Central odontogenic fibroma, hyperplastic dental follicle, or dentigerous cyst? A diagnostic dilemma: A case report.

Central odontogenic fibroma (COF) is an extremely rare benign odontogenic tumor, which is associated with an unerupted tooth in one-third of the cases. Hyperplastic dental follicle (HDF) is an odontogenic hamartomatous lesion associated with delayed or tooth eruption failure in young patients. Dentigerous cyst (DC) is an epithelial-lined developmental cyst surrounding the crown of an unerupted or impacted tooth. Here, we present a case of 13-year-old boy with pericoronal radiolucency around impacted right maxillary canine tooth, which detected during routine dental examination on panoramic radiograph. The size of radiolucency was varied between 5 and 10 mm and was asymmetrical. Lesion was underwent biopsy with suspicion to a dentigerous cyst. On microscopic examination, the lesion was composed of a cellular fibrous connective tissue with odontogenic epithelium in the form of strands or nests throughout the lesion and calcifications in the form of basophilic cementum-like material and dentinoid. Due to its nonspecific histological features, we encountered a diagnostic dilemma. In this case report, we discuss the clinical and radiologic features of COF, DC, and HDF. We preferred COF for this lesion. By combining surgical and orthodontic treatments, the impacted tooth was directed to its correct position in the maxilla. This case report highlights the importance of clinicopathological correlation in the diagnosis of pericoronal radiolucencies.