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Year : 2011  |  Volume : 22  |  Issue : 2  |  Page : 345-347
Ameloblastic fibrodentinoma

Department of Oral & Maxillofacial Pathology, SGT Dental College and Hospital, Gurgaon, India

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Date of Submission12-Dec-2009
Date of Decision03-May-2010
Date of Acceptance15-Apr-2011
Date of Web Publication27-Aug-2011


Odontogenic tumors comprise a complex group of lesions of diverse histopathological types and clinical behavior. The group of mixed odontogenic tumors, which are also rare, is composed of proliferating odontogenic epithelium in a cellular ectomesenchyme resembling dental papilla. Ameloblastic fibrodentinoma is a rare benign odontogenic tumor. The present case report discusses this tumor composed of odontogenic epithelium and odontogenic mesenchyme with dentin or dentin like tissue. The present paper also throws light on various histological similarities and complexities which make the interpretation of these set of odontogenic tumors a diagnostic dilemma.

Keywords: Ameloblastic fibrodentinoma, ameloblastic fibro-odontoma

How to cite this article:
Bhargava D, Dave A, Sharma B, Nanda K. Ameloblastic fibrodentinoma. Indian J Dent Res 2011;22:345-7

How to cite this URL:
Bhargava D, Dave A, Sharma B, Nanda K. Ameloblastic fibrodentinoma. Indian J Dent Res [serial online] 2011 [cited 2019 Oct 21];22:345-7. Available from:
Odontogenic tumors constitute a heterogeneous group of lesions with diverse histopathologic features and clinical manifestations. Ameloblastic fibrodentinoma (AFD) is a rare benign odontogenic tumor. [1] It is considered as hamartomatous lesion of odontogenic origin and believed to be an intermediate stage between ameloblastic fibro-odontoma and ameloblastic fibroma. [2] AFD is a slow-growing lesion. It is usually an asymptomatic lesion and more frequently involves the posterior part of mandible. It occurs in younger age group. Central as well as peripheral AFD have been reported. [1] The clinical and radiological presentation may mimic like ameloblastic fibro-odontoma, odontoma, ameloblastic fibroma, and cemento-ossifying fibroma.

   Case Report Top

A 51-year-old male patient reported to the Department of Oral Medicine and Radiology with the chief complaint of inability to eat food due to missing teeth. On intraoral examination, in the maxillary arch, all teeth were missing except for root stumps of 12; in the mandibular arch, 42 and 44 were present. On palpation, a tooth like structure was felt in maxillary canine region. The overlying mucosa was normal. Patient was advised IOPA in relation to 12, 13 and maxillary occlusal radiograph. The medical history of the patient and his family was non-contributory.

Radiographic examination revealed a radiopaque mass surrounded by a radiolucent area, obstructing the path of impacted maxillary canine. On the basis of clinical and radiological findings, a provisional diagnosis of odontoma was given and the patient was advised extraction of impacted canine with removal of odontome. The patient was referred to the Oral Surgery Department where the lesion was surgically removed and sent for histopathological examination. The associated canine was not sent.

One soft tissue specimen measuring about 2×1.5 cm in size, brownish white in color, irregular in shape and firm in consistency was received along with one hard tissue, irregular in shape, brownish in color and measuring about 2×1×1 cm in size, resembling tooth like structure or root piece. On histopathological examination, the H and E stained section showed scattered islands of odontogenic epithelium consisting of cuboidal cells. At places, odontogenic epithelium resembled cap like arrangement [Figure 1]. The mesenchymal component appeared as cellular connective tissue (matured stroma). Decalcified section of the hard tissue showed dentin like structure [Figure 2]. Based on radiographic and histological findings, a diagnosis of AFD was made.
Figure 1: Odontogenic epithelium showing cap like arrangement

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Figure 2: Decalcified section showing dentin like structure

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   Discussion Top

AFD is a rare odontogenic tumor composed of odontogenic epithelium and odontogenic mesenchyme with dentin or dentin like tissue. [1] In revised WHO classification of odontogenic tumors, a distinction is made between ameloblastic fibro-odontoma and AFD. [3] The presence of both dentin and enamel is essential to call the tumor an ameloblastic fibro-odontoma. Exclusive dentin formation in an otherwise identical tumor is called AFD. [3]

AFD presents itself as an asymptomatic, slow-growing lesion commonly associated with an unerupted tooth. [4] In this case too, the lesion was associated with the crown of an unerupted canine which was seen during routine radiological investigation. AFD is seen in young individuals and is more common in males than females, with a ratio of 3:1. AFD is generally seen in the first and second decade; however, AFD may also occur in adults. Few cases are seen in adults as old as 60 years. [2] In the present case, the lesion was seen in a patient in his fifth decade. The tumors related to deciduous teeth usually arise in incisor area while those related to permanent teeth develop in molar area. [1] Similar pattern of age and site predilection is seen in case of ameloblastic fibro-odontoma. In this case, the lesion was seen to be located in the anterior region in an individual in his fifth decade. AFD radiographically shows a fairly well-delineated radiolucency with varying degree of radiopacity. [1] It may be associated with an unerupted tooth. Similar appearance is seen in AFO [5] and odontoma which also shows a well-circumscribed radiolucent image containing a variable amount of radiopaque material. Distinction from developing odontoma may be difficult. In addition to histological features, careful consideration must be given to the age of the patient and the location of lesion. [6]

In the WHO classification of odontogenic tumors, AFD is described as a distinct entity and it clinically and sometimes pathologically resembles ameloblastic fibro-odontoma and odontoma. Epithelial and mesenchymal portions are similar to ameloblastic fibroma. [2] Ameloblastic fibro-odontoma is made of islands, strands and chords of odontogenic epithelium immersed in a cell-rich embryonic connective tissue containing variable amounts of irregular formation of enamel and dentin, [5] whereas in odontoma, normal appearing enamel or enamel matrix, dentin, pulp and cementum like tissue which may or may not exhibit normal relationship to one another is seen. In case of AFD, epithelium is usually in the form of slender strands consisting of double layer of cuboidal cells and connective tissue resembles dental papilla. [6] Presence of hard tissue similar to dentin may be seen near epithelial cells.

In this case, a definitive odontogenic epithelium was seen in a cellular connective tissue stroma. The connective tissue stroma in AFD is more like dental papilla. However, in this case, the connective tissue stroma appeared relatively mature. Decalcified section of hard tissue showed dentin like structure exhibiting tubular structure resembling dentinal tubules. A diagnosis of AFD was made. As the presence of enamel like material could not be seen, it posed a diagnostic dilemma weather to call it as ameloblastic fibro-odontoma or AFD as only dentin was seen. However, consensus was arrived on the present diagnosis of AFD based on clinical, radiological and histological correlation. Most authors agree that the treatment of choice for isolated lesion of jaw is simple enucleation. A conservative approach is recommended for ameloblastic fibro-odontoma and AFD. [7]

   References Top

1.Akal U, Gunhan O, Guler M. Ameloblastic fibrodentinoma: Report of two cases. Int J Oral Maxillofac Surg 1997;26:455-7.  Back to cited text no. 1
2.Ghom A, Mhaske S. Textbook of Oral Pathology. 1 ed. Jay Pee Brothers Medical Publishers (P) Ltd, New Delhi 2009  Back to cited text no. 2
3.Friedrich R, Siegert J, Donath K, Jakel KT. Recurrent ameloblastic fibro-odontoma in a 10 year old boy. J Oral Maxillofac Surg 2001;59:1362-6.   Back to cited text no. 3
4.Ahmed M, Sadat SM, Rita SN. Ameloblastic fibrodentinoma of mandible: A case report. J Bangladesh Coll Phys Surg 2006;24:119-21.  Back to cited text no. 4
5.Reis S, Freitas C, Santo A. Management of ameloblastic fibroodontoma in a 6 year old girl preserving the associated impacted permanent tooth. J Oral Sci 2007;49:331-5.  Back to cited text no. 5
6.Kramer IR, Pindborg JJ, Shear M. Histological typing of Odontogenic Tumor. 2 ed. Germany: Springer-Verlag; 1992.  Back to cited text no. 6
7.Brandt S, Mason M, Barkley R. Ameloblastic fibrodentinoma: Report of a case. ASDC J Dent Child 1988;55:372-5.  Back to cited text no. 7

Correspondence Address:
Aparna Dave
Department of Oral & Maxillofacial Pathology, SGT Dental College and Hospital, Gurgaon
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0970-9290.84287

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  [Figure 1], [Figure 2]

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