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Nemec SF, Schneider S, Friedrich KM, Weber M, Schwarz-Nemec U. Radiological follow-up of cemento-osseous dysplasia on cone-beam computed tomography. J Craniomaxillofac Surg 2024; 52:644-651. [PMID: 38582672 DOI: 10.1016/j.jcms.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 03/12/2024] [Indexed: 04/08/2024] Open
Abstract
This study investigated the natural course of cemento-osseous dysplasia (COD) on cone-beam computed tomography (CBCT). Retrospectively, 104 CBCT scans from 36 patients (mean age, 44.5 years; 33 female and three male) with mandibular COD (10 florid, seven focal, 19 periapical) were included, based upon clinico-radiological features, without complications such as infection and related surgery. Changes in maximum diameter and morphology (lytic, mixed lytic-sclerotic, sclerotic) were evaluated in 83 lesions, with a mean follow-up of 28.3 months. The occurrence of a diameter increase was assessed by time-to-event analysis; interreader agreement for diameter and morphological evaluation by intraclass correlation coefficient and weighted κ statistics, respectively. Fifteen of 83 (18.1%) lesions (eight florid, one focal, six periapical) in 10 patients increased in diameter; 12 of 83 (14.5%) lesions (five florid, seven periapical) in 11 patients changed morphologically. The median period until a diameter increase was longest (120 months) for periapical COD, and shortest (66 months) for florid COD (p = 0.023). There was high reader agreement (ICC = 0.891; weighted κ = 0.901). In conclusion, CBCT is an effective tool with which to follow-up COD. If any, the natural progress in uncomplicated COD is prolonged, which underlines its non-surgical character and aids in its long-term management.
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Affiliation(s)
- Stefan F Nemec
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Vienna, Austria
| | - Steffen Schneider
- Department of Oral and Maxillofacial Surgery, Medical University of Vienna, Vienna, Austria
| | - Klaus M Friedrich
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Vienna, Austria.
| | - Michael Weber
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Vienna, Austria
| | - Ursula Schwarz-Nemec
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Vienna, Austria
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2
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Albagieh H, Aldosari M, Alkhathlan A, Alfawaz N, Almutairi M. Radiolucent lesions that may resemble inflammatory periapical lesions: A review article. Saudi Dent J 2023; 35:916-919. [PMID: 38107039 PMCID: PMC10724350 DOI: 10.1016/j.sdentj.2023.11.003] [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: 08/16/2023] [Revised: 11/02/2023] [Accepted: 11/02/2023] [Indexed: 12/19/2023] Open
Abstract
Non-endodontic lesions (NEL) closely resemble lesions of endodontic origin. Its etiology can be odontogenic, non-odontogenic, neoplastic, or anatomic variations that can resemble inflammatory periapical lesions in the periapical area. Inflammatory periapical lesions are caused by pulpal pathoses and require endodontic treatment. Since numerous NEL may resemble inflammatory periapical lesions, they can lead to misdiagnosis and inappropriate management. Thus, a detailed review of the patients' medical and dental histories with clinical examination, including radiographic findings, is essential for the proper assessment of periapical lesions. Numerous cases of misdiagnoses of NEL have been reported in literature. Thus, this review aimed to strengthen the awareness of clinicians on periapical radiolucency, which may resemble inflammatory periapical lesions.
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Affiliation(s)
- Hamad Albagieh
- Oral Medicine and Diagnostic Sciences Department, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | | | | | - Nawaf Alfawaz
- College of Dentistry, King Saud University, Riyadh, Saudi Arabia
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Zhang J, Yu Y, Tang W, Pan J, Jing W. Cemento-Osseous Dysplasia: A Detailed Comparison of the 2005 and 2017 WHO Classifications and Case Analysis. Cureus 2023; 15:e49041. [PMID: 38116337 PMCID: PMC10729712 DOI: 10.7759/cureus.49041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2023] [Indexed: 12/21/2023] Open
Abstract
The WHO substantially redefined cemento-osseous dysplasia (COD) in 2017. The descriptions of COD in the 2005 and 2017 WHO classifications are quite different. In this study, we compared the difference in COD description between the 2005 and 2017 editions of the WHO classifications in detail. There are remarkable differences in the terminology, definition, synonyms, epidemiology, classifications, clinical features, radiation/pathology, prognosis, and predictive factors of COD between the two versions. At present, the surgical treatment of COD is less defined, and there is no clear guidance for the treatment of sclerotic bone. In this study, we extracted the affected teeth without removing the sclerotic bone when the bone absorption line can be only found between the root and the lesion, and we extracted the teeth as well as the lesion and curetted the granulation tissue when a bone absorption line could be seen between the lesion and the alveolar bone. According to our observation, the position of the bone absorption line can be used as a reference for the selection of sclerotic bone treatment. Sclerotic bone preservation did not increase its volume and density after tooth extraction. Sclerotic bone was composed of highly mineralized tissue with less blood vessels and cells. The position of the bone resorption line can be used as a basis for treatment selection. The high mineralization of the lesion may weaken its anti-infection ability.
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Affiliation(s)
- Jiankang Zhang
- Department of Oral and Maxillofacial Surgery, State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, CHN
| | - Yunbo Yu
- Department of Oral and Maxillofacial Surgery, Stomatological Hospital of Chongqing Medical University, Chongqing, CHN
| | - Wei Tang
- Department of Oral and Maxillofacial Surgery, State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, CHN
| | - Jian Pan
- Department of Oral and Maxillofacial Surgery, State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, CHN
| | - Wei Jing
- Department of Oral and Maxillofacial Surgery, State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, CHN
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4
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Ebrahimi F, Ebrahimi F, An J. Surgical Management of Infection Secondary to Cemento-osseous Dysplasia. J Craniofac Surg 2023; 34:e614-e617. [PMID: 37552103 DOI: 10.1097/scs.0000000000009556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 06/01/2023] [Indexed: 08/09/2023] Open
Abstract
Cemento-osseous dysplasia (COD) of the jaws generally has no clinical manifestations when asymptomatic, thus requiring no treatment. However, secondary infection in COD requires surgical intervention. This study was focused on the evaluation of the surgical treatment of COD patients with secondary infections. The clinical data of COD patients with secondary infections, treated at the Peking University, Hospital of Stomatology between March 2021 and June 2022, were retrospectively reviewed. The data included age, sex, lesion characteristics, number of surgeries, and surgical outcomes. Seven COD patients with secondary infections underwent curettage, and the wounds were repaired using local soft tissue flaps, such as the buccal fat pad. Four of the patients had primary wound healing, while 3 presented with wound dehiscence. Healing occurred in 2 of these 3 patients after ~1 month of dressings. The remaining patient showed no improvement after 9 weeks, and underwent a second surgery, which led to primary wound healing. In conclusion, secondary infection in COD is an indication for surgical intervention, which may arrest the disease progression.
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Affiliation(s)
- Farin Ebrahimi
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology South Avenue Zhongguancun, Haidian District, Beijing, PR China
| | - Faraz Ebrahimi
- Department of Prosthodontics, Peking University School and Hospital of Stomatology, Beijing China
| | - Jingang An
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology South Avenue Zhongguancun, Haidian District, Beijing, PR China
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Modi K, Padmapriya R, Elango S, Khandelwal P, Arul B, Natanasabapathy V. Nonmalignant nonendodontic lesions mimicking periapical lesions of endodontic origin: A systematic review. J Conserv Dent 2022; 25:214-225. [PMID: 35836562 PMCID: PMC9274689 DOI: 10.4103/jcd.jcd_13_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 01/24/2022] [Accepted: 01/30/2022] [Indexed: 11/04/2022] Open
Abstract
The objective of the study is to describe the clinical and radiographic features of nonmalignant nonendodontic periapical lesions (NMNPLs) mimicking lesions of endodontic cause. Five electronic databases, PubMed, Web of Science, Scopus, Embase, and ProQuest, were searched (till July 2021) for case reports, case series, and cross-sectional studies, in English language, reporting NMNPLs, which were clinically and/or radiographically simulating periapical pathosis of endodontic origin. Data extraction was done followed by quality assessment of the included articles using the Joanna Briggs Institute tool for case reports and case series. Seventy-three articles comprising 176 cases were included. Sixty-one articles were case reports, nine articles were case series, and three articles were retrospective studies. Male:female ratio was 1.5:1, with a higher prevalence of lesions occurring in the fourth and second decades of life. The majority of the lesions were located in the anterior maxilla. Radiographically, most of the lesions were well defined, radiolucent, and unilocular. Histologically, 29 different types of NMNPLs were reported, with the most common ones being odontogenic keratocyst (25.56%), dentigerous cyst (17.61%), ameloblastoma (11.36%), nasopalatine duct cyst (10.79%), and adenomatoid odontogenic tumor (5.68%). As all the included studies were observational, the quality of available evidence is considered low. Various features such as loss of tooth vitality, history of trauma, and presence of periapical radiolucency may lead to misdiagnosis of NMNPLs and must be considered during diagnosis of the lesion. Additional imaging modalities and histopathology can aid in right diagnosis.
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Affiliation(s)
- Kajal Modi
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Meenakshi Academy of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Ramanujam Padmapriya
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Meenakshi Academy of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Subashini Elango
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Meenakshi Academy of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Priyal Khandelwal
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Meenakshi Academy of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Buvaneshwari Arul
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Meenakshi Academy of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Velmurugan Natanasabapathy
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Meenakshi Academy of Higher Education and Research, Chennai, Tamil Nadu, India,Address for correspondence: Dr. Velmurugan Natanasabapathy, Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Meenakshi Academy of Higher Education and Research, Chennai, Tamil Nadu, India. E-mail:
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Gumru B, Akkitap MP, Deveci S, Idman E. A retrospective cone beam computed tomography analysis of cemento-osseous dysplasia. J Dent Sci 2021; 16:1154-1161. [PMID: 34484583 PMCID: PMC8403794 DOI: 10.1016/j.jds.2021.03.009] [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: 03/08/2021] [Revised: 03/14/2021] [Accepted: 03/15/2021] [Indexed: 11/26/2022] Open
Abstract
Background/purpose Radiological examination is indispensable in the diagnosis and follow-up of cemento-osseous dysplasia (COD). The aim of this retrospective study was to describe a series of COD cases, identify the frequencies of COD subtypes, and investigate the demographic and radiological characteristics in relation to subtypes. Materials and methods Cone beam computed tomography (CBCT) images/reports of patients with a diagnosis of COD were included in the study. The data collected included information on the age, sex, subtype of COD, location of COD, and region involved. Information regarding the internal density, effects on surrounding structures, and presence of concomitant lesions was also collected. The data obtained were evaluated statistically. Results The study group included CBCT images of 142 patients (130 females (91.5%) and 12 males (8.5%)) with a mean age of 46.97 ± 10.57 years. The mandible was involved in almost all cases (99.3%). The most common subtype was florid COD (51.4%) and lesions with hyperdense internal density (81.7%) were more commonly observed. Cortical thinning (78.2%) was a prominent feature. The frequency of root resorption in periapical COD cases (57.1%) was observed to be significantly higher (p < 0.05). All hypercementosis cases were associated with florid subtype (p < 0.05). In a minority of cases (6.3%), the lesions were associated with bone cysts and osteomyelitis. Conclusion CBCT images clearly demonstrated the effect of COD lesions on surrounding structures. CBCT is an appropriate imaging modality for the diagnosis and follow-up of COD which is the most common fibro-osseous lesion in clinical practice.
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Affiliation(s)
- Birsay Gumru
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Marmara University, Istanbul, Turkey
| | - Melda Pelin Akkitap
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Marmara University, Istanbul, Turkey
| | - Sevilay Deveci
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Marmara University, Istanbul, Turkey
| | - Ender Idman
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Marmara University, Istanbul, Turkey
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Guimarães GG, Perez DE, Netto JD, Costa AC, Leonel AC, Castro JF, Pires FR. Nonendodontic periapical lesions: a retrospective descriptive study in a Brazilian population. Med Oral Patol Oral Cir Bucal 2021; 26:e502-e509. [PMID: 33772568 PMCID: PMC8254893 DOI: 10.4317/medoral.24379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 02/22/2021] [Indexed: 12/12/2022] Open
Abstract
Background Several nonendodontic diseases can occur in the periapical region, resembling endodontic inflammatory conditions. Therefore, the aim of the present study was to determine the frequency of nonendodontic periapical lesions diagnosed in a Brazilian population.
Material and Methods The files of two Oral Pathology laboratories were reviewed and all cases including at least one clinical diagnosis of endodontic periapical lesions were selected for the study. After initial selection, demographic and clinical data, clinical diagnosis and final diagnosis were reviewed and tabulated. Final diagnosis included endodontic periapical lesions, and benign and malignant nonendodontic periapical lesions. Data were descriptively and comparatively analyzed among the three groups, with a significance level of 5% (p<0.05).
Results Nonendodontic periapical lesions were identified in 208 (19%) out of the 1.125 registries included in the final sample. Benign nonendodontic periapical lesions (200 cases, 18%) were mostly odontogenic keratocysts, ameloblastomas, nasopalatine cysts, dentigerous cysts, glandular odontogenic cysts, and benign fibroosseous lesions. Malignant nonendodontic periapical lesions (8 cases, 1%) included carcinomas, adenocarcinomas, and melanoma. In general, nonendodontic periapical lesions were more common in males and in the posterior mandible (p>0.05).
Conclusions The frequency of nonendodontic periapical lesions was high and, although the general distribution was similar to the results from other populations, some features were probably associated with the profile of the studied populations and to the methods applied in the present study. Knowledge on differential diagnosis of endodontic and nonendodontic periapical lesions is essential to avoid unnecessary treatments and diagnostic delay in routine dental practice. Key words:Differential diagnosis, nonendodontic, periapical lesion, pulp necrosis.
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Affiliation(s)
- G-G Guimarães
- Post graduation Program in Dentistry, Estácio de Sá University Av. Alfredo Baltazar da Silveira, 580 cobertura CEP 22790-701, Recreio dos Bandeirantes, Rio de Janeiro/RJ, Brazil
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8
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Farah CS, Matias MAT. Natural history of florid osseous dysplasia of the jaws with important clinical implications. AUST ENDOD J 2021; 47:684-689. [PMID: 34062036 DOI: 10.1111/aej.12530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 05/09/2021] [Accepted: 05/13/2021] [Indexed: 11/30/2022]
Abstract
Osseous dysplasia (OD) is the most common fibro-osseous lesion of the jaws. A number of cases of florid osseous dysplasia (FOD) have been described; however, to our knowledge none have shown radiographic disease progression for a single case involving multiple regions of the jaws over an extended period of time. This report presents the 18-year history and radiographic disease progression of a patient diagnosed with FOD demonstrating progression from the osteolytic phase through the osteoblastic phase and to maturation phase at different intervals. Additionally, it outlines the importance of cone beam computed tomography (CBCT) in diagnostic workup to avoid unnecessary and invasive treatment such as bone biopsy, endodontic treatment or tooth extraction due to misdiagnosis of FOD. Dental practitioners should establish a correct diagnosis themselves by making use of important clinical and radiographic cues such as tooth vitality of affected teeth, or by referral to an appropriate specialist before commencing irreversible dental treatment.
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Affiliation(s)
- Camile S Farah
- The Oral Medicine Clinic, Hollywood Private Hospital, Nedlands, Western Australia, Australia.,Qscan Radiology Clinics, Brisbane, Queensland, Australia
| | - Marie Anne T Matias
- Qscan Radiology Clinics, Brisbane, Queensland, Australia.,Perth Radiological Clinic, Subiaco, Western Australia, Australia
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Panta P, Shahid I, Patil S, Seshadri M. Florid Cemento-osseous Dysplasia: A Report of Two Cases and Literature Review. J Contemp Dent Pract 2021; 22:304-309. [PMID: 34210933 DOI: 10.5005/jp-journals-10024-3029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
AIM This report aims to provide the clinical and radiographic features of two symptomatic Indian patients with florid cemento-osseous dysplasia (FCOD), along with a discussion of the differential diagnosis, potential challenges, and therapeutic implications. BACKGROUND FCOD is a rare, multifocal, periapical, and bilateral condition involving the premolar and molar region of the posterior mandible and sometimes the maxilla. CASE DESCRIPTION The first patient is a 30-year-old female with a recent history of dental pain. The patient was otherwise healthy and the medical history was unremarkable. The second patient is a 50-year-old female with a history of orthodontic therapy. Radiographic evaluation using cone-beam computed tomography (CBCT) revealed bilateral involvement of the posterior mandible, sparing the entire maxilla in both patients Clinical significance: For a pathognomonic condition like FCOD, a radiology survey alone is often sufficient to arrive at the final diagnosis, and therefore surgical interventions should ideally be avoided.
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Affiliation(s)
- Prashanth Panta
- Department of Oral Medicine and Radiology, MNR Dental College and Hospital, Sangareddy, Telangana, India, Phone: +91-9701806830, e-mail:
| | - Imran Shahid
- Department of Oral Medicine and Radiology, MNR Dental College and Hospital, Sangareddy, Telangana, India
| | - Shankargouda Patil
- Department of Maxillofacial Surgery and Diagnostic Sciences, Division of Oral Pathology, College of Dentistry, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Mukund Seshadri
- Department of Oral Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, United States
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Shibata N, Inamoto K, Naitoh M, Ariji E. Clinical assessment of cemento-osseous dysplasia based on three-dimensional diagnostic imaging: A case report. AUST ENDOD J 2021; 47:105-112. [PMID: 33523556 DOI: 10.1111/aej.12488] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 12/31/2022]
Abstract
Cemento-osseous dysplasia (COD) is a lesion in which periapical bone is replaced by fibrous tissue, including osseous or cementum-like tissue. In the initial stage of COD, radiolucencies are noted at the root apex on periapical radiography, which can be confused with apical periodontitis. Understanding of correct pathological condition and careful assessment of COD is critical to avoid unnecessary endodontic interventions in healthy teeth. This report describes the ability and usefulness of cone-beam computed tomography (CBCT) and multi-slice computed tomography (MSCT) to detect COD. The findings in this case suggest that MSCT is more appropriate than CBCT, especially for patients with early- to middle-stage COD. However, the radiation dose is higher in MSCT than in CBCT; the application of MSCT should be limited to assessment of whether treatment or surgical management is necessary.
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Affiliation(s)
- Naoki Shibata
- Department of Endodontics, School of Dentistry, Aichi Gakuin University, Aichi, Japan
| | - Kyoko Inamoto
- Department of Endodontics, School of Dentistry, Aichi Gakuin University, Aichi, Japan
| | - Munetaka Naitoh
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Aichi Gakuin University, Aichi, Japan
| | - Eiichiro Ariji
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Aichi Gakuin University, Aichi, Japan
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Abstract
Odontogenic cysts are epithelial-lined pathologic cavities and surrounded by fibrous connective tissue that originate from odontogenic tissues that occur in tooth-bearing regions of maxilla and mandible. Cystic conditions of the jaw cause bony destruction and may cause resorption or displacement of adjacent teeth. Odontogenic cysts have developmental or inflammatory origins. More cases have been published in the adult age group than the pediatric population. Periapical cyst and dentigerous cysts are frequently reported conditions in dental practice. Histopathologic examination remains the gold standard investigation. Odontogenic cysts are managed with enucleation or marsupialization procedures. Early recognition and referral to oral surgery minimize the extent of jaw bone destruction.
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Affiliation(s)
- Arvind Babu Rajendra Santosh
- School of Dentistry, Faculty of Medical Sciences, The University of the West Indies, Mona campus, Kingston 7, Jamaica, West Indies.
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12
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Brody A, Zalatnai A, Csomo K, Belik A, Dobo-Nagy C. Difficulties in the diagnosis of periapical translucencies and in the classification of cemento-osseous dysplasia. BMC Oral Health 2019; 19:139. [PMID: 31291935 PMCID: PMC6617922 DOI: 10.1186/s12903-019-0843-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 07/01/2019] [Indexed: 11/10/2022] Open
Abstract
Background Cemento-osseous dysplasia is a benign fibro-osseous lesion of the tooth-bearing region of the jaws with a periodontal ligament origin. It appears predominantly in Black and Asian middle-aged females. Its importance is that it could mimic a periapical lesion in the early, translucent stage. Case presentation In this report a rare case of familial cemento-osseous dysplasia is presented: a 50-years old Caucasian woman with labial paraesthesia and radiological translucency around the roots of the mandibular incisors and the first molar teeth. The lesion around the first molar was diagnosed as periapical granuloma and a root canal treatment was carried out. The diagnosis of florid cemento-osseous dysplasia and the treatment plan based on two- and three-dimensional radiographic examinations were certified histologically after surgical removal of the lesion. We screened the family members - including the patient’s mother, daughter and son - and identified a periapical version of cemento-osseous dysplasia in the daughter. Our case highlights the difficulties of differential diagnosis of cemento-osseous dysplasia and other periapical pathologies. The inconsistencies in the present classification of cemento-osseous dysplasia are also discussed with a proposal for a different classification based on new aspects that would be very helpful in setting up a correct treatment plan. Conclusion Differentiation of endodontic and non-endodontic origin of radiolucency and distinguishing it from anatomical landmarks by appropriate clinical evaluation and using vitality testing can give an opportunity to prevent unnecessary endodontic treatment. The current categories of cemento-osseous dysplasia classification do not cover the early stage of a hereditary florid form of cemento-osseous dysplasia. Instead of anatomical location of the lesion, clinical and genetic features may be recommended as parameters of cemento-osseous dysplasia classification.
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Affiliation(s)
- Andrea Brody
- Department of Oral Diagnostics, Faculty of Dentistry, Semmelweis University, Szentkirályi u. 47, Budapest, 1088, Hungary.
| | - Attila Zalatnai
- Department of Pathology and Experimental Cancer Research, Faculty of Medicine, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary
| | - Krisztian Csomo
- Department of Oral Diagnostics, Faculty of Dentistry, Semmelweis University, Szentkirályi u. 47, Budapest, 1088, Hungary
| | - Andrea Belik
- Department of Medical Chemistry, Molecular Biology and Pathobiochemistry, Semmelweis University, Tűzoltó u. 37-47, Budapest, 1094, Hungary
| | - Csaba Dobo-Nagy
- Department of Oral Diagnostics, Faculty of Dentistry, Semmelweis University, Szentkirályi u. 47, Budapest, 1088, Hungary
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Consolaro A, Paschoal SRB, Ponce JB, Miranda DAO. Florid cemento-osseous dysplasia: a contraindication to orthodontic treatment in compromised areas. Dental Press J Orthod 2019; 23:26-34. [PMID: 30088561 PMCID: PMC6072450 DOI: 10.1590/2177-6709.23.3.026-034.oin] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 04/26/2018] [Indexed: 11/27/2022] Open
Abstract
Florid cemento-osseous dysplasia is a sclerosing disease that affects the mandible, especially the alveolar process, and that is, in most cases, bilateral; however, in some cases it affects up to three or even four quadrants. During the disease, normal bone is replaced with a thinly formed, irregularly distributed tissue peppered with radiolucent areas of soft tissue. Newly formed bone does not seem to invade periodontal space, but, in several images, it is confused with the roots, without, however, compromising pulp vitality or tooth position in the dental arch. There is no replacement resorption, not even when the images suggest dentoalveolar ankylosis. Orthodontists should make an accurate diagnosis when planning treatments, as this disease, when fully established, is one of the extremely rare situations in which orthodontic treatment is contraindicated. This contraindication is due to: (a) procedures such as the installment of mini-implants and mini-plaques, surgical maneuvers to apply traction to unerupted teeth and extractions should be avoided to prevent contamination of the affected bone with bacteria from the oral microbiota; and (b) tooth movement in the areas affected is practically impossible because of bone disorganization in the alveolar process, characterized by high bone density and the resulting cotton-wool appearance. Densely mineralized and disorganized bone is unable to remodel or develop in an organized way in the periodontal ligaments and the alveolar process. Organized bone remodeling is a fundamental phenomenon for tooth movement.
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Affiliation(s)
- Alberto Consolaro
- Universidade de São Paulo, Faculdade de Odontologia de Bauru (Bauru/SP, Brazil).,Universidade de São Paulo, Faculdade de Odontologia de Ribeirão Preto, Programa de Pós-graduação em Odontopediatria (Ribeirão Preto/SP, Brazil)
| | | | - Jose Burgos Ponce
- Centro Universitário de Adamantina, Curso de Medicina, Disciplina de Patologia (Adamantina/SP, Brazil)
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Cavalcanti PHP, Nascimento EHL, Pontual MLDA, Pontual ADA, Marcelos PGCLD, Perez DEDC, Ramos-Perez FMDM. Cemento-Osseous Dysplasias: Imaging Features Based on Cone Beam Computed Tomography Scans. Braz Dent J 2018; 29:99-104. [PMID: 29267533 DOI: 10.1590/0103-6440201801621] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 08/01/2017] [Indexed: 12/18/2022] Open
Abstract
Imaging exams have important role in diagnosis of cemento-osseous dysplasia (COD). Cone beam computed tomography (CBCT) stands out for allowing three-dimensional image evaluation. This study aimed to assess the prevalence of cases diagnosed as COD on CBCT scans, as well identify the main imaging features related to these lesions. An analysis was performed in a database containing 22,400 radiological reports, in which all cases showing some type of COD were initially selected. These CBCT exams were reevaluated to confirm the radiographic diagnosis and determine the prevalence and distribution of the types of COD with regard to gender, age and preferred location, while describing its most common imaging aspects. Data were presented using descriptive analyses. There were 82 cases diagnosed as COD in the CBCT images (prevalence of 0.4%). The distribution of patients was 11 (13.4%) male and 71 (86.6%) female, with a mean age of 49.8 years (age-range 17-85 years). There were 47 (57.3%) cases of periapical COD, 23 (28%) of focal COD and 12 (14.6%) of florid COD. The mandible was more affected than the maxilla. In most cases, the lesions were mixed or hyperdense. All COD had well-defined limits and there were no cases of tooth displacement. In conclusion, periapical COD was the most common type and the most affected bone was the mandible. Imaging evaluation is critical for diagnosis and dentists should bear in mind all possible radiographic presentations of COD in order to prevent misleading diagnoses and consequently, inadequate treatments.
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Affiliation(s)
| | | | | | - Andréa Dos Anjos Pontual
- Department of Clinical and Preventive Dentistry, UFPE - Universidade Federal de Pernambuco, Recife, PE, Brazil
| | | | - Danyel Elias da Cruz Perez
- Department of Clinical and Preventive Dentistry, UFPE - Universidade Federal de Pernambuco, Recife, PE, Brazil
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Min CK, Koh KJ, Kim KA. Recurrent symptomatic cemento-osseous dysplasia: A case report. Imaging Sci Dent 2018; 48:131-137. [PMID: 29963485 PMCID: PMC6015922 DOI: 10.5624/isd.2018.48.2.131] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 03/22/2018] [Accepted: 03/30/2018] [Indexed: 12/19/2022] Open
Abstract
Cemento-osseous dysplasia (COD) is a benign fibro-osseous lesion of bone, in which normal bone is replaced by fibrous tissue, followed by calcification with osseous and cementum-like tissue. COD is classified into 3 categories according to its location: periapical, focal, and florid COD (FCOD). On radiography, FCOD appears radiolucent in its early stages. As it matures, radiopacities appear within the lesion, causing them to show a mixed appearance of radiolucency and radiopacity. Because FCOD is usually asymptomatic and grows in a self-limited manner, it does not require treatment. Secondary infection is the most frequent cause of symptomatic cases. We report a case of FCOD with symptoms that appeared after a dental restoration procedure and persisted after repeated operations. The purpose of this report is to emphasize the importance of thorough radiological evaluations of patients with FCOD before treatment.
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Affiliation(s)
- Chang-Ki Min
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Chonbuk National University, Jeonju, Korea
| | - Kwang-Joon Koh
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Chonbuk National University, Jeonju, Korea
| | - Kyoung-A Kim
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Chonbuk National University, Jeonju, Korea
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Kato CDNADO, Nunes LFM, Chalub LLFH, Etges A, Silva TA, Mesquita RA. Retrospective Study of 383 Cases of Fibro-Osseous Lesions of the Jaws. J Oral Maxillofac Surg 2018; 76:2348-2359. [PMID: 29859157 DOI: 10.1016/j.joms.2018.04.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 04/26/2018] [Accepted: 04/28/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE The aims of this study were to describe the clinical and radiologic features of 383 fibro-osseous lesions (FOLs) from an oral pathology reference service in Brazil and to compare the findings with previous studies. The hypothesis of the study was that the most common type of FOL would differ from other investigations. MATERIALS AND METHODS We conducted a descriptive and retrospective study with review of the records of the clinical and biopsy services (1990 to 2015). All records of the patients included showed a definitive diagnosis of FOL. The primary outcome variable was the type of FOL, and the predictor variables were gender, age, ethnicity, location, and clinical and radiologic characteristics. Descriptive analyses and χ2 tests were performed. The P value was set at .05. RESULTS From the 27,998 records available, 383 showed FOLs, with 187 (48.8%) being cemento-osseous dysplasias (CODs), 103 (26.9%) being fibrous dysplasias (FDs), and 93 (24.3%) being ossifying fibromas (OFs). The mean age of the patients was 38.5 ± 17.5 years. CODs presented a predilection for female gender (n = 314, 82.0%), African descent (n = 134, 71.6%), and the mandible (n = 248, 64.6%). The most common radiologic feature was a mixed radiolucent-radiopaque image (n = 149, 51.7%). FDs and OFs were commonly diagnosed during the first and second decades of life (P < .001), whereas CODs were more frequently diagnosed beyond the third decade (P < .001). Secondary osteomyelitis was more significantly observed in CODs (P < .001) than in FDs and OFs. Swelling was more frequently reported for FDs and OFs than for CODs (P < .001). CONCLUSIONS CODs were the most frequently observed FOLs in this Brazilian population. Female patients, patients of African descent, and patients with mandibular localization were most commonly affected by these conditions. The most common type of FOL differed from that in similar case reports or series from various geographic locations. It is believed that the data source (clinical and/or biopsy services) can directly influence the outcome.
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Affiliation(s)
| | | | - Loliza Luiz Figueiredo Houri Chalub
- Professor, Department of Community and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Adriana Etges
- Professor, Departament Oral Pathology, School of Dentistry, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Tarcília Aparecida Silva
- Professor, Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ricardo Alves Mesquita
- Professor, Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Aiuto R, Gucciardino F, Rapetti R, Siervo S, Bianch AE. Management of symptomatic florid cemento-osseous dysplasia: Literature review and a case report. J Clin Exp Dent 2018; 10:e291-e295. [PMID: 29721232 PMCID: PMC5923893 DOI: 10.4317/jced.54577] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 02/17/2018] [Indexed: 11/25/2022] Open
Abstract
Introduction Cemento-osseous dysplasia is a jaw disorder characterized by a reactive process in which normal bone is replaced by connective tissue matrix. There are different Cemento-osseous dysplasia entities. The treatment of these lesions, once diagnosed by radiology, is not required because generally they are asymptomatic. The localization is in the tooth-bearing areas of the jaws and its distribution is symmetric. Case Reports In this case report, a 57-year-old Caucasian female patient was referred to our attention complaining of painful inflammatory events localized in the right angle of the jaw. The radiographic appearance, the distribution of several lesions and the positive vitality test of the involved teeth, supported the diagnosis of Florid Cemento-osseous dysplasia. Because of the symptomatology, the patient was submitted to surgery and the lesion and the second inferior right molar were removed. The histological examination of the specimens confirmed the diagnosis. Discussion Many lesions that may exhibit a similar sclerotic appearance on conventional radiographs have to be differentiated and dental imaging can be used to discriminate between Florid COD and other lesions. Diagnosis of Florid Cemento-osseous dysplasia can be made with accurate clinical and radiographic assessment. In asymptomatic cases no treatment is required and the patient should have regular follow-up, but in this symptomatic case it was necessary to proceed with surgical intervention. The surgery treatment in the symptomatic case had a favourable prognosis and the two years follow-up has shown a complete healing. Given the abow, it is concluded that the choice of treatment must be selective according to the disease sites. Key words:Cemento-ossifying dysplasia, fibro-osseous lesions, florid cemento-osseous dysplasia, cementoma.
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Affiliation(s)
- Riccardo Aiuto
- Department of Periodontology and Oral Implantology - Istituto Stomatologico Italiano
| | - Federico Gucciardino
- Department of Periodontology and Oral Implantology - Istituto Stomatologico Italiano
| | - Roberta Rapetti
- Department of Periodontology and Oral Implantology - Istituto Stomatologico Italiano
| | - Sandro Siervo
- Department of Maxillofacial Surgery - Istituto Stomatologico Italiano
| | - Andrea-Edoardo Bianch
- Chief of Department of Periodontology and Oral Implantology - Istituto Stomatologico Italiano
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18
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Esfahanizadeh N, Yousefi H. Successful Implant Placement in a Case of Florid Cemento-Osseous Dysplasia: A Case Report and Literature Review. J ORAL IMPLANTOL 2018; 44:275-279. [PMID: 29406819 DOI: 10.1563/aaid-joi-d-17-00140] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Florid cemento-osseus dysplasia (FCOD) has been described as a reactive process in which normal bone is replaced by fibrous connective tissues and cementum-like materials. Radiographically it appears as dense, lobulated masses, often occurring bilaterally with symmetric involvement. In this case report, a successful implant placement has been reported in a 62-year-old Caucasian woman with a chief complaint of mandibular partial edentulous. Radiographic images showed the bilateral radiopaque lesions in edentulous regions of mandible, and mandibular anterior teeth alike. All mandibular teeth were vital and no root resorption was detected. The findings of X-ray images were attributable to FCOD. A highly conservative step-by-step 2-stage implant surgery was performed. After 6 months the implants loaded with fixed prosthesis. 2, 4, 6, 12, and 18 months after the surgery radiographic images were taken, which revealed an optimal functional rehabilitation and complete integration of implants. This report confirms that treating the edentulous area near the FCOD lesions could be planned, if conservative step- by-step implant placement been considered. To the best of our knowledge, a case of FCOD with successful implant placement has not been reported previously. More studies in more patients are needed to confirm results of such a therapeutic modality.
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Affiliation(s)
- Nasrin Esfahanizadeh
- 1 Department of Periodontics, Dental Branch, Islamic Azad University, Tehran, Iran.,2 Dental Implant Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hila Yousefi
- 3 Toxicology and Diseases Group, Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, Iran
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19
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Pereira DL, Pires FR, Lopes MA, Carlos R, Wright JM, Patel P, van Heerden W, Uys A, Vargas PA. Clinical, demographic, and radiographic analysis of 82 patients affected by florid osseous dysplasia: an international collaborative study. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 122:250-7. [PMID: 27422424 DOI: 10.1016/j.oooo.2016.04.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 04/12/2016] [Accepted: 04/20/2016] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The aim of this study was to correlate the clinical, demographic, and radiographic aspects of 82 cases of florid osseous dysplasia (FOD) from four countries assessed by five reviewers. STUDY DESIGN Retrospective data of patients diagnosed with FOD were obtained from archives of five institutes and analyzed according to clinical and radiographic criteria. RESULTS A total of 82 cases of FOD were included in the study. In the majority (77.5%) of FOD cases, black women were affected. The disease mainly affected the mandible (100%), and the stage of the lesion was directly correlated with the age (P < .05). The rates of convergence showed confluence of assessment in the mandible (posterior), and the highest rate of divergence between the reviewers was in assessing involvement in the maxilla. There were no differences among the characteristics of the lesion provided by the five institutions, except for the variable proportion of black patients affected by the disease. CONCLUSIONS FOD mostly affects the mandible of middle-aged black women, and its stage is correlated with patient age. Although panoramic radiography is used for diagnosis, the divergence in assessment of the maxilla might indicate that this method is not the most suitable to evaluate this area.
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Affiliation(s)
- Débora Lima Pereira
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas - UNICAMP, Piracicaba, Sao Paulo, Brazil
| | - Fábio Ramôa Pires
- Oral Pathology, State University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Márcio Ajudarte Lopes
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas - UNICAMP, Piracicaba, Sao Paulo, Brazil
| | - Román Carlos
- Head and Neck Clinical Center, Ciudad de Guatemala, Guatemala
| | - John Marshal Wright
- Department of Diagnostic Sciences, Texas A&M University Baylor College of Dentistry, Dallas, TX, USA
| | - Paras Patel
- Department of Diagnostic Sciences, Texas A&M University Baylor College of Dentistry, Dallas, TX, USA
| | - Willie van Heerden
- Department of Oral Pathology and Oral Biology, University of Pretoria, Pretoria, South Africa
| | - Andre Uys
- Department of Oral Pathology and Oral Biology, University of Pretoria, Pretoria, South Africa
| | - Pablo Agustin Vargas
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas - UNICAMP, Piracicaba, Sao Paulo, Brazil.
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20
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Рогожин ДВ, Бертони Ф, Ванель Д, Гамбаротти М, Риги А, Булычева ИВ, Коновалов ДМ, Талалаев АГ, Рощин ВЮ, Эктова АП, Болотин МВ, Лопатин АВ. Benign Fibro-Osseous Lesions of the Craniofacial Area in Children and Adolescents: A Review. Arkh Patol 2015; 77:63-70. [PMID: 26485782 DOI: 10.17116/patol201577463-70] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Benign fibro-osseous lesions (BFOL) of the craniofacial area are represented by a variety of morphologic processes that are characterized by pathologic ossifications and calcifications in association with a hypercellular fibroblastic marrow element. The current classification includes neoplasms, developmental dysplastic lesions and inflammatory/reactive processes [5]. The final diagnosis depends on-clinical, radiological and pathological features. The clinico-pathologic features of this heterogeneous group of diseases are presented in this article.
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Affiliation(s)
- Д В Рогожин
- Russian Children's Clinical Hospital, Moscow, Russian Federation; Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation
| | - Ф Бертони
- Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Д Ванель
- Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - А Риги
- Istituto Ortopedico Rizzoli, Bologna, Italy
| | - И В Булычева
- Russian Children's Clinical Hospital, Moscow, Russian Federation
| | - Д М Коновалов
- Russian Children's Clinical Hospital, Moscow, Russian Federation; Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation
| | - А Г Талалаев
- Russian Children's Clinical Hospital, Moscow, Russian Federation; Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation
| | - В Ю Рощин
- Russian Children's Clinical Hospital, Moscow, Russian Federation; Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation
| | - А П Эктова
- Russian Children's Clinical Hospital, Moscow, Russian Federation; Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation
| | - М В Болотин
- Russian Children's Clinical Hospital, Moscow, Russian Federation
| | - А В Лопатин
- Russian Children's Clinical Hospital, Moscow, Russian Federation
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21
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Krishnan U, Al Maslamani M, Moule AJ. Cone beam CT as an aid to diagnosing mixed radiopaque radiolucent lesions in the mandibular incisor region. BMJ Case Rep 2015; 2015:bcr-2014-207617. [PMID: 25576510 DOI: 10.1136/bcr-2014-207617] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present two cases where the identities of mixed radiopaque radiolucent lesions in the lower incisor region were unclear, although the position of the lesions and positive pulp sensitivity tests were suggestive of periapical osseous dysplasia. In the first case, the lesion presented as a solitary round mixed radiopaque radiolucent periapical lesion, suggestive in some images as periapical osseous dysplasia. Cone beam CT (CBCT) provided clear images, which confirmed the diagnosis and, additionally, the images showed evidence of initial lesions associated with other anterior teeth and some destruction of the labial plate, not evident on the conventional radiographs. In the second case, radiopacities were identified within the lesion on conventional radiographs, but CBCT imaging also showed extensive and unexpected perforation of the lingual plate. Such destruction of cortical plates may be a feature of periapical osseous dysplasia, which is not visible in conventional radiography.
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Affiliation(s)
- Unni Krishnan
- Department of Dentistry, New Mowasat Hospital, Salmiya, Kuwait
| | | | - Alex J Moule
- Department of Faculty of Dentistry, Kuwait University, Safat, Kuwait School of Dentistry, University of Queensland, Australia
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