Differential diagnosis of cemento-osseous dysplasia and periapical cyst using texture analysis of CBCT

BACKGROUND

Radiolucencies found at the root apex in patients with cemento-osseous dysplasia (COD) may be mistaken for periapical cysts (PC) of endodontic origin. The purpose of this study was to examine the utility of quantitative texture analysis using cone-beam computed tomography (CBCT) to differentiate between COD and PC.

METHODS

Patients who underwent CBCT at Wonkwang University Daejeon Dental Hospital between January 2019 and December 2022 and were diagnosed with COD and PC by clinical, radiologic, and, if necessary, histopathologic examination were included. Twenty-five patients each were retrospectively enrolled in the COD and PC group. All lesions observed on axial CBCT images were manually segmented using the open-access software MaZda version 4.6 to establish the regions of interest, which were then subjected to texture analysis. Among the 279 texture features obtained, 10 texture features with the highest Fisher coefficients were selected. Statistical analysis was performed using the Mann-Whitney U-test, Welch's t-test, or Student's t-test. Texture features that showed significant differences were subjected to receiver operating characteristics (ROC) curve analysis to evaluate the differential diagnostic ability of COD and PC.

RESULTS

The COD group consisted of 22 men and 3 women, while the PC group consisted of 14 men and 11 women, showing a significant difference between the two groups in terms of sex (p=0.003). The 10 selected texture features belonged to the gray level co-occurrence matrix and included the sum of average, sum of entropy, entropy, and difference of entropy. All 10 selected texture features showed statistically significant differences (p<0.05) when comparing patients with COD (n=25) versus those with PC (n=25), osteolytic-stage COD (n=11) versus PC (n=25), and osteolytic-stage COD (n=11) versus cementoblastic-stage COD (n=14). ROC curve analysis to determine the ability to differentiate between COD and PC showed a high area under the curve ranging from 0.96 to 0.98.

CONCLUSION

Texture analysis of CBCT images has shown good diagnostic value in the differential diagnosis of COD and PC, which can help prevent unnecessary endodontic treatment, invasive biopsy, or surgical intervention associated with increased risk of infection.

Imaging of Fibro-osseous Lesions and Other Bone Conditions of the Jaws

This review directs the focus on the imaging features of various fibro-osseous lesions and other bone lesions that can be of similar presentation. Broad diagnosis of "fibrous osseous lesion" may culminate in improper treatment and management. Radiographic discriminating factors between these entities are highlighted and summarized to improve the diagnostic process when encountering these lesions.

Radiological follow-up of cemento-osseous dysplasia on cone-beam computed tomography

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.

Florid Cemento-osseous Dysplasia Associated with Secondary Infection - A Case Report

Rationale

The term cemento-osseous dysplasia (COD) refers to a bony fibro-osseous lesion, in which fibrous tissue and cementum-like tissue replace normal bone. There are three types of COD: periapical, focal and florid. The condition is usually asymptomatic and treatment is unnecessary; however, a secondary infection could occur, which requires treatment.

Patient Concern

A 58-year-old female patient presented with symptoms in the mandibular posterior region of the right jaw for six months.

Diagnosis

Infected florid COD (FCOD).

Treatment

A pre-operative antibiotic, followed by extraction of non-restorable teeth, debridement of the infected tissue and necrotic bone removal.

Outcome

The patient was followed for one year, during which all previously reported signs and symptoms were resolved.

Take-away Lessons

Early lesion detection is essential. Treatment depends on the presence or absence of clinical and radiographic manifestations. The current case was treated surgically to minimise complications.

The True History of Cementoblastoma

REVIEW OF THE LITERATURE

Cementoblastoma (CB) is unique among odontogenic tumors because its gross pathological anatomy is pathognomonic in most cases, i.e., a rounded calcified growth that is fused to the root of a tooth and completely encapsulated by fibrous tissue. The resulting radiographic appearance is a well-defined, globular mixed radiopaque/lucent or completely radiopaque mass obliterating some details of the root, with a thin radiolucent zone surrounding the central opacity. Although hundreds of publications have covered the clinicopathologic features of CB, almost nothing is known about its true history. Also it seems there is little understanding about how the term "CB" was originally introduced as a pathologic entity. This report covers some overlooked papers on CB dating back to the 19th century, including the first complete description in 1888 and the first radiographic presentation in 1906.

Cemento-osseous dysplasia is caused by RAS-MAPK activation

Cemento-osseous dysplasia (COD) belongs to the spectrum of benign fibro-osseous lesions occurring exclusively in the tooth-bearing areas of the jaws. Depending on site and extent of involvement, periapical, focal and florid subtypes can be distinguished that share an identical histomorphology. Most cases are asymptomatic and follow a self-limited course requiring no specific treatment. Over time, lesions progressively mineralise while the cellularity decreases. However, the molecular pathogenesis of COD, has not yet been explored. We analysed a series of 31 COD samples by targeted sequencing and detected pathogenic hotspot mutations involving the RAS-MAPK signalling pathway in 5/18 evaluable cases (28%). The mutations were found in the BRAF, HRAS, KRAS, NRAS, and FGFR3 genes. Our findings suggest that COD is driven by RAS-MAPK activation; however, the mechanism underlying the spontaneous growth arrest typically occuring in most of the lesions remains elusive.

Florid cemento-osseous dysplasia-related osteonecrosis: A series of cases

OBJECTIVE

The aim of this study was to assess the clinicopathological features of florid cemento-osseous dysplasia (FCOD)-related osteonecrosis highlighting their histopathological aspects and bone structure.

METHODS

Twenty-two FCOD-related osteonecrosis cases were evaluated retrospectively. Osteonecrosis, osteomyelitis, bacterial colonization, bone resorption, reactive bone, osteon-like structure, lamellar bone, and basophilic lines were analyzed. Specific staining and fluorescence and polarized light microscopy analyses were also performed.

RESULTS

The mandible was more affected by FCOD-related osteonecrosis. There was a predominance of African-Brazilian women in the fifth and seventh decades of life. Osteomyelitis was present in 82 % of cases whereas bone resorption and bacterial colonization were present in 100 % of FCOD-related osteonecrosis cases. Thick basophilic lines were seen in all cases (100 %). Actinomycosis and osteoclasts were not often.

CONCLUSIONS

This study showed female adult preference, mandibular location, and some findings such as osteomyelitis, bone resorption, and bacterial colonization were histopathological features more frequent in FCOD-related osteonecrosis. In the absence of a close clinical and radiographic correlation, the morphology of the necrotized bone similar to cementum could help to recognize FCOD.

Cemento-osseous dysplasia: clinical presentation and symptoms

Objectives

The purpose of this study was to evaluate risk factors and symptoms in cemento-osseous dysplasia (COD) patients.

Materials and Methods

In this study, 62 patients who were diagnosed histologically with COD were investigated from 2010 to 2020 at the author's institution. We compared clinical and radiological characteristics of symptomatic and asymptomatic patients. The factors were sex, age, lesion size, site, radiologic stage of lesion, apical involvement, sign of infection, and history of tooth extraction. Statistical analysis was performed using Fisher's exact test and the chi-square test.

Results

COD was more prevalent in female patients. With the exception of three cases, all were focal COD. The majority of patients presented with symptoms when the lesion was smaller than 1.5 cm in size. Symptoms were observed when the apex of the tooth was included in the lesion or there was a local infection around the lesion. The history of tooth extraction and previous endodontic treatment were evaluated, and history was not a significant predictor for the onset of symptoms.

Conclusion

In this study, risk factors associated with symptomatic patients were size of lesion, apical involvement, and local infection.

A retrospective cone beam computed tomography analysis of cemento-osseous dysplasia

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.

Ossifying Fibroma of Non-odontogenic Origin: A Fibro-osseous Lesion in the Craniofacial Skeleton to be (Re-)considered

In the cranio-facial skeleton, a heterogeneous group of well characterized fibro-osseous lesions can be distinguished. Whereas fibrous dysplasia can affect any skeletal bone, ossifying fibroma and cemento-osseous dysplasia exclusively develop in the cranio-facial region, with most subtypes restricted to the tooth bearing areas of the jaws. Herein we present a series of 20 fibro-osseous lesions that developed mostly in the frontal bone and in the mandible, presenting as expansile intramedullary tumors with a unique histologic appearance and an indolent clinical course. We provide evidence that these tumors are distinct from the categories included in the WHO classification and are therefore currently unclassifiable. The definition of cemento-ossifying fibroma as an odontogenic neoplasm developing only in close proximity to teeth should be re-considered and incorporate also extragnathic lesions as shown here.

The importance of clinical and radiological findings for the definitive histopathologic diagnosis of benign fibro-osseous lesions of the jaws: Study of 276 cases

PURPOSE

Benign fibro-osseous lesions (BFOLs) are heterogeneous intraosseous disease processes sharing overlapping histopathologic features and demonstrate a wide range of biological behavior. The aim of this study is to highlight the importance of clinical and radiological findings for the definitive histopathologic diagnosis of benign fibro-osseous lesions of the jaws.

MATERIALS AND METHODS

This is a cross-sectional retrospective study evaluating the three main groups of BFOLs: Cemento-osseous dysplasia, ossifying fibromas, and fibrous dysplasia. Previously diagnosed BFOL cases were searched for thoroughly from the archives of Istanbul University, Institute of Oncology, Department of Tumor Pathology in between 2005 and 2015. Clinical and radiological data of these cases were identified and recorded. The histopathologic features were reevaluated from the H&E-stained slides.

RESULTS

A total of 276 BFOL cases were identified and reevaluated for the study. The most common BFOL type was cemento-osseous dysplasia (n = 135), followed by cemento-ossifying fibroma (n = 77), fibrous dysplasia (n = 53) and juvenile ossifying fibroma (n = 11). The female/male ratio was 3.4:1 with a strong predilection for the 4th decade (n = 102). The mandible (n = 209) was the predominantly affected jaw. Prominent osteoblastic rimming around the bony lesion was commonly observed for cemento-ossifying fibroma (n = 60/77), followed by cemento-osseous dysplasia (n = 23/135). Predominant ossification patterns showed some differences among the groups. The most common radiological feature was the mixed radiolucent/radiopaque internal structure.

CONCLUSION

Our results document various clinical, radiological and histopathologic findings of BFOLs. Even some histopathologic differences are observed, clinical and radiographic correlation is mandatory prior to the definitive histopathologic diagnosis of BFOLs for the prevention of possible misdiagnoses or inappropriate treatments.

[The role of piezosurgery in the treatment of a rare case of superinfected cemento-osseous dysplasia caused by actinomyces: a case report]

La dysplasie cémento-osseuse est une lésion fibro-osseuse non néoplasique qui touche l´os alvéolaire. Elle peut se présenter sous l´une des trois formes: périapicale, focale ou floride. Elle est souvent asymptomatique de découverte fortuite lors d´un examen radiologique de routine. Cependant, elle peut devenir symptomatique suite à une surinfection, une fois exposée à la flore bactérienne buccale. Nous rapportons un cas de dysplasie cémento-osseuse floride associée à une actinomycose osseuse chez une femme tunisienne de 53ans. Cette surinfection est rarement évoquée dans la littérature; une recherche sur PubMed utilisant la formule booléenne « cemento-osseous dysplasia AND actinomyces » a révélé un seul article (Smith et al. 2011). Le traitement de l´infection actinomycosique nécessite souvent une antibiothérapie de longue durée parfois associée à une chirurgie de débridement comme dans ce cas où la piézochirurgie a été utilisée dans l´élimination de la dysplasie et de l´os nécrotique.

Cemento-osseous dysplasia: Clinicopathological spectrum of 10 cases analyzed in a tertiary dental institute

Background:

Cemento-osseous dysplasia (COD) is a distinct entity, which is confined to the tooth-bearing areas of the jaws or edentulous alveolar processes.

Aims:

This study analyzes the demographic, clinical, radiographic and histopathological features of COD.

Materials and Methods:

Archival data from 2013 to 2017 present in the Department of Oral Pathology were retrieved. Clinicopathological and radiological features of all the cases which had been previously diagnosed as COD were analyzed in detail.

Results:

In the present study, 10 cases of COD were analyzed (1 periapical, 6 florid and 3 focal). Equal sex predilection was observed. The mean age in females and males was 42.6 years (22–64 years) and 28.6 years (17–36 years), respectively. Bony expansion was seen frequently, but pain was not a common feature. Mandible was affected almost twice as frequently as maxilla and posterior region was affected more than anterior region. Most cases showed mixed radiopaque and radiolucent lesion (5/10) and peripheral radiolucent rim (9/10) on radiographic examination. Histopathological features included the presence of curvilinear trabeculae (4/10), sheets of compact bone (3/10) or both (3/10). Foci of mineralization in form of ossicles or cementicles were noted in 5 out of 10 cases.

Conclusion:

COD is a nonneoplastic process usually confined to the tooth-bearing areas of the jaws or edentulous alveolar processes. Depending on the location and extent, it can be either focal/periapical/florid variant. Histopathological features of COD can overlap with other fibro-osseous lesions. Hence, the correlation of clinical, radiological and histopathological features is of paramount importance in the accurate diagnosis of COD.

Concomitant cemento-osseous dysplasia and aneurysmal bone cyst of the mandible: a rare case report with literature review

Background

Concomitant cemento-osseous dysplasia (COD) and aneurysmal bone cyst (ABC) are rare in the head and neck region. In our search of the English language literature, we found only one case report describing the simultaneous occurrence of COD and ABC in the head and neck region. Here, we report a case of COD associated with ABC. Further, we performed a systematic search of the literature to identify studies on patients with COD associated with nonepithelial lined cysts of the jaws.

Case presentation

The patient was a 32-year-old woman who was referred from a private dental clinic because of a cystic lesion below the mandibular right first molar. She had no pain or significant systemic disease. After performing panoramic radiography and cone-beam computed tomography, the imaging diagnosis was COD with a cystic lesion, such as ABC or solitary bone cyst. Excisional biopsy was performed, which revealed concomitant COD and ABC.

Conclusion

This case of ABC associated with COD provides insight for the diagnostic process of radiographically mixed lesions with cystic changes.

Osteosarcoma of the Mandible in a Patient with Florid Cemento-Osseous Dysplasia and Li-Fraumeni Syndrome: A Rare Coincidence

Cemento-osseous dysplasia (COD) is the most common benign fibro-osseous lesion of the jaws and generally considered non-neoplastic and self-limited. Here, we present a 30-year old female who noticed a bilateral swelling of her posterior mandible with irregular periapical mineralization and incomplete root resorption on panoramic radiographs. A biopsy revealed florid COD and no further treatment was initiated. 9 years later, she presented with a progressive expansion of her left posterior mandible after being treated for bilateral breast cancer 4 and 8 years before. CT scans showed expansile and densely mineralized lesions in all four quadrants with the left posterior mandible showing a focal penetration of the buccal cortical bone. Biopsies revealed an osteoblastic high-grade osteosarcoma in the left and a COD in the right mandible, notably with cellular atypia in the spindle cell component. The patient underwent segmental resection of the left mandible with clear margins and adjuvant chemotherapy. Subsequent genetic testing identified a heterozygous germline TP53 mutation (p.V173G) which confirmed the clinically suspected Li-Fraumeni syndrome (LFS). 3 years after the resection, the patient is free of disease and the other foci of COD remained stable in size on follow-up imaging analyses. Our case illustrates LFS-related osteosarcoma developing within florid COD. Given the rarity of this coincidence, a causative relation between the two lesions seems unlikely but in patients with tumor predisposition syndromes it might be advisable to closely monitor even benign lesions like COD.

A clinicopathologic analysis of 135 cases of cemento-osseous dysplasia: To operate or not to operate?

PURPOSE

The aim of this retrospective study was to investigate the characteristics of cemento-osseous dysplasia (COD) lesions for devising a clinical algorithm to help management decisions, specifically discussing the need for a possible surgical intervention versus solely follow-up.

MATERIALS AND METHODS

One hundred thirty-five subjects were thus identified having previously diagnosed and treated for COD from the archives of the pathology in between 2005-2015. These were then re-evaluated. Demographic features, radiographic and histopathologic findings were assessed.

RESULTS

The most frequent variant was the focal type (n=83), and the mandible (n=131) was predominantly affected jaw bone. Female predilection was evident for all subtypes. Almost half of the lesions (n=72) presented with mixed radiolucent and radiopaque appearances in radiography at the time of the biopsy. Cementicles/psammoma body-like calcifications and trabecular pattern were the most common hard tissue appearances.

CONCLUSION

COD lesions are non-neoplastic fibro-osseous lesions which can exhibit similar histopathologic and radiologic features with other bone lesions. Ideally, these lesions should be clinically identified and followed-up. Considering the possible complications, a thorough knowledge of these lesions and their differentials is essential in order to avoid unnecessary surgical interventions.

Florid cemento-osseous dysplasia in a young Indian female: A rare case report with review of literature

Florid cemento-osseous dysplasia (FCOD) is a reactive bone dysplasia that involves tooth-bearing areas of the jaws. It most commonly affects females and is seen less frequently in Caucasian and Asian groups. The age group may vary from 19 to 76 years and typically presents in the fourth and fifth decades. FCOD associated with impacted teeth and bony expansion is very rare and only a few familial cases have been reported in literature. Till date, <2% cases in Indians have been reported in literature. Here, we report a case of nonfamilial FCOD in a 27-year-old young Indian female with cortical plate expansion, one over-retained and one impacted teeth.

Soft Tissue Special Issue: Gnathic Fibro-Osseous Lesions and Osteosarcoma

Gnathic fibro-osseous lesions are a diverse group of disease processes which share overlapping microscopic features characterized by fibroblastic stroma with variable cellularity and a range of bone forming pathological processes leading to woven, sclerotic and cementum-like structures. Some of the lesions are unique to craniofacial location and a combination of clinical, radiological and pathological correlation is often necessary for diagnostic accuracy. Gnathic osteosarcomas are rare tumors with differences in age distribution and behavior as compared to osteosarcoma of long bones. This review will discuss the clinicopathological and radiological features of gnathic fibro-osseous lesions and osteosarcoma with updates on current genetics and molecular pathogenesis.

A retrospective clinico-pathologic analysis of cemento-osseous dysplasia in a South African patient population

Background

Cemento-osseous dysplasia (COD) is a fibro-osseous jaw bone lesion. The affected bone in COD progressively becomes sclerotic, poorly vascularized and susceptible to secondary osteomyelitis.

Objective

To provide a clinico-pathologic appraisal of COD in a South African patient population.

Methods

Archived records of 133 patients diagnosed with COD were reviewed for patient demographics, COD location, COD type, osteomyelitis or simple bone cyst secondary to COD.

Results

The mean age was 53.4 ± 13.5 years with a 94.7% female predilection. COD mainly affected the mandible (57.1%), followed by involvement of both jaws (38.3%) and maxilla (4.5%). Florid COD was the most prevalent (69.9%), followed by focal COD (18%) and periapical COD (12%). Florid COD showed a clear trend of increasing with age, peaking in the sixth decade and decreasing thereafter. Osteomyelitis and simple bone cyst presented as complications of COD in 74.4% and 5.3% of cases respectively, while 21.8% of all cases of jaw osteomyelitis during the study period were secondary to COD.

Conclusion

A higher frequency of jaw osteomyelitis secondary to COD was found compared to previous studies. No significant association was shown between any of the COD types and secondary osteomyelitis.

Difficulties in the diagnosis of periapical translucencies and in the classification of cemento-osseous dysplasia

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.

A case report]

Cemento-osseous dysplasia is a benign lesion which affects the jaw bones. It is a frequent incidental finding but no aggressive therapy is necessary. However, it may be confused with more aggressive entities, such as ossifying and cementifying fibroma, which do require treatment. There are no clear-cut histopathological criteria to differentiate between these entities. We present a case of a 13-year old boy who underwent a biopsy of a clinically undiagnosed maxillary lesion. Histopathological analysis revealed moderately cellular fibrous tissue with bone trabeculae with no osteoblastic rimming and clusters of intensely basophilic material corresponding to cementum. The final diagnosis was cemento-osseus dysplasia. The main histopathological features important in the distinction of these entities are discussed.

Benign Fibro-Osseous Lesions of the Head and Neck

Benign fibro-osseous lesions (BFOLs) are a particularly challenging set of diagnoses for the pathologist. This diverse collection of diseases includes fibrous dysplasia, ossifying fibroma and cemento-osseous dysplasia. While all three conditions have similar microscopic presentations, their treatment and prognosis differ, demanding an accurate and definitive diagnosis. A practical and systematic approach considering the patient's history, demographics, intraoperative presentation, and gross appearance with an emphasis on radiology and histology will be discussed.

Dental implants in a patient with left mandibular fibrous dysplasia: Two-year outcomes on the normal and affected sides

Dental rehabilitation raises specific challenges in patients with mandibular fibrous dysplasia. We report the 2-year post-operative outcomes on the normal and affected sides in a 64-year-old female with focal left mandibular fibrous dysplasia and bilateral posterior edentulism. On the left, bone shaving of the lesion to restore sufficient vertical height was followed by the insertion of two dental implants. Three dental implants were inserted into the normal bone on the right. Dental prostheses were added 6 months later. Two years after the first procedure, no complications had been recorded and the patient reported similar high satisfaction for both sides. This comparison of outcomes of dental implants inserted into dysplastic versus normal bone in the same patient suggests that dental implants may constitute a valid option for managing edentulism in selected patients with fibrous dysplasia, provided appropriate precautions are taken.

Sensory disturbance along the inferior alveolar nerve as a first clinical sign of multiple florid cemento-osseous dysplasia of the mandible-A case report

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.

Florid cemento-osseous dysplasia: review of an uncommon fibro-osseous lesion of the jaw with important clinical implications

Florid cemento-osseous dysplasia (FCOD) is a rare, benign, multifocal fibro-osseous dysplastic process affecting tooth-bearing areas of the jaw, characterized by replacement of normal trabecular bone with osseous tissue and dense acellular cementum in a fibrous stroma. It is one clinicopathologic variant in a spectrum of related non-neoplastic fibro-osseous lesions known as cemento-osseous dysplasias (CODs), thought to arise from elements of the periodontal ligament. Diagnosis primarily relies upon radiographic and clinical findings; unnecessary biopsy should be avoided, as inoculation with oral pathogens may precipitate chronic infection in these hypovascular lesions. Appropriate management of uncomplicated FCOD consists of periodic radiographic follow-up. Accordingly, it is important that both radiologists and clinicians performing endodontic interventions possess familiarity with this entity in order to prevent misdiagnosis and inappropriate intervention, which may result in a protracted clinical course. Lesions are usually asymptomatic in the absence of infection, typically discovered on routine dental radiographs or imaging performed for unrelated indications. Radiographically, the condition typically manifests as widespread non-expansile intraosseous masses of varying internal lucency and sclerosis that surround the root apices of vital teeth or edentulous areas in the posterior jaw. While all CODs share similar microscopic features, FCOD is distinguished by its multifocal distribution, involving two or more quadrants of the maxilla and mandible, often in a bilateral symmetric fashion. The vast majority of cases are sporadic, though few exhibit an autosomal dominant familial inheritance pattern. In this pictorial review, we discuss the radiologic characteristics of this entity, pertinent clinical and histologic features, differential diagnoses, and management options.

Maxillectomy for Cementifying Osseous Dysplasia of the Maxilla: A Case Report

OBJECTIVES

Osseous dysplasias are the most common subtype of fibro-osseous lesions of the maxillofacial bones. They are benign and often present as incidental asymptomatic lesions. Diagnosis can be made with clinical and radiographic examination.

CASE REPORT

This article reports the case of a 47-year-old man with a huge cementifying osseous dysplasia of the maxilla that presented with secondary infection after teeth extraction and repair of oroantral fistula. A subtotal maxillectomy had to be done after conservative treatment failed to resolve the infection.

DISCUSSION/CONCLUSION

Biopsy, tooth extraction or surgical trauma to the affected bones of osseous dysplasia could easily lead to severe secondary infection, the treatment of which may be very difficult, and thus should be avoided if possible.

Focal cemento-osseous dysplasia masquerading as benign cementoblastoma: A diagnostic dilemma

Context:

Focal cemento-osseous dysplasia (FCOD) is a fibro-osseous lesion that is a nonneoplastic reactive lesion.

Case Report:

A case of 47-year-old female patient presenting with a diagnostic dilemma to the clinician is reported. Methods to achieve definitive diagnosis are discussed.

Conclusions:

FCOD can present with features of periapical pathology or other osseous lesions. Hence, to arrive at a definitive diagnosis biopsy and histopathologic examination is imperative.

Periapical cemento-osseous dysplasia: clinicopathological features

Periapical cemento-osseous dysplasia (PCOD) is a rare benign lesion, often asymptomatic, in which fibrous tissue replaces the normal bone tissue, with metaplasic bone and neo-formed cement. We present a rare case of mandibular PCOD in a woman of 55 years, who presented with moderate swelling and mobility of teeth 32-33-34. Endoral radiography showed that these teeth had been devitalized; they had deep periodontal pockets and marked radicular radiotransparency; the root apices exhibited mixed radiotransparency and radio-opacity. Clinical and radiographical findings led to a diagnosis of periapical rarefying osteitis, and the three teeth were thus extracted. Due to the persistence of swelling and slight pain post-extraction, a cone-beam computed tomographic scan was taken; this showed a mixed radiotransparent and radio-opaque lesion in the area of the extracted teeth. A bone biopsy of the affected area was taken for histopathological evaluation; a diagnosis of PCOD was rendered. This case demonstrates the importance of a full investigation when a patient presents after tooth extraction with non-healing socket, pain, and swelling. A multidisciplinary approach is required to manage these rare cases.

Florid cemento osseous dysplasia in association with dentigerous cyst

We present a case of florid cemento-osseous dysplasia occurring in a 20-year-old Indian woman. The subject presented with three lesions involving the maxillary right quadrant, maxillary left quadrant and mandibular left quadrant. The mandibular left quadrant also demonstrated a cyst.The diagnosis was made by correlating the clinical presentation with that of the radiological and histopathological findings. This is a rare entity because of an unusual combination of Asian race along with the association of dentigerous cyst.