Mixed Odontogenic Tumors in Children and Adolescents

Abstract

The typical forms of mixed odontogenic tumors in the jaws of children and adolescents are ameloblastic fibroma, ameloblastic fibroodontoma, complex odontoma, and compound odontoma. Ameloblastic fibromas (AFs) are true, mixed, soft tissue neoplasms, deriving from the proliferation of both odontogenic epithelium and mesenchyma. They have a potential for both recurrence and malignant transformation. Ameloblastic fibroodontomas (AFOs) may be regarded as hamartomas, which exhibit epithelial, mesenchymal, and abundant hard tissue components of the developing teeth. Odontomas are calcifying benign hamartomas and represent the most common type of odontogenic jaw tumors among patients less than 20 years old. Complex odontomas (CXOs) are built up from amorphous hard tissue elements, and generally occur in the premolar or molar regions of the maxilla. Compound odontomas (CDOs) usually appear in the maxilla, in the region of the incisors and canines and contain small, radio-opaque structures reminiscent of rudimentary teeth. In the present study, mixed odontogenic tumor cases are presented in patients under 20 years old. All of them were associated with tooth eruption disturbances. Further aim of this study was to discuss the nature and interrelationships of this group of lesions.

Complex and Compound Odontomas

“…In fact, in literature, recurrence of the lesion is extremely rare. 9 In conclusion, odontomas are hamartomas not rarely encountered by oral and maxillofacial surgeons. Odontomas usually determine delayed eruption; thus, in case of any dentition anomaly or jaw deformation in children and adolescents, it is very important to investigate the presence of possible odontomas by radiographs.…”

“…Therefore, when delayed eruption of the teeth is found, periapical radiographs should be obtained to clarify whether any small area of radiopaque material exists. 4,9,10 Radiographically, odontomas appear as clearly outlined, dense radiopaque lesions surrounded by a thin, radiolucent halo corresponding to the connective tissue capsule. 8,10 Compound odontomas present an irregular radiopaque image with variations in contour and size, composed of multiple radio-opacities corresponding to the small malformed or rudimentary teeth (denticles).…”

“…8,10 Instead, complex odontomas are made up of haphazard conglomerates of immature dentin, enamel, enamel matrix, cementum, and pulp tissue. 9,10 Ghost cells can be found in both compound and complex odontomas. Therefore, odontomas can be considered hard keratinexpressing tumorlike lesions, in which the Wnt signaling pathway may be involved in the formation of ghost cells.…”

Ameloblastic fibro-odontoma: A conservative surgical approach

“…The difference is that the AFO is characterized by showing not only osteodentin or dentin-like material, but also by the production of enamel matrix (6). In relation to the AF, no dental hard tissues are present in this lesion (8) and it has a potential to both recurrence and malignant transformation (4,10). The age of patients and the size of the lesion at initial discovery could be the important factors in judging the behavior and the nature of the lesions (7).…”

“…The mean age of the patients affected is between 8 to 12 years, and there is no gender or anatomic site predilection, although some studies relate slight involvement of posterior mandible (2,4). Most of the cases are painless swelling and may be occasionally detected as a result of failure of tooth eruption (2,3,(5)(6)(7).…”