Linlin Wang,1,2,* Qibao Wang,2,* Li Li,3 Xiangning Song,2 HongSheng Tian,4 Chengyuan Han2,5 

1Medical Imaging Department, Jinan Stomatological Hospital, Jinan, Shandong Province, 250001, People’s Republic of China; 2Central Laboratory, Jinan Key Medical and Health Laboratory of Oral Diseases and Tissue Regeneration, Jinan Key Laboratory of Oral Diseases and Tissue Regeneration, Shandong Provincial Key Medical and Health Laboratory of Oral Diseases and Tissue Regeneration, Jinan Stomatological Hospital, Jinan, Shandong Province, 250001, People’s Republic of China; 3Medical imaging department, Laizhou City People’s Hospital, Laizhou, Shandong Province, 261400, People’s Republic of China; 4Medical Imaging Department, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, 250011, People’s Republic of China; 5School of Stomatology, Binzhou Medical University, Yantai, Shandong Province, 264003, People’s Republic of China

*These authors contributed equally to this work

Correspondence: HongSheng Tian, Affiliated Hospital Shandong University of Traditional Chinese Medicine, Wenhua Road No. 42, Jinan, Shandong Province, 250011, People’s Republic of China, Email hongshengtian@163.com Chengyuan Han, School of Stomatology, Binzhou Medical University, Yantai, Shandong Province, 264003, People’s Republic of China, Email lwhcy2626@163.com

Purpose: Ameloblastic fibroma (AF), an exceedingly rare benign mixed odontogenic tumor, scarcely occurs in the anterior region of the maxilla. This case report aims to delineate the formidable challenges faced during the early diagnosis of such cases, with the ultimate goal of averting missed diagnoses.
Methods: A 6-year-old female patient presented with the delayed eruption of bilateral maxillary central incisors. As early as 2 years old, tooth 62 was found to be impacted, accompanied by a supernumerary tooth in the anterior maxilla upon X-ray examination at another facility. Currently, for supernumerary tooth extraction, the child visited our hospital. Cone-beam Computed Tomography (CBCT) disclosed a supernumerary tooth between 11 and 21, along with a well-defined 5mm× 6mm× 6mm low-density shadow encircling the crown of impacted permanent tooth 62. The clinical diagnosis was anterior maxillary supernumerary tooth, impacted 62, and dentigerous cyst.
Results: Maxillary mass resection, extraction of impacted 62, and removal of the supernumerary tooth were carried out. Post-operative pathology confirmed AF, and long-term follow-up revealed no tumor recurrence.
Conclusion: Despite its rarity, AF should be contemplated in pediatric patients with tooth eruption delay and radiographic low-density lesions with irregular edge. This case offers invaluable insights for clinicians in diagnosing and managing small, early-stage lesions. Probing into the causes of non-erupted deciduous teeth may contribute to early lesion detection.

Keywords: odontogenic tumor, ameloblastic fibroma, supernumerary teeth, maxilla, pediatric dentistry