7/31/2019 Odontomes & Odontogenic Tumors (Lab 6)
1/64
Dent 356-11 Laboratory Session 5
Odontomes & Odontogenic Tumors
Dr. Rima SafadiModified from Dr. Huda Hammad
7/31/2019 Odontomes & Odontogenic Tumors (Lab 6)
2/64
Complex Odontome: Radiographic Features
7/31/2019 Odontomes & Odontogenic Tumors (Lab 6)
3/64
Compound Odontome: Radiographic Features
http://www.aichi-gakuin.ac.jp/~radio/Teaching%20file/JB028.jpg/03e.jpghttp://www.aichi-gakuin.ac.jp/~radio/Teaching%20file/JB028.jpg/02e.jpg7/31/2019 Odontomes & Odontogenic Tumors (Lab 6)
4/64
Compound Odontome: Radiographic Features
7/31/2019 Odontomes & Odontogenic Tumors (Lab 6)
5/64
Compound odontome
Prof. JH, U of Iowa/USA
pulp
7/31/2019 Odontomes & Odontogenic Tumors (Lab 6)
6/64
Complex & Compound Odontomes:Histopathological Features
Complex odontome:
Mass of irregularly arranged,well-formed enamel, dentin,pulp & cementum surroundedby a fibrous capsule.
Compound odontome:
a number of separatedenticles embedded in fibroustissue.
7/31/2019 Odontomes & Odontogenic Tumors (Lab 6)
7/64
Complex & Compound Odontomes:Histopathological Features
Both developing complexand compound odontomescontain varying amounts ofodontogenic epithelium
and structures resemblingenamel organs.
They show all stages ofodontogenesis and may be
difficult to differentiatefrom ameloblastic fibromaand ameloblastic fibro-odontoma.
7/31/2019 Odontomes & Odontogenic Tumors (Lab 6)
8/64
Ameloblastoma: Radiographic Features
Most commonly appears as a multilocularradiolucency.
Root resorption of involved teeth.
7/31/2019 Odontomes & Odontogenic Tumors (Lab 6)
9/64
Ameloblastoma: Radiographic Features
May be associatedwith an uneruptedtooth, particularly animpacted 3rd molar.
The appearance thenmay mimic adentigerous cyst.
Less frequently, itmay present as aunilocularradiolucency.
http://www.usc.edu/hsc/dental/opfs/OT/008bb.html7/31/2019 Odontomes & Odontogenic Tumors (Lab 6)
10/64
Ameloblastoma
Prof. JH, U of Iowa/USA
7/31/2019 Odontomes & Odontogenic Tumors (Lab 6)
11/64
7/31/2019 Odontomes & Odontogenic Tumors (Lab 6)
12/64
AmeloblastomaProf. JH, U of Iowa/USA
Squammetapl
ameloblasts
te reticulum like cells
7/31/2019 Odontomes & Odontogenic Tumors (Lab 6)
13/64
AmeloblastomaProf. JH, U of Iowa/USA
stroma
Odontoge
7/31/2019 Odontomes & Odontogenic Tumors (Lab 6)
14/64
AmeloblastomaProf. JH, U of Iowa/USA
Could be arising from cyst wall
7/31/2019 Odontomes & Odontogenic Tumors (Lab 6)
15/64
Ameloblastoma: Histopathological Features
Variable patterns dependingon arrangement of neoplasticepithelium.
Follicular pattern:- Discrete, rounded islands or
follicles, each resembling theenamel organ.- Stellate reticulum like cells at
center, surrounded bycuboidal or columnar cellsresembling ameloblasts.
- Nuclei of peripheral cells are
polarized away from thebasement membrane.
- Islands are separated byvarying amounts offibrocollagenous stroma.
http://www.usc.edu/hsc/dental/opfs/OT/010bb.html7/31/2019 Odontomes & Odontogenic Tumors (Lab 6)
16/64
Ameloblastoma: Histopathological Features
Follicular pattern: severalchanges can occur within thestellate area, including:
1. cystic breakdown.
2. squamous metaplasia
3. granular cell change.
http://www.usc.edu/hsc/dental/opfs/OT/015bb.htmlhttp://www.usc.edu/hsc/dental/opfs/OT/012bb.htmlhttp://www.usc.edu/hsc/dental/opfs/OT/013big.html7/31/2019 Odontomes & Odontogenic Tumors (Lab 6)
17/64
Ameloblastoma: Histopathological Features
Plexiform pattern:epitheliumarranged as a
tangled network ofstrands andirregular masses,each showing the
same cell layersseen in thefollicular pattern.
7/31/2019 Odontomes & Odontogenic Tumors (Lab 6)
18/64
Ameloblastoma: Behavior
Typical ameloblastomais locally invasive andtumor islands infiltratecancellous marrow
spaces without initiallycausing bonedestruction.
This requires wide
surgical excision withnormal margins toavoid recurrence.
http://www.usc.edu/hsc/dental/opfs/OT/014bb.htmlhttp://www.usc.edu/hsc/dental/opfs/OT/017bb.html7/31/2019 Odontomes & Odontogenic Tumors (Lab 6)
19/64
Unicystic Ameloblastoma
Typically presents in a younger age group than other variants 2nd-3rd decade).
Radiographically, it appears as a well-defined, unilocular radiolucency, usuallyassociated with an unerupted tooth, i.e. similar to dentigerous cyst.
The diagnosis is made only after histopathological examination.
Treatment is conservative, since epithelium in most cases is limited to cyst lumen.
If epithelium infiltrates the cyst wall, it should be treated like typical ameloblastoma.
7/31/2019 Odontomes & Odontogenic Tumors (Lab 6)
20/64
Ameloblastoma, UnicysticProf. JH, U of Iowa/USA
7/31/2019 Odontomes & Odontogenic Tumors (Lab 6)
21/64
Ameloblastomaunicystic
Prof. JH, U of Iowa/USA
7/31/2019 Odontomes & Odontogenic Tumors (Lab 6)
22/64
Peripheral (Extraosseous) Ameloblastoma
Rare variant whicharises in gingival oralveolar soft tissueswithout involving
bone.
May arise from basalcell layer of oral
epithelium, or fromextraosseous dentallamina remnants.
http://www.srt-psc.com/jsamelo3.jpghttp://conganat.uninet.edu/IVCVHAP/COMUNICACION-E/004/C004F03.jpg7/31/2019 Odontomes & Odontogenic Tumors (Lab 6)
23/64
AmeloblastomaProf. JH, U of Iowa/USA
7/31/2019 Odontomes & Odontogenic Tumors (Lab 6)
24/64
Ameloblastic fibroma
Young fibrous tissue, part of the tumor
7/31/2019 Odontomes & Odontogenic Tumors (Lab 6)
25/64
Ameloblastic fibroma
7/31/2019 Odontomes & Odontogenic Tumors (Lab 6)
26/64
7/31/2019 Odontomes & Odontogenic Tumors (Lab 6)
27/64
7/31/2019 Odontomes & Odontogenic Tumors (Lab 6)
28/64
7/31/2019 Odontomes & Odontogenic Tumors (Lab 6)
29/64
Ameloblastic fibro odontoma
7/31/2019 Odontomes & Odontogenic Tumors (Lab 6)
30/64
Squamous Odontogenic Tumor
Rare tumor presentingwith tooth mobility.
Radiographicallypresents as a well-circumscribed,semilunar ortriangularradiolucencyassociated with roots
of teeth.
Histologically consistsof islands of benign,well-differentiated
squamous epithelium.
7/31/2019 Odontomes & Odontogenic Tumors (Lab 6)
31/64
Ameloblastic Fibroma
Important todifferentiate from
ameloblastoma sinceit is not invasive anddoes not requireaggressive therapy.
Radiographically, well-defined unilocularradiolucency.
http://www.usc.edu/hsc/dental/opfs/OT/059bb.html7/31/2019 Odontomes & Odontogenic Tumors (Lab 6)
32/64
Ameloblastic Fibroma
Proliferating strands ofodontogenicepithelium lying inhighly cellular
fibroblastic tissueresembling dentalpapilla.
Epithelium resembles
that of ameloblastomabut stellate cells aremuch less abundant.
http://www.usc.edu/hsc/dental/opfs/OT/057bb.htmlhttp://www.usc.edu/hsc/dental/opfs/OT/056bb.html7/31/2019 Odontomes & Odontogenic Tumors (Lab 6)
33/64
Adenomatoid Odontogenic Tumor
Well-definedradiolucency, may
have radiopacities.often associatedwith uneruptedtooth, simulating
dentigerous cyst.
http://www.usc.edu/hsc/dental/opfs/OT/039bb.html7/31/2019 Odontomes & Odontogenic Tumors (Lab 6)
34/64
Adenomatoid Odontogenic Tumor
Well-encapsulated, solid orcystic.
Sheets, strands, masses ofepithelium which in some
places forms duct-likestructures lined bycolumnar epithelium.
Small foci of calcification
and occasional dentin andenamel matrix may beseen.
http://www.usc.edu/hsc/dental/opfs/OT/043bb.html7/31/2019 Odontomes & Odontogenic Tumors (Lab 6)
35/64
7/31/2019 Odontomes & Odontogenic Tumors (Lab 6)
36/64
AOT, odontogenic epithelial tumor
7/31/2019 Odontomes & Odontogenic Tumors (Lab 6)
37/64
7/31/2019 Odontomes & Odontogenic Tumors (Lab 6)
38/64
7/31/2019 Odontomes & Odontogenic Tumors (Lab 6)
39/64
AOT
7/31/2019 Odontomes & Odontogenic Tumors (Lab 6)
40/64
AOT
7/31/2019 Odontomes & Odontogenic Tumors (Lab 6)
41/64
Odontogenic Fibroma
Odont. Epith remenants
7/31/2019 Odontomes & Odontogenic Tumors (Lab 6)
42/64
COCProf. JH, U of Iowa/USA
7/31/2019 Odontomes & Odontogenic Tumors (Lab 6)
43/64
COCDr. John Hellstein, UIOWA
COC
7/31/2019 Odontomes & Odontogenic Tumors (Lab 6)
44/64
COCProf. JH, U of Iowa/USA
7/31/2019 Odontomes & Odontogenic Tumors (Lab 6)
45/64
Ghost cellsCOCProf. JH, U of Iowa/USA
CEOT
7/31/2019 Odontomes & Odontogenic Tumors (Lab 6)
46/64
CEOTProf. JH, U of Iowa/USA
7/31/2019 Odontomes & Odontogenic Tumors (Lab 6)
47/64
CEOTProf. JH, U of Iowa/USA
7/31/2019 Odontomes & Odontogenic Tumors (Lab 6)
48/64
CEOTProf. JH, U of Iowa/USA calcifications
Odont. Epith. Cellsprominent intercel
7/31/2019 Odontomes & Odontogenic Tumors (Lab 6)
49/64
CEOTProf. JH, U of Iowa/USA
7/31/2019 Odontomes & Odontogenic Tumors (Lab 6)
50/64
CEOTProf. JH, U of Iowa/USA
7/31/2019 Odontomes & Odontogenic Tumors (Lab 6)
51/64
CEOT
Prof. JH, U of Iowa/USA
7/31/2019 Odontomes & Odontogenic Tumors (Lab 6)
52/64
CEOT
Prof. JH, U of Iowa/USA
calcification
Amyloid like material
Odontogeni
Od t i M Cli i l &
7/31/2019 Odontomes & Odontogenic Tumors (Lab 6)
53/64
Odontogenic Myxoma: Clinical &Radiographic Features
Multilocualrradiolucency,
soap-bubble, or
tennis-racketappearance, oftenwith well-definedmargins.
Root resorption.
http://www.usc.edu/hsc/dental/opfs/OT/090bb.html7/31/2019 Odontomes & Odontogenic Tumors (Lab 6)
54/64
Odontogenic Myxoma: Histopathological Features
Nonencapsulated immatureodontogenic connectivetissue (not very fibrous)rich in ground substance.
Inactive rests ofodontogenic epithelial cellssurrounded by maturefibroblasts with delicatecytoplasmic processes.
May contain variableamounts of collagen, hencethe term myxofibroma.
http://www.usc.edu/hsc/dental/opfs/OT/092bb.html7/31/2019 Odontomes & Odontogenic Tumors (Lab 6)
55/64
Odontogenic Myxoma
7/31/2019 Odontomes & Odontogenic Tumors (Lab 6)
56/64
Cementoblastoma
A rare, benign, well-circumscribed neoplasm ofcementum-like tissuegrowing in continuity withthe apical cemental layerof a molar or premolar thatproduces expansion ofcortical plates and pain.
Identical to osteoblastomaexcept for association with
tooth roots.
Cementoblastoma
7/31/2019 Odontomes & Odontogenic Tumors (Lab 6)
57/64
CementoblastomaProf. JH, U of Iowa/USA
7/31/2019 Odontomes & Odontogenic Tumors (Lab 6)
58/64
7/31/2019 Odontomes & Odontogenic Tumors (Lab 6)
59/64
7/31/2019 Odontomes & Odontogenic Tumors (Lab 6)
60/64
CementoblastomaProf. JH, U of Iowa/USA
Tumors of Debatable Origin:
7/31/2019 Odontomes & Odontogenic Tumors (Lab 6)
61/64
Tumors of Debatable Origin:Congenital Epulis
7/31/2019 Odontomes & Odontogenic Tumors (Lab 6)
62/64
7/31/2019 Odontomes & Odontogenic Tumors (Lab 6)
63/64
Congenital epulis
Granular cells
7/31/2019 Odontomes & Odontogenic Tumors (Lab 6)
64/64
MNETI