Diagnostic Challenges in Differentiating Unicystic Ameloblastoma From Odontogenic Cysts: Report of Two Cases

Ameloblastomas are benign odontogenic tumors characterized by local aggressiveness and a high potential for recurrence. Unicystic ameloblastoma (UA) is an uncommon variant that often mimics odontogenic cysts, making preoperative diagnosis challenging. Early and accurate differentiation is essential for guiding appropriate treatment planning and minimizing the risk of recurrence. This study is aimed at reporting two cases highlighting the diagnostic dilemma posed by UA. The first case involves a 65-year-old male patient with a well-defined unilocular radiolucency extending from Teeth 35 to 44. Clinical and radiographic findings initially suggested a benign odontogenic cyst. However, cone beam computed tomography (CBCT) revealed cortical perforation, and histopathological examination confirmed a diagnosis of a mural unicystic ameloblastoma. The second case concerns a 20-year-old female patient who consulted with the chief complain of incidental discovery of a radiolucent image associated with an impacted wisdom mandibular right tooth during follow-up orthodontic treatment on panoramic radiography. CBCT showed cortical expansion and thinning, with mandibular canal displacement. The differential diagnosis included a dentigerous cyst, an odontogenic keratocyst, and UA. Histopathological analysis confirmed a follicular ameloblastoma. These cases emphasize the importance of correlating clinical, radiographic, and histopathological findings to differentiate UA from cystic odontogenic lesions. Advanced imaging modalities such as CBCT, combined with histological examination, remain essential for a precise diagnosis and suitable treatment plan.