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Nemec SF, Schneider S, Friedrich KM, Weber M, Schwarz-Nemec U. Radiological follow-up of cemento-osseous dysplasia on cone-beam computed tomography. J Craniomaxillofac Surg 2024; 52:644-651. [PMID: 38582672 DOI: 10.1016/j.jcms.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 03/12/2024] [Indexed: 04/08/2024] Open
Abstract
This study investigated the natural course of cemento-osseous dysplasia (COD) on cone-beam computed tomography (CBCT). Retrospectively, 104 CBCT scans from 36 patients (mean age, 44.5 years; 33 female and three male) with mandibular COD (10 florid, seven focal, 19 periapical) were included, based upon clinico-radiological features, without complications such as infection and related surgery. Changes in maximum diameter and morphology (lytic, mixed lytic-sclerotic, sclerotic) were evaluated in 83 lesions, with a mean follow-up of 28.3 months. The occurrence of a diameter increase was assessed by time-to-event analysis; interreader agreement for diameter and morphological evaluation by intraclass correlation coefficient and weighted κ statistics, respectively. Fifteen of 83 (18.1%) lesions (eight florid, one focal, six periapical) in 10 patients increased in diameter; 12 of 83 (14.5%) lesions (five florid, seven periapical) in 11 patients changed morphologically. The median period until a diameter increase was longest (120 months) for periapical COD, and shortest (66 months) for florid COD (p = 0.023). There was high reader agreement (ICC = 0.891; weighted κ = 0.901). In conclusion, CBCT is an effective tool with which to follow-up COD. If any, the natural progress in uncomplicated COD is prolonged, which underlines its non-surgical character and aids in its long-term management.
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Affiliation(s)
- Stefan F Nemec
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Vienna, Austria
| | - Steffen Schneider
- Department of Oral and Maxillofacial Surgery, Medical University of Vienna, Vienna, Austria
| | - Klaus M Friedrich
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Vienna, Austria.
| | - Michael Weber
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Vienna, Austria
| | - Ursula Schwarz-Nemec
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Vienna, Austria
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Park S, Jeon SJ, Yeom HG, Seo MS. Differential diagnosis of cemento-osseous dysplasia and periapical cyst using texture analysis of CBCT. BMC Oral Health 2024; 24:442. [PMID: 38605361 PMCID: PMC11008037 DOI: 10.1186/s12903-024-04208-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/29/2024] [Indexed: 04/13/2024] Open
Abstract
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.
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Affiliation(s)
- Sanghee Park
- Department of Conservative Dentistry, Wonkang University Daejeon Dental Hospital, 77 Dunsan-Ro, Seo-Gu, Daejeon, 302-120, Republic of Korea
| | - Su-Jin Jeon
- Department of Conservative Dentistry, Wonkang University Daejeon Dental Hospital, 77 Dunsan-Ro, Seo-Gu, Daejeon, 302-120, Republic of Korea
| | - Han-Gyeol Yeom
- Department of Oral and Maxillofacial Radiology and Wonkwang Dental Research Institute, College of Dentistry, Wonkwang University, Iksan, Republic of Korea
| | - Min-Seock Seo
- Department of Conservative Dentistry, Wonkang University Daejeon Dental Hospital, 77 Dunsan-Ro, Seo-Gu, Daejeon, 302-120, Republic of Korea.
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Tidke P, Gupta N, Patil D, Ghadage M, Sinha A, Dalave P, Makkad RS. Periapical Cemento-Osseous Dysplasia: A Journey from Diagnostic Dilemma to Accurate Diagnosis with Use of 3D Imaging. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2024; 16:S951-S954. [PMID: 38595463 PMCID: PMC11000969 DOI: 10.4103/jpbs.jpbs_465_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 08/06/2023] [Accepted: 08/10/2023] [Indexed: 04/11/2024] Open
Abstract
Cemento-osseous dysplasia is a subgroup of fibro-osseous dysplasia commonly invading the tooth-bearing regions of the mandible quite often. These bony pathologies are asymptomatic and are seen on radiographs as an incidental finding. Accurate diagnosis of periapical cemento-osseous dysplasia is very crucial as it will help in the proper management of the patient as the incorrect diagnosis can lead to the unnecessary endodontic treatment of the concerned teeth as it may be misdiagnosed as a periapical pathology. We describe a case of periapical cemento-osseous dysplasia in which a 52-year-old woman had been experiencing discomfort in the right mental area of her mandible for the previous 6 months and had finally sought help at the outpatient department. This case study aims to highlight the significance of making an accurate diagnosis of cemento-osseous dysplasias in the tooth-bearing area.
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Affiliation(s)
- Priyanka Tidke
- Department of Oral Medicine and Radiology, MGM Dental College and Hospital, Navi Mumbai, Maharashtra, India
| | - Neha Gupta
- Department of Oral Pathology, Microbiology and Forensic Odontology, Dental Institute, Rajendra Institute of Medical Sciences (RIMS), Ranchi, Jharkhand, India
| | - Dipooja Patil
- Department of Conservative Dentistry and Endodontics, Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Navi Mumbai, Maharashtra, India
| | - Mahesh Ghadage
- Department of Prosthodontics and Crown and Bridge, Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Navi Mumbai, Maharashtra, India
| | - Anamika Sinha
- Department of Conservative Dentistry and Endodontics, Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Navi Mumbai, Maharashtra, India
| | - Pranita Dalave
- Department of Periodontology and Implantology, Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Navi Mumbai, Maharashtra, India
| | - Ramanpal S. Makkad
- Department of Oral Medicine and Radiology, New Horizon Dental College and Research Institute, Sakri, Bilaspur, Chhattisgarh, India
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Zhang J, Liu L, Yang L, Wang J, Tan X, Huang D. Diagnosis of Odontogenic Maxillary Sinusitis by Cone-beam Computed Tomography: A Critical Review. J Endod 2023; 49:1445-1456. [PMID: 37659441 DOI: 10.1016/j.joen.2023.08.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 09/04/2023]
Abstract
INTRODUCTION This review aims to provide an up-to-date overview of the current applications of cone-beam computed tomography (CBCT) and other imaging modalities in diagnosing odontogenic maxillary sinusitis (OMS). Furthermore, the clinical operation procedures of radiography modalities in OMS diagnosis were summarized, with the goal of assisting clinicians in improving OMS diagnostic accuracy in clinical practice. METHOD A comprehensive review of researches that discussed the applications of radiography modalities in the diagnosis of OMS was conducted. Pertinent information was evaluated and organized for this review. RESULTS Cone-beam computed tomography (CBCT) offers a superior, high-resolution, and three-dimensional view of the maxillary tooth-bone-sinus complex compared to conventional radiography modalities. It enables a better understanding and classification of the spatial relationships between root apices/periapical lesions and maxillary sinus. The use of CBCT, combined with the advantages of other radiography modalities and proper image interpretation, is indispensable to enhance OMS diagnostic accuracy and mitigate the risk of missed or misdiagnosis. CONCLUSION The significance of CBCT in the diagnosis of oral and maxillofacial conditions has garnered widespread recognition. It provides highly precise diagnostic information and classification basis for OMS. The clinical operation procedures for imaging examination are essential in ensuring the consistency and reliability of the diagnosis.
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Affiliation(s)
- Jinglan Zhang
- State Key Laboratory of Oral Diseases & National Center of Stomatology & National Clinical Research Center for Oral Diseases & Department of Operative Dentistry and Endodontics West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Liu Liu
- State Key Laboratory of Oral Diseases & National Center of Stomatology & National Clinical Research Center for Oral Diseases & Department of Operative Dentistry and Endodontics West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Lei Yang
- State Key Laboratory of Oral Diseases & National Center of Stomatology & National Clinical Research Center for Oral Diseases & Department of Operative Dentistry and Endodontics West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jing Wang
- State Key Laboratory of Oral Diseases & National Center of Stomatology & National Clinical Research Center for Oral Diseases & Department of Operative Dentistry and Endodontics West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xuelian Tan
- State Key Laboratory of Oral Diseases & National Center of Stomatology & National Clinical Research Center for Oral Diseases & Department of Operative Dentistry and Endodontics West China Hospital of Stomatology, Sichuan University, Chengdu, China.
| | - Dingming Huang
- State Key Laboratory of Oral Diseases & National Center of Stomatology & National Clinical Research Center for Oral Diseases & Department of Operative Dentistry and Endodontics West China Hospital of Stomatology, Sichuan University, Chengdu, China.
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Fatani B, Alotaibi AG, Alzahrani Y, Almahmoud MI. Periapical Cemento-Osseous Dysplasia in a Medically Compromised Patient: A Case Report. Cureus 2023; 15:e39623. [PMID: 37388605 PMCID: PMC10300659 DOI: 10.7759/cureus.39623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2023] [Indexed: 07/01/2023] Open
Abstract
A fibro-osseous lesion is a condition where the regular bone is changed with a fibrous connective tissue matrix that includes an abnormal bone or cementum. These lesions are divided into three groups: ossifying fibroma, cemento-osseous dysplasia (COD), and fibrous dysplasia. COD is the most recurring benign fibro-osseous lesion. These lesions are usually not detected unless infected and are commonly noted accidentally on an X-ray. In this report, we demonstrate a case of periapical cemento-osseous dysplasia in a medically compromised patient with multiple systemic diseases.
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Affiliation(s)
- Bader Fatani
- Dentistry, College of Dentistry, King Saud University, Riyadh, SAU
| | | | - Yazeed Alzahrani
- Dentistry, College of Dentistry, King Saud University, Riyadh, SAU
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Lee YP, Hwang MJ, Lang MJ, Chiang CP. Periapical cemento-osseous dysplasia of the right maxillary central incisor. J Dent Sci 2022; 17:1420-1422. [PMID: 35784150 PMCID: PMC9237171 DOI: 10.1016/j.jds.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Indexed: 12/01/2022] Open
Affiliation(s)
- Yi-Pang Lee
- Department of Dentistry, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Ming-Jay Hwang
- Department of Dentistry, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Ming-Jane Lang
- Department of Dentistry, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Chun-Pin Chiang
- Department of Dentistry, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- Department of Dentistry, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Oral Biology, School of Dentistry, National Taiwan University, Taipei, Taiwan
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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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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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Berlin-Broner Y, Levin L. Retrospective evaluation of endodontic case reports published in the International Endodontic Journal and the Journal of Endodontics for their compliance with the PRICE 2020 guidelines. Int Endod J 2020; 54:210-219. [PMID: 32961626 DOI: 10.1111/iej.13415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 09/15/2020] [Indexed: 01/25/2023]
Abstract
AIM To evaluate, retrospectively, the quality of previously published case reports in Endodontics according to the PRICE 2020 guidelines. METHODOLOGY An electronic literature search was conducted in PubMed database on 12 March 2020, to identify case reports published during the last five years in the International Endodontic Journal and the Journal of Endodontics. For each of the included case reports, information regarding fulfilment of each of the items of the PRICE 2020 guidelines was extracted as '0' (not present in the manuscript), '1' (present in the manuscript) and 'NA' (not applicable) and translated into a score (percentage of items fulfilled). Additionally, the percentage of papers fulfilling each item was calculated. RESULTS Overall, 70 endodontic case reports were identified. The scores of the papers ranged between 56.41% and 79.55%, with a mean score of 70.26 ± 4.36% (SD). The percentage of papers fulfilling each item of the applicable PRICE 2020 items ranged widely, between 0% and 100%. The median of the percentage of all the items (n = 47) was 97.01% and mean 73.33 ± 36.28% (SD). The lowest scores were recorded for specific items in the following domains: 'Case Report Information'-Items 6c, 6g-i, 'Patient Perspective'-Item 8a and 'Quality of Images'-Items 12c-d. CONCLUSIONS Several areas with low reporting rates were identified in case reports published over the last 5 years in Endodontics. Authors should be encouraged to follow the PRICE 2020 guidelines in order to increase the quality and improve reproducibility of their case reports.
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Affiliation(s)
- Y Berlin-Broner
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - L Levin
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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Kato CNAO, Barra SG, Pereira MJC, Gomes LTF, Amaral TMP, Abreu LG, Brasileiro CB, Mesquita RA. Mandibular radiomorphometric parameters of women with cemento-osseous dysplasia. Dentomaxillofac Radiol 2020; 49:20190359. [PMID: 31846355 PMCID: PMC7213529 DOI: 10.1259/dmfr.20190359] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 12/06/2019] [Accepted: 12/11/2019] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To compare the radiomorphometric parameters of mandibular trabecular and cortical bone of females with and without cemento-osseous dysplasia (COD). METHODS A retrospective cross-sectional paired study was conducted. Digital panoramic radiographs were obtained from females diagnosed in a public service of Oral Medicine. The participants were divided into two groups of 50 subjects each: females with a diagnosis of COD (COD group) and females without a diagnosis of COD (non-COD group), randomly chosen from the image database and paired for age. The radiomorphometric parameters analyzed were: mandibular cortical width (MCW), fractal dimension (FD) and mandibular cortical index (MCI). The paired t-test and Wilcoxon test were used to compare MCW and FD values and the McNemar-Bowker test compared the MCI. RESULTS The mean age of both groups was 46.84 ± 11.38 years. The median MCW index was 3.12 mm (2.15-4.55) for the COD group and 3.52 mm (1.90-4.70) for the non-COD group (p = 0.034). The mean FD value of the COD group (1.2039 ± 0.0926) was lower than that of the non-COD group (1.2472 ± 0.0894) in the anatomical region of the interest of mandibular cortical bone (p = 0.031), while no difference was detected in alveolar trabecular bone. The C3 degree of MCI was more frequent in the COD group (p = 0.009). CONCLUSION Females with COD had lower values of radiomorphometric parameters in mandibular cortical bone than females of the same age without COD. These results suggest that, in addition to the dental care recommended in the literature, COD females also require more attention and screening for low bone mineral density.
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Affiliation(s)
- Camila NAO 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 G 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
| | - Mateus JC Pereira
- 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 TF Gomes
- 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 MP 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
| | - Lucas G 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 B 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 A 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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Mupparapu M, Shi KJ, Ko E. Differential Diagnosis of Periapical Radiopacities and Radiolucencies. Dent Clin North Am 2020; 64:163-189. [PMID: 31735225 DOI: 10.1016/j.cden.2019.08.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Periapical pathoses represent changes noted at the apices of teeth within the alveolar process that are suspected on examination, visualized via imaging, and confirmed via histopathology. They can be bone forming or destructive. There are pathologic entities that show both types of changes at the apical regions. These lesions must be identified if they are odontogenic in origin because treatment modalities differ. This article discusses identification of radiopaque and radiolucent lesions noted on radiographs. The common opacities and lucencies are described. When required, advanced imaging is used to depict changes within the bone near the periapical regions of mandibular and maxillary teeth.
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Affiliation(s)
- Mel Mupparapu
- Department of Oral Medicine, Robert Schattner Center, University of Pennsylvania School of Dental Medicine, 240 South 40th Street, Philadelphia, PA 19104, USA.
| | - Katherine Jie Shi
- Department of Endodontics, Tufts University School of Dental Medicine, 1 Kneeland Street, Boston, MA 02111, USA
| | - Eugene Ko
- Department of Oral Medicine, Robert Schattner Center, University of Pennsylvania School of Dental Medicine, 240 South 40th Street, Philadelphia, PA 19104, USA
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Dube NC, Moshy JR, Vuhahula EA, Sohal KS. Benign fibro-osseous lesions of the jaws: a clinicopathologic study of 98 Tanzanian patients. JOURNAL OF ORAL MEDICINE AND ORAL SURGERY 2019. [DOI: 10.1051/mbcb/2019026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Introduction: The benign fibro-osseous lesions (BFOL) are characterized by replacement of the normal bone by cellular fibrous tissue containing various forms of ossification. They encompass common clinical, radiologic and histopathological features and hence pose considerable diagnostic and therapeutic challenges to clinicians and pathologists. Objective: To analyze the clinico-pathological and radiological features of BFOLs of the jaws in patients treated at Muhimbili National Hospital, Tanzania. Material and methods: A retrospective study of files of patients who were diagnosed with BFOLs from January 2011 to December 2013 was done. The collected information included data on demographic characteristics, the duration of the lesion, location of the lesion, presence of swelling, associated symptoms and reported radiological and histological features. Results: A total of 98 patient's records were retrieved. There was a predominance of females (59, 60.2%), with a male to female ratio of 1:1.5. The patient's age at presentation ranged from 5 years to 75 years with a mean age of 29.81 ± 15.28 years. Four types of BFOLs were encountered. Ossifying fibroma were the most frequent (61.2%), followed by fibrous dysplasia (19.4%). Maxilla was more affected than the mandible. Majority (>70%) of the BFOLs were radio-opaque. The common histological features in all four types of BFOL included presence of: woven bone in fibrous stroma, giant cells, loose collagen and foci of hemorrhage. Conclusion: In this sample, BFOLs, were slightly more prevalent in females than males, affecting individuals below 40 years at large. They showed several overlapping clinical, radiological and histological features; thus a combination of different modalities seems necessary for an accurate diagnosis.
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Brody A, Zalatnai A, Csomo K, Belik A, Dobo-Nagy C. Difficulties in the diagnosis of periapical translucencies and in the classification of cemento-osseous dysplasia. BMC Oral Health 2019; 19:139. [PMID: 31291935 PMCID: PMC6617922 DOI: 10.1186/s12903-019-0843-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 07/01/2019] [Indexed: 11/10/2022] Open
Abstract
Background Cemento-osseous dysplasia is a benign fibro-osseous lesion of the tooth-bearing region of the jaws with a periodontal ligament origin. It appears predominantly in Black and Asian middle-aged females. Its importance is that it could mimic a periapical lesion in the early, translucent stage. Case presentation In this report a rare case of familial cemento-osseous dysplasia is presented: a 50-years old Caucasian woman with labial paraesthesia and radiological translucency around the roots of the mandibular incisors and the first molar teeth. The lesion around the first molar was diagnosed as periapical granuloma and a root canal treatment was carried out. The diagnosis of florid cemento-osseous dysplasia and the treatment plan based on two- and three-dimensional radiographic examinations were certified histologically after surgical removal of the lesion. We screened the family members - including the patient’s mother, daughter and son - and identified a periapical version of cemento-osseous dysplasia in the daughter. Our case highlights the difficulties of differential diagnosis of cemento-osseous dysplasia and other periapical pathologies. The inconsistencies in the present classification of cemento-osseous dysplasia are also discussed with a proposal for a different classification based on new aspects that would be very helpful in setting up a correct treatment plan. Conclusion Differentiation of endodontic and non-endodontic origin of radiolucency and distinguishing it from anatomical landmarks by appropriate clinical evaluation and using vitality testing can give an opportunity to prevent unnecessary endodontic treatment. The current categories of cemento-osseous dysplasia classification do not cover the early stage of a hereditary florid form of cemento-osseous dysplasia. Instead of anatomical location of the lesion, clinical and genetic features may be recommended as parameters of cemento-osseous dysplasia classification.
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Affiliation(s)
- Andrea Brody
- Department of Oral Diagnostics, Faculty of Dentistry, Semmelweis University, Szentkirályi u. 47, Budapest, 1088, Hungary.
| | - Attila Zalatnai
- Department of Pathology and Experimental Cancer Research, Faculty of Medicine, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary
| | - Krisztian Csomo
- Department of Oral Diagnostics, Faculty of Dentistry, Semmelweis University, Szentkirályi u. 47, Budapest, 1088, Hungary
| | - Andrea Belik
- Department of Medical Chemistry, Molecular Biology and Pathobiochemistry, Semmelweis University, Tűzoltó u. 37-47, Budapest, 1094, Hungary
| | - Csaba Dobo-Nagy
- Department of Oral Diagnostics, Faculty of Dentistry, Semmelweis University, Szentkirályi u. 47, Budapest, 1088, Hungary
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Consolaro A, Paschoal SRB, Ponce JB, Miranda DAO. Florid cemento-osseous dysplasia: a contraindication to orthodontic treatment in compromised areas. Dental Press J Orthod 2019; 23:26-34. [PMID: 30088561 PMCID: PMC6072450 DOI: 10.1590/2177-6709.23.3.026-034.oin] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 04/26/2018] [Indexed: 11/27/2022] Open
Abstract
Florid cemento-osseous dysplasia is a sclerosing disease that affects the mandible, especially the alveolar process, and that is, in most cases, bilateral; however, in some cases it affects up to three or even four quadrants. During the disease, normal bone is replaced with a thinly formed, irregularly distributed tissue peppered with radiolucent areas of soft tissue. Newly formed bone does not seem to invade periodontal space, but, in several images, it is confused with the roots, without, however, compromising pulp vitality or tooth position in the dental arch. There is no replacement resorption, not even when the images suggest dentoalveolar ankylosis. Orthodontists should make an accurate diagnosis when planning treatments, as this disease, when fully established, is one of the extremely rare situations in which orthodontic treatment is contraindicated. This contraindication is due to: (a) procedures such as the installment of mini-implants and mini-plaques, surgical maneuvers to apply traction to unerupted teeth and extractions should be avoided to prevent contamination of the affected bone with bacteria from the oral microbiota; and (b) tooth movement in the areas affected is practically impossible because of bone disorganization in the alveolar process, characterized by high bone density and the resulting cotton-wool appearance. Densely mineralized and disorganized bone is unable to remodel or develop in an organized way in the periodontal ligaments and the alveolar process. Organized bone remodeling is a fundamental phenomenon for tooth movement.
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Affiliation(s)
- Alberto Consolaro
- Universidade de São Paulo, Faculdade de Odontologia de Bauru (Bauru/SP, Brazil).,Universidade de São Paulo, Faculdade de Odontologia de Ribeirão Preto, Programa de Pós-graduação em Odontopediatria (Ribeirão Preto/SP, Brazil)
| | | | - Jose Burgos Ponce
- Centro Universitário de Adamantina, Curso de Medicina, Disciplina de Patologia (Adamantina/SP, Brazil)
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15
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Cavalcanti PHP, Nascimento EHL, Pontual MLDA, Pontual ADA, Marcelos PGCLD, Perez DEDC, Ramos-Perez FMDM. Cemento-Osseous Dysplasias: Imaging Features Based on Cone Beam Computed Tomography Scans. Braz Dent J 2018; 29:99-104. [PMID: 29267533 DOI: 10.1590/0103-6440201801621] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 08/01/2017] [Indexed: 12/18/2022] Open
Abstract
Imaging exams have important role in diagnosis of cemento-osseous dysplasia (COD). Cone beam computed tomography (CBCT) stands out for allowing three-dimensional image evaluation. This study aimed to assess the prevalence of cases diagnosed as COD on CBCT scans, as well identify the main imaging features related to these lesions. An analysis was performed in a database containing 22,400 radiological reports, in which all cases showing some type of COD were initially selected. These CBCT exams were reevaluated to confirm the radiographic diagnosis and determine the prevalence and distribution of the types of COD with regard to gender, age and preferred location, while describing its most common imaging aspects. Data were presented using descriptive analyses. There were 82 cases diagnosed as COD in the CBCT images (prevalence of 0.4%). The distribution of patients was 11 (13.4%) male and 71 (86.6%) female, with a mean age of 49.8 years (age-range 17-85 years). There were 47 (57.3%) cases of periapical COD, 23 (28%) of focal COD and 12 (14.6%) of florid COD. The mandible was more affected than the maxilla. In most cases, the lesions were mixed or hyperdense. All COD had well-defined limits and there were no cases of tooth displacement. In conclusion, periapical COD was the most common type and the most affected bone was the mandible. Imaging evaluation is critical for diagnosis and dentists should bear in mind all possible radiographic presentations of COD in order to prevent misleading diagnoses and consequently, inadequate treatments.
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Affiliation(s)
| | | | | | - Andréa Dos Anjos Pontual
- Department of Clinical and Preventive Dentistry, UFPE - Universidade Federal de Pernambuco, Recife, PE, Brazil
| | | | - Danyel Elias da Cruz Perez
- Department of Clinical and Preventive Dentistry, UFPE - Universidade Federal de Pernambuco, Recife, PE, Brazil
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Nagvekar S, Syed S, Spadigam A, Dhupar A. Rare presentation of cementoblastoma associated with the deciduous maxillary second molar. BMJ Case Rep 2017; 2017:bcr-2017-221977. [PMID: 29170176 DOI: 10.1136/bcr-2017-221977] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Cementoblastoma is a benign odontogenic neoplasm accounting for less than 0.69%-8% of all odontogenic tumours and is characterised by the presence of sheets of cementum-like tissue demonstrating large number of reversal lines. It shows an unlimited growth potential and a recurrence rate as high as 37.1%. It most commonly affects the permanent mandibular molars. This paper presents the third reported case of cementoblastoma affecting the deciduous maxillary posterior dentition. A 12-year-old male patient reported to the Department of Oral and Maxillofacial Pathology with a chief complaint of pain and swelling in relation to the deciduous maxillary left second molar.
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Affiliation(s)
- Shruti Nagvekar
- Department of Oral and Maxillofacial Pathology, Goa Dental College and Hospital, Bambolim, Goa, India
| | - Shaheen Syed
- Department of Oral and Maxillofacial Pathology, Goa Dental College and Hospital, Bambolim, Goa, India
| | - Anita Spadigam
- Department of Oral and Maxillofacial Pathology, Goa Dental College and Hospital, Bambolim, Goa, India
| | - Anita Dhupar
- Department of Oral and Maxillofacial Pathology, Goa Dental College and Hospital, Bambolim, Goa, India
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17
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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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Jalali P, Kim SG. Multiple periradicular radiolucencies mimicking endodontic lesions in renal osteodystrophy of the mandible: a case report. Int Endod J 2015. [DOI: 10.1111/iej.12512] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- P. Jalali
- Division of Endodontics; Columbia University College of Dental Medicine; New York NY USA
| | - S. G. Kim
- Division of Endodontics; Columbia University College of Dental Medicine; New York NY USA
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