly in anterior maxilla Mostly pericoronal


Calcifying Cystic Odontogenic Tumor

Can be pericoronal Varied amounts of calcifications: If sparse, may resemble AFO Older mean age group
Calcifying Epithelial Odontogenic Tumor

Occurs in older patients with prevalence in middle age Usually much larger
PATHOLOGY

Microscopic Features Small islands of odontogenic epithelium in loose primitive connective tissue that resembles dental papilla Calcified foci of enamel and dentin matrix formation in close relationship to epithelial structures
CLINICAL ISSUES

Presentation Most common signs/symptoms Missing or unerupted tooth Tooth may be displaced Painless swelling of affected bone Demographics Age 2nd decade

While teeth are developing Gender: No gender predilection Treatment Enucleation Tumor separates easily from bony bed Recurrence is rare Development of ameloblastic fibrosarcoma after curettage has been reported but is very rare
DIAGNOSTIC CHECKLIST

Consider AFO is considered to be stage of development of odontoma and not separate entity by some investigators due to similarity in histopathology