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Table of Contents   
ORIGINAL RESEARCH  
Year : 2012  |  Volume : 23  |  Issue : 5  |  Page : 698
Radiographic analysis of ameloblastoma: A retrospective study


1 Department of Oral Medicine & Radiology, K. M. Shah Dental College & Hospital, Sumandeep Vidyapeeth, Piparia, Vadodara, Gujarat, India
2 Department of Oral Medicine & Radiology, Karnavati School of Dental Sciences, Gandhinagar, Gujarat, India
3 Department of Oral Medicine & Radiology, J. G. Dental College & Hospital, Akola, Maharashtra, India

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Date of Submission15-Jun-2011
Date of Decision23-Dec-2011
Date of Acceptance14-Feb-2012
Date of Web Publication19-Feb-2013
 

   Abstract 

Background: Ameloblastoma is benign odontogenic tumor, usually affecting the posterior region of mandible. It is seen in the third to fifth decades of life. Radiographically the lesion is variable in appearance and may be unilocular or multilocular, with well-defined cortical borders in the mandible and ill-defined margins in the maxilla.
Objective: To analyze cases of ameloblastoma, with emphasis on the radiographic findings. We also review the current literature briefly and discuss the clinical and radiographic findings.
Materials and Methods: The present hospital-based retrospective study was conducted by reviewing the clinical and radiographic records of ameloblastoma cases from 2009 to 2011, available in the archives of the department. The data of a total of 14 patients were analyzed.
Results: We observed that the patients affected with ameloblastoma were in the age-group of 19-68 years. The male: female ratio was 1.3:1. The mandible (78.57%) was more commonly affected than the maxilla (14.28%). Six patients (42.86%) had unilateral involvement and eight cases (57.14%) had bilateral involvement. The multilocular and unilocular types of ameloblastoma were noted in 12 (85.72%) and 2 cases (14.28%), respectively. The soap-bubble (50.00%), spider-web (21.43%), and honeycomb (14.28%) appearances were seen in the multilocular variety. Root resorption of variable degree was distinctly observed in 11 cases (78.57%).
Conclusion: Radiographs are an important aid for the diagnosis of oral lesions of various types, especially those that involve bone. It is important for the practicing clinicians to know the salient features of ameloblastoma which are peculiar to the local population.

Keywords: Ameloblastoma, multilocular, radiographic analysis, root resorption

How to cite this article:
More C, Tailor M, Patel HJ, Asrani M, Thakkar K, Adalja C. Radiographic analysis of ameloblastoma: A retrospective study. Indian J Dent Res 2012;23:698

How to cite this URL:
More C, Tailor M, Patel HJ, Asrani M, Thakkar K, Adalja C. Radiographic analysis of ameloblastoma: A retrospective study. Indian J Dent Res [serial online] 2012 [cited 2019 Oct 21];23:698. Available from: http://www.ijdr.in/text.asp?2012/23/5/698/107436
Ameloblastoma (from the English word amel, meaning enamel, and the Greek word blastos, meaning germ) [1] is a rare, benign epithelial odontogenic tumor, representing 1% of all oral ectodermal tumors and 9% of odontogenic tumors. [2] It was recognized in 1827 by Cusack. [3] This type of odontogenic neoplasm was designated as 'adamantinoma' in 1885 by the French physician Louis-Charles Malassez. [4] It was first detailed and described by Falkson in 1879. The term ameloblastoma was coined by Ivey and Churchill in 1930. [2],[3],[5] It is considered as a true neoplasm and, as the name implies, it resembles the cells of the enamel-forming organ. The general agreement that ameloblastomas are odontogenic in origin is largely based on the histologic similarities of the tumor with the developing enamel organ. [2],[6],[7]

Ameloblastoma appears most commonly in the third to fifth decades of life, but it has been reported in patients with age ranging from 10-90 years. [5],[8],[9] It commonly affects the mandible and only rarely the maxilla or the soft tissue (peripheral ameloblastoma). [8] Over 80% of these lesions occur in the mandible, with 70% of these arising in the molar-ramus area; they are occasionally associated with unerupted third molar teeth. [2],[6],[8],[9],[10] They are slow-growing tumors and are usually asymptomatic until a large size is achieved. These tumors characteristically expand within the jaw and displace bone, teeth, and roots. Occasionally, infiltrating tumors may erode through the bone and extend into the soft tissue. [9]

Radiographically, ameloblastoma appears either unilocular or multilocular and, histologically, as unicystic or multicystic. Both forms have been shown to recur, particularly following inadequate surgical treatment. The periphery of the lesion may be smooth or scalloped. The cortical plate may become thin, expanded, and may even be perforated if the lesion is in its advanced stage. An occlusal radiograph may demonstrate cyst-like expansion, with thinning of the adjacent cortical plate leaving only a thin 'eggshell' of bone. [11]

The structure of this lesion can be detected on panoramic radiographs. Therefore, panoramic radiographs may be preferred over computed tomograms (CT). However, panoramic radiographs are inadequate for localization of such lesions because of the nature of panoramic radiography, with its inherently less-sharp image and ghost image. CT is usually helpful for determining the contours of the lesion, its contents, and its extension into soft tissues. Ameloblastoma typically shows expansive growth with an osseous shell. On CT there are cystic areas of low attenuation along with isoattenuating solid regions. Contrast-enhanced CT shows an enhancement effect in the solid components. Although there are no major differences between MRI and CT in the ability to detect the cystic component of the tumor, MRI is slightly superior. MRI is essential for establishing the exact extent of an advanced maxillary ameloblastoma. [2],[9]

It has been stated that, radiographically, ameloblastoma may be mistaken for keratocystic odontogenic tumor, fibroma, fibromyxoma, fibrosarcoma, hemangioma, aneurysmal bone cyst, and giant cell tumor. [11],[12] The desmoplastic ameloblastoma is especially deceptive radiographically, as it may mimic fibro-osseous lesions or globulomaxillary cyst. [12] The purpose of the present study was to analyze cases of ameloblastoma, with emphasis on radiographic findings. We also review the current literature and discuss the clinical and radiographic findings that may aid in diagnosis and the strategies for preventing recurrences.


   Materials and Methods Top


The present hospital-based retrospective study was conducted by reviewing the clinical and radiographic records of ameloblastoma cases for the years 2009-2011, available in the archives of department. Permission to undertake this study was obtained from the institutional ethics committee. A total of 14 cases that were diagnosed clinically, radiographically, and histopathologically were included in the study. The intraoral and panoramic radiographs and computed tomograms formed the basis of the present study. Radiographs with any type of artifact or fault were excluded from the study. All the radiographs and images were taken by standard techniques, were processed under standardized conditions, and viewed on a standard illuminated screen by three oral radiologists to prevent inter-observer bias. The descriptive data of these patients was evaluated and compared with previously documented data in the literature. The study variables included age, gender, site of lesion, type, radiographic appearance, neurovascular bundle, and root resorption.


   Case Reports Top


Case 1

A 44-year-old male with unilateral involvement of the body and ramus of mandible. The panoramic radiograph reveals a single, well-defined, circumscribed, corticated multilocular radiolucency extending from 35 to the ramus of mandible. Knife-edge and complete root resorption, respectively, are seen in 35 and 36. The neurovascular bundles are affected. The lesion mimics a 'soap bubble.'

Case 2

A 60-year-old female with unilateral involvement of the symphysis and body of mandible. The panoramic radiograph reveals a single, well-defined, circumscribed, corticated multilocular radiolucency extending from the midline to the retromolar region, with thinning of the inferior border of the mandible. The root apices from 41 to 43 show multiplanar resorption. The neurovascular bundles are affected. The lesion has a spider-web-like pattern.

Case 3

A 52-year-old female with involvement of bilateral symphysis; unilateral body, ramus, coronoid, and condyle of mandible; and maxillary tuberosity. The panoramic radiograph and CT scan show a single, extensive, well-defined, circumscribed, multilocular radiolucency extending from 44 to the left ramus, condyle, and coronoid process, and the left maxillary tuberosity. The antrum floor is displaced superiorly. Lower anteriors and unerupted 38 are displaced within the lesion. The inferior border of the mandible is severely thinned. The neurovascular bundles are severely destructed. The lesion appears like a soap bubble.

Case 4

A 60-year-old male with bilateral involvement of premaxilla and the canine fossa of maxilla. The occlusal and panoramic radiographs show a single, well-defined, circumscribed, corticated unilocular radiolucency associated with horizontally impacted 23; the radiolucency is seen extending from 11 to the 24 region. Multiplanar root resorption is present in 21.

Case 5

A 22-year-old female with bilateral involvement of the body and symphysis of mandible. The panoramic radiograph and CT scan reveal a single, well-defined, corticated unilocular radiolucency extending from 36 to 44. All these teeth are displaced and have multiplanar root resorption. The neurovascular bundles are displaced inferiorly.

Case 6

A 40-year-old male with bilateral involvement of the body of mandible. The panoramic radiograph and CT scan reveal a single, well-defined, circumscribed, corticated multilocular radiolucency extending from the right body of the mandible to 36, expansion of the cortical plate, and thinning of the inferior border of the mandible. The neurovascular bundles are affected. The lesion mimics a soap bubble.

Case 7

A 28-year-old male with bilateral involvement of the body and symphysis of mandible. The panoramic radiograph reveals a single, well-defined, circumscribed multilocular radiolucency with scalloped margins and corticated borders, extending from 43 to 37. The root apices from 43 to 36 show multiplanar root resorption. The neurovascular bundles are affected. The lesion mimics a soap bubble.

Case 8

A 55-year-old male with bilateral involvement of the body and symphysis of mandible. The panoramic radiograph reveals a single, well-defined, circumscribed multilocular radiolucency with scalloped margins and corticated borders, extending from 47 till 34. Knife-edge root resorption is present in 44 to 47, and multiplanar type of root resorption is seen in 43 to 33. The neurovascular bundles are destructed. The lesion mimics a soap bubble.

Case 9

A 42-year-old male with unilateral involvement of the body and ramus of mandible. The panoramic radiograph shows a single, well-defined, circumscribed multilocular radiolucency with corticated borders, extending from 36 to the posterior border of the left ramus. The roots of 36, 37, and 38 show knife-edge resorption. Thinning of the inferior border of the mandible and destruction of the neurovascular bundle is observed. The lesion mimics a soap bubble.

Case 10

A 19-year-old female with unilateral involvement of the body of the mandible. The panoramic radiograph and CT scan reveal a single, well-defined, corticated unilocular radiolucency extending from 36 to 38. All these teeth are displaced and the roots show knife-edge resorption. The neurovascular bundle is displaced inferiorly. The lesion appears like a honeycomb.

Case 11

A 40-year-old male with unilaterally involved parasymphysis, body, and ramus of mandible. Panoramic radiograph shows a single, well-defined, multilocular radiolucency extending from 33 to the middle third of the ramus of the mandible. Multiplanar type of root resorption is seen in 34 to 36. The neurovascular bundle is displaced inferiorly. The lesion shows a spider-web-like pattern.

Case 12

A 20-year-old female with bilateral involvement of the symphysis, body, and ramus of mandible. The panoramic radiograph reveals a single, well-defined, circumscribed, multilocular radiolucency extending from 34 to the lower third of the right ramus. The roots of associated teeth show multiplanar type of root resorption. Thinning of the inferior border of the mandible and inferior displacement of the neurovascular bundle is observed. The lesion mimics a soap bubble.

Case 13

A 21-year-old male with bilateral involvement of premaxilla and the lateral part of the left maxilla. Panoramic radiograph and CT scan reveal a single well-defined multilocular radiolucency extending from 11 to 26. There is displacement of 21 and 23. The antrum floor is displaced superiorly. The lesion shows a honeycomb pattern.

Case 14

A 68-year-old old female with unilateral involvement of the symphysis, body, and ramus of mandible. The panoramic radiograph and CT scan reveal a single, well-defined, multilocular radiolucency extending from 31 to anterior third of the ramus of the mandible. The roots of 32, 33, and 34 show knife-edge resorption, while the root of 35 shows multiplanar type of root resorption. Thinning of the inferior border of the mandible and destruction of the neurovascular bundle is observed. The lesion shows a spider-web-like pattern.


   Results Top


In the present study, the patients affected with ameloblastoma were in the age range of 19-68 years, with a mean age of 43.5 years. The maximum number of patients were in the age-groups of 20-29 (28.57%) and 40-49 (28.57%). The male: Female ratio was 1.3:1.

Among these 14 cases, the mandible was the most affected jaw: The mandible alone was involved in 11 cases (78.57%), the maxilla in two cases (14.28%), and the maxilla and mandible together in one case (7.15%).

In the mandible, the body was involved in two cases (14.28%); the symphysis and body in four cases (28.57%); the body and ramus in two cases (14.28%); the parasymphysis, body, and ramus in one case (7.15%); and the symphysis, body, and ramus in two cases (14.28%). In the maxilla, the premaxilla and the lateral part of maxilla were involved in one case (7.15%) and the premaxilla and canine fossa in one case (7.15%). In one case (7.15%), the lesion involved the maxilla and the mandible together.

Out of these 14 cases of ameloblastoma, 6 cases (42.86%) had unilateral involvement of jaw and 8 cases (57.14%) had bilateral involvement.

The multilocular and unilocular type of ameloblastoma was noted in 12 (85.72%) and 2 cases (14.28%), respectively. In the multilocular type, the soap-bubble appearance was seen in seven cases (50.00%), the spider-web-like pattern was seen in three cases (21.43%), and the honeycomb pattern was seen in two cases (14.28%).

Root resorption of variable degree was distinctly observed in 11 cases (78.57%). Six cases (54.55%) showed multiplanar type of root resorption, 3 (27.27%) cases showed knife-edge root resorption, and 2 cases (18.18%) showed a combination of multiplanar and knife-edge types of root resorption.


   Discussion Top


Ameloblastomas are an enigmatic group of oral tumors. They are usually benign in growth pattern but frequently invade locally and occasionally metastasize. They have a persistent and slow growth, spreading into marrow spaces with pseudopods, without concomitant resorption of the trabecular bone. As a result, the margins of the tumor are not clearly evident radiographically or grossly during operation and, consequently, the lesion frequently recurs after inadequate surgical removal, demonstrating a locally malignant pattern. [5]

In most cases, ameloblastoma present a characteristic, though not diagnostic, radiographic appearance. [2],[5],[13] Radiographically, the margins of the lesion in the mandible are usually well-defined, frequently corticated, and occasionally scalloped; in contrast, in the maxilla, the margins are severely ill-defined as the lesion tends to grow along the bone rather than expanding it. The internal structure varies from totally radiolucent to mixed, with the presence of bony septa creating internal compartments. The compartments in bone are round and of varying size. The septae are usually coarse and curved and originate from normal bone that has been trapped within the tumor. With growth or expansion of the tumor, there may be coalescence and fusion of the compartments and, as a result, there may be transformation from a multilocular to a monolocular cystic space. Tumors in which the compartments are large and few in number may resemble a multilocular epithelium-lined cyst. [11]

The radiographic appearance of ameloblastoma is variable. H. M. Worth has described four patterns [14] [Figure 1] and [Figure 2]:
Figure 1: Schematic diagram showing radiographic appearance of ameloblastoma

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Figure 2: (a) Maxillary occlusal radiograph showing unicystic type of ameloblastoma; (b) cropped panoramic radiograph showing spider-web type; (c) cropped panoramic radiograph showing soap-bubble type; and (d) intraoral periapical radiograph showing honeycomb type

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  • Unicystic type: This appears as a unilocular radiolucency resembling a cyst. However, unlike cyst, it causes a break or discontinuity in the peripheral cortex and may even show trabeculae within the lumen.
  • Spider-web pattern: This is the most common appearance, where the lesion is seen as a large radiolucent area with scalloped borders. From the center of the lumen coarse strands of trabeculae radiate peripherally, giving rise to a gross caricature of a spider.
  • Soap-bubble pattern: This lesion is seen as a multilocular radiolucency with large compartments of varying sizes, giving rise to the soap-bubble appearance, or a multi-chambered or multi-cystic 'bunch of grapes' appearance.
  • Honeycomb or solid pattern: This is also called a beehive pattern. These are tumors that have not undergone cystic degeneration. Hence, multiple small radiolucencies are seen surrounded by hexagonal or polygonal thick-walled bony cortices, giving rise to a honeycomb appearance.
In this study, ameloblastoma was observed to occur between the ages of 19 years and 68 years [Figure 3], with the mean age being 43.5 years. This finding is not consistent with the studies conducted by Darshani et al., Fregnani et al., Adeline et al. and Krishnapillai et al., where the mean age of occurrence was 33.2 years, 33.2 years, 30.2 years, and 30.2 years, respectively. [15],[16],[17],[18]
Figure 3: Graph showing age-wise distribution

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Various studies show inconsistent findings regarding gender predilection. The present study showed a slight male predilection, with a male: female ratio of 1.3:1. This is similar to the findings of Krishnapillai et al. and Potdar et al.[18],[19] However, the studies of Khan et al., Takahashi et al., and Olaitan et al. found a slight female predilection, and Keszlar et al. and Takahashi et al. reported no gender predilection for ameloblastoma. [20]

Numerous studies have concluded that the mandible is more commonly affected with ameloblastoma than the maxilla. In this study, the maximum number of lesions were found in mandible (78.57%); the maxilla was involved in only 14.28%. Lesion involving both maxilla and mandible was seen in 7.15% of the cases [Figure 4]. Our observations are similar to the findings of Gunawardhana et al., Ogunsalu et al., Adeline et al., and Chidzonga et al.[15],[17],[20],[21]
Figure 4: Graph showing jaw-wise distribution

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The most common site of occurrence of ameloblastoma is the body-ramus region. [2],[6] Our observations in the present study showed presence of the lesion in the posterior mandible (28.57%), the anterior as well as posterior mandible (50.00%), the maxilla (14.28%), and involving both maxilla and mandible in the posterior region (7.15%). Our study results contradict the studies of Fregnani et al. and Robinson et al.[14],[16] In the maxilla, ameloblastoma is mostly found in the canine and antrum region. [2] In this study, anterior as well as posterior maxilla was involved, and this finding is consistent with the literature [Table 1].
Table 1: Location wise distribution

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Robinson et al. in his study observed that 10%-15% of ameloblastomas are associated with an unerupted tooth. [2],[8],[10] In our study, 14.28% of lesions were associated with an impacted tooth and all these lesions were in the maxilla.

Various published articles have confirmed the pattern of the lesion on the radiographs. In the present study, radiographically, all our 14 cases had well-defined corticated borders. Out of these cases, 85.72% tumors were multilocular and 14.28% were unilocular [Figure 5]. In comparison, Fregnani et al. and Adeline et al., observed multilocular lesion in 60% and 83.2% of their cases, respectively. [16],[17] It is pertinent to note that among the 14 cases discussed here, 12 cases were multilocular; of these 12 cases, 7 showed the soap-bubble pattern, 2 showed the honeycomb pattern, and 3 cases showed the spider-web pattern.
Figure 5: Graph showing radiographic type wise distribution

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There is a pronounced tendency for ameloblastomas to cause extensive root resorption, either blunting of root apex/knife-edge root resorption or multiplanar or sharp root edges. In our study, 11 cases (78.57%) showed root resorption [Table 2]. The multiplanar type was the most common, followed by the knife-edge type. Our findings did not match the observations of Ogunsalu et al. who found only 31.6% cases with root resorption. [20]
Table 2: Type of root resorption

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Tooth displacement, displacement or destruction of inferior alveolar canal, and displacement of the sinus membrane are the common findings in ameloblastoma. [11] In the present study, four (28.57%) cases radiographically showed teeth displacement: inferiorly, superiorly, or laterally. Neurovascular bundles were affected in 12 (85.71%) cases. In this study, expansion of the cortical plate, with resultant facial deformity, was a distinct feature of large ameloblastomas [Figure 6].
Figure 6: (a) Coronal section showing buccal cortical plate expansion and thinning; (b) axial section showing buccal cortical plate expansion and thinning; (c) axial section showing both buccal and lingual cortical plate expansion and thinning; (d) 3D reconstruction showing destruction of part of the maxilla and mandible; (e) axial section showing both buccal and lingual cortical plate destruction, with area of central necrosis; (f) 3D reconstruction showing destruction of part of the madible

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   Conclusion Top


Radiographs are an important aid for the diagnosis of oral lesions of various types, especially those that involve bone. It is important for the practicing clinicians to know the salient features of ameloblastoma which are peculiar to the local population. Although very often the diagnosis of ameloblastoma is made on the basis of radiographic features, one should never rely on it alone. All such lesions should be biopsied and an accurate histologic diagnosis should be obtained before definitive treatment is commenced.

 
   References Top

1.Brazis PW, Miller NR, Lee AG, Holliday MJ. "Neuro-ophthalmologic Aspects of Ameloblastoma". Skull Base Surg 1995;5:233-44.  Back to cited text no. 1
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2.Cakur B, Caglayan F, Altun O, Miloglu O. Plexiform ameloblastoma. Erciyes Medical Journal 2009;Supplement 1:S62-7.  Back to cited text no. 2
    
3.Madhup R, Srivastava K, Bhatt M, Srivastava S, Singh S, Srivastava AN. Giant ameloblastoma of jaw successfully treated by radiotherapy. Oral Oncology extra 2006;42:22-5.  Back to cited text no. 3
    
4.Malassez L. "Sur Le role des debris epitheliaux papdentaires". Arch Physiol Norm Pathol 1885;5:309-40, 6:379-449.  Back to cited text no. 4
    
5.Iordanidis S, Makos C, Dimitrakopoulous J, Kariki H. Ameloblastoma of the maxilla: Case report. Aust Dent J 1999;44:51-5.  Back to cited text no. 5
    
6.Drew CP, Moreno V. Ameloblastoma - A case report form an international allied dental program. Practical Hygiene 1997:35-9.  Back to cited text no. 6
    
7.More C, Patel H, Singh P, Adalja C. Unicystic Ameloblastoma of Anterior mandible: A report with review. JOHS 2011;1:26-30.  Back to cited text no. 7
    
8.Shafer W, Hine M, Levy B. Shafer's textbook of Oral Pathology. Rajendran R, Sivapathasundharam B, editors. Elsevier A division of Reed Elsevier India Private Limited. Cyst and tumours of Odontogenic origin. 5 th ed.p. 381-91.  Back to cited text no. 8
    
9.Wood N, Goaz P. Differential diagnosis of oral and maxillofacial lesions. Multilocular radiolucencies. Fifth ed. Mosby an imprint of Elsevier; p. 337-40.  Back to cited text no. 9
    
10.Tozaki M, Hayashi K, Fukuda K. Dynamic multislice Helical CT of Maxillomandibular Lesions: Distinction of Ameloblastomas from Other Cystic Lesions. Radiat Med 2001;19:225-30.  Back to cited text no. 10
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11.White S, Pharoah M. Oral Radiology Principles and interpretation. Benign tumours of the jaw. Fifth ed. Mosby an imprint of Elsevier; p. 419-22.  Back to cited text no. 11
    
12.Yacoob H. The radiographic appearance of ameloblastoma in Malaysians. Singapore Med J 1991;32:70-2.  Back to cited text no. 12
    
13.Gumgum S, Hosgoren B. Clinical and Radiographic Behaviour of ameloblastoma in four cases. J Can Dent Assoc 2005;71:481-4.  Back to cited text no. 13
    
14.Worth H. Principles and practice of Oral Radiographic Interpretation. Year Book Medical Publishers Copyright; 1963. p. 476-88.  Back to cited text no. 14
    
15.Darshani KS, Jayasooriya PR, Rambukewela IK, Tilakaratne WM. A clinico-pathological comparison between mandibular and maxillary ameloblastomas in Sri Lanka. J Oral Pathol Med 2010;39:236-41.  Back to cited text no. 15
    
16.Fregnani ER, Cruz DE, Almeida OP, Kowalski LP, Soares FA, Abreu F. Clinicopathological study and treatment outcomes of 121 cases of ameloblastomas. Int J Oral Maxillofac Surg 2010;39:145-9.  Back to cited text no. 16
    
17.Adeline VL, Dimba EA, Wakoli KA, Njiru AK, Awange DO, Onyango JF, et al. Clinicopathologic features of ameloblastoma in Kenya: A 10-year audit. J Craniofac Surg 2008;19:1589-93.  Back to cited text no. 17
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18.Krishnapillai R, Angadi PV. A clinical, radiographic, and histologic review of 73 cases of ameloblastoma in an Indian population. Quintessence Int 2010;41:e90-100.  Back to cited text no. 18
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19.Potdar G, Ameloblastoma of the jaw as seen in Bombay, India. Oral Surg Oral Med Oral Pathol 1969;28:297-303.  Back to cited text no. 19
    
20.Ogunsalu C, Daisley H, Henry K, Bedayse S, White K, Jagdeo B, et al. A New Radiological Classification for Ameloblastoma Based on Analysis of 19 Cases. West Indian Med J 2006;55:36-41.  Back to cited text no. 20
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21.Chidzonga MM. Ameloblastoma in children. The Zimbabwean experience. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996;81:168-70.  Back to cited text no. 21
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Correspondence Address:
Chandramani More
Department of Oral Medicine & Radiology, K. M. Shah Dental College & Hospital, Sumandeep Vidyapeeth, Piparia, Vadodara, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.107436

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    Figures

  [Table 1], [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
 
 
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