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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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Grün P, Schneider B, Bandura P, Pfaffeneder-Mantai F, Bytyqi D, Turhani D. Bone remodelling after minimally invasive surgical management of a recurrent florid cemento-osseous dysplasia in a Caucasian woman – 18 years follow-up of a unique case - A case report. Int J Surg Case Rep 2023; 105:108074. [PMID: 36989622 PMCID: PMC10074572 DOI: 10.1016/j.ijscr.2023.108074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 03/29/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Florid cemento-osseous dysplasia (FCOD) is a multifocal fibro-osseous tumour originating from the periodontal ligament that presents as being rare, benign and slow-growing. The lesion is characterised by the replacement of regular bone-structure with fibrous tissue and dysplastic bone. Depending on localisation, the initial characteristics of FCOD resemble those of periapical lesions of inflammatory origin. CASE PRESENTATION We report on the current findings relating to the case of a 39-year-old Caucasian woman, who initially had persistent paresthesia of the right alveolaris inferior nerve (NAI) for longer than 2 weeks. The orthopantomogram showed multiple bilateral periapical radiolucency and a biopsy was indicated to rule out malignancy. Four years later, the radiolucency occurred once again in region 37, suggesting a recurrence of the lesion. Therefore, another minimally invasive surgery had to be performed, which revealed a bone cavity. Two years later, the bone of the affected region almost completely regenerated. CLINICAL DISCUSSION We were aware that an invasive treatment could lead to infection of the hypovascular lesion. Because of the paresthesia, a biopsy was essential. Unexpectedly, the second minimally invasive surgical treatment was a significant success, as the bone lesion regenerated almost completely. CONCLUSION The follow-up of this case was documented over more than 18 years. To date, this is the longest documented case of a FCOD. Minimally invasive surgical treatment of such lesions may lead to better bone regeneration and even a better quality of life for the patient.
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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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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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Shadid R, Kujan O. Success of dental implant osseointegration in a florid cemento-osseous dysplasia: A case report with 8-year follow-up. Clin Pract 2020; 10:1281. [PMID: 32952986 PMCID: PMC7482179 DOI: 10.4081/cp.2020.1281] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 08/24/2020] [Indexed: 11/22/2022] Open
Abstract
Florid cemento-osseous dysplasia (FCOD) is a rare benign fibro-osseous lesion which affects multiple quadrants and predominantly the mandible. This case report presents a successful implant placement with 8-year of follow-up in a 44-yearold woman asking for a fixed restoration in mandibular right posterior edentulous area. Radiographic images showed lobular, irregularly shaped radiopacities and radiolucencies almost symmetrically observed in the premolar-molar area of the right and left regions of the mandible. The findings of Xray images were attributable to FCOD. Minimally invasive two-stage surgery with strict infection control was followed to place two implants in lower right posterior region. The implants demonstrated clinically rigid fixation and restored successfully after 6 months. A direct functional connection between dysplastic bone and the implant load bearing surface was evidenced by the lack of symptoms, and the lack of soft tissues inflammation or peri-implant bone loss up to 8 years follow-up.
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Affiliation(s)
- Rola Shadid
- Faculty of Dentistry, Arab American University, Jenin, Palestinian Territory; Private practice, Tulkarm, Palestinian Territory
| | - Omar Kujan
- Lead Discipline in Oral Pathology, UWA Dental School, University of Western Australia, Nedlands WA, Australia
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Kato CDNADO, Barra SG, Amaral TMP, Silva TA, Abreu LG, Brasileiro CB, Mesquita RA. Cone-beam computed tomography analysis of cemento-osseous dysplasia-induced changes in adjacent structures in a Brazilian population. Clin Oral Investig 2020; 24:2899-2908. [PMID: 32076867 DOI: 10.1007/s00784-019-03154-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 11/11/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To describe the effects of cemento-osseous dysplasia (COD) on anatomical structures. METHODS CBCT scans were retrospectively selected from a database of individuals who attended an Oral Medicine service. Cases with a confirmed diagnosis of periapical, focal, or florid COD were included. Two oral and maxillofacial radiologists assessed the scans. Frequencies of the variables were described according to COD case, lesion areas, and teeth. RESULTS Sixty COD cases affected 244 areas and 426 teeth. Florid COD was the most common (n = 48). Cortical bone (buccal, lingual, palatine, or mandibular) (n = 42) and the maxillary sinus (n = 13) were the structures most frequently affected by displacement or perforation. Thinning (n = 80), expansion (n = 62), and perforation (n = 60) of the cortical bone were common effects. The median size of the lesions was 12 mm in the mesiodistal direction, 8 mm in the buccal-lingual/palatal direction, and 9 mm in the superior-inferior direction. Root resorption was observed in 18.1% of all teeth, while tooth displacement was uncommon (0.6%). All teeth affected by COD had a discontinuous lamina dura and non-uniformly visible periodontal ligament space. CONCLUSIONS CBCT images revealed that cortical bone, lamina dura, and periodontal ligament space were the structures most affected by COD and the effects of COD on anatomical structures were more frequent than previously described. CLINICAL RELEVANCE CODs are fibro-osseous lesions common in the clinical practice, and relationship with anatomical structures is poorly described. CBCT is an appropriate method for the diagnosis and follow-up of patients with COD.
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Affiliation(s)
- Camila de Nazaré Alves de Oliveira Kato
- Department of Oral Pathology and Surgery, School of Dentistry, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil.
| | - Sâmila Gonçalves Barra
- Department of Oral Pathology and Surgery, School of Dentistry, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Tânia Mara Pimenta Amaral
- Department of Oral Pathology and Surgery, School of Dentistry, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Tarcília Aparecida Silva
- Department of Oral Pathology and Surgery, School of Dentistry, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Lucas Guimarães Abreu
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Cláudia Borges Brasileiro
- Department of Oral Pathology and Surgery, School of Dentistry, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Ricardo Alves Mesquita
- Department of Oral Pathology and Surgery, School of Dentistry, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
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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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10
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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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Toledano-Serrabona J, Núñez-Urrutia S, Vegas-Bustamante E, Sánchez-Torres A, Gay-Escoda C. Florid cemento-osseous dysplasia: Report of 2 cases. J Clin Exp Dent 2019; 10:e1145-e1148. [PMID: 30607236 PMCID: PMC6311402 DOI: 10.4317/jced.55288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 10/03/2018] [Indexed: 11/05/2022] Open
Abstract
Introduction Florid cemento-osseous dysplasia is a non-neoplastic fibro-osseous lesion which often has an asymptomatic slow growth. Unfortunately, these lesions are usually diagnosed through routine radiographic examination. The aim of this study was to describe the main clinical, radiological and histological characteristics of two case reports diagnosed with florid cemento-osseous dysplasia. Case reports Two cases of florid cemento-osseous dysplasia with different clinical and radiological features were presented. Panoramic radiographs showed multiple radiopacities compatible with fibro-osseous lesions in distinct areas of the maxillary bones. The histological study revealed a sclerotic mass which continued imperceptibly with root cement with scarce fibrous lax tissue. Conclusions The replacement of healthy bone by metaplastic bone and fibrous tissue is the main histological feature. Therapeutic abstention with active clinical and radiographic control visits is recommended in asymptomatic cases. Key words:Fibro-osseous lesions, cemento-osseous dysplasia, florid cemento-osseous dysplasia, gigantiform cementoma, osseous dysplasia.
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Affiliation(s)
- Jorge Toledano-Serrabona
- Student in Dental Degree. School of Medicine and Health Sciences, University of Barcelona, Barcelona (Spain) 2 DDS, MS. Master's Degree Program in Oral Surgery and Implantology, School of Medicine and Health Sciences, University of Barcelona (Spain)
| | - Sergio Núñez-Urrutia
- DDS, MS. Master's Degree Program in Oral Surgery and Implantology, School of Medicine and Health Sciences, University of Barcelona (Spain)
| | - Erika Vegas-Bustamante
- DDS, MS. Associated professor in Oral Surgery. Master's Degree Program in Oral Surgery and Implantology, School of Medicine and Health Sciences, University of Barcelona. Researcher of the IDIBELL institute, Barcelona (Spain)
| | - Alba Sánchez-Torres
- DDS, MS. Associated professor in Oral Surgery. Master's Degree Program in Oral Surgery and Implantology, School of Medicine and Health Sciences, University of Barcelona. Researcher of the IDIBELL institute, Barcelona (Spain)
| | - Cosme Gay-Escoda
- MD, DDS, MS, PhD, EBOS, OMFS. Chairman and Professor of Oral and Maxillofacial Surgery, School of Medicine and Health Sciences, University of Barcelona. Director of the Master's Degree Program in Oral Surgery and Implantology (EFHRE International University/FUCSO). Coordinator/Researcher of the IDIBELL Institute. Head of the Oral Surgery, Implantology and Maxillofacial Surgery Department of the Teknon Medical Center, Barcelona (Spain)
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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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13
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Nikdel C, Nikdel K, Ibarra-Noriega A, Kalenderian E, Walji MF. Clinical Dental Faculty Members' Perceptions of Diagnostic Errors and How to Avoid Them. J Dent Educ 2018; 82:340-348. [PMID: 29606650 DOI: 10.21815/jde.018.037] [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: 06/28/2017] [Accepted: 10/09/2017] [Indexed: 11/20/2022]
Abstract
Diagnostic errors are increasingly recognized as a source of preventable harm in medicine, yet little is known about their occurrence in dentistry. The aim of this study was to gain a deeper understanding of clinical dental faculty members' perceptions of diagnostic errors, types of errors that may occur, and possible contributing factors. The authors conducted semi-structured interviews with ten domain experts at one U.S. dental school in May-August 2016 about their perceptions of diagnostic errors and their causes. The interviews were analyzed using an inductive process to identify themes and key findings. The results showed that the participants varied in their definitions of diagnostic errors. While all identified missed diagnosis and wrong diagnosis, only four participants perceived that a delay in diagnosis was a diagnostic error. Some participants perceived that an error occurs only when the choice of treatment leads to harm. Contributing factors associated with diagnostic errors included the knowledge and skills of the dentist, not taking adequate time, lack of communication among colleagues, and cognitive biases such as premature closure based on previous experience. Strategies suggested by the participants to prevent these errors were taking adequate time when investigating a case, forming study groups, increasing communication, and putting more emphasis on differential diagnosis. These interviews revealed differing perceptions of dental diagnostic errors among clinical dental faculty members. To address the variations, the authors recommend adopting shared language developed by the medical profession to increase understanding.
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Affiliation(s)
- Cathy Nikdel
- Dr. Cathy Nikdel is Clinical Assistant Professor, Department of General Practice and Dental Public Health, The University of Texas School of Dentistry at Houston; Dr. Kian Nikdel is Clinical Assistant Professor, Department of General Practice and Dental Public Health, The University of Texas School of Dentistry at Houston; Dr. Ibarra-Noriega is Graduate Research Assistant, Department of Diagnostic and Biomedical Sciences, The University of Texas School of Dentistry at Houston; Dr. Kalenderian is Chair, Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco; and Dr. Walji is Associate Dean for Technology Services and Informatics, and Professor, Department of Diagnostics and Biomedical Sciences, The University of Texas School of Dentistry at Houston
| | - Kian Nikdel
- Dr. Cathy Nikdel is Clinical Assistant Professor, Department of General Practice and Dental Public Health, The University of Texas School of Dentistry at Houston; Dr. Kian Nikdel is Clinical Assistant Professor, Department of General Practice and Dental Public Health, The University of Texas School of Dentistry at Houston; Dr. Ibarra-Noriega is Graduate Research Assistant, Department of Diagnostic and Biomedical Sciences, The University of Texas School of Dentistry at Houston; Dr. Kalenderian is Chair, Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco; and Dr. Walji is Associate Dean for Technology Services and Informatics, and Professor, Department of Diagnostics and Biomedical Sciences, The University of Texas School of Dentistry at Houston
| | - Ana Ibarra-Noriega
- Dr. Cathy Nikdel is Clinical Assistant Professor, Department of General Practice and Dental Public Health, The University of Texas School of Dentistry at Houston; Dr. Kian Nikdel is Clinical Assistant Professor, Department of General Practice and Dental Public Health, The University of Texas School of Dentistry at Houston; Dr. Ibarra-Noriega is Graduate Research Assistant, Department of Diagnostic and Biomedical Sciences, The University of Texas School of Dentistry at Houston; Dr. Kalenderian is Chair, Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco; and Dr. Walji is Associate Dean for Technology Services and Informatics, and Professor, Department of Diagnostics and Biomedical Sciences, The University of Texas School of Dentistry at Houston
| | - Elsbeth Kalenderian
- Dr. Cathy Nikdel is Clinical Assistant Professor, Department of General Practice and Dental Public Health, The University of Texas School of Dentistry at Houston; Dr. Kian Nikdel is Clinical Assistant Professor, Department of General Practice and Dental Public Health, The University of Texas School of Dentistry at Houston; Dr. Ibarra-Noriega is Graduate Research Assistant, Department of Diagnostic and Biomedical Sciences, The University of Texas School of Dentistry at Houston; Dr. Kalenderian is Chair, Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco; and Dr. Walji is Associate Dean for Technology Services and Informatics, and Professor, Department of Diagnostics and Biomedical Sciences, The University of Texas School of Dentistry at Houston
| | - Muhammad F Walji
- Dr. Cathy Nikdel is Clinical Assistant Professor, Department of General Practice and Dental Public Health, The University of Texas School of Dentistry at Houston; Dr. Kian Nikdel is Clinical Assistant Professor, Department of General Practice and Dental Public Health, The University of Texas School of Dentistry at Houston; Dr. Ibarra-Noriega is Graduate Research Assistant, Department of Diagnostic and Biomedical Sciences, The University of Texas School of Dentistry at Houston; Dr. Kalenderian is Chair, Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco; and Dr. Walji is Associate Dean for Technology Services and Informatics, and Professor, Department of Diagnostics and Biomedical Sciences, The University of Texas School of Dentistry at Houston.
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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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15
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Differentiating early stage florid osseous dysplasia from periapical endodontic lesions: a radiological-based diagnostic algorithm. BMC Oral Health 2017; 17:161. [PMID: 29284472 PMCID: PMC5745995 DOI: 10.1186/s12903-017-0455-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 12/10/2017] [Indexed: 11/24/2022] Open
Abstract
Background Osseous dysplasia (OD) is the most common fibro-osseous lesion of the jaw affecting the periapical region. Early stages of OD can resemble periapical radiolucencies, thus mimicking the radiological aspects of an endodontic pathology. Such radiolucent lesions affecting previously decayed or treated teeth are even more complex to interpret. Case presentation The aim of this paper is to report a case-series of representative clinical situations describing the radiological features and illustrating the diagnostic workup of patients with florid osseous dysplasia (FOD). Emphasis is given to the endodontic implications of such periapical bone disease and the complexity of accurate diagnosis in the context of endodontic retreatment. We then propose a practical radiological-based diagnostic algorithm to assist the clinician in the diagnostic of OD periapical lesions. Conclusion Periapical lesions may be confused with bone diseases such as osseous dysplasia, especially in the radiolucent initial stage. Knowledge of clinical features associated with a careful reading of cone beam CT images, such as fine opacities within the hypodense periapical lesion, may help determine the right diagnostic.
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16
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Silva BSF, Bueno MR, Yamamoto-Silva FP, Gomez RS, Peters OA, Estrela C. Differential diagnosis and clinical management of periapical radiopaque/hyperdense jaw lesions. Braz Oral Res 2017; 31:e52. [PMID: 28678971 DOI: 10.1590/1807-3107bor-2017.vol31.0052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 05/21/2017] [Indexed: 11/22/2022] Open
Abstract
Great attention has been given to the study of radiolucent periapical lesions to avert possible misdiagnosis of apical periodontitis associated with certain radiolucent non-endodontic lesions. However, there are a significant number of radiopaque lesions found in the periapical region, which could be equally relevant to endodontic practice. The diagnosis and management of these radiopaque/hyperdense lesions could be challenging to the endodontist. These bone alterations could be neoplastic, dysplastic or of metabolic origin. In the context of the more widespread use of cone-beam CT, a detailed review of radiopaque inflammatory and non-inflammatory lesions is timely and may aid clinicians perform a differential diagnosis of these lesions. Distinguishing between inflammatory and non-inflammatory lesions simplifies diagnosis and consequently aids in choosing the correct therapeutic regimen. This review discusses the literature regarding the clinical, radiographic, histological and management aspects of radiopaque/hyperdense lesions, and illustrates the differential diagnoses of these lesions.
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Affiliation(s)
| | - Mike Reis Bueno
- Universidade de Cuiabá - UNIC, School of Dentistry, Department of Stomatology, University of Cuiabá, Cuibá, MT, Brazil
| | - Fernanda P Yamamoto-Silva
- Universidade Federal de Goiás - UFG, School of Dentistry, Department of Stomatologic Sciences, Goiânia, GO, Brazil
| | - Ricardo Santiago Gomez
- Universidade Federal de Minas Gerias - UFMG, School of Dentistry, Department of Oral Surgery and Pathology, Belo Horizonte, MG, Brazil
| | - Ove Andreas Peters
- University of the Pacific, Arthur A. Dugoni School of Dentistry, Department of Endodontics, San Francisco, CA, United States of America
| | - Carlos Estrela
- Universidade Federal de Goiás - UFG, School of Dentistry, Department of Stomatologic Sciences, Goiânia, GO, Brazil
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