Follicular adenomatoid odontogenic tumor in adolescents: A systematic review of tooth-preserving management and a consecutive case report

Background: The conventional management of follicular adenomatoid odontogenic tumor (AOT) involves the extraction of the associated impacted tooth. This systematic review incorporating a consecutive case aims to evaluate the feasibility and outcomes of a conservative, tooth-preserving strategy for follicular AOT in adolescents. Methods: A systematic search was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines across multiple databases (PubMed/MEDLINE, Embase, Web of Science, Scopus, CENTRAL) and trial registries from inception to August 15, 2025. Studies reporting on tooth-preserving management of histopathologically confirmed follicular AOT were included. A consecutive case of a 15-year-old female with a follicular AOT in the mandible affecting tooth #44 was incorporated and analyzed alongside the extracted data. Results: The review included 7 studies (7 cases) from the literature, which were pooled with the present case for a total of 8 patients (mean age: 14.1 years). All cases successfully retained the involved tooth with no recurrence reported during a mean follow-up of 23.1 months (range: 9–48 months). Primary treatment involved enucleation/curettage in 7 cases and marsupialization in one. Orthodontic traction was used to guide eruption in 7 teeth, while 1 tooth (the present case) erupted spontaneously following space maintenance. Factors associated with success included adolescent age, well-defined lesion borders, and teeth at favorable developmental stages (Nolla stage VIII-IX). Conclusion: This systematic review demonstrates that intentional tooth preservation is a viable management strategy for selected cases of follicular AOT in adolescents. The approach successfully avoids permanent tooth loss without increasing the risk of recurrence in the short-to-mid term, aligning with the benign biology of AOT. Key factors for success are identified to guide case selection. Nevertheless, long-term follow-up is essential to confirm the durability of these outcomes, and future prospective studies with larger cohorts are warranted to strengthen the evidence base.