Challenge in treatment of recurring peripheral ameloblastoma at mandibular premolar region

Ameloblastoma is ranged to be 1% of all oral tumour and also 11% of all types of odontogenic tumour. The World Health Organization (WHO) 2005 histological classification of odontogenic neoplasms; describes ameloblastoma as a benign yet locally invasive epithelial odontogenic tumour of enamel organ origin. Ameloblastoma is postulated to arise from either the remnants of dental lamina, epithelial lining of an odontogenic cyst, or from the basal cells of the oral mucosa. In general, ameloblastoma is classified as conventional intraosseus form; categorized further as solid, multicystic or unicystic while the extraosseus ameloblastoma is an untypical form. Male to female ratio of conventional ameloblastoma occurrence is 2:1 with more predilection towards mandible as compared to maxilla. Histologically its feature appears similar to that of cutaneous basal cell carcinoma, while it can be well differentiated from peripheral odontogenic fibroma. Peripheral ameloblastoma is an extraosseus type, rare form of ameloblastoma that proliferates on the soft tissue of tooth bearing region. It is usually an exophytic odontogenic tumour that exhibits with either smooth or irregular surface and is mainly located in the mandibular region namely the gingival area. This lesion is mainly limited by the periosteum but a larger lesion can have features of bony marginal saucerization as well as displacement of teeth. We hereby report a case of recurring peripheral ameloblastoma on the mandibular left premolar region in a 37-year-old Malay gentleman seen at the Department of Oral Maxillofacial Surgery, Faculty of Dentistry, International Islamic University Malaysia