A mixed radiopaque - radiolucent lesion in the anterior mandible associated with multiple impacted teeth: A radiodiagnostic challenge?

Desmoplastic ameloblastoma (DA) exhibits important differences in gender, anatomic distribution, radiographic findings, and histologic appearance compared to other types of ameloblastoma. Radiologically, DA is seen either as ill-defined mass containing osteolytic and sclerotic areas or as multifocal radiodense flecks within radiolucent background resembling a honeycomb. The radiographic differential diagnosis includes fibro-osseous lesions such as cemento-ossifying fibroma, fibrous dysplasia, calcifying odontogenic cyst, and chronic sclerosing osteomyelitis. Thus, DA should primarily be included in the differential diagnosis of a mixed radiopaque-radiolucent lesion with diffuse borders in the anterior premolar region of the jaws. This report adds to the literature of mixed radiolucent-radiopaque lesions which may not always be histopathologically diagnosed as a fibro-osseous lesion but could turn out to be a DA. This report also benefits the dental community by cautioning them to be aware of DA that can be associated with multiple unerupted teeth which is quite a rare finding.