Aggressive ameloblastic fibro-odontoma assessment with CBCT and treatment.

BACKGROUND: Ameloblastic fibro-odontomas (AFO) are rare lesions and defined by the World Health Organisation as a tumour composed of a proliferation of odontogenic epithelium immersed in ectomesenchyme reminiscent of the interdental papilla. It also presents inductive processes leading to formation of enamel and dentine, confusing, histopathologically, with odontoma. Despite numerous efforts, there is still considerable confusion over its controversial aetiopathogenesis and treatment. A brief review of the literature on the clinical, pathological and therapeutic features of this lesion is reported.

CASE REPORT: A case of aggressive AFO in a 3-year-old boy was referred to the Oral Diagnostics Service of Hospital General de Fortaleza for evaluation following a 3-months painless swelling in the right mandibular and facial regions. During anamnesis, the patient's carers reported no systemic problem and his medical history was non-contributory. Intra-orally there was a swelling of the right lateral portion of the mandible, adjacent teeth were not mobile and the oral mucosa appeared normal and showed no signs of ulceration. Radiographic examination, with panoramic radiography and cone beam computed tomography with three-dimensional (3D) reconstruction, was better able to identify the extent of bone involvement and showed an expansive hypodense image in the right mandibular region. 3D reconstruction showed expansion of buccal and lingual cortical bone and the preservation of basal bone.

TREATMENT: Enucleation and curettage of the lesion were carried out and care was taken not to fracture the basal bone during the surgical procedure. Tissue specimens were sent for histopathologic analysis. Aspiration performed during surgery was negative for blood and other exudates.

FOLLOW-UP: No recurrence has occurred during a follow-up period of 11 months.

CONCLUSION: A comprehensive diagnosis including all clinical, radiographic and histopathologic features is necessary for the success of therapy, which varies from case to case, thus, improving the quality of life of patients with AFO.