To evaluate whether selected large ameloblastomas (maximum diameter ≥50 mm) could be initially managed with a jaw-preserving strategy and to describe treatment trajectories during repetitive dredging.

We retrospectively reviewed consecutive ameloblastoma patients treated at a single institution between August 2011 and September 2022. Patients with a maximum tumor diameter of ≥50 mm on preoperative CT who underwent initial jaw-preserving management (enucleation alone or repetitive dredging) were included. In the repetitive dredging cohort, the primary endpoint was 2-year event-free status (EFS2), with events defined as histopathologically confirmed recurrence or conversion to definitive resection. Secondary endpoints included dredging burden and achievement of pathological and confirmed clearance.

Thirteen patients met the eligibility criteria, of whom four underwent repetitive dredging. EFS2 was 75% (3/4). One patient underwent hemimandibulectomy 12 months after the first dredging session because of persistent histopathological positivity. No recurrence occurred within 2 years. During longer follow-up, one patient developed histopathologically confirmed recurrence after confirmed clearance, approximately 3.5 years after the first dredging session. The number of dredging sessions ranged from 3 to 5, and confirmed clearance was achieved in three patients.

In this small retrospective descriptive study, jaw-preserving management was observed in highly selected large ameloblastoma cases. Within this strategy, persistent histopathological positivity supported timely conversion to definitive resection, whereas recurrence could still occur after confirmed clearance. These findings should be interpreted as hypothesis-generating and support continued long-term surveillance.