1. BENIGN NEOPLASMS OF ORAL TISSUES
Neo: new; Plasia: formation. A neoplasm is defined as an uncoordinated proliferation of tissue, the growth of which persists in a potentially unlimited fashion, even after cessation of the stimulus which evoked the change.

2. OF ORAL TISSUES BENIGN NEOPLASMS
CLASSIFICATION
BENIGN NEOPLASMS
Odontogenic tumors
Non-odontogenic tumors
Hyperplastic lesions
1. Polyp
2. Epulis
3. Giant cell granuloma
Epithelial origin
1. Papilloma
2. Adenoma
3. Pigmented nevus
4. Keratoacanthoma
Mesenchymal
1. Connective tissue origin
a. Fibroma
b. Lipoma / Fibrolipoma
c. Haemangioma
d. Lymphangioma
e. Chondroma
f. Osteoma
Mesenchymal
2. Muscle tissue origin
a. Leiomyoma
b. Rhabdomyoma
c. Granular cell myoblastoma
3. Nerve tissue origin
a. Neurofibroma
b. Neurilemmoma
c. Melanotic progonoma
Epithelial origin
1. Ameloblastoma
2. Adenomatoid odontogenic tumor
3. Calcifying epithelial odontogenic tumor
4. Squamous odontogenic tumor
B Mixed origin
1. Ameloblastic fibroma
2. Odontomes
C Mesodermal origin
1. Myxoma & Myxofibroma
2. Odontogenic fibroma
3. Cementifying fibroma
4. Periapical cemental dysplasia
5. Benign cementoblastoma
6. Familial multiple cementoma

3. Common Clinical Features
OF ORAL TISSUES
BENIGN NEOPLASMS
ODONTOGENIC TUMORS
Common Clinical Features
Age of occurrence: Varies with each tumor
Sex predilection: Varies with each tumor
Symptoms: Most of the tumors present as a painless, gradually / rapidly enlarging swelling. If infected, pain may be present. Other symptoms include facial deformity, mobility in teeth, numbness.

4. Common Clinical Features
OF ORAL TISSUES
BENIGN NEOPLASMS
ODONTOGENIC TUMORS
Common Clinical Features
Signs: The swelling has the following features:
Inspection: usually single, round or oval, well-defined boundaries, smooth or nodular surface, normal overlying skin or mucosa, expansion of jaw bone, obliteration of vestibule
Palpation: Normal temperature of the overlying skin or mucosa, non-tender, consistency is bony hard (if entirely within bone); ‘egg-shell crackling’ (if overlying bone is thin); firm (if no bone coverage), teeth mobility, paraesthesia
Additional features: missing tooth or normal dentition, displacement of teeth, pathological jaw fracture, signs of inflammation if tumor is infected

5. Common Radiographic Features
OF ORAL TISSUES
BENIGN NEOPLASMS
ODONTOGENIC TUMORS
Common Radiographic Features
Type of lesion: radiolucent
Site: body of jaw bone
Size: usually more than 1.5 cms
Shape: round or oval, unilocular or multi-locular
Number: mostly single
Outline: regular if unilocular, scalloped if multi-locular
Border: well-defined hyperostotic (‘partially hyperostotic’)
Contents: homogenous radiolucency (‘radiopaque foci’)
Additional features: expansion of jaw bone, displacement/resorption of roots, displacement of inferior alveolar canal, obliteration of maxillary antrum, thinning of both cortical plates, thinning of inferior border of mandible, ‘cyst-in-cyst’ appearance, pathological jaw fracture

6. Common Radiographic Features
OF ORAL TISSUES
BENIGN NEOPLASMS
ODONTOGENIC TUMORS
Common Radiographic Features

7. Common Radiographic Features
OF ORAL TISSUES
BENIGN NEOPLASMS
ODONTOGENIC TUMORS
Common Radiographic Features

8. Common Radiographic Features
OF ORAL TISSUES
BENIGN NEOPLASMS
ODONTOGENIC TUMORS
Common Radiographic Features

9. OF ORAL TISSUES BENIGN NEOPLASMS
CLASSIFICATION
BENIGN NEOPLASMS
Odontogenic tumors
Non-odontogenic tumors
Epithelial origin
1. Ameloblastoma
2. Adenomatoid odontogenic tumor
3. Calcifying epithelial odontogenic tumor
4. Squamous odontogenic tumor
5. Ameloblastic fibroma
6. Odontomes
Mesodermal origin
1. Myxoma & Myxofibroma
2. Odontogenic fibroma
3. Cementifying fibroma
4. Periapical cemental dysplasia
5. Benign cementoblastoma
6. Familial multiple cementoma
Pathogenesis: Proliferation of tissues differentiated from dental lamina. Stimulus for this proliferation not known.

10. (‘locally malignant’)
OF ORAL TISSUES
BENIGN NEOPLASMS
ODONTOGENIC TUMORS
Ameloblastoma
(‘locally malignant’)
Clinical Features
Age of occurrence: mostly between 20 to 50 years of age, peak frequency at 33 years of age
Sex predilection: males slightly more commonly affected than females
Site: 80% of tumors in mandible, in mandible 3rd molar-ramus region more affected
Symptoms: Most of the tumors present as a painless, gradually / rapidly enlarging swelling. If infected, pain may be present. Other symptoms include facial deformity, mobility in teeth, numbness

11. (‘locally malignant’)
OF ORAL TISSUES
BENIGN NEOPLASMS
ODONTOGENIC TUMORS
Ameloblastoma
(‘locally malignant’)
Clinical Features
Signs: The swelling has the following features:
Inspection: single, round or oval, well-defined boundaries, smooth or lobulated, normal overlying skin or mucosa (ulcerated if large), expansion of jaw bone in all the 3 planes, obliteration of vestibule
Palpation: normal temperature of the overlying skin or mucosa, non-tender, consistency is bony hard (if entirely within bone); ‘egg-shell crackling’ (if overlying bone is thin); firm (if no bone coverage) or soft (if unicystic), teeth mobility, paraesthesia
Additional features: missing tooth or normal dentition, displacement of teeth, pathological jaw fracture, thin straw colored fluid on aspiration (unicystic variety) signs of inflammation if tumor is infecte
Image: Lucas’s Pathology of Tumors of the Oral Tissues, 5th edition

12. OF ORAL TISSUES BENIGN NEOPLASMS
ODONTOGENIC TUMORS
Ameloblastoma
(‘locally malignant’)
Radiographic Features
Type of lesion: radiolucent
Site: usually mandibular 3rd molar-ramus region
Size: large lesion
Shape: unilocular (round or oval), multilocular (‘soap bubble’, ‘honeycomb’) with locules separated by bony septae
Number: single
Outline: regular or scalloped
Border: well-defined hyperostotic (‘partially hyperostotic’)
Contents: homogenous radiolucency
Additional features: impaction of tooth with displacement deep in the jaw, expansion of jaw bone bucco-lingually, antero-posteriorly and vertically, displacement & resorption of roots, displacement of inferior alveolar canal, obliteration of maxillary antrum, thinning of cortical plates, thinning of inferior border of mandible, ‘cyst-in-cyst’ appearance, pathological jaw fracture

13. (‘locally malignant’)
OF ORAL TISSUES
BENIGN NEOPLASMS
ODONTOGENIC TUMORS
Ameloblastoma
(‘locally malignant’)
Images: Atlas of Oral Diagnostic Imaging by Higashi

14. (‘locally malignant’)
OF ORAL TISSUES
BENIGN NEOPLASMS
ODONTOGENIC TUMORS
Ameloblastoma
(‘locally malignant’)
Differential Diagnosis:
Unilocular - other odontogenic tumors (except radiopaque) and cysts
Multilocular - ameloblastic fibroma, myxoma, haemangioma, central giant cell granuloma, early stages of fibro-osseous lesions, odontogenic keratocyst
Management: wide surgical excision to avoid recurrence, bone grafts

15. OF ORAL TISSUES BENIGN NEOPLASMS
CLASSIFICATION
BENIGN NEOPLASMS
Odontogenic tumors
Non-odontogenic tumors
Epithelial origin
1. Ameloblastoma
2. Adenomatoid odontogenic tumor
3. Calcifying epithelial odontogenic tumor
4. Squamous odontogenic tumor
5. Ameloblastic fibroma
6. Odontomes
Mesodermal origin
1. Myxoma & Myxofibroma
2. Odontogenic fibroma
3. Cementifying fibroma
4. Periapical cemental dysplasia
5. Benign cementoblastoma
6. Familial multiple cementoma

16. Adenomatoid Odontogenic Tumor
OF ORAL TISSUES
BENIGN NEOPLASMS
ODONTOGENIC TUMORS
Adenomatoid Odontogenic Tumor
(‘AOT’)
Clinical Features
Age of occurrence: mostly in 2nd & 3rd decades of life
Sex predilection: females slightly more commonly affected than males
Symptoms: Most of the tumors present as a painless, gradually enlarging swelling. Sometimes asymptomatic, being discovered radiographically.
Site: almost all cases involve maxillary anterior teeth
Signs: The swelling has the following features:
Inspection: single, round or oval, well-defined boundaries, smooth, normal overlying skin or mucosa, little expansion of jaw bone, obliteration of vestibule
Palpation: normal temperature of the overlying skin or mucosa, non-tender, consistency is bony hard (if entirely within bone); ‘egg-shell crackling’ (if overlying bone is thin); firm (if no bone coverage)
Additional features: normal dentition, displacement of teeth

17. OF ORAL TISSUES BENIGN NEOPLASMS
ODONTOGENIC TUMORS
Adenomatoid Odontogenic Tumor
(‘AOT’)
Radiographic Features
Type of lesion: predominantly radiolucent (‘mixed’)
Site: maxillary anterior region
Size: about 3 cms in diameter
Shape: unilocular (round or oval)
Number: single
Outline: regular
Border: well-defined hyperostotic
Contents: homogenous radiolucency interspersed with radiopaque foci (‘driven snow’ appearance)
Additional features: sometimes impaction of tooth, little expansion of jaw bone, displacement & resorption of roots, thinning of cortical plates

18. Adenomatoid Odontogenic Tumor
OF ORAL TISSUES
BENIGN NEOPLASMS
ODONTOGENIC TUMORS
Adenomatoid Odontogenic Tumor
(‘AOT’)
Differential Diagnosis:
No radiopaque foci – ameloblastoma, ameloblastic fibroma, odontogenic fibroma, primordial cyst, lateral periodontal cyst
Radiopaque foci – CEOC, CEOT
Management: surgical enucleation
Image: Atlas of Oral Diagnostic Imaging by Higashi

19. OF ORAL TISSUES BENIGN NEOPLASMS
ODONTOGENIC TUMORS
Calcifying Epithelial Odontogenic Tumor
(‘CEOT’, Pindborg tumor)
Clinical Features
Signs: The swelling has the following features:
Inspection: single, round or oval, well-defined boundaries, smooth, normal overlying skin or mucosa, little expansion of jaw bone, obliteration of vestibule
Palpation: normal temperature of the overlying skin or mucosa, non-tender, consistency is bony hard (if entirely within bone); ‘egg-shell crackling’ (if overlying bone is thin); firm (if no bone coverage)
Additional features: missing tooth, displacement of teeth
Age of occurrence: mostly in middle aged patients
Sex predilection: females equally affected as males
Symptoms: Most of the tumors present as a painless, gradually enlarging swelling. Sometimes non-eruption of tooth / asymptomatic, being discovered radiographically.
Site: majority in mandibular premolar-molar region

20. OF ORAL TISSUES BENIGN NEOPLASMS
ODONTOGENIC TUMORS
Calcifying Epithelial Odontogenic Tumor
(‘CEOT’, Pindborg tumor)
Radiographic Features
Type of lesion: predominantly radiolucent (‘mixed’)
Site: mandibular premolar-molar region
Size: about 3 cms in diameter
Shape: somewhat irregular
Number: single
Outline: somewhat irregular
Border: well-defined, at times diffuse
Contents: homogenous radiolucency interspersed with diffuse radiopacities
Additional features: impaction of tooth is common, little expansion of jaw bone, displacement & resorption of roots, thinning of cortical plates

21. OF ORAL TISSUES BENIGN NEOPLASMS
ODONTOGENIC TUMORS
Calcifying Epithelial Odontogenic Tumor
(‘CEOT’, Pindborg tumor)
Differential Diagnosis: CEOC, AOT, intermediate stages of fibro-osseous lesions
Management: wide surgical excision to avoid recurrence
Image: Lucas’s Pathology of Tumors of the Oral Tissues, 5th edition

22. OF ORAL TISSUES BENIGN NEOPLASMS
CLASSIFICATION
BENIGN NEOPLASMS
Odontogenic tumors
Non-odontogenic tumors
Epithelial origin
1. Ameloblastoma
2. Adenomatoid odontogenic tumor
3. Calcifying epithelial odontogenic tumor
4. Squamous odontogenic tumor
5. Ameloblastic fibroma
6. Odontomes
Mesodermal origin
1. Myxoma & Myxofibroma
2. Odontogenic fibroma
3. Cementifying fibroma
4. Periapical cemental dysplasia
5. Benign cementoblastoma
6. Familial multiple cementoma

23. (‘complex/compound composite odontome’, Odontoma)
OF ORAL TISSUES
BENIGN NEOPLASMS
ODONTOGENIC TUMORS
Odontome
(‘complex/compound composite odontome’, Odontoma)
Clinical Features
Signs: If present, the swelling has the following features:
Inspection: single, round or oval, well-defined boundaries, smooth, normal overlying skin or mucosa, little expansion of jaw bone,
Palpation: normal temperature of the overlying skin or mucosa, non-tender, consistency is bony hard (if entirely within bone); firm or hard (if no bone coverage)
Additional features: missing tooth
Age of occurrence: mostly in young adults
Sex predilection: males more frequently affected
Symptoms: mostly asymptomatic, being discovered radiographically for non-eruption of tooth, sometimes slowly enlarging swelling
Site: complex more common in mandibular premolar-molar region, compound more common in maxillary anterior region

24. OF ORAL TISSUES BENIGN NEOPLASMS
ODONTOGENIC TUMORS
Odontome
(‘complex/compound composite odontome’, Odontoma)
Radiographic Features
Type of lesion: radiopaque mass surrounded by a radiolucent line and further by a radiopaque line, ‘mixed’ in early stages
Site: mandibular premolar-molar region / maxillary anterior region
Size: complex can be large, compound usually small
Shape: round or oval
Number: single
Outline: regular
Border: well-defined hyperostotic
Contents: radiopacities of varying densities interspersed with tiny radiolucencies, radiopacities arranged in haphazard manner (‘complex’) or in anatomical relation forming several small teeth ‘denticles’ (‘compound’)
Additional features: associated with supernumerary tooth, impaction of tooth, little expansion of jaw bone, displacement & resorption of roots, thinning of cortical plates

25. (‘complex/compound composite odontome’, Odontoma)
OF ORAL TISSUES
BENIGN NEOPLASMS
ODONTOGENIC TUMORS
Odontome
(‘complex/compound composite odontome’, Odontoma)
Images: Atlas of Oral Diagnostic Imaging by Higashi

26. (‘complex/compound composite odontome’, Odontoma)
OF ORAL TISSUES
BENIGN NEOPLASMS
ODONTOGENIC TUMORS
Odontome
(‘complex/compound composite odontome’, Odontoma)
Differential Diagnosis:
in the early stage: CEOC, AOT, intermediate stage of fibro-osseous lesions
in the mature stage: mature stage of fibro-osseous lesions, osteoma
Management: surgical removal to allow eruption of impacted tooth and avoid cystic changes

27. Fibro-osseous lesions
OF ORAL TISSUES
BENIGN NEOPLASMS
CLASSIFICATION
BENIGN NEOPLASMS
Odontogenic tumors
Non-odontogenic tumors
Epithelial origin
1. Ameloblastoma
2. Adenomatoid odontogenic tumor
3. Calcifying epithelial odontogenic tumor
4. Squamous odontogenic tumor
5. Ameloblastic fibroma
6. Odontomes
Mesodermal origin
1. Myxoma & Myxofibroma
2. Odontogenic fibroma
3. Cementifying fibroma
4. Periapical cemental dysplasia
5. Benign cementoblastoma
6. Familial multiple cementoma
Fibro-osseous lesions

28. OF ORAL TISSUES BENIGN NEOPLASMS
CLASSIFICATION
BENIGN NEOPLASMS
Odontogenic tumors
Non-odontogenic tumors
Hyperplastic lesions
1. Polyp
2. Epulis
3. Giant cell granuloma
Epithelial origin
1. Papilloma
2. Adenoma
3. Pigmented nevus
4. Keratoacanthoma
Mesenchymal
1. Connective tissue origin
a. Fibroma
b. Lipoma / Fibrolipoma
c. Haemangioma
d. Lymphangioma
e. Chondroma
f. Osteoma

29. (‘central/peripheral’, reparative/hyperplastic giant cell lesion’ )
OF ORAL TISSUES
BENIGN NEOPLASMS
NON-ODONTOGENIC TUMORS
Giant Cell Granuloma
(‘central/peripheral’, reparative/hyperplastic giant cell lesion’ )
Pathogenesis: excessive reparative response to an irritant (trauma, infection)
Clinical Features
Age of occurrence: central variety occurs in young adults especially below 30 years of age, peripheral variety usually in adults
Sex predilection: both varieties more common in females
Site: the region of the jaws anterior to molars involved by the central variety , the peripheral variety involves only gingiva / alveolar mucosa

30. (‘central/peripheral’, reparative/hyperplastic giant cell lesion’ )
OF ORAL TISSUES
BENIGN NEOPLASMS
NON-ODONTOGENIC TUMORS
Giant Cell Granuloma
(‘central/peripheral’, reparative/hyperplastic giant cell lesion’ )
Symptoms: mostly slowly enlarging swelling, sometimes mobility in teeth
Clinical Features
Signs: the swelling has the following features:
Inspection: single, round or oval, well-defined boundaries, smooth, normal overlying mucosa, bluish discoloration of mucosa if cortex is perforated, expansion of jaw bone,
Palpation: normal temperature of the overlying skin or mucosa, non-tender, consistency is bony hard (if entirely within bone); soft (if no bone coverage)
Additional features: displacement / mobility in teeth
Radiographic Features
Type of lesion: radiolucent
Site: usually anterior to mandibular 1st molar
Size: medium sized lesion
Shape: unilocular (round or oval), multilocular (‘soap bubble’) with locules separated by thin bony septae
Number: single
Outline: regular or scalloped
Border: well-defined hyperostotic
Contents: homogenous radiolucency
Additional features: expansion of jaw bone bucco-lingually and vertically, displacement of developing teeth, thinning of cortical plates, thinning of inferior border of mandible

31. (‘central/peripheral’, reparative/hyperplastic giant cell lesion’ )
OF ORAL TISSUES
BENIGN NEOPLASMS
NON-ODONTOGENIC TUMORS
Giant Cell Granuloma
(‘central/peripheral’, reparative/hyperplastic giant cell lesion’ )
Radiographic Features
Differential Diagnosis: from other multilocular lesions like ameloblastoma, hemangioma, myxoma and early fibro-osseous lesions
Management: surgical removal with adequate margins to avoid recurrence, screening for hyperparathyroidism
Image: Lucas’s Pathology of Tumors of the Oral Tissues, 5th edition

32. OF ORAL TISSUES BENIGN NEOPLASMS
CLASSIFICATION
BENIGN NEOPLASMS
Odontogenic tumors
Non-odontogenic tumors
Hyperplastic lesions
1. Polyp
2. Epulis
3. Giant cell granuloma
Epithelial origin
1. Papilloma
2. Adenoma
3. Pigmented nevus
4. Keratoacanthoma
Mesenchymal
1. Connective tissue origin
a. Fibroma
b. Lipoma / Fibrolipoma
c. Haemangioma
d. Lymphangioma
e. Chondroma
f. Osteoma

33. OF ORAL TISSUES BENIGN NEOPLASMS
CLASSIFICATION
BENIGN NEOPLASMS
Odontogenic tumors
Non-odontogenic tumors
Hyperplastic lesions
1. Polyp
2. Epulis
3. Giant cell granuloma
Epithelial origin
1. Papilloma
2. Adenoma
3. Pigmented nevus
4. Keratoacanthoma
Mesenchymal
1. Connective tissue origin
a. Fibroma
b. Lipoma / Fibrolipoma
c. Haemangioma
d. Lymphangioma
e. Chondroma
f. Osteoma

34. OF ORAL TISSUES BENIGN NEOPLASMS
NON-ODONTOGENIC TUMORS
Osteomas

35. OF ORAL TISSUES BENIGN NEOPLASMS
NON-ODONTOGENIC TUMORS
Osteomas

36. OF ORAL TISSUES BENIGN NEOPLASMS
CLASSIFICATION
BENIGN NEOPLASMS
Odontogenic tumors
Non-odontogenic tumors
Mesenchymal
2. Muscle tissue origin
a. Leiomyoma
b. Rhabdomyoma
c. Granular cell myoblastoma
3. Nerve tissue origin
a. Neurofibroma
b. Neurilemmoma
c. Melanotic progonoma

37. Thank you!!!!