Fibro-odontoma ameloblástico versus odontoma em desenvolvimento: revisão de literatura

Abstract

Ameloblastic fibroodontoma (AFO) is a rare, mixed odontogenic tumor that exhibits the histological characteristics of ameloblastic fibroma (AF) and complex odontoma (OD). The occurrence of AFO in the oral region accounts for 1-3% of all odontogenic tumors. It usually occurs in patients younger than 20 years of age and has a propensity for the mandibular molar area and there is no significant inclination towards any gender. Some authors have suggested that an AF becomes an AFO as it matures and, in turn, can evolve into a OD. In view of this, there is a debate about the classification of the AFO. Thus, the objective was to discuss the AFO in the face of the last Classification of Odontogenic and Maxillofacial Bone Tumors of the World Health Organization (WHO) of 2022 (5th edition), to review the literature of the AFO compared to the OD, bringing clinical and radiological characteristics, as well as the behavior of both lesions, therapeutic approach, diagnosis and histopathological analysis of such lesions. The bibliographic search was carried out in November 2022 in the electronic databases: Scopus, EMBASE, LILACS and Pubmed/MEDLINE. Data such as age, gender, symptoms, extraoral appearance, intraoral appearance, type of imaging test used, imaging description of the lesion, treatment, lesion size, histopathological characteristics, impaction of teeth, recurrence of the lesion and diagnosis were extracted. A total of 214 articles were included, totaling 271 cases. There were 191 cases of OD (70.5%) and 78 cases of AFO (28.8%). Both lesions affected more males, with a mean age of 14.32 years for OD and 14.33 for AFO. The symptoms included asymptomatic cases and the presence of swelling in both lesions; There was the presence of extraoral edema and facial asymmetry in both lesions. Intraoral edema and clinical absence of at least one tooth were observed in OD and AFO. Panoramic radiography was the most used method in the diagnosis of both lesions. Although the internal structure differed for the lesions, both were well delimited, irregularly shaped, with a higher prevalence in the posterior region of the mandible, with tooth impaction being a prevalent finding. The treatment of choice was surgical removal for both. Regarding the size in its largest dimension, there was variability for the two lesions, with a mean of 19.4 mm for the OD and 40.4 mm for the AFO. Regarding the histopathological examination, dentin, enamel, cementum, pulp tissue, and the presence of odontogenic epithelium were identified for both lesions. The impaction of permanent teeth was higher than that of deciduous teeth in both. There was recurrence in 2 cases of AFO. It was possible to conclude divergences between the AFO and OD tumors, especially in the clinical aspect of each lesion, in relation to their imaging characteristics provided in the imaging studies and histopathological examination. It is undoubted that for better conclusions about the classification of the AFO it would be necessary to have a comparative analysis of its molecular profile compared to the OD.