Ossifying fibroma (OF) is a rare benign fibro-osseous neoplasm developing mostly in maxillo-facial bones. OF is divided in cemento-ossifying fibroma (COF), juvenile trabecular ossifying fibroma (JTOF) and psammomatoid ossifying fibroma (PSOF). The aim of this systematic review was to synthetize the existing literature on OF, investigating the clinical and radiological parameters related to the different forms of the disease, and to compare the treatment modalities according to their associated recurrence rate. Three databases were searched in March 2024, with an update in September 2024. Eligibility criteria included studies reporting on patients with OF, surgical treatment and follow-up data. Of the 2016 studies identified, 22 were retained after eligibility assessment. A total of 492 patients were included. Most OF presented with painless swelling. COF affected 61.1 % of women with a mean age of 29.5, JTOF presented in 55.7 % of male children, and PSOF had no predilection for sex with a mean age of 19.5 years. Enucleation and curettage were associated with an elevated recurrence rate in JTOF (12/30) and PSOF (10/16). PSOF (6 cases) and JTOF (15 cases) showed no recurrence with radical surgery. Same recurrence rates in COF were seen for conservative and radical surgery. Although radical surgery seemed to avoid recurrence in JTOF and PSOF, conservative surgery such as enucleation and curettage with additional peripheral ostectomy should be considered primarily to lessen the morbidity induced by radical resection. Close clinical and radiological follow-up should be undertaken to diagnose early recurrence.