The central odontogenic fibroma: how difficult can be making a preliminary diagnosis

Central odontogenic fibroma (COF) is a rare benign odontogenic tumor derived from the dental ectomesenchymal tissues. A 16-year-old Caucasian female patient was referred by her dentist for a radiolucent asymptomatic area associated with the crown of the impacted lower right third molar. A preliminary diagnosis of a follicular cyst was supposed. The lesion was surgically removed under general anesthesia together with the impacted tooth. The microscopic diagnosis of the excised tissue revealed an odontogenic fibroma. No clinical or radiographic signs of recurrence were found five years after surgical excision. Despite the various differential diagnoses of homogeneous unilocular and well delimited radiolucencies of the jaws, enucleation with peripheral curettage, without any other pre-operative imaging exams or biopsies, can be considered as the treatment of choice.