The 40-years of experience in a single institution with the treatment of previously untreated ameloblastoma have been reported, followed by a management protocol. Retrospectively, 25 consecutive patients treated between 1969 and 2009 have been analyzed. In 11 patients, a preoperative diagnosis of ameloblastoma was available. In the remaining 14 patients the diagnosis of ameloblastoma was a postoperative one. For the recurrence rate a minimum follow-up period of 5 years was observed; 20 patients met these criteria. After primary radical surgery in five patients, no recurrences were observed. In case of conservative surgical treatment, performed in 15 patients, a recurrence was observed in eight (53%) of them. Six of these patients were then treated successfully by radical surgery, while two patients refused such surgical approach. In one of the patients with a recurrence a cervical lymph node metastasis was detected at the same time, resulting in a diagnosis of metastasizing ameloblastoma.