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Year : 2014  |  Volume : 2  |  Issue : 3  |  Page : 92-94

Focal cemento-osseous dysplasia

1 Department of Dentomaxillofacial Radiology, Gazi University, Ankara, Turkey
2 Department of Dentomaxillofacial Surgery, Gazi University, Ankara, Turkey
3 Department of Oral Pathology, Gazi University, Ankara, Turkey

Date of Web Publication14-Nov-2014

Correspondence Address:
Mustafa Gumusok
Department of Dentomaxillofacial Radiology, Gazi University, Dis Hekimligi Fakültesi Emek Ankara
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2321-3841.144683

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Focal cemento-osseous dysplasia (FCOD) is a benign fibro-osseous lesion which changes cancellous bone tissue with each fibrous tissue and cementum-like material, or both together. The teeth that are related to the lesion are vital, and FCOD is generally asymptomatic. FCOD is, usually, found during routine radiographic examination. The etiology and pathogenesis of FCOD are unknown. This lesion is evaluated to be a reactive or a dysplastic process in the periapical tissues. Radiologic images of FCOD change depending on the amount of mineralization. Radiological appearance of FCOD is either only complete radiolocent or only complete radio-opaque or mixed radiolucent, radio-opaque together. In this case report an FCOD is presented, which is located between the first premolar and the second molar on the left side mandible of a 60-year-old female patient. The lesion caused perforation and expansion of alveolar bone. The diagnosis, treatment and 1 year follow-up after surgery are reported.

Keywords: Cone beam volumetric tomography, fibro osseous lesion, focal cemento-osseous dysplasia

How to cite this article:
Gumusok M, Alkurt MT, Hamurcu K, Kilavuz DK, Baris E, Simsek B. Focal cemento-osseous dysplasia . J Oral Maxillofac Radiol 2014;2:92-4

How to cite this URL:
Gumusok M, Alkurt MT, Hamurcu K, Kilavuz DK, Baris E, Simsek B. Focal cemento-osseous dysplasia . J Oral Maxillofac Radiol [serial online] 2014 [cited 2023 Mar 22];2:92-4. Available from: https://www.joomr.org/text.asp?2014/2/3/92/144683

  Introduction Top

Cemento-osseous dysplasia is classified into three groups, the periapical, focal and florid based on their clinical and radiological characteristics. Focal cemento-osseous dysplasia (FCOD) is the type seen in one single location. [1] FCOD is believed to originate from the periodontal ligament and is not neoplastic in nature. [2] While is more frequent in females as compared to males, it is generally seen within the fourth and fifth decades. They generally occur in the near vicinity of the apex of a tooth in the posterior mandible or in the space left from a distracted tooth. [3] The differential diagnosis of FCOD, which is thought as a reactive process, must include the ossifying fibroma (OF), which is mainly neoplastic. [4] The accurate diagnosis of FCOD and differentiation from OF, which must be removed with surgery, will prevent the unnecessary surgical intervention on FCOD. [3]

  Case Report Top

A 63-year-old female patient without any systemic disease was referred to Gazi University Faculty of Dentistry for accurate identification of the lesion in the posterior left mandible. The lesion was observed on the panoramic radiograph taken in a private dental clinic that she had applied for routine dental treatment. The patient did not report any discomfort or tenderness. There was no pathological finding in her extraoral and intraoral examinations. On the panoramic radiograph of the patient, a radio-opaque area was observed in the near vicinity of the apex of the second premolar and a radiolucent area surrounding it [Figure 1].
Figure 1: Panoramic radiograph of the patient

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Cone-beam computed tomography (CBCT) images were taken to evaluate the relationship with the adjacent anatomic structures. CBCT images were obtained with Promax 3D® (Planmeca, Helsinki, Finlandia) with exposure settings of 120 kV, 165 mA, and 39 s. On CBCT images, it was observed that the lesion was in close vicinity of the mandibular canal, the radiographic border of the lesion was ill-defined, and extended to the mandibular buccal and lingual cortices. The size of the lesion was approximately 16 mm × 20 mm × 18 mm. It caused perforation in the buccal bone [Figure 2]. In addition, it leaded the expansion of the alveolar bone both in buccal and lingual cortices [Figure 3].
Figure 2: The cone beam computed tomography reformatted crosssectional image showing the perforation of buccal bone (white arrows show close vicinity to the mandibular canal, black arrow shows the perforation of buccal bone)

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Figure 3: The cone beam computed tomography axial section of the patient showing expansion of alveolar bone (white arrow)

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Excision of the lesion was decided with the preliminary diagnosis of fibro-osseous lesion. Histopathological examination of the lesion, which was performed under local anesthesia, was carried out [Figure 4].
Figure 4: The lesion showing cellular fibrous stroma containing an admixture of irregular trabeculae of bone and rounded globules of cementum-like material (H and E, ×200)

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The lesion was diagnosed as FCOD after clinical, radiological, and histological examinations. Regular follow-up was considered. One year after the surgery a panoramic radiograph was taken and there was no sign of recurrence [Figure 5].
Figure 5: The panoramic radiograph taken 1 year after the operation

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  Discussion Top

Benign fibro-osseous lesions are disorders that the normal bone is replaced with the connective tissue matrix that transforms into cemento-osseous tissue. [5] FCOD, however, is a fibro-osseous lesion that is frequently seen in the chin bones. [6] Etiology of FCOD is not clearly known. Affecting factors including trauma, caries, periodontal disease, infection, or systemic diseases have not been clarified. Zegarelli et al. have reported that hormonal disorders can cause or contribute to the condition. [7] Furthermore, autosomal dominant familial inheritance is reported as etiological factor for periapical cemento-osseous dysplasia. [8]

Focal cemento-osseous dysplasia and periapical cemento-osseous dysplasia are two terms that state same pathologic processes in different localizations. Fluoroid cemento-osseous dysplasia however, means the multifocal wide involvement of chins by the lesions with the same histological appearance of periapical cemento-osseous dysplasia and FCOD. [9]

Focal cemento-osseous dysplasia is generally asymptomatic and related tooth is vital. [4] FCODs are discovered during routine radiologic examinations. However, MacDonald-Jankowski has reported that pain and swelling was seen with rates of 25% and 28%, respectively. [10] Su et al. have reported that some swelling and slight discomfort can be seen. [3] In present case, the patient had no complaint and no swelling or any pathologic finding was not examined. FCOD have average size of 1.8 cm. [3] In present case, the lesion size was in accordance with the reported averages. It is a benign heterogeneous lesion that histologically includes cement-like material and irregular trabeculas of mature and immature bone within benign fibrous stroma. [4]

They most frequently appear on radiographs as opaque or lucent/opaque images with poorly-definable radiologic borders. One quarter of FCODs have definable outlines. Radiologic images of FCOD change depending on the increase of mineralization. Well defined radiolucency can be observed in the early stage but it is not frequent. In the intermediate stage, mixed or full radiodensity with sclerotic borders is seen, and sometimes the characteristic radiolucent rim around the radio-opacity are observed. In this stage, semi-lucent no-rim poorly defined mixed radiodensity is observed in half of the cases. The last stage is more mature. In this stage, a sclerotic radiodensity with poorly-defined borders is typical. The radio-opaque appearance of FCOD can be cotton wool-like irregular or diffuse. [3] The radiologic features of present case are in accordance with the last stage; a poorly defined radio-opaque area surrounded by a radiolucent rim was observed. Additionally, cortical alveolar bone expansion and perforation are observed on CBCT images, which is possible only with tomographic images. CBCT images may be preferable to observe the progression of the lesion. Diagnosis of FCODs must be based on the radiologic characteristics and clinical findings. The development stage of the lesion must be considered in the differential diagnosis. Periapical granuloma, cysts, and chronic osteomyelitis should be considered in the osteolytic stage of the lesion. Chronic sclerosing osteomyelitis, OF, odontoma and osteoblastoma should be considered in the mixed and radio-opaque stages. [11],[12],[13] In the present case, differential diagnosis from OF was critical as expansion and cortical perforation were observed on CBCT images. The final diagnosis was carried out with histopathologic examination.

Focal cemento-osseous dysplasias do not require surgical intervention as they are benign and their growth is limited. [1] It is recommended that these lesions should be followed regularly, because they can turn into fluoroid osseous dysplasia, which is the advanced form of dysplasia, or simple bony cysts can developed within the FCOD areas. [14],[15] In present case, since the lesion had reached a large size and caused destruction of alveolar bone, surgical excision was decided and the patient was taken under regular follow-up.

  Conclusion Top

Although FCOD is generally asymptomatic and nonneoplastic, sometimes it can reach large sizes. It may cause expansion and/or perforation of the alveolar bone. In order to obtain detailed radiographic examination CBCT images can be considered more effective when compared to conventional methods such as panoramic radiography as CBCT images can provide three-dimensional examination. Care must be given for differentiation of FCOD, which is a reactive condition, from neoplastic and inflammatory conditions to prevent unnecessary surgical and/or endodontic treatments.

  References Top

Bulut EU, Acikgoz A, Ozan B, Zengin AZ, Gunhan O. Expansive focal cemento-osseous dysplasia. J Contemp Dent Pract 2012;13:115-8.  Back to cited text no. 1
Summerlin DJ, Tomich CE. Focal cemento-osseous dysplasia: A clinicopathologic study of 221 cases. Oral Surg Oral Med Oral Pathol 1994;78:611-20.  Back to cited text no. 2
Su L, Weathers DR, Waldron CA. Distinguishing features of focal cemento-osseous dysplasia and cemento-ossifying fibromas. II. A clinical and radiologic spectrum of 316 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997;84:540-9.  Back to cited text no. 3
Bhandari R, Sandhu SV, Bansal H, Behl R, Bhullar RK. Focal cemento-osseous dysplasia masquerading as a residual cyst. Contemp Clin Dent 2012;3:S60-2.  Back to cited text no. 4
MacDonald-Jankowski DS. Fibro-osseous lesions of the face and jaws. Clin Radiol 2004;59:11-25.  Back to cited text no. 5
Potochny EM, Huber AR. Focal osseous dysplasia. Head Neck Pathol 2011;5:265-7.  Back to cited text no. 6
Zegarelli EV, Kutscher AH, Napoli N, Iurono F, Hoffman P. The cementoma. A study of 230 patients with 435 cementomas. Oral Surg Oral Med Oral Pathol 1964;17:219-24.  Back to cited text no. 7
Young SK, Markowitz NR, Sullivan S, Seale TW, Hirschi R. Familial gigantiform cementoma: Classification and presentation of a large pedigree. Oral Surg Oral Med Oral Pathol 1989;68:740-7.  Back to cited text no. 8
Eversole R, Su L, ElMofty S. Benign fibro-osseous lesions of the craniofacial complex. A review. Head Neck Pathol 2008;2:177-202.  Back to cited text no. 9
Macdonald-Jankowski DS. Focal cemento-osseous dysplasia: A systematic review. Dentomaxillofac Radiol 2008;37:350-60.  Back to cited text no. 10
Forman GH. Periapical cemental dysplasia resembling apical granulomata and radicular cysts. Br Dent J 1975;138:22-4.  Back to cited text no. 11
Neville BW, Albenesius RJ. The prevalence of benign fibro-osseous lesions of periodontal ligament origin in black women: A radiographic survey. Oral Surg Oral Med Oral Pathol 1986;62:340-4.  Back to cited text no. 12
Natkin E. Zebra hunt. J Endod 1994;20:147.  Back to cited text no. 13
Su L, Weathers DR, Waldron CA. Distinguishing features of focal cemento-osseous dysplasias and cemento-ossifying fibromas: I. A pathologic spectrum of 316 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997;84:301-9.  Back to cited text no. 14
Brannon RB, Fowler CB. Benign fibro-osseous lesions: A review of current concepts. Adv Anat Pathol 2001;8:126-43.  Back to cited text no. 15


  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]

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