Pericoronal radiolucency with snowflake calcifications in a teenager
16-year-old female
§Chief complaint
Swelling of the upper front jaw with a missing canine
§Medical & dental history
- 01Healthy, no medication
- 02Retained deciduous canine; permanent 13 unerupted
- 03No pain
§Clinical examination
- 01Firm, non-tender buccal swelling over 12-14, mucosa normal
- 02Retained 53 in situ, 13 not palpable buccally
- 03Adjacent teeth vital, no mobility
- 04No lymphadenopathy
§ figuresFigures (3)
Fig. 1The adenomatoid odontogenic tumor is an odontogenic tumor arising from the enamel organ or dental lamina.
“Adenomatoid odontogenic tumor” · JXtra · CC BY-SA 3.0 · Wikimedia Commons
Verified open-access images only, reproduced for education under their stated licences · no AI-generated or illustrative artwork · Adenomatoid Odontogenic Tumour figures pending faculty review.
§Differential diagnosis
§Final diagnosis
Adenomatoid odontogenic tumour (follicular type) associated with impacted 13
The two-thirds rule fits: two-thirds occur in the maxilla, in females, in the second decade and are associated with an unerupted canine. Radiolucency extending apically past the CEJ with faint snowflake flecks distinguishes it from a dentigerous cyst.
§Investigations
- 01Vitality testing of 12, 11, 14 — all vital
- 02Excisional biopsy with histopathology
§Radiology
- 01IOPA — unilocular corticated radiolucency enclosing the crown and part of the root of 13 with fine radiopaque flecks
- 02CBCT — palatally displaced 13, intact buccal cortex, lesion 22 mm
§Treatment plan
- 01Conservative enucleation of the lesion with removal of the impacted 13
- 02Orthodontic space management and prosthetic or orthodontic closure
§Surgical procedure
- 01Buccal flap 11-15, bone window, lesion shelled out intact within its capsule with the tooth
- 02Cavity curetted; primary closure
§Histopathology report
Well-encapsulated tumour composed of spindle and cuboidal odontogenic epithelium forming whorls, rosettes and duct-like structures with eosinophilic material, plus scattered calcified foci. Adenomatoid odontogenic tumour.
§Follow-up & outcome
- 011 week — uneventful
- 026 months — bony healing
- 0324 months — no recurrence, orthodontic treatment completed
Outcome: Complete cure after simple enucleation; space closed orthodontically with good aesthetics.
§Discussion
- 01AOT is a benign, encapsulated hamartomatous lesion — enucleation is curative and recurrence is exceptional.
- 02It is frequently misdiagnosed radiographically as a dentigerous cyst; the radiolucency extending apical to the CEJ is the discriminator.
§Clinical pearls / learning points
- 01Remember the two-thirds tumour: maxilla, females, second decade, canines, dentigerous-like.
- 02Encapsulation means conservative surgery is enough.
§Viva questions
What is the classic radiographic clue separating AOT from a dentigerous cyst?
The AOT radiolucency extends apically beyond the cemento-enamel junction and often contains fine calcifications.
What is the recurrence rate?
Essentially nil after complete enucleation.
§MCQs
Q1AOT most commonly involves which tooth?
Q2Histology of AOT typically shows:
§ evidenceReferences & Evidence
Current Classification
WHO Classification of Head and Neck Tumours
5th Edition — Volume 9
WHO Classification of Tumours Editorial Board · 2022
The authoritative international classification of head and neck, odontogenic and salivary gland tumours. Current terminology on this site follows this edition.
Evidence summary
Highest level of evidence linked to this page: WHO / Official Classification.
- L1 · Classification — 3
- L4 · Research — 1
- L6 · Textbook — 3
1 linked source was published from 2024 onwards. Where guidance is limited or contested, rely on the higher-level sources above rather than this summary. Educational use only — not a substitute for clinical judgement.
Content last reviewed
September 2026
Evidence last reviewed
September 2026
Next scheduled review
September 2027
Review status
EVIDENCE REVIEWED
Search latest PubMed evidence
Last literature search: 7 September 2026
Current Classification
WHO Classification of Tumours Editorial Board. IARC / World Health Organization · 2022
The authoritative international classification of head and neck, odontogenic and salivary gland tumours. Current terminology on this site follows this edition.
Vered M, Wright JM. Head and neck pathology · 2022 · 16(1):63-75
Summary of odontogenic and maxillofacial bone tumour changes in the 5th edition WHO classification.
IARC / WHO. IARC · 2022
Continuously updated online edition of the WHO head and neck tumour classification.
Radiology References
Dunfee BL, Sakai O, Pistey R et al.. Radiographics : a review publication of the Radiological Society of North America, Inc · 2006 · 26(6):1751-68
Radiologic-pathologic correlation of benign and malignant odontogenic lesions of the jaws.
Histopathology References
Barnes L. CRC Press · 2008
Detailed histopathological reference for head and neck diagnostic criteria.
Textbook References
Neville BW, Damm DD, Allen CM et al.. Elsevier · 2024
Standard reference textbook of oral and maxillofacial pathology used throughout this atlas.
Rajendran R, Sivapathasundharam B. Elsevier · 2020
Undergraduate and postgraduate oral pathology textbook widely used in BDS and FCPS curricula.
Additional sources cited on this page
- WHO Classification of Head and Neck Tumours, 5th edition, 2022.
- Philipsen HP, Reichart PA. Adenomatoid odontogenic tumour: facts and figures. Oral Oncol 1999.
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