|Year : 2014 | Volume
| Issue : 2 | Page : 240-243
Central odontogenic fibroma
Sanjay Venugopal1, Satish Radhakrishna2, Akshatha Raj1, Anshul Sawhney1
1 Department of Periodontology, Sree Siddhartha Dental College, Tumkur, Karnataka, India
2 Department of Oral and Maxillofacial Surgery, Sree Siddhartha Dental College, Tumkur, Karnataka, India
|Date of Submission||29-May-2013|
|Date of Acceptance||16-Oct-2013|
|Date of Web Publication||23-Apr-2014|
Department of Periodontology, Sri Siddhartha Dental College,Tumkur, Karnataka 572 107
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Central odontogenic fibroma (COF), which has been categorized under the subheading of odontogenic tumors of ectomesenchyme, is such an uncommon neoplasm that much of its nature is left uncharted. COF is a rare tumor that accounts for 0.1% of all odontogenic tumors. Clinically, the lesion grows slowly and leads to cortical expansion. Radiologically, the lesion may be unilocular or multilocular. In some cases, it may be associated with root resorption or displacement. Histopathologically, the lesion is characterized by mature collagen fibers and numerous fibroblasts. A case of COF of the mandible in a male patient aged 49 years is described in this report. The patient showed no symptoms, no history of swelling discomfort or pain, and was unaware of the presence of the lesion. Orthopantomogram (OPG) showed generalized bone loss along with a unilocular radiolucent area, with a clear sclerotic lining and angular bone loss. Surgical enucleation of the lesion along with placement of osseo-graft, which is a bioresorbable demineralized bone matrix (DMBM), and platelet-rich fibrin was carried out in the defect site. Following surgery, patient was recalled for revaluation of the lesion; the surgical site showed good healing and an increase in bone height was seen.
Keywords: Central odontogenic fibroma, neoplasms, odontogenic tumors
|How to cite this article:|
Venugopal S, Radhakrishna S, Raj A, Sawhney A. Central odontogenic fibroma. J Indian Soc Periodontol 2014;18:240-3
| Introduction|| |
Central odontogenic fibroma (COF) is a rare benign neoplasm that could appear very similar to the endodontic lesions and/or to the other odontogenic tumors. , This lesion is considered to be derived from the mesenchymal tissue of dental origin, such as periodontal ligament, dental papilla, or dental follicle. Connective tissue proliferation can have different localizations. It exists both as intraosseous (central) and gingival (peripheral) lesions and is designated as odontogenic fibroma. While peripheral odontogentic fibroma clearly represents a periodontal lesion, the COF usually resembles an endodontic lesion and has been reported in the literature. , It should be pointed out that the most usual site of presentation of COF in the mandible is the posterior area, while in the maxilla it is in the anterior region.  This neoplasm is a rare tumor and accounts for 0.1% of all odontogenic tumors. COF radiologically presents both as unilocular , and multilocular radiolucent lesion.  Root resorption and displacement have been reported in cases of severe lesions.
The purpose of this report is to present a case of COF in the mandibular left premolar and the mesial root of first mandibular molar in a male patient aged 49 years and to compare its clinical, radiographic, and histologic features with those cases previously reported.
| Case Report|| |
A male patient aged 49 years reported to the Department of Periodontics, Sri Siddhartha Dental College and Hospital, Tumkur, with the chief complaint of deposits present on his teeth and he desired to get his teeth cleaned. Patient's medical history was not contributory. Patient had undergone extraction of upper right canine 2 years back, with uneventful healing.
On intraoral examination, stains and calculus were present along with generalized gingival inflammation and bleeding on probing [Figure 1]. Generalized periodontal pockets and attrition were present. Grade I mobility was present w.r.t. 12, 17, 25, 26, 35, and 36. Periodontal pocket measuring 7 mm was found w.r.t. 35 and 36, and no carious lesion was seen. The patient was advised orthopantomogram (OPG) which revealed presence of generalized bone loss along with a unilocular radiolucent area resembling a "tear drop shape" with a clear sclerotic lining, along with angular bone loss involving the mandibular left premolar and the mesial root of mandibular first molar [Figure 2].
The vitality of the pulp was checked w.r.t. 35 and 36; it showed positive response as that of the contralateral side, and hence, endodontic involvement was ruled out. The patient was explained regarding the presence of lesion and a surgical excision of lesion was planned. The patient showed no symptoms, no history of swelling, discomfort, or pain, and was unaware of the presence of the lesion. Hematological investigation was done prior to surgery and was found to be normal. A comprehensive explanation was given to the patient regarding the intended surgical procedure to be done and an informed consent was taken before starting the procedure.
For surgical enucleation of the lesion, crevicular incision was given extending from canine till the first molar region [Figure 3], with two vertical releasing incisions given, one on the mesial aspect of 33 and the other on the distal aspect of 36. A subperiosteal flap was raised [Figure 4] and a surgical window was prepared [Figure 5] between 35 and 36 using a straight fissure surgical bur under copious irrigation and the lesion was enucleated in the Department of Oral and Maxillofacial Surgery [Figure 6]. The biopsy specimen was sent to the Department of Oral Pathology for histopathologic investigation. Ten millilitres of blood was drawn from the median cubital vein using a 5-ml syringe with 25-gauge needle [Figure 7] and it was centrifuged at 3000 rpm for 12 min for procuring platelet-rich fibrin [Figure 8], [Figure 9], [Figure 10]. Platelet-rich fibrin obtained was mixed with osseo-graft (DMBM) [Figure 11] which is a sterile bioresorbable demineralized bone matrix for bone void filling. The cavity was filled with the mixture of platelet-rich fibrin and DMBM, marketed by [Advanced Biotech Products (P) Ltd, Chennai, India]. The defect was closed using 3-O silk suture [Figure 12]. The patient was prescribed amoxicillin 500 mg, 3 times daily, for 5 days. The patient was advised to use chlorhexidine 0.12% (Periogard) as postoperative oral rinse for 30 days. Postoperative instructions were given to the patient to neither brush nor floss the surgical area for the first 4 weeks and to continue with the chlorhexidine (0.12%) oral rinse for 4 weeks. The patient was recalled after 7 days for suture removal at the surgical site and postoperative evaluation was done. The patient was recalled after 15 days and 3 rd and 5 th months for checkup and revaluation. After the 5 th month, the surgical site showed good healing and an increase in bone height was seen [Figure 13].
|Figure 2: Orthopantomogram showing generalized bone loss along with unilocular radiolucent area resembling a "tear drop shape" involving mandibular left premolar and the mesial root of mandibular fi rst molar|
Click here to view
Histological examination of the lesion was carried out as follows: The specimen was fixed in phosphate-buffered neutral formalin for 1 day. Later, 5-micron paraffin sections were obtained and stained with hematoxylin and eosin stain. Sections showed connective tissue stroma made up of bundles of thick, mature collagen fibers, resembling fibroma with plump fibroblast uniformly distributed. Also seen were many islands of odontogenic epithelium which appeared to be inactive [Figure 14]. The features were suggestive of COF (simple type).
| Discussion|| |
According to the latest classification of the World Health Organization (WHO), COF is defined as a fibroblastic neoplasm that contains varying amounts of apparently inactive odontogenic epithelium. Although COF is a rare lesion, it should be considered by the general dentists and periodontists as it closely resembles endodontic lesions.  According to Neville and Damn, the lesion is reported to occur in patients whose age ranges from 4 to 80 years, with a 2.2:1 female: male ratio. According to the latest classification of odontogenic tumors reported by Gardner,  COF is classified as a benign lesion derived from "odontogenic ectomesenchyme with or without odontogenic epithelium". The author reviewed the information, identifying lesions with two different histologic patterns. The first is classified as the simple type which consists of fibrous tissue along with varying amounts of collagen, while the second has been referred to as the WHO type or the complex type, which consists of fibrous tissue along with myxoid area associated with odontogenic epithelium.
COF responds well to surgical enucleation with no tendency to undergo malignant transformation  and recurrence is very uncommon.  Some lesions may contain varying amounts of hard tissue that resembles dysplastic cementum or bone. Finally, clinical, radiological, and histological aspects of the case reported here were consistent with the diagnosis of COF (simple type). The lesion was surgically removed and no recurrence of the lesion was observed until 1 year of follow-up.
| Conclusion|| |
Because of the scarce number of reported cases in the literature, diagnosis of this tumor cannot be based only on clinical and radiographic features. But like most of the lesions, only histological findings can confirm this particular entity.
| References|| |
|1.||Gardner DG. The peripheral odontogenic fibroma: An attempt at clarification. Oral Surg Oral Med Oral Pathol 1982;54:40-8. |
|2.||Dunlap CL. Odontogenic fibroma. Semin Diagn Pathol 1999;16:293-6. |
|3.||Gardner DG, Baker DC. Fibromatous epulis in dogs and peripheral odontogenic fibroma in human beings: Two equivalent lesions. Oral Surg Oral Med Oral Pathol 1991;71:317-21. |
|4.||Huey MW, Bramwell JD, Hutter JW, Kratochvil FJ. Central odontogenic fibroma mimicking a lesion of endodontic origin. J Endod 1995;21:625-7. |
|5.||Kaffe I, Buchner A. Radiologic features of central odontogenic fibroma. Oral Surg Oral Med Oral Pathol 1994;78:811-8. |
|6.||Hamner JE, Gamble JW, Gallegos GJ. Odontogenic fibroma: Report of two cases. Oral Surg Oral Med Oral Pathol 1966;21:113-9. |
|7.||Scofield ID. Central odontogenic fibroma: Report of case. J Oral Surg 1981;39:218-20. |
|8.||Regezi JA, Sciubba JJ. Oral Pathology clinical-pathologic correlations. 3 rd ed. Philadelphia: WB Saunders; 1993. p. 383-5. |
|9.||Covani U, Crespi R, Perrini N, Barone A. Central odontogenic fibroma: A case report. Med Oral PatolOral Cir Bucal 2005;10 Suppl 2:154-7. |
|10.||Gardner DG. Central Odontogenic fibroma: Current concepts. J Oral Pathol Med 1996;25:556-61. |
|11.||Whaits E. Essentials of dental radiography and radiology. Edinburgh: Churchill Livingstone; 1992. p. 247-8. |
|12.||Dahl EC, Wolfson HS, Hausen JC. Central odontogenic fibroma: Review of the literature and report of cases. J Oral Surg 1981;39:120-4. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12], [Figure 13], [Figure 14]