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Grün P, Schneider B, Bandura P, Pfaffeneder-Mantai F, Bytyqi D, Turhani D. Bone remodelling after minimally invasive surgical management of a recurrent florid cemento-osseous dysplasia in a Caucasian woman – 18 years follow-up of a unique case - A case report. Int J Surg Case Rep 2023; 105:108074. [PMID: 36989622 PMCID: PMC10074572 DOI: 10.1016/j.ijscr.2023.108074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 03/29/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Florid cemento-osseous dysplasia (FCOD) is a multifocal fibro-osseous tumour originating from the periodontal ligament that presents as being rare, benign and slow-growing. The lesion is characterised by the replacement of regular bone-structure with fibrous tissue and dysplastic bone. Depending on localisation, the initial characteristics of FCOD resemble those of periapical lesions of inflammatory origin. CASE PRESENTATION We report on the current findings relating to the case of a 39-year-old Caucasian woman, who initially had persistent paresthesia of the right alveolaris inferior nerve (NAI) for longer than 2 weeks. The orthopantomogram showed multiple bilateral periapical radiolucency and a biopsy was indicated to rule out malignancy. Four years later, the radiolucency occurred once again in region 37, suggesting a recurrence of the lesion. Therefore, another minimally invasive surgery had to be performed, which revealed a bone cavity. Two years later, the bone of the affected region almost completely regenerated. CLINICAL DISCUSSION We were aware that an invasive treatment could lead to infection of the hypovascular lesion. Because of the paresthesia, a biopsy was essential. Unexpectedly, the second minimally invasive surgical treatment was a significant success, as the bone lesion regenerated almost completely. CONCLUSION The follow-up of this case was documented over more than 18 years. To date, this is the longest documented case of a FCOD. Minimally invasive surgical treatment of such lesions may lead to better bone regeneration and even a better quality of life for the patient.
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Nilius M, Nilius M, Müller C, Leonhardt H, Haim D, Novak P, Franke A, Weiland B, Lauer G. Multiple periapical dysplasias analyzed by cone-beam-computer tomography and 99Tcm-Scintigraphy. Radiol Case Rep 2021; 16:3757-3765. [PMID: 34630813 PMCID: PMC8493495 DOI: 10.1016/j.radcr.2021.08.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/22/2021] [Accepted: 08/25/2021] [Indexed: 11/27/2022] Open
Abstract
Periapical cemental dysplasia (PCD) is considered a non-neoplastic proliferation of fibrous tissues and cementum-like hard tissues, usually occurring in the periapical regions of teeth. PCD is characterized by the presence of vital pulp and is often accidentally discovered during a general radiographic survey. PCD may arise from the tissue of odontogenic origin or occur as a reactive process in the periapical tissue. Multilocular occurrences in both jaws are rare. However, we encountered a case of multiple PCDs by orthopantomography, which showed different degrees of maturation in the mandible and maxilla by osteodensitometric detection via cone-beam computed tomography (CB-CT) validated by Tc-99m bone-scintigraphy (BS). Biopsies confirmed the radiological results. CB-CT osteodensitometry allows for the categorization and assessment of different stages of PCD maturation from beginning to florid, detection of remittent osseous changes, and evaluation in the clinical follow-up. When using the local cortical bone as a reference value of 100%, periapical dysplasias show density values of 75% in the mandible and 80% in the maxilla. Early classification of PCD is possible with CB-CT osteodensitometry.
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Affiliation(s)
- Manfred Nilius
- Niliusklinik, Dept. of Oral and Maxillofacial Surgery, Dortmund, Germany.,Department of Oral and Maxillofacial Surgery, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
| | - Minou Nilius
- Niliusklinik, Dept. of Oral and Maxillofacial Surgery, Dortmund, Germany
| | - Charlotte Müller
- Niliusklinik, Dept. of Oral and Maxillofacial Surgery, Dortmund, Germany
| | - Henry Leonhardt
- Department of Oral and Maxillofacial Surgery, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
| | - Dominik Haim
- Department of Oral and Maxillofacial Surgery, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
| | - Patrick Novak
- Department of Oral and Maxillofacial Surgery, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
| | - Adrian Franke
- Department of Oral and Maxillofacial Surgery, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
| | - Bernhard Weiland
- Department of Oral and Maxillofacial Surgery, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
| | - Guenter Lauer
- Department of Oral and Maxillofacial Surgery, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
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Grün P, Bandura P, Grün A, Sutter W, Meller O, Turhani D. Sensory disturbance along the inferior alveolar nerve as a first clinical sign of multiple florid cemento-osseous dysplasia of the mandible-A case report. Int J Surg Case Rep 2018; 53:452-457. [PMID: 30567067 PMCID: PMC6277216 DOI: 10.1016/j.ijscr.2018.11.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 11/04/2018] [Accepted: 11/15/2018] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Florid cemento-osseous dysplasia (FCOD) is a rare, benign, slow growing, multifocal fibro-osseous tumour originating from the periodontal ligament. The lesion is characterised by regular bone-structure replacement with fibrous tissue and dysplastic bone. The initial characteristics of FCOD, depending on localisation, resemble those of periapical lesions of inflammatory origin, potentially leading to misdiagnosis. In the absence of infection signs, the treatment of choice is conservative therapy with antibiotics and regular follow-up examinations. PRESENTATION OF CASE We report the case of a 39-year-old Caucasian woman with sensory disturbance along the inferior alveolar nerve for >2 weeks. The involved teeth were vital and the digital orthopantomogram indicated multiple bilateral periapical brightening. Biopsy was indicated to exclude malignancy and to confirm the FCOD diagnosis with predominantly reactive calcification and cell-rich connective-tissue reaction. The sensory disturbances disappeared after the biopsy. Further conservative therapy included regular radiological examinations every 2 years to prevent surgical intervention due to infection risk. DISCUSSION Sensory disturbances around the nervus alveolaris inferior are well-known complications of dental and maxillofacial operations and of malignant tumours. Sensitivity disorder as a first symptom of fibro-osseous dysplasia has not been previously described. Although uncommon in its clinical behaviour, FCOD was finally diagnosed after thorough clinical, radiological, and histological examinations. CONCLUSION Paraesthesia combined with FCOD has not been previously described. Correct diagnosis is essential for proper treatment and to avoid further complications even when the clinical symptoms appear unrelated.
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Affiliation(s)
- Pascal Grün
- Centre for Oral and Maxillofacial Surgery, University of Dental Medicine and Oral Health, Danube Private University, Steiner Landstraße 124, 3500, Krems-Stein, Austria
| | - Patrick Bandura
- Centre for Oral and Maxillofacial Surgery, University of Dental Medicine and Oral Health, Danube Private University, Steiner Landstraße 124, 3500, Krems-Stein, Austria
| | - Andrew Grün
- Maxillofacial Private Surgery, Rottenburg am Neckar, Germany
| | - Walter Sutter
- Centre for Oral and Maxillofacial Surgery, University of Dental Medicine and Oral Health, Danube Private University, Steiner Landstraße 124, 3500, Krems-Stein, Austria
| | - Oliver Meller
- Centre for Oral and Maxillofacial Surgery, University of Dental Medicine and Oral Health, Danube Private University, Steiner Landstraße 124, 3500, Krems-Stein, Austria
| | - Dritan Turhani
- Centre for Oral and Maxillofacial Surgery, University of Dental Medicine and Oral Health, Danube Private University, Steiner Landstraße 124, 3500, Krems-Stein, Austria.
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Borghesi A, Tonni I, Pezzotti S, Maroldi R. Peripheral osteoma, compound odontoma, focal cemento-osseous dysplasia, and cemento-ossifying fibroma in the same hemimandible: CBCT findings of an unusual case. Radiol Case Rep 2017; 12:756-759. [PMID: 29484064 PMCID: PMC5823294 DOI: 10.1016/j.radcr.2017.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 08/04/2017] [Accepted: 08/20/2017] [Indexed: 11/16/2022] Open
Abstract
Peripheral osteoma is the most common subtype of osteoma that arises most frequently in the craniofacial bones. It may occur at any age with a male-to-female ratio of 2:1. Peripheral osteoma may affect the mandible, particularly the ramus and the condyle. Compound odontoma is a subtype of odontoma that occurs in young subjects without gender predilection. It affects the maxilla more frequently than the mandible. Focal cemento-osseous dysplasia and cemento-ossifying fibroma are 2 benign fibro-osseous lesions with a female predominance that occur most commonly in the posterior region of the mandible. We report the first case involving the simultaneous occurrence of these 4 benign lesions in the same hemimandible diagnosed by CBCT.
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Affiliation(s)
- Andrea Borghesi
- Department of Radiology, Medical School, University of Brescia, Piazzale Spedali Civili 1, I 25123, Brescia, Italy
| | - Ingrid Tonni
- Dental Clinic, Dental School, University of Brescia, Italy
| | - Stefania Pezzotti
- Department of Radiology, Medical School, University of Brescia, Piazzale Spedali Civili 1, I 25123, Brescia, Italy
| | - Roberto Maroldi
- Department of Radiology, Medical School, University of Brescia, Piazzale Spedali Civili 1, I 25123, Brescia, Italy
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Mortazavi H, Baharvand M, Rahmani S, Jafari S, Parvaei P. Radiolucent rim as a possible diagnostic aid for differentiating jaw lesions. Imaging Sci Dent 2015; 45:253-61. [PMID: 26730374 PMCID: PMC4697011 DOI: 10.5624/isd.2015.45.4.253] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 09/01/2015] [Accepted: 09/05/2015] [Indexed: 01/30/2023] Open
Abstract
In this study, we formulate a new proposal that complements previous classifications in order to assist dental practitioners in performing a differential diagnosis based on patients' radiographs. We used general search engines and specialized databases such as Google Scholar, PubMed, PubMed Central, MedLine Plus, Science Direct, Scopus, and well-recognized textbooks to find relevant studies by using keywords such as "jaw disease," "jaw lesions," "radiolucent rim," "radiolucent border," and "radiolucent halo." More than 200 articles were found, of which 70 were broadly relevant to the topic. We ultimately included 50 articles that were closely related to the topic of interest. When the relevant data were compiled, the following eight lesions were identified as having a radiolucent rim: periapical cemento-osseous dysplasia, focal cemento-osseous dysplasia, florid cemento-osseous dysplasia, cemento-ossifying fibroma, osteoid osteoma, osteoblastoma, odontoma, and cementoblastoma. We propose a novel subcategory, jaw lesions with a radiolucent rim, which includes eight entities. The implementation of this new category can help improve the diagnoses that dental practitioners make based on patients' radiographs.
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Affiliation(s)
- Hamed Mortazavi
- Department of Oral Medicine, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Baharvand
- Department of Oral Medicine, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Somayeh Rahmani
- Department of Oral Medicine, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soudeh Jafari
- Department of Oral Medicine, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parvin Parvaei
- Department of Oral Medicine, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Delai D, Bernardi A, Felippe GS, da Silveira Teixeira C, Felippe WT, Santos Felippe MC. Florid Cemento-osseous Dysplasia: A Case of Misdiagnosis. J Endod 2015; 41:1923-6. [PMID: 26410152 DOI: 10.1016/j.joen.2015.08.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 08/15/2015] [Accepted: 08/20/2015] [Indexed: 11/29/2022]
Abstract
Florid cemento-osseous dysplasia (FCOD) belongs to the group of fibro-osseous lesions in which normal bone is replaced by fibrous connective tissue and calcified cementum tissue of the avascular type. Among the various types of fibro-osseous lesions, FCOD is one of the most commonly encountered diseases in clinical practice and may involve 3 or 4 of the quadrants. FCOD is located in the periapical regions of teeth, and the lesions are predominantly radiolucent (osteolytic phase), become mixed over time (cementoblast phase), and ultimately become radiopaque (osteogenic phase) with a thin radiolucent peripheral halo. The characteristics of FCOD in the initial stages are similar to those of periapical lesions of inflammatory origin, which may lead to misdiagnosis. A 38-year-old woman sought dental care because of complaints of pain on the right side of her face. A clinical examination revealed no marked alterations; a panoramic radiograph was therefore requested and revealed the presence of radiolucent lesions associated with the periapical regions of some of the lower teeth. Thus, the professional referred the patient for endodontic treatment of the associated teeth with the justification that the lesions were of endodontic origin. However, the endodontist found that the teeth responded positively to a sensitivity test. The initial diagnosis could have resulted in unnecessary root canal treatment, but after careful clinical, radiographic, and tomographic assessments by different professionals, FCOD was diagnosed, conservatively treated, and regularly monitored. It is important that dentists have a basic knowledge of the various injuries that affect the jaw bones to prevent errors in diagnosis and treatment and to promote oral health.
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Affiliation(s)
- Débora Delai
- Postgraduate Program, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - Anarela Bernardi
- Postgraduate Program, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - Gabriela Santos Felippe
- Postgraduate Program, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | | | - Wilson Tadeu Felippe
- Department of Endodontics, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
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Eskandarloo A, Yousefi F. CBCT findings of periapical cemento-osseous dysplasia: A case report. Imaging Sci Dent 2013; 43:215-8. [PMID: 24083217 PMCID: PMC3784683 DOI: 10.5624/isd.2013.43.3.215] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 02/22/2013] [Accepted: 03/01/2013] [Indexed: 11/24/2022] Open
Abstract
Periapical cemento-osseous dysplasia (PCOD) is a subtype of cemento-osseous dysplasia that usually occurs in middle-aged black women. This report described a case of a 45-year-old Iranian woman who was diagnosed with PCOD on the basis of cone beam computed tomographic (CBCT) findings. CBCT enabled detailed visualization of the bone changes. This report described the special radiographic characteristics of PCOD, including discontinuity of the lingual cortex on the CBCT sectional and three-dimensional images.
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Affiliation(s)
- Amir Eskandarloo
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Hamadan University of Medical Science, Hamadan, Iran
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Huh JK, Shin SJ. Misdiagnosis of florid cemento-osseous dysplasia leading to unnecessary root canal treatment: a case report. Restor Dent Endod 2013; 38:160-6. [PMID: 24010083 PMCID: PMC3761125 DOI: 10.5395/rde.2013.38.3.160] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 05/20/2013] [Accepted: 05/23/2013] [Indexed: 11/16/2022] Open
Abstract
This case report demonstrates an unnecessary endodontic treatment of teeth with florid cemento-osseous dysplasia (FCOD) due to a misdiagnosis as periapical pathosis and emphasizes the importance of correct diagnosis to avoid unnecessary treatment. A 30-year-old woman was referred to our institution for apicoectomies of the mandibular left canine and both the lateral incisors. The periapical lesions associated with these teeth had failed to resolve after root canal treatment over a 3-year period. Radiographic examinations revealed multiple lesions on the right canine, the second premolar, and both first molars as well as the anterior region of the mandible. Based on clinical, radiographic and histological evaluations, the patient condition was diagnosed as FCOD. The patient has been monitored for 2 years. To avoid unnecessary invasive treatment, accurate diagnosis is essential before treatment is carried out in managing FCOD.
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Affiliation(s)
- Jong-Ki Huh
- Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, Korea
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