C L I N I C A L P R A C T I C E

Ameloblastic Fibro-odontoma: A Case Report

• Hyunho Chang, DDS, MSD, PhD •
• Michael S. Shimizu, BSc, DMD, MD, MSc •
• David S. Precious, DDS, MSc, FRCD(C) •

A b s t r a c t
Ameloblastic fibro-odontoma is a benign epithelial odontogenic tumour with odontogenic mesenchyme exhibiting
the histologic characteristics of ameloblastic fibroma and complex odontoma. It is usually associated with devel-
oping teeth and occurs predominantly in children and adolescents. In many cases, such lesions are found on radi-
ographic evaluation of patients in whom eruption of teeth is delayed. Ameloblastic fibro-odontoma is generally
asymptomatic but may cause swelling and discomfort. This report describes an ameloblastic fibro-odontoma in the
posterior mandible of a 26-year-old woman and discusses the histogenesis and clinical features of the lesion.

MeSH Key Words: case report; mandibular neoplasms/pathology; odontoma/pathology

© J Can Dent Assoc 2002; 68(4):243-6

This article has been peer reviewed.

A
meloblastic fibro-odontoma is a benign, slow- scribed except along the posterior aspect, where the margin
growing, expansile epithelial odontogenic tumour was irregular and ill defined (Fig. 1).
with odontogenic mesenchyme. It may inhibit The differential diagnosis included ameloblastic fibro-
tooth eruption or displace involved teeth, although teeth in odontoma, immature complex odontoma, calcifying epithe-
the affected area are vital.1-3 Radiography shows a well- lial odontogenic tumour and calcifying odontogenic cyst.
defined, radiolucent area containing various amounts of Excisional biopsy was performed, and the mass, including the
radiopaque material of irregular size and form.1,3-5 The third molar, was submitted for histopathologic diagnosis.
lesions are usually diagnosed during the first and second Light microscopic examination of sections stained with
decade of life.1,4-7 It occurs with equal frequency in the hematoxylin and eosin revealed characteristics of both
maxilla and the mandible and with equal frequency in ameloblastic fibroma and odontoma. The connective tissue
males and females.1,5-7 This report describes an ameloblastic was moderately cellular with spindle-shaped fibroblasts, and
fibro-odontoma in a 26-year-old woman. there were epithelial islands within the fibroblastic matrix
(Fig. 2). High-power microscopy revealed epithelial cells
Case Report producing enamel matrix and dentin. No evidence of malig-
A 26-year-old woman was referred to the Department of nancy, such as nuclear pleomorphism, was found (Fig. 3), and
Oral and Maxillofacial Surgery at the Queen Elizabeth II the tumour was diagnosed as ameloblastic fibro-odontoma.
Health Sciences Centre in Halifax, Nova Scotia, by her The patient was followed postoperatively for 12 months,
family dentist for evaluation of an asymptomatic left but there was no sign of recurrence. Soft-tissue healing was
mandibular lesion that had been discovered on routine uneventful, and postoperative panoramic radiography
radiography. demonstrated completion of bone healing.
The medical, social and family histories were unremark-
able, as were the results of a review of systems and a physi-
cal examination. Panoramic radiography showed an expan-
Discussion
sile, radiolucent lesion around an impacted lower left third Classification, Histogenesis and Histological
molar. The lesion contained scattered foci of calcified mate- Features
rial coronal to the impacted tooth. The root of the impacted Ameloblastic fibro-odontoma has traditionally been
third molar was 75% developed, and the lesion had classified as a benign mixed odontogenic tumour. The term
displaced the tooth inferiorly. The lesion was well circum- “epithelial odontogenic tumour with odontogenic

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Chang, Shimizu, Precious

Figure 1: Panoramic radiograph showing a mixed radiolucent– Figure 2: High-power microscopic view showing epithelial cells
radiopaque lesion in the left angle of the mandible. producing enamel matrix and dentin. (Hematoxylin and eosin,
original magnification ×250.)

ated tumour, develops first into a moderately differentiated

form, ameloblastic fibro-odontoma, and eventually into
complex odontoma. However, the concept that these
lesions represent a continuum of differentiation is not
widely accepted, and others feel that they are separate
pathologic entities.6,8,11 Most now agree that ameloblastic
fibro-odontoma exists as a distinct entity, but it can be
histologically indistinguishable from immature complex
odontoma. The relative arrangement of the soft tissues and
the stage of development of the involved tooth are useful
criteria for diagnosis.
The tumour mass is surrounded by a fibrous capsule and
is composed predominantly of a fibroblastic connective
tissue matrix containing strands of odontogenic epithelium
Figure 3: Microscopic section showing epithelial islands surrounded and immature tooth structures, including enamel and
by fibroblast connective tissue. (Hematoxylin and eosin, original
magnification ×65.)
dentin. The connective tissue is moderately cellular with
spindle-shaped fibroblasts. No evidence of malignancy is
found.
mesenchyme” is becoming more widely accepted these days
and avoids potential controversy over the nature of the Clinical Features
neoplasia. The term “ameloblastic fibro-odontoma”7 repre- Ameloblastic fibro-odontoma is relatively rare. The
sents a histologic combination of ameloblastic fibroma and prevalence among oral biopsies is about 1%,12,13 and the
complex odontoma. This lesion exhibits the same benign frequency of ameloblastic fibro-odontoma among odonto-
biologic behaviour as ameloblastic fibroma. In contrast, the genic tumours is reported as 1% to 3%.12-15 Daley and
term “ameloblastic odontoma”7 refers to tumors represent- others12 investigated the relative incidence of odontogenic
ing a histologic combination of ameloblastoma and tumours in the Canadian population and found that
complex odontoma, which behave in the invasive manner 3.06% of all odontogenic tumors were ameloblastic fibro-
of classic ameloblastoma. The term “ameloblastic fibro- odontomas.2
odontoma” appears in the World Health Organization Ameloblastic fibro-odontoma usually occurs in people
(WHO) classification of odontogenic tumours, whereas less than 20 years old, and age is thus an important charac-
ameloblastic odontoma is called odonto-ameloblastoma in teristic in the differential diagnosis.1,3,4,6,7,16-22 Hooker7
the WHO classification.8,9 reported the mean age of patients as 11.5 years (range
Controversy exists regarding the histogenesis of the 6 months to 39 years). Slootweg6 reviewed 50 patients with
mixed odontogenic tumors. Cahn and Blum10 postulated this lesion, for whom the mean age was 8.1 years (range 1
that ameloblastic fibroma, the histologically least differenti- to 22 years).

244 April 2002, Vol. 68, No. 4 Journal of the Canadian Dental Association
 Ameloblastic Fibro-odontoma: A Case Report

There is no difference in prevalence between the sexes.6,7 oral and maxillofacial sciences at Dalhousie University in Halifax,
Nova Scotia. He is currently an assistant professor at Ulsan
Ameloblastic fibro-odontoma is usually found in the University, Asan Medical Center, in Seoul, Korea.
molar area.6,7 The distribution is roughly equal between the Dr. Shimizu is a former clinical fellow of oral and maxillofacial
maxilla and mandible.6,7 surgery at the Queen Elizabeth II Health Sciences Centre and the
The 2 most common presenting complaints are swelling faculty of oral and maxillofacial sciences at Dalhousie University in
Halifax, Nova Scotia. He is currently a clinical assistant professor,
and failure of tooth eruption. The lesion may displace division of oral and maxillofacial surgery and hospital dentistry,
erupted teeth, but other symptoms, such as pain and pares- faculty of medicine and dentistry, University of Western Ontario,
thesia, are uncommon. Asymptomatic cases are usually London, Ontario.
discovered incidentally on radiography. This lesion is gener- Dr. Precious is chief of oral and maxillofacial surgery at the Queen
Elizabeth II Health Sciences Centre and professor and chair of oral
ally considered a slow-growing central jaw tumour; and maxillofacial sciences at Dalhousie University in Halifax, Nova
however, several exceptions to this pattern have been Scotia.
reported.23 Occasionally, the tumour exhibits marked Correspondence to: Dr. David S. Precious, Oral and Maxillofacial
Sciences, Dalhousie University, 5981 University Ave., Halifax, NS
swelling, which results in facial disfigurement.3 B3H 3J5. E-mail: [email protected].
The authors have no declared financial interests.
Radiographic Features
Radiography usually shows a well-defined radiolucent
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