Recurrent Ameloblastic Fibroma of the Posterior Maxilla With Radiopaque Foci: A Diagnostic Challenge Within the Odontogenic Tumor Spectrum

Ameloblastic fibroma (AF) is classically defined as a benign mixed odontogenic tumor lacking calcified dental tissues and typically presenting as a radiolucent lesion in the posterior mandible of young patients. This case report presents a recurrent AF of the posterior maxilla in a 16‑year‑old girl, characterized by radiopaque foci and a discordance between radiological and histopathological findings. A panoramic radiograph and cone-beam computed tomography (CBCT) initially suggested an odontoma indirectly interfering with the eruption of tooth 27. Surgical enucleation revealed a radiolucent lesion containing distinct radiopaque structures and multiple gelatinous fragments, all removed and submitted for histopathological analysis. Repeated histopathological evaluations twice confirmed the diagnosis of AF without evidence of organized dental hard tissue or malignancy. Five years later, a routine follow‑up CBCT revealed a similar lesion at the same site, again managed by surgical enucleation and again diagnosed as AF. This case challenges current concepts in the World Health Organization odontogenic tumor classification, particularly the separation of AF from developing odontomas, and underscores the diagnostic complexity created by internal calcifications in lesions histologically lacking dental hard tissue. The findings emphasize the critical importance of extensive histopathological sampling and close clinico‑radiologic-pathologic correlation in atypical or recurrent mixed odontogenic tumors. It is also suggested that AF may occasionally exhibit limited inductive or calcific features, without justifying reclassification within the developing odontoma spectrum.