Multiple calcifying hyperplastic dental follicles

https://doi.org/10.1016/S1079-2104(05)80102-7Get rights and content

This article describes two additional examples of this unusual condition; two others were reported previously. The microscopic features are those of the hyperplastic dental follicles that occur in regional odontodysplasia. However, the teeth are not defective, as in regional odontodysplasia. This rare condition is sufficiently distinctive to be considered a pathologic entity.

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    In the absence of tooth abnormality, osseous involvement, and familial characteristics, the aforementioned diagnoses were ruled out in our case. Multiple impacted teeth are present in several syndromes such as cleidocranial dysplasia, Gardner syndrome, Noonan syndrome, and mucopolysaccharidosis (Hunter syndrome); however, no relationship has been established between MCHDF and these disorders.7,15 COFs are destructive lesions with persistent growth, and they have a high chance of recurrence if not removed completely.16

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    The thick fibrotic capsule displayed strands of odontogenic epithelium and scattered aggregations of basophilic psammomatoid calcifications; in areas, amphophilic cementum-like extracellular matrix formed around these basophilic calcospherites, entrapping them (Figure 4).27 These capsular calcifications are similar to those found in the dental follicular tissue that envelops normal or abnormal developing teeth.28,29 The external cemento-osseous shell had broad eosinophilic anastomosing trabeculae of woven and lamellar bone exhibiting bulbous processes and a thick coat of acellular amphophilic cementum (Figure 5).

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    TF and DP may be present within the tooth bearing areas of the jaws and may extend into the maxillary sinus. Lack of familiarly with these innocuous normal structures poses a risk for misdiagnosing them as myxoma or possibly an odontogenic tumor, which could lead to unnecessary surgical procedures.5,12,13 Radiographic assessment should aid in deciphering whether the structures are either normal or represent the possibility of a myxoma or odontogenic tumor.

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a

Division of Oral Pathology and Oncology, University of Colorado School of Dentistry.

b

School of Dental Science, University of Melbourne.

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