Treatment of large ameloblastic fibroma: a case report.

Ameloblastic fibroma (AF) is an extremely rare true mixed benign tumor that can occur in either the mandible or the maxilla, but is most frequently found in the posterior region of the mandible. It usually occurs in the first two decades of life and is associated with tooth enclosure, causing a delay in eruption or altering the dental eruption sequence. AF is diagnosed on routine radiographic evaluation and is clinically and radiographically similar to ameloblastic fibrodontoma and odontoma, which makes an accurate diagnosis mandatory. There is controversy in the literature as to whether treatment should be conservative or agressive. A conservative treatment strategy, such as enucleation and curettage, is usually sufficient. However, extensive lesions require radical treatment. We describe a case of ameloblastic fibroma with a very unusual clinical manifestation: it demonstrated considerable extension but no associated impacted tooth, was located in the anterior region of the mandible, and became symptomatic in the fifth decade of life. A radical surgical approach was taken, with immediate reconstruction.