impa case report Chiara Baroni, DDS, MD,’ Mauro Farneti, DDS,” Stefano Stea, DDS,b and Lia Rimondini, DDS,b Bologna, Italy DEPARTMENT
OF PEDIATRIC
DENTISTRY,
UNIVERSITY
OF BOLOGNA
A case report of the management of an ameloblastic fibroma causing the impaction of a mandibular first molar, with subsequent orthodontic care to salvage the impacted mandibular first molar, is presented. (ORALSURGORAL
MEDORAI.
PATHOL
1992;73:548-9)
issed eruption of a first permanent molar in an otherwise normal development might posediagnostic and therapeutic problems that warrant thorough investigation. CASE REPORT An 11-year-old boy was referred for evaluation of the delayed eruption of a mandibular permanent first molar. His medical history was noncontributory. Radiographic evaluation revealed a radiolucent area between a fully developed and impacted first molar and the germ of the second molar. An excisional biopsy revealed the proliferation of double-layered strands of cells and a stroma of embryonic connective tissue with a diagnosis of an ameloblastic fibroma (Fig. 1, A and B).lW5 Six months later no substantial eruptive movement of the first molar was observed. The first molar was approached through a vestibular and a lingual flap and the tooth was slightly luxated. A metallic loop was bonded by composite resin and macrofilled material. Three weeks after surgery, a light elastic force was applied between the impacted first molar and an anchoring transpalatal bar (Fig. 2, A, B, C). In a matter of days, movement of the first molar toward correct occlusion was evident (Fig. 3). BlSCUSSlON
The pathogenesisof ameloblastic fibroma indicates that there may be two lesionsthat appear similar on histologic examination. The first would be a part of the developmental stagesof odontoma and/or ameloblastic fibro-odontoma.6-9The secondwould beamelo“Assistant Professor. bPrivate practice. 7112132767
548
Fig. 1. A, Panoramic x-ray view of the unilocuiar area iarrows] that has caused the impaction of the fully formed permanent first molar and posterior shift of the developing second molar. B, Stellate reticulum formations in a stroma of embryonic connective tissue.
Vohlme 73 Number 5
Ameloblasticjibroma
and impacted mandibular$rst
molar
Fig. 3. Shows the movement of the mandibular ward correct occlusion.
549
molar to-
a useful tooth. The patient is scheduled for long-term continuing evaluation. REFERENCES 1. Lucas RB. Pathology of tumors of the oral tissues. Edinburgh: Churchill Livingstone, 1976:76-80. 2. Slootweg PJ. Epithelio-mesenchymal morphology in ameloblastic fibro-odontoma: a light and electron microscopic study. J Oral Path01 Med 1980;9:29-40. 3. Sponge JD. Odontogenic tumors. ORAL SURG ORAL MED ORAL
PATHOL
1967;24:392-403.
4. Filicori R, Valentini AF. Le neoformazioni odontogene: cisti e tumori. Minerva Stomatol 1983;32:637-48. 5. Gorlin RJ, Meakin LH, Brodey R. Odontogenic tumors in man and animals: pathologic classification and clinical behavior-a review. Ann N Y Acad Sci 1963;108:722-71. 6. Carr RF, Halperin V, Wood C, Krust L, Schoen J. Recurrent ameloblastic fibroma. ORAL SURG ORAL MED ORAL PATHOL 1970;29:85-90.
7. Eversole RL, Tomich CE, Cherrick HM. Histogenesis of odontogenic tumors. ORAL SURG ORAL MED ORAL PATHOL 1971;32:569-81.
8. Regezi JA, Kerr DA, Courtney RM. Odontogenic tumorsanalysis of 706 cases. J Oral Surg 1978;36:771-8. 9. Cina MT, Dahlin DC, Gores RJ. Ameloblastic sarcoma. ORAL SURC
Fig. 2. b\, Metallic loop bonded on the central fossa of occlusal surface of the impacted mandibular first molar. Placement of the transpalatal bar used for achorage of elastic extrusive force. C, The light elastic force between maxillary and the mandibular first molars.
the
B, the the
blastic fibromas occurring as mesodermal tumors with locally invasive and malignant capacities.10‘16 Literature reviews agree on (1) the need for a very accurate histologic examination, (2) a conservative approach to ameloblastic fibromas except for recurrent cases, and (3) long-term postoperative evaluations that include radiography. In this case, the combination of surgical and orth-
odontic therapy removed the neoplasm and salvaged
ORAL
MED
ORAL
PATHOL
1962;15:696-700.
10. Reichart PA, Zobl H. Transformation of ameloblastic fibroma to fibrosarcoma. Int J Oral Maxillofac Surg 1978;7:503-7. 11. Pindborg JJ. Ameloblastic sarcoma in maxilla: report of a case, Cancer 1960;13:917-20. 12. Leider AS, Nelson JF, Trodhal JN. Ameloblastic fibrosarcoma of the jaws. ORAL SURG ORAL MED ORAL PATHOL 1972;33:559-69.
13. Navone R, Mela F, Romagnoli R, Papotti M. Studio clinic0 patologico di un case di evoluzione sarcomatosa di fibroma ameloblastico. Minerva Stomatol 1982;31:673-8. 14. Howell RM, Burkes EJ. Malignant transformation of ameloblastic fibro-odontoma to ameloblastic fibrosarcoma. ORAL SURG
ORAL
MED
ORAL
PATHOL
1977;43:391-401.
15. Sawyer DR, Nwoku AL, Mosadomi A. Recurrent ameloblastic fibroma: report of two cases. ORAL SURG ORAL MED ORAL PATHOL
1982;53:19-23.
16. Carr RF, Wood C, Shoen J. Recurrent ameloblastic fibroma. ORAL
Reprint
SURG
ORAL
MED
requests:
Chiara Baroni, DDS, MD Via Lame 44 40 100 Bologna, Italy
ORAL
PATHOL
1970;29:85-90.
OF PEDIATRIC
DENTISTRY,
UNIVERSITY
OF BOLOGNA
A case report of the management of an ameloblastic fibroma causing the impaction of a mandibular first molar, with subsequent orthodontic care to salvage the impacted mandibular first molar, is presented. (ORALSURGORAL
MEDORAI.
PATHOL
1992;73:548-9)
issed eruption of a first permanent molar in an otherwise normal development might posediagnostic and therapeutic problems that warrant thorough investigation. CASE REPORT An 11-year-old boy was referred for evaluation of the delayed eruption of a mandibular permanent first molar. His medical history was noncontributory. Radiographic evaluation revealed a radiolucent area between a fully developed and impacted first molar and the germ of the second molar. An excisional biopsy revealed the proliferation of double-layered strands of cells and a stroma of embryonic connective tissue with a diagnosis of an ameloblastic fibroma (Fig. 1, A and B).lW5 Six months later no substantial eruptive movement of the first molar was observed. The first molar was approached through a vestibular and a lingual flap and the tooth was slightly luxated. A metallic loop was bonded by composite resin and macrofilled material. Three weeks after surgery, a light elastic force was applied between the impacted first molar and an anchoring transpalatal bar (Fig. 2, A, B, C). In a matter of days, movement of the first molar toward correct occlusion was evident (Fig. 3). BlSCUSSlON
The pathogenesisof ameloblastic fibroma indicates that there may be two lesionsthat appear similar on histologic examination. The first would be a part of the developmental stagesof odontoma and/or ameloblastic fibro-odontoma.6-9The secondwould beamelo“Assistant Professor. bPrivate practice. 7112132767
548
Fig. 1. A, Panoramic x-ray view of the unilocuiar area iarrows] that has caused the impaction of the fully formed permanent first molar and posterior shift of the developing second molar. B, Stellate reticulum formations in a stroma of embryonic connective tissue.
Vohlme 73 Number 5
Ameloblasticjibroma
and impacted mandibular$rst
molar
Fig. 3. Shows the movement of the mandibular ward correct occlusion.
549
molar to-
a useful tooth. The patient is scheduled for long-term continuing evaluation. REFERENCES 1. Lucas RB. Pathology of tumors of the oral tissues. Edinburgh: Churchill Livingstone, 1976:76-80. 2. Slootweg PJ. Epithelio-mesenchymal morphology in ameloblastic fibro-odontoma: a light and electron microscopic study. J Oral Path01 Med 1980;9:29-40. 3. Sponge JD. Odontogenic tumors. ORAL SURG ORAL MED ORAL
PATHOL
1967;24:392-403.
4. Filicori R, Valentini AF. Le neoformazioni odontogene: cisti e tumori. Minerva Stomatol 1983;32:637-48. 5. Gorlin RJ, Meakin LH, Brodey R. Odontogenic tumors in man and animals: pathologic classification and clinical behavior-a review. Ann N Y Acad Sci 1963;108:722-71. 6. Carr RF, Halperin V, Wood C, Krust L, Schoen J. Recurrent ameloblastic fibroma. ORAL SURG ORAL MED ORAL PATHOL 1970;29:85-90.
7. Eversole RL, Tomich CE, Cherrick HM. Histogenesis of odontogenic tumors. ORAL SURG ORAL MED ORAL PATHOL 1971;32:569-81.
8. Regezi JA, Kerr DA, Courtney RM. Odontogenic tumorsanalysis of 706 cases. J Oral Surg 1978;36:771-8. 9. Cina MT, Dahlin DC, Gores RJ. Ameloblastic sarcoma. ORAL SURC
Fig. 2. b\, Metallic loop bonded on the central fossa of occlusal surface of the impacted mandibular first molar. Placement of the transpalatal bar used for achorage of elastic extrusive force. C, The light elastic force between maxillary and the mandibular first molars.
the
B, the the
blastic fibromas occurring as mesodermal tumors with locally invasive and malignant capacities.10‘16 Literature reviews agree on (1) the need for a very accurate histologic examination, (2) a conservative approach to ameloblastic fibromas except for recurrent cases, and (3) long-term postoperative evaluations that include radiography. In this case, the combination of surgical and orth-
odontic therapy removed the neoplasm and salvaged
ORAL
MED
ORAL
PATHOL
1962;15:696-700.
10. Reichart PA, Zobl H. Transformation of ameloblastic fibroma to fibrosarcoma. Int J Oral Maxillofac Surg 1978;7:503-7. 11. Pindborg JJ. Ameloblastic sarcoma in maxilla: report of a case, Cancer 1960;13:917-20. 12. Leider AS, Nelson JF, Trodhal JN. Ameloblastic fibrosarcoma of the jaws. ORAL SURG ORAL MED ORAL PATHOL 1972;33:559-69.
13. Navone R, Mela F, Romagnoli R, Papotti M. Studio clinic0 patologico di un case di evoluzione sarcomatosa di fibroma ameloblastico. Minerva Stomatol 1982;31:673-8. 14. Howell RM, Burkes EJ. Malignant transformation of ameloblastic fibro-odontoma to ameloblastic fibrosarcoma. ORAL SURG
ORAL
MED
ORAL
PATHOL
1977;43:391-401.
15. Sawyer DR, Nwoku AL, Mosadomi A. Recurrent ameloblastic fibroma: report of two cases. ORAL SURG ORAL MED ORAL PATHOL
1982;53:19-23.
16. Carr RF, Wood C, Shoen J. Recurrent ameloblastic fibroma. ORAL
Reprint
SURG
ORAL
MED
requests:
Chiara Baroni, DDS, MD Via Lame 44 40 100 Bologna, Italy
ORAL
PATHOL
1970;29:85-90.
