Clinical and Radiological Profile of Ameloblastic Fibro-Odontoma: an Update on an Uncommon Odontogenic Tumor Based on a Critical Analysis of 114 Cases

Abstract

Ameloblastic fibro-odontoma is an uncommon benign tumor of the jaws that belongs to the group of mixed odontogenic tumors. The descriptions of its clinical and radiological features in the literature are not always accurate and sometimes even contradictory. The aim of the present study was to critically evaluate their clinical and radiological features as reported in the English-language literature. A total of 114 well-documented cases of ameloblastic fibro-odontomas (103 from publications and 11 of our own new cases) were analyzed. The patients' age ranged from 8 months to 26 years (mean 9.6). There were 74 (65 %) males, with a male-to-female ratio of 1.85:1 (P = 0.001). The mandible was involved in 74 (65 %) cases, and the mandible-to-maxilla ratio was 1.85:1 (P \ 0.001). Nearly 80 % of the lesions were located in the posterior region of the jaws, and most (58 %) were in the posterior mandible. Radiographically, most of the lesions were unilocular and only a few (*10 %) were multilocular. Most lesions were mixed radiolucent-radiopaque, and only a few (*5 %) were radiolucent. Almost all lesions (*92 %) were associated with the crown of an unerupted tooth/teeth. This comprehensive analysis of a large number of patients with an uncommon lesion revealed that ameloblastic fibro-odontomas are significantly more common in males and in the mandible, and that multilocular lesions are uncommon. It also revealed that, based on their clinical and radiological features, some of them are probably true neoplasms while others appear to be developing odontomas (hamartomas).

Ameloblastic fibro-odontoma: case report

“…The ameloblastic fibro-odontoma is a rare disease that affects a young population, with a mean age of 2l years, according to Buchner et al 7 , and the area most affected is the posterior mandibular region. In the present study, the case related is compatible with the mean age, since the patient was 19 years old when the AFO was discovered in the posterior mandibular region on the left.…”

“…In the histopathological exam results, the cut stained by the HE technique showed an odontogenic epithelium sometimes in cords, and sometimes in islands (Figure 1), with juxtaposed ameloblasts that resembled the cause slight asymmetry in the patient's face 7,11 . Even with the intraoral increase in volume, the color of the mucosa is not changed, but its consistency becomes hardened.…”

“…Buchner et al 7 conducted a study in which they revealed that approximately 90% of the lesions were unilocular and that multilocular lesions were uncommon, however, present in 10% of the cases.…”

“…In histopathological exams, odontogenic tumors tend to reproduce their tissue of origin; that is, they may resemble the enamel or dental pulp organ, as well as contain immature mineralized tissue fragments, such as enamel, dentin and cement 15-16. As differential diagnosis of this lesion, according to the WHO and Buchner et al 7 we may consider the odontoma and ameloblastic fibroma.…”

“…Buchner et al 7 showed that recurrence of AFO is uncommon and normally occurs due to a residual lesion resulting from inadequate surgical removal at the time of initial treatment. The prognosis is favorable, bearing in mind that transformation into the ameloblastic fibrosarcoma is rare 15 .…”