[4] Though it is generally regarded as benign, there have been cases of its malignant transformation into ameloblastic fibrosarcoma[5] and odontogenic sarcoma.
[6] Cahn LR and Blum T, believed in "maturation theory", which suggested that AFO was an intermediate stage and eventually developed during the period of tooth formation to a complex odontoma thus, being a hamartoma.
[7] World Health Organization (WHO) defines AFO as a neoplasm consisting of odontogenic ectomesenchyme resembling the dental papilla, epithelial strands and nest resembling dental lamina and enamel organ conjunction with the presence of dentine and enamel.
Such inductive changes along with proliferating odontogenic epithelium warrant AFO to be regarded as a separate entity.
[7] AFO exhibits the same benign biologic behavior as that of AF, along with inductive changes that lead to the formation of both dentin and enamel.
Massive maxillary AFOs cause destruction of the sinus, facial disfigurement, perforated the cortical plates or extended to the orbital floor-pterygoid region.
The amount of calcified material present is variable and hence the lesion may be either radiolucent, radio-opaque or mixed.
The odontogenic epithelium may be either arranged as follicles that resemble developing enamel organ or they may be seen as cords or strands.