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Case Report

Odontogenic fibroma WHO-type

simulating periodontal disease: Report
of a case
Juliana Lucena Schussel,1,2 Marina H. C. Gallottini,1 Paulo Henrique Braz-Silva1,3

1
Department of Oral
Pathology, School of
Dentistry, 2Department
of Oral and Maxillofacial
Surg Erasto Gaertner
Hospital Curitiba,
3
Department of Virology,
Institute of Tropical
Medicine So Paulo,
University of So Paulo,
So Paulo, Brazil

Abstract:
Central odontogenic fibroma World Health Organization (WHO)-type (OFWT) is a rare lesion that has differential
diagnosis with other radiolucent periapical lesions. It has a slow growth and is usually an asymptomatic lesion
found in routine examinations. We report a case of a central OFWT occurring in the maxilla, for which the first
symptom was teeth mobility, simulating a periodontal condition. A 54-year-old woman, with superior premolar
mobility, was referred to our clinic. An oral examination showed teeth vitality and advanced periodontal disease.
Radiography showed a unilocular radiolucent area between the left superior lateral incisor and first left molar,
with bone reabsorption. The granulomatous tissue was removed and microscopic examination revealed cellular
connective tissue with multiple islands of odontogenic epithelium, covered by stratified squamous epithelium,
confirming the OFWT diagnosis. The central OFWT is a non-aggressive lesion, with rare recidivism. Biopsy is an
important procedure for correct diagnosis and treatment, as some radiolucent lesions can lead to misdiagnosis.
Key words:
Endodontic/diagnosis lesions, intraosseous fibroma, odontogenic fibroma, radiolucent lesions

INTRODUCTION

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www.jisponline.com
DOI:
10.4103/0972-124X.128242
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Address for
correspondence:
Dr. Paulo Henrique
Braz-Silva,
Av. Dr. Enas Carvalho de
Aguiar, 470, 05403-000,
So Paulo-SP Brazil.
E-mail: pbraz@usp.br
Submission: 27-03-2013
Accepted: 18-07-2013

entral odontogenic fibroma WHO-type is a

rare lesion that corresponds to 0.1% of the
jaw tumors.[1] It is a benign neoplasm, probably
derived from the odontogenic mesenchymal
tissue.[2-4] Histologically, the odontogenic fibroma
is characterized by fibroblastic neoplasia, with
a variable amount of odontogenic epithelium
that may contain dentin or cementum-like
material.[3,5,6] It can occur in the gingiva (peripheral)
or intraosseous (central) and most of time can
resemble a periodontal or endodontic lesion.[5,7]
It usually appears like an asymptomatic,
slow-growing lesion, which can cause cortical
expansion with no predilection for the mandible
or maxilla. [1-3] Radiographic images show a
radiolucent lesion, sometimes with a mixed
radiodensity and well-defined borders, either
uni- or multilocular. There are reports in literature
on root reabsorption and displacement.[1,2] The
aim of this study is to report a case where a
careful diagnosis process was decisive for correct
treatment.

CASE REPORT
A 54-year-old Caucasian woman was referred
to the clinic of Periodontology at the School
of Dentistry of the University of So Paulo,
complaining of mobility of tooth 25. Oral
examination showed the overlying mucosa and

Journal of Indian Society of Periodontology - Vol 18, Issue 1, Jan-Feb 2014

gingiva to be with normal color and texture, with

no swelling, accentuated mobility of tooth 25, and
no other symptoms or history of pain. Percussion
and palpation tests showed normal response.
There was generalized advanced periodontal
disease compromising the other teeth.
The radiographic examination showed the
presence of a unilocular radiolucent area between
the left superior lateral incisor and the first left
molar [Figure 1]. Computed tomography (CT)
showed bone wall reabsorption between the right
first premolar and first molar, compromising of
the maxillary sinus floor.
An incisional biopsy was performed; removing
all the granulomatous tissue present in the
area and tooth 25 was removed, as it was
decayed [Figure 2]. The specimen was sent
for histopathological analysis [Figure 3]. The
microscopic examination revealed a cellular
connective tissue with multiple islands and
strands of odontogenic epithelium covered by
stratified squamous epithelium [Figure 4a].
Immunohistochemical reactions for AE1/AE3
showed positive staining for an odontogenic
epithelium, confirming the central odontogenic
fibroma WHO-type diagnosis [Figure 4b].
The lesion was surgically removed along with
other teeth extractions, as the bone support was
lost. The patient showed no signs of recidivism
after the six-month follow up.
85

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Schussel, et al.: Odontogenic fibroma simulating periodontal disease

Figure 2: Lesion surgical enucleation and extraction of tooth 26

Figure 1: Radiography showing a radiolucent area with bone resorption between
teeth 22 and 26

Figure 3: Specimen for histopathological analysis

and tooth 26

DISCUSSION
The central odontogenic fibroma WHO-type is a rare lesion that
often resembles an endodontic lesion or odontogenic tumor.
It is usually diagnosed in the second or third decade of life,
with a small preference for women (2:1).[1] Most times it is an
asymptomatic lesion, and the most frequent sign is swelling
and sometimes teeth dislocation.[2,3] Symptoms like pain and
paresthesia are uncommon.[3]
The radiographic features may generate doubts, as many
lesions have similar characteristics, such as, traumatic bone cyst,
ameloblastoma, odontogenic cysts, central giant cell granuloma,
and endodontic lesions.[1,2] Most reported cases show a unilocular
presentation, and the multilocular aspect may be related to an
advanced lesion and more aggressive behavior.[2]
Histologically it has a more complex aspect, with a fibrous
connective tissue and enlaced collagen fibers. Presence of
calcifications, dentin or cementum can differentiate it from a
simple-type odontogenic fibroma.[6] Odontogenic fibroma and
similar fibrous lesions of the jaw must also be included in the
differential diagnosis. The presence of multiple islands and
strands of odontogenic epithelium are also important findings
for the diagnosis.[1,3,4,6]
The most recent WHO classification suggested that this variety
should be named as the, odontogenic fibroma complex type
86

Figure 4: (a) Histological features of the biopsy specimen showing

cellular connective tissue and
an presence of multiple islands and strands of
odontogenic epithelium (Hematoxylin-eosin stain; original magnification 400).
(b) Immunohistochemical reaction for AE1/AE3 positive staining for odontogenic
epithelium (original magnification 400)

or fibroblastic odontogenic fibroma.[1] Much confusion existed

in the past about the real nature of this entity.
The treatment of choice is surgical excision.[4,6] The lesion
is usually easily removed, showing little adherence to
the bone. Recidivism is not expected and conservative
surgical intervention with enucleation and curettage is often
successful.[1] Depending on the extent of the lesion, the bone
regenerative procedure may be considered.[3] In our case, there
was no need of a bone regenerative procedure and the patient
showed good reparation, without a bone defect.
Radiolucent lesions on the periapical region of a non-endodontic
origin may lead to wrong initial diagnosis.[3] It is important to
include pulp vitality tests and periodontal examinations in the
clinical examination.
This case report showed an asymptomatic lesion, which
had led to dental dislocation and mobility, and had already
compromised the maxillary sinus floor. The patient showed
poor oral hygiene and generalized periodontitis, which
corroborated with the initial diagnosis of periodontal disease.
The clinical characteristics of the presented case could have led
to misdiagnosis if biopsy had not been performed. Analysis of
the specimen removed at the time of tooth 25 extraction was of
great importance for a correct diagnosis. Fortunately, the lesion
could be easily removed and no bone defects could be seen after,
despite the size and extension of the lesion.
Journal of Indian Society of Periodontology - Vol 18, Issue 1, Jan-Feb 2014

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Schussel, et al.: Odontogenic fibroma simulating periodontal disease

Careful examination of the clinical and radiographic findings as

also an incisional biopsy, are important for the correct diagnosis
and treatment of radiolucent lesions of the maxillomandibular
complex.

REFERENCES
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report and literature survey. Minerva Stomatol 2006;55:229-39.
Martelli-Jnior H, Mesquita RA, De Paula AM, Pgo SP,
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How to cite this article: Schussel JL, Gallottini MH, Braz-Silva PH.
Odontogenic fibroma WHO-type simulating periodontal disease:
Report of a case. J Indian Soc Periodontol 2014;18:85-7.
Source of Support: Nil, Conflict of Interest: None declared.

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