Dental Research Journal

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1 Dental Research Journal Original Article Odontogenic s in Iran, Isfahan: A study of 0 cases Mahsa Kowkabi, Sayed Mohammad Razavi, Negin Khosravi, Amir Arsalan Navabi Torabinejad Dental Research Center and Department of Oral Pathology, School of Dentistry, Isfahan University of Medical Sciences, Department of Endodontics, Azad University of Medical Science, Khorasgan, Isfahan, Iran ABSTRACT Received: June 0 Accepted: September 0 Address for correspondence: Dr. Mahsa Kowkabi, Torabinejad Dental Research Center and Department of Oral Pathology, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran. sm.kowkabi@gmail. com Background: The aim of this study was to record the relative frequency of odontogenic s (OTs), evaluate and analyze the epidemiological features of the lesions in patients referring to dental faculty of Isfahan and compare these data with previous studies. Materials and Methods: In this study, we reviewed the records of,0 lesions from to 00 archived in the oral pathology department of dental faculty of Isfahan retrospectively and using criteria for histological typification published by the WHO in 00. Age, sex, site and extent of s were analyzed. Results: Among recorded lesions 0 were OTs (.%). Of these, were benign and just was malignant. The most common lesions were ameloblastomas (n = ) followed by odontomas (n = ), odontogenic myxomas (n = ) and others. There were a few more female patients (n =,.%) than male and the mean age of patients was. years (range.-0 years). The posterior of mandible was the most common site (n =, %). Conclusion: According to accumulated data, odontogenic s are uncommon lesions and malignant s are very rare. Key Words:, odontogenic lesions, odontogenic s, odontoma INTRODUCTION Odontogenic s (OTs) are a group of heterogenous lesions derived from epithelial and/or mesenchymal elements that are part of the tooth forming apparatus. [] Although, some of them represent hamartomas, there are many others that are true benign and malignant neoplasm with different degrees of aggressiveness. [] OTs are rare lesions of the mandible and maxilla that must be considered as a differential diagnosis of lesions that occur in the jaws. [] In humans, OTs comprises about % of all jaw s, [] and are located mainly in the maxilla and mandible, and occasionally in the gingiva. [,] In, the first Access this article online Website: edition to classify this group of lesions was published by the World Health Organization (WHO) [] and in 00 a revised third edition was done. [] There are not enough reports, to our knowledge, on OTs in Iranian population, thus our analyses of OT in Isfahan population could provide useful additional data to the literature. This study evaluates the relative frequency of odontogenic s recorded at the Dental faculty of Isfahan, Iran over a period of years (-00) and compares these data with other parts of the world. MATERIALS AND METHODS This study is a descriptive and crosssectional research. We reviewed,0 samples of oral and biopsy from the patient records of the oral pathology service, Dental faculty of Isfahan, Iran over a year period (-00). Data were analyzed for age, gender, site and histopathologic typing according to 00 WHO classification. Those cases Dental Research Journal / November 0 / Vol / Issue

2 lacking information about one of the above features were documented in a new column in their relative table. We divided OTs in to major groups based on WHO classification: benign and malignant. The jaw was divided in to areas: Anterior region (from canine to canine), posterior region (posterior to the canine) and anterior posterior region, posterior area of the mandible included the ascending ramus. Data was analyzed by the SPSS for windows (version.0) statistical software package. RESULTS We found 0 cases of oral cavity and jaw lesions referred to oral pathology laboratory of Dental faculty of Isfahan, Iran during this year period were OTs, which constituted. % of these lesions. were benign and only was malignant which was ameloblastic carcinoma. With regard to benign s, there were males and females. Benign s presented a male: female ratio of :.0 and that one malignant was found in yearold male. Table shows the frequency and gender distribution of odontogenic s listed based on WHO classification of odontogenic s. It reveals 0.% of all s were malignant and.% were benign. The most prevalent was ameloblastoma followed by odontoma and myxoma. Table : Frequency and gender distribution of odontogenic s listed by diagnostic type, WHO classification of odontogenic s Table shows the mean age of this patient population is.. Most cases (n = ) were found in the second, third and fourth decades, with the peak in the second decade (.%). The most prevalent OT arose in the second decade of life was odontoma (.%), following by ameloblastoma (.%), AOT (.%), and myxoma (0.%). Table shows the distribution of benign and malignant OT based on their location. The mandible was more common site, with the ratio of.:. The posterior region of the mandible and the anterior region of the maxilla were the most frequent affected area, that % and 0.% of all s were appeared there, respectively. The anterior zone was the most common involved area for each OTs that occurred in the maxilla, with the one exception of fibromyxoma., ameloblastic fibroma and squamous odontogenic were only detected in the mandible..% of the ameloblastoma were affected the mandible and most frequently the posterior zone; besides, odontoma and odontogenic myxoma were mostly occurred in the posterior area of mandible, 0.% and 0.%, respectively. Cases of odontogenic s which affected both area of each jaw, anterior and posterior, were odontoma and ameloblastoma. Table gather prevalence of all histopathologic types of OTs from different studies and compare them with our study. In the Ochsenius series, Fernandes series and Saghravanian series we can notice the referrals from other places. DISCUSSION Benign Ameloblastic fibro odontoma Calcifying epithelial odontogenic Squamous odontogenic Adenomatoid odontogenic Malignant Female Male There are a few numbers of published studies that reveal about odontogenic s, besides based on our information there is just one comprehensive related survey in our country, which was done in Mashhad, [] so this made us to plan this survey in another state of our country in order to collect more reasonable data source about odontogenic s incidence in Iran. In the present study we made the comparison the Saghravanian, [] Fernandes, [0] Ochsenius, [] Ledeinde, [] Adebayo, [] Olgac [] and Lu [] series. In this study, OTs found as an infrequent lesions (.%) among jaw and oral biopsies, which is similar to many published series [,0,,] and different with some others which carried out in Nigeria [,] that OTs represent.% and % of all oral lesions, respectively. Dental Research Journal / November 0 / Vol / Issue

3 Table : Age distribution of 0 odontogenic s Age (years) NS* Mean age+sd** (Yrs) Age range (Yrs).±..±..0 Ameloblastic fibro odontoma 0±...±. 0 Calcifying epithelial odontogenic.±. 0.±..±. ± Squamous odontogenic Adenomatoid odontogenic 0.± ±.0 NS*: Not specified, SD**: Standard deviation Table : Distribution of 0 benign and malignant s by location Maxilla NS, n (%) Mandible NS, n (%) NS, n (%) Ant Post Antpost Ant Post Antpost ODT 0 (.) (.) () AME (.) (.) (.) AFO (.) (.) (.) CF (00) AMC (00) AF (00) CEOT (00) OF (.) (.) MYX () (.) (.) FMYX () (0) SOT (00) AOT 0 (.) (.) (.) NS: Not specified,odt:, AME:, AFO: Ameloblastic fibro odontoma, CF:, AMC:, AF:, CEOT: Calcifying epithelial odontogenic, OF:, MYX:, FMYX:, SOT: Squamous odontogenic AOT: Adenomatoid odontogenic According to sex distribution, in this study the male to female ratio of :.0 was found. In Saghravanian series [] it is :., in Fernandes series [0] it is :., in Ochsenius series [] it is :., in Olgac series [] it is :., in Lu series [] it is :., but in Ledeinde [] and Adebayo [] series the ratio was found.0: and.:, respectively. By all these studies we can conclude the equal sex predilection for odontogenic s. These s were mostly detected in the mandible (.:). In Nigeria [,] and China [] this ratio was found.:,.: and.:, respectively, which could be due to the greater prevalence of ameloblastoma. While another Iranian, [] Brazilian, [0] Chilean [] and Turkish [] series showed a slight frequency for the mandible (.:,.:,.: and.: respectively). was the most common in this study (.%) which is comparable with the reports in Iran; Mashhad, [] Brazil, [0] Nigeria, [,] Istanbul [] and China [] but, in contrast of studies in America, [] Canada [] and Chile. [] In latest series, odontoma was the most frequent (.%,.% and.% respectively). In our study, we considered on incidence of ameloblastoma of.% to occur in the posterior site of mandible, while in other studies it shows major frequency in this area for this. [,0,,] We found odontoma as the second most frequent OT (%) after ameloblastoma. Its prevalence is less than the result from Chile, [] USA [] and Canada [] but Dental Research Journal / November 0 / Vol / Issue

4 Table : Comparison of the relative frequency of odontogenic s from selected references of different countries and this study Benign Ameloblastic fibro odontoma Calcifying epithelial odontogenic Squamous odontogenic Adenomatoid odontogenic Clear cell odontogenic Odonto ameloblastoma Calcifying odontogenic cyst Benign cementoblastoma Ameloblastic fibro dentinoma Gigantiform cementoma Cemento osseous dysplasia Ameloblastic odontoma Malignant Clear cell odontogenic carcinoma Odontogenic carcino sarcoma Malignant ameloblastoma Odontogenic carcinoma Odontogenic sarcoma Ameloblastic sarcoma Primary intraosseous carcinoma Malignant calcifying odontogenic Kowkabi (Iran, Isfahan) Saghravanian (Iran, Mashhad) Cases 0 % Fernandes (Brazil) Ochsenius (Chile) Ladeinde (Nigeria) Adebayo (Nigeria) Olgac (Istanbul) Lu (China) more than the results from Iran; Mashhad, [] Brazil, [0] Nigeria, [,] Turkish [] and China. [] In the present study, male to female ratio for odontogenic myxoma was found :. that is agree with Saghravanian, [] Lu, [] Fernandes [0] and Olgac [] studies. With regard to myxoma, we did not found any gender predilection. This agreed with related contents in oral and maxillofacial pathology textbook. [,] Other studies of OT reported a female predilection. [,] In our study, ameloblastic fibro odontoma was more common (.%) than other reports. [] Our findings show a mean age of. years for ameloblastoma, which is comparable with other reports [,0] which shows.,.,.,., Dental Research Journal / November 0 / Vol / Issue

5 years respectively for mean age. In the present study, malignant s were rare (0.% of the total OT). This rarity was also confirmed by studies in Iran; Mashhad, [] Brazil, [0] Chile, [] Istanbul [] and America [,] while in African [] and Chinese [] series we can see significantly higher frequency for malignant s (.% and.% respectively). It should be mentioned that in 00 WHO classification, odontogenic keratocyst has been renamed as keratocystic odontogenic and COC classified as a. However, some of the standard references in oral pathology still use the term OKC [,] and definitely classify COC as a cyst, [] so we have not termed OKC and COC as in this study. CONCLUSION In conclusion, this study shows odontogenic s are not common among oromaxillofacial lesions and malignant types are very rare. These s mostly occurred in posterior site of mandible and there is a slight prevalency for females. Also, most cases were found in second decade of life. 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Source of Support: This report is based on a research project which was submitted to the school of dentistry, Isfahan University of Medical Sciences, Isfahan, Iran (#0). The study was approved by the Medical Ethics and Research Office at the Isfahan University of Medical Science and financially supported by this university. Conflict of Interest: None declared. Dental Research Journal / November 0 / Vol / Issue