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Indermun S, Titinchi F, Alwan J, Morkel J, Nortje CJ. Osteosarcoma associated with cemento-osseous dysplasia: co-incidence or two related entities? Oral Radiol 2024; 40:546-554. [PMID: 38852116 PMCID: PMC11379726 DOI: 10.1007/s11282-024-00758-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 05/27/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Osteosarcoma of the jaws is a rare primary malignant tumor of bone. The clinical, radiological and histopathological features of a case associated with cemento-osseous dysplasia is presented. CASE REPORT A 57-year-old mixed-race female presented with a large, progressive, swelling of the right mandible. Radiographic examination revealed two associated lesions. Partially defined irregular radiopacities were noted in the left mandible, extending from the premolar to the molar region. The lesion had a cotton-wool appearance and resembled a fibro-osseous lesion; i.e. cemento-osseous dysplasia. A second large, expansive and irregular, radiopaque lesion was noted on the right angle of the mandible, extending beyond the inferior cortex of the mandible. The internal structure was heterogeneous and resembled irregular bone formation. The classic "sunburst" appearance of radiating bony spicules can be seen in the posterior-anterior view and the CBCT 3D reconstruction, indicating the outgrowth of the tumor matrix. Histopathological exam confirmed a final diagnosis of osteosarcoma closely associated with cemento-osseous dysplasia. The patient underwent a fludeoxyglucose-18 (FDG) positron emission tomography (PET) scan which indicated metastasis in the left lung and increased uptake in the right mandible. Chemotherapy was initially administered with a plan to resect the tumor, however, the patient demised as a result of medical complications. CONCLUSION The question in the literature remains whether these two entities are coincidentally found or arise from each other. Nevertheless, it is important for clinicians to closely monitor patients with cemento-osseous dysplasia and biopsy any suspicious lesions that may develop into osteosarcoma.
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Affiliation(s)
- Suvarna Indermun
- Department of Craniofacial Biology, Pathology and Radiology, Faculty of Dentistry and WHO Collaborating Centre, University of the Western Cape, Cape Town, South Africa.
| | - Fadi Titinchi
- Department of Maxillo-Facial and Oral Surgery, Faculty of Dentistry and WHO Collaborating Centre, University of the Western Cape, Cape Town, South Africa
| | - Julandi Alwan
- Department of Craniofacial Biology, Pathology and Radiology, Faculty of Dentistry and WHO Collaborating Centre, University of the Western Cape, Cape Town, South Africa
- Department of Anatomical Pathology, National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
| | - Jean Morkel
- Department of Maxillo-Facial and Oral Surgery, Faculty of Dentistry and WHO Collaborating Centre, University of the Western Cape, Cape Town, South Africa
| | - Christoffel Johannes Nortje
- Department of Craniofacial Biology, Pathology and Radiology, Faculty of Dentistry and WHO Collaborating Centre, University of the Western Cape, Cape Town, South Africa
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Hosseinpour S, Khademi MH, Erfani M, Mosaddad SA, Heboyan A. Are implant-based treatments considered viable for patients with focal or florid cemento-osseous dysplasia? A systematic review. Maxillofac Plast Reconstr Surg 2024; 46:23. [PMID: 38900334 PMCID: PMC11189879 DOI: 10.1186/s40902-024-00432-x] [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: 01/04/2024] [Accepted: 06/14/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Focal and florid cemento-osseous dysplasia are benign fibro-osseous lesions affecting the quality and quantity of the jawbones. This study aimed to determine the viability of implant-based approaches in the affected patients. MAIN TEXT Different scientific databases, including PubMed/MEDLINE, Scopus, Web of Science, Embase, the Cochrane Library, and Google Scholar, were searched until October 8, 2023, using a pre-determined search strategy. Two reviewers screened the retrieved reports and extracted the required information from the included studies. The eligibility criteria included English-language case reports/series or clinical trials. The JBI critical appraisal checklist for case reports was used to assess the methodological quality of the included studies. Three studies were deemed eligible to be included in this study out of the initial 202 records found. Five implants were placed in three patients, positioned in the proximity of the lesion area, without any additional treatment to remove the pathology. The mandibular posterior area was the affected site in all patients. Only one implant failed in one patient after 16 years, which was attributed to peri-implantitis and not the lesion. Other implants demonstrated successful maintenance over follow-up periods. CONCLUSIONS Although the number of the included records was relatively low to draw firm conclusions, it seems that implant-based treatments in patients with focal/florid cemento-osseous dysplasia could be viable, considering a conservative and well-planned approach.
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Affiliation(s)
- Setareh Hosseinpour
- Student Research Committee, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hadi Khademi
- Student Research Committee, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Erfani
- Student Research Committee, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Ali Mosaddad
- Student Research Committee, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran.
- Department of Research Analytics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India.
| | - Artak Heboyan
- Department of Research Analytics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India.
- Department of Prosthodontics, Faculty of Stomatology, Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia.
- Department of Prosthodontics, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran.
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Jagtap R, Gupta S, Bhat M, Mehta N, Gupta S. Dilemma with implant placement in patients with florid cemento-osseous dysplasia: A literature review. Sci Prog 2024; 107:368504241244657. [PMID: 38614470 PMCID: PMC11024584 DOI: 10.1177/00368504241244657] [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: 04/15/2024]
Abstract
METHODOLOGY An electronic search was done in PUBMED, SCOPUS, and a hand search was done in radiology, periodontology, and oral surgery journals. The search yielded 428 results, from which only 6 articles were selected for this literature review. Both prospective and retrospective studies were included. Clinical studies with information on the pre-implant condition of the site, detailed implant procedure, and follow-up after implant placement of more than 6 months were only considered for this review. RESULTS AND CONCLUSION Limited clinical studies, shorter follow-up periods were the shortcomings of this review. However, it can be summarized that dental implants should not be placed at the site of FCOD, however can be placed at adjacent sites. Variations in implant type or the implant length had no bearing on the survival of implants at the sites of FCOD.
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Affiliation(s)
- Rohan Jagtap
- Division of Oral and Maxillofacial Radiology, University of Mississippi Medical Center, Jackson, MS, 39216, USA
- Department of Care Planning and Restorative Sciences, University of Mississippi Medical Center, Jackson, MS, 39216, USA
- Department of Radiology, School of Medicine, University of Mississippi Medical Center, Jackson, MS, 39216, USA
| | - Swati Gupta
- Henry Goldman School of Dental Medicine, Boston, MA, 02118, USA
| | - Mythili Bhat
- Department of Advanced General Dentistry, University of Mississippi Medical Center School of Dentistry, Jackson, MS, 39216, USA
| | - Neeta Mehta
- Department of Advanced General Dentistry, University of Mississippi Medical Center School of Dentistry, Jackson, MS, 39216, USA
| | - Sumit Gupta
- Muffin Healthcare Pvt Ltd, Chandigarh, 160036, India
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Lee AM, Alotaibi FH, Alshamrani Y, Shirley B, Cheng YSL. Osseous Dysplasia With Gross Jaw Expansion - A Case Report. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, MEDICINE, AND PATHOLOGY 2022. [DOI: 10.1016/j.ajoms.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Johnston DT, Phero JA, Hechler BL. The Necessity of Antibiotics in the Management of Surgically Treated Mandibular Osteomyelitis: A Systematic Review. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 135:11-23. [PMID: 35863960 DOI: 10.1016/j.oooo.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/01/2022] [Accepted: 05/05/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Mandibular osteomyelitis remains an incompletely understood entity, and treatment of its various presentations remains diverse. The purpose of this study was to review the necessity of antibiotic therapy after surgical treatment of mandibular osteomyelitis. STUDY DESIGN A systematic review of published articles on surgical management of mandibular osteomyelitis with or without postoperative antibiotic therapy was performed to answer the question, "Does the use of postoperative antibiotics compared with surgery alone alter the success rate in treating mandibular osteomyelitis?" The most recent evidence was sought by searching PubMed, Embase, and Scopus databases. Article appraisal was performed by 2 reviewers. RESULTS Forty-five articles were found that met the inclusion criteria, with all studies being retrospective cohort or case series designs. Only 13 articles used Zurich classification designations of acute osteomyelitis, secondary chronic osteomyelitis, or primary chronic osteomyelitis, and the general heterogeneity of these articles made comparison difficult. No study made an intentional statistical assessment of various antibiotic protocols. CONCLUSIONS Limited evidence suggested that resection may have better success rates than other forms of surgical intervention, regardless of antibiotic therapy. This systematic review questions the perceived necessity of intermediate- or long-term antibiotic therapy in the management of mandibular osteomyelitis after surgical resection.
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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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Nadler C, Perschbacher SE, Septon D, Abdalla-Aslan R, Pharoah M, Lee L. Important radiographic features in the identification of osseous dysplasia-related osteomyelitis. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 131:730-737. [PMID: 33191167 DOI: 10.1016/j.oooo.2020.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 09/07/2020] [Accepted: 09/19/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aims of this study were to identify radiographic features that distinguish osseous dysplasia-related osteomyelitis (OD-related OM) from OD without OM and to detect possible causes of OD-related OM. STUDY DESIGN Seventeen OD cases with and without OM were examined on planar and volumetric (cone beam computed tomography or multidetector computed tomography) imaging. Cases were divided into 3 groups based on clinical data: symptomatic OM, incidental (asymptomatic) OM, and control (OD without OM). Images were reviewed by 3 precalibrated observers, blinded to clinical information, for OD characteristics (location and extent); radiographic features of OD-related OM; and possible causes. Radiographic features of OD-related OM chosen by at least 2 observers were statistically analyzed within and between groups. RESULTS Discontinuity of the cortical plates, widening of the radiolucent rim, decreased attenuation of the radiolucent rim, and sequestrum formation were significantly more common in symptomatic and incidental OM groups than in the control group (P ≤ .05). Two causes, atrophy of the edentulous ridge and presence of a periapical lesion, were also correlated with OD-related OM (P ≤ .05, P ≤ .01, respectively). CONCLUSIONS Radiographic features can distinguish OD-related OM from OD. Familiarity with these radiographic features and possible causes may help improve the identification of secondarily infected OD.
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Affiliation(s)
- Chen Nadler
- Oral Maxillofacial Imaging Unit, Oral Medicine Department, the Hebrew University, Hadassah School of Dental Medicine, Ein Kerem, Jerusalem, 91120, Israel.
| | - Susanne E Perschbacher
- Discipline of Oral and Maxillofacial Radiology, Faculty of Dentistry, University of Toronto, Toronto, ON, Canada
| | - Daniel Septon
- Researcher, Oral Maxillofacial Imaging Unit, Oral Medicine Department, the Hebrew University, Hadassah School of Dental Medicine, Ein Kerem, Hadassah Medical Center, Jerusalem, Israel
| | - Ragda Abdalla-Aslan
- Department of Oral and Maxillofacial Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Michael Pharoah
- Discipline of Oral and Maxillofacial Radiology, Faculty of Dentistry, University of Toronto, Toronto, ON, Canada
| | - Linda Lee
- Discipline of Oral and Maxillofacial Radiology, Faculty of Dentistry, University of Toronto, Toronto, ON, Canada
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Infected Cemento-Osseous Dysplasia: Analysis of 66 Cases and Literature Review. Head Neck Pathol 2019; 14:173-182. [PMID: 31011984 PMCID: PMC7021850 DOI: 10.1007/s12105-019-01037-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 04/16/2019] [Indexed: 12/14/2022]
Abstract
The aim of this study was to describe a series with 66 cases of infected cemento-osseous dysplasia (COD) and to discuss the demographic distribution, clinicoradiographic features and treatment of this condition. A study looking back on the diagnoses made at a single Brazilian centre within a 28-year timeframe was performed. A literature review with searches across five databases was also conducted to identify reports on osteomyelitis/infected COD. Descriptive and statistical analyses were performed. The case series study showed a female/male ratio of 21:1. Affected individuals' mean age was 57.4 years. Mandible was the most affected site (95.5%) and florid subtype was the most frequent infected COD (62.1%). Tooth extraction was the main factor associated with the development of infection associated within a COD lesion. The literature review retrieved 30 studies reporting 46 cases of this condition. Asian women in their 40 s and 50 s were more affected. Surgery for removal/curettage of necrotic bone was acknowledged as an appropriate approach to the treatment of this infection. The clinicodemographic data of the study were similar to data collected across the literature. Clinicians, maxillofacial surgeons and oral rehabilitation providers should be alert to the diagnosis of COD, since infection is a frequent complication whose management is challenging.
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Lv M, You G, Wang J, Fu Q, Gupta A, Li J, Sun J. Identification of a novel ANO5 missense mutation in a Chinese family with familial florid osseous dysplasia. J Hum Genet 2019; 64:599-607. [PMID: 30996299 DOI: 10.1038/s10038-019-0601-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 03/23/2019] [Accepted: 04/05/2019] [Indexed: 11/09/2022]
Abstract
Familial florid osseous dysplasia (FFOD) is an autosomal dominant disorder of connective tissue, characterized by lobulated cementum-like masses scattered throughout the jaws and the alveolar process. This study aimed to identify the genetic etiology of a three-generation Chinese family affected with FFOD. A novel missense mutation p.C356W in anoctamin 5 (ANO5) gene was successfully identified as the pathogenic mutation by whole-exome sequencing (WES). The p.C356W mutation is located in the first loop between the first and second transmembrane domain of ANO5 protein. Sequence alignment of ANO5 protein among many different species revealed that this position is highly conserved. The p.C356W mutation may damage the predicted protein stability of ANO5 by altering the structure of several extracellular loops of ANO5 and affecting the formation of the disulfide bond, thereby disrupting the correct folding of ANO5 protein. Thus, the amino acid at position 356 appears to play a key role in the protein structural stability and function of ANO5 protein. Our results may also provide new insights into the cause and diagnosis of FFOD and may have implications for genetic counseling and clinical management.
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Affiliation(s)
- Mingming Lv
- Department of Oral Maxillofacial-Head Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Guoling You
- Department of Laboratory Medicine, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinbing Wang
- Department of Oral Maxillofacial-Head Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Qihua Fu
- Department of Laboratory Medicine, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Anand Gupta
- Department of Dentistry, Government Medical College Hospital, Chandigarh, India
| | - Jun Li
- Department of Oral Maxillofacial-Head Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China. .,National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China.
| | - Jian Sun
- Department of Oral Maxillofacial-Head Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China. .,National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China.
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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: 11] [Impact Index Per Article: 1.8] [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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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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14
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Florid cemento-osseous dysplasia: review of an uncommon fibro-osseous lesion of the jaw with important clinical implications. Skeletal Radiol 2017; 46:581-590. [PMID: 28194495 DOI: 10.1007/s00256-017-2590-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 01/22/2017] [Accepted: 01/27/2017] [Indexed: 02/02/2023]
Abstract
Florid cemento-osseous dysplasia (FCOD) is a rare, benign, multifocal fibro-osseous dysplastic process affecting tooth-bearing areas of the jaw, characterized by replacement of normal trabecular bone with osseous tissue and dense acellular cementum in a fibrous stroma. It is one clinicopathologic variant in a spectrum of related non-neoplastic fibro-osseous lesions known as cemento-osseous dysplasias (CODs), thought to arise from elements of the periodontal ligament. Diagnosis primarily relies upon radiographic and clinical findings; unnecessary biopsy should be avoided, as inoculation with oral pathogens may precipitate chronic infection in these hypovascular lesions. Appropriate management of uncomplicated FCOD consists of periodic radiographic follow-up. Accordingly, it is important that both radiologists and clinicians performing endodontic interventions possess familiarity with this entity in order to prevent misdiagnosis and inappropriate intervention, which may result in a protracted clinical course. Lesions are usually asymptomatic in the absence of infection, typically discovered on routine dental radiographs or imaging performed for unrelated indications. Radiographically, the condition typically manifests as widespread non-expansile intraosseous masses of varying internal lucency and sclerosis that surround the root apices of vital teeth or edentulous areas in the posterior jaw. While all CODs share similar microscopic features, FCOD is distinguished by its multifocal distribution, involving two or more quadrants of the maxilla and mandible, often in a bilateral symmetric fashion. The vast majority of cases are sporadic, though few exhibit an autosomal dominant familial inheritance pattern. In this pictorial review, we discuss the radiologic characteristics of this entity, pertinent clinical and histologic features, differential diagnoses, and management options.
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Maccotta M, Radoï L. [Florid osseous dysplasia: Management of a symptomatic case]. ACTA ACUST UNITED AC 2016; 117:425-428. [PMID: 27825664 DOI: 10.1016/j.revsto.2016.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Accepted: 10/10/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Florid osseous dysplasia is a rare and benign fibro-osseous pathology, in which bone is replaced by fibrous tissue and metaplastic bone. It can remain asymptomatic for a long time and is most often discovered incidentally during a radiological examination. Sometimes, patients are seen because of an infectious complication. OBSERVATION An edentulous 62 years-old woman was referred for a painful mandibular swelling preventing insertion of her removable denture. Clinical examination showed a chin swelling, a deformation of mandibular bone tables of approximately four centimeters in diameter, an intra-oral fistula and a suppuration. Radiological examination showed a mixed bone lesion blowing up the buccal and lingual cortical plates and a bone sequestrum. Blood test was normal and there were no other skeletal abnormalities. The diagnosis of florid osseous bone dysplasia was made thanks to the confrontation of the clinical, radiological and histological examinations. Excision of the bone sequestrum associated to remodeling osteoplasty was performed under general anesthesia. The removable denture was rebased to drivehealing. DISCUSSION Surgical management of osseous bone dysplasia is legitimate only in the presence of complications not responding to medical treatment. In all other cases, therapeutic abstention and long term supervision are essential.
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Affiliation(s)
- M Maccotta
- Service de chirurgie orale, faculté de chirurgie dentaire Paris-Diderot, 5, rue Garancière, 75006 Paris, France.
| | - L Radoï
- Service de médecine buccale et chirurgie buccale, faculté de chirurgie dentaire Paris-Descartes, 1, rue Maurice-Arnoux, 92120 Montrouge, France
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Mainville GN, Turgeon DP, Kauzman A. Diagnosis and management of benign fibro-osseous lesions of the jaws: a current review for the dental clinician. Oral Dis 2016; 23:440-450. [PMID: 27387498 DOI: 10.1111/odi.12531] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 06/28/2016] [Accepted: 07/02/2016] [Indexed: 02/07/2023]
Abstract
Benign fibro-osseous lesions of the maxillofacial skeleton constitute a heterogeneous group of disorders that includes developmental, reactive (dysplastic) and neoplastic lesions. Although their classification has been reviewed multiple times in the past, the most common benign fibro-osseous lesions are fibrous dysplasia, osseous dysplasia and ossifying fibroma. For the dental clinician, the challenges involve diagnosis and treatment (or lack thereof). A careful correlation of all clinical, radiologic and microscopic features is essential to establish a proper diagnosis and a clear treatment plan. This article aimed to review the clinical, radiologic and histopathologic characteristics of benign fibro-osseous lesions of the jaws, with emphasis on their differential diagnoses. With a deeper understanding of benign fibro-osseous lesions, clinicians will be better prepared to manage these lesions in their practice.
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Affiliation(s)
- G N Mainville
- Department of Stomatology, Faculty of Dentistry, Université de Montréal, Montreal, QC, Canada
| | - D P Turgeon
- Department of Stomatology, Faculty of Dentistry, Université de Montréal, Montreal, QC, Canada
| | - A Kauzman
- Department of Stomatology, Faculty of Dentistry, Université de Montréal, Montreal, QC, Canada
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Woo SB. Central Cemento-Ossifying Fibroma: Primary Odontogenic or Osseous Neoplasm? J Oral Maxillofac Surg 2016; 73:S87-93. [PMID: 26608158 DOI: 10.1016/j.joms.2015.05.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 05/11/2015] [Indexed: 01/05/2023]
Abstract
Currently, central cemento-ossifying fibroma is classified by the World Health Organization as a primary bone-forming tumor of the jaws. However, histopathologically, it is often indistinguishable from cemento-osseous dysplasias in that it forms osteoid and cementicles (cementum droplets) in varying proportions. It is believed that pluripotent cells within the periodontal membrane can be stimulated to produce either osteoid or woven bone and cementicles when stimulated. If this is true, cemento-ossifying fibroma would be better classified as a primary odontogenic neoplasm arising from the periodontal ligament. Cemento-ossifying fibromas also do not occur in the long bones. The present report compares several entities that fall within the diagnostic realm of benign fibro-osseous lesions and reviews the evidence for reclassifying central cemento-ossifying fibroma as a primary odontogenic neoplasm.
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Affiliation(s)
- Sook-Bin Woo
- Associate Professor, Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA; Chief, Clinical Affairs, Division of Oral Medicine and Dentistry and Consultant Pathologist, Department of Pathology, Brigham and Women's Hospital, Boston, MA.
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Akbulut S, Demir MG, Basak K, Paksoy M. Maxillectomy for Cementifying Osseous Dysplasia of the Maxilla: A Case Report. ACTA MEDICA (HRADEC KRÁLOVÉ) 2016; 58:32-4. [PMID: 26454805 DOI: 10.14712/18059694.2015.89] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Osseous dysplasias are the most common subtype of fibro-osseous lesions of the maxillofacial bones. They are benign and often present as incidental asymptomatic lesions. Diagnosis can be made with clinical and radiographic examination. CASE REPORT This article reports the case of a 47-year-old man with a huge cementifying osseous dysplasia of the maxilla that presented with secondary infection after teeth extraction and repair of oroantral fistula. A subtotal maxillectomy had to be done after conservative treatment failed to resolve the infection. DISCUSSION/CONCLUSION Biopsy, tooth extraction or surgical trauma to the affected bones of osseous dysplasia could easily lead to severe secondary infection, the treatment of which may be very difficult, and thus should be avoided if possible.
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Affiliation(s)
- Sevtap Akbulut
- Kartal Dr. Lutfi Kirdar Education and Research Hospital ENT Department Istanbul, Turkey
| | - Mehmet Gokhan Demir
- Prof. Dr. Celal Ertuğ Etimesgut State hospital ENT Department, Etimesgut-Ankara, Turkey.
| | - Kayhan Basak
- Kartal Dr. Lutfi Kirdar Education and Research Hospital Pathology Department Istanbul, Turkey
| | - Mustafa Paksoy
- Kartal Dr. Lutfi Kirdar Education and Research Hospital ENT Department Istanbul, Turkey
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Sukegawa S, Kanno T, Kawai H, Shibata A, Matsumoto K, Sukegawa-Takahashi Y, Sakaida K, Nagatsuka H, Furuki Y. Surgical Treatment and Dental Implant Rehabilitation after the Resection of an Osseous Dysplasia. J HARD TISSUE BIOL 2016. [DOI: 10.2485/jhtb.25.437] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Shintaro Sukegawa
- Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital
| | - Takahiro Kanno
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
| | - Hotaka Kawai
- Department of Oral Pathology and Medicine, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Akane Shibata
- Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital
| | - Kenichi Matsumoto
- Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital
| | | | - Kyosuke Sakaida
- Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital
| | - Hitoshi Nagatsuka
- Department of Oral Pathology and Medicine, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Yoshihiko Furuki
- Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital
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Delai D, Bernardi A, Felippe GS, da Silveira Teixeira C, Felippe WT, Santos Felippe MC. Florid Cemento-osseous Dysplasia: A Case of Misdiagnosis. J Endod 2015; 41:1923-6. [PMID: 26410152 DOI: 10.1016/j.joen.2015.08.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 08/15/2015] [Accepted: 08/20/2015] [Indexed: 11/29/2022]
Abstract
Florid cemento-osseous dysplasia (FCOD) belongs to the group of fibro-osseous lesions in which normal bone is replaced by fibrous connective tissue and calcified cementum tissue of the avascular type. Among the various types of fibro-osseous lesions, FCOD is one of the most commonly encountered diseases in clinical practice and may involve 3 or 4 of the quadrants. FCOD is located in the periapical regions of teeth, and the lesions are predominantly radiolucent (osteolytic phase), become mixed over time (cementoblast phase), and ultimately become radiopaque (osteogenic phase) with a thin radiolucent peripheral halo. The characteristics of FCOD in the initial stages are similar to those of periapical lesions of inflammatory origin, which may lead to misdiagnosis. A 38-year-old woman sought dental care because of complaints of pain on the right side of her face. A clinical examination revealed no marked alterations; a panoramic radiograph was therefore requested and revealed the presence of radiolucent lesions associated with the periapical regions of some of the lower teeth. Thus, the professional referred the patient for endodontic treatment of the associated teeth with the justification that the lesions were of endodontic origin. However, the endodontist found that the teeth responded positively to a sensitivity test. The initial diagnosis could have resulted in unnecessary root canal treatment, but after careful clinical, radiographic, and tomographic assessments by different professionals, FCOD was diagnosed, conservatively treated, and regularly monitored. It is important that dentists have a basic knowledge of the various injuries that affect the jaw bones to prevent errors in diagnosis and treatment and to promote oral health.
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Affiliation(s)
- Débora Delai
- Postgraduate Program, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - Anarela Bernardi
- Postgraduate Program, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - Gabriela Santos Felippe
- Postgraduate Program, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | | | - Wilson Tadeu Felippe
- Department of Endodontics, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
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Massive expansile ossifying fibroma of the mandible with osteomyelitis. Oral Radiol 2014. [DOI: 10.1007/s11282-013-0164-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Onder B, Kurşun S, Oztaş B, Barış E, Erdem E. Florid osseous dysplasia in a middle-aged Turkish woman: A case report. Imaging Sci Dent 2013; 43:197-200. [PMID: 24083214 PMCID: PMC3784680 DOI: 10.5624/isd.2013.43.3.197] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 10/19/2012] [Accepted: 03/07/2013] [Indexed: 11/18/2022] Open
Abstract
Florid osseous dysplasia (FOD) is an uncommon, benign, cemento-osseous lesion of the jaws. The etiology of FOD is still unknown. It is often asymptomatic and may be identified on routine dental radiographs. The classic radiographic appearance of FOD is amorphous, lobulated, mixed radiolucent/radiopaque masses of cotton-wool appearance with a sclerotic border in the jaws. In our case the lesion was found incidentally on routine periapical radiographs taken for restored teeth and edentulous areas. For further and detailed examination, a panoramic radiograph and cone-beam computed tomograph (CBCT) were taken. The panoramic radiograph and CBCT revealed maxillary bilateral and symmetrical, non-expansile, well-defined, round, radiopaque masses in contact with the root of the maxillary right second molar and left first molar teeth. Our aim in presenting this case report was to highlight the importance of imaging in diagnosis of FOD.
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Affiliation(s)
- Buket Onder
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Ankara University, Ankara, Turkey
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Huh JK, Shin SJ. Misdiagnosis of florid cemento-osseous dysplasia leading to unnecessary root canal treatment: a case report. Restor Dent Endod 2013; 38:160-6. [PMID: 24010083 PMCID: PMC3761125 DOI: 10.5395/rde.2013.38.3.160] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 05/20/2013] [Accepted: 05/23/2013] [Indexed: 11/16/2022] Open
Abstract
This case report demonstrates an unnecessary endodontic treatment of teeth with florid cemento-osseous dysplasia (FCOD) due to a misdiagnosis as periapical pathosis and emphasizes the importance of correct diagnosis to avoid unnecessary treatment. A 30-year-old woman was referred to our institution for apicoectomies of the mandibular left canine and both the lateral incisors. The periapical lesions associated with these teeth had failed to resolve after root canal treatment over a 3-year period. Radiographic examinations revealed multiple lesions on the right canine, the second premolar, and both first molars as well as the anterior region of the mandible. Based on clinical, radiographic and histological evaluations, the patient condition was diagnosed as FCOD. The patient has been monitored for 2 years. To avoid unnecessary invasive treatment, accurate diagnosis is essential before treatment is carried out in managing FCOD.
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Affiliation(s)
- Jong-Ki Huh
- Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, Korea
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Multiple radiopaque mandibular lesions in a patient with Apert syndrome. J Endod 2012; 38:1639-43. [PMID: 23146653 DOI: 10.1016/j.joen.2012.06.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2012] [Revised: 06/28/2012] [Accepted: 06/30/2012] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Apert syndrome (acrocephalosyndactyly) is a rare congenital malformation characterized by craniosynostosis, craniofacial anomalies, and symmetric syndactyly of the hands and feet. Oral manifestations usually include bifid uvula, a Byzantine arch palate associated with lateral swellings of the palatine processes, severe maxillary dental crowding associated with teeth malposition, severe open bite, dental caries, and gingival and periodontal disorders. Florid osseous dysplasia is an asymptomatic lesion mostly encountered during casual dental radiographic examinations as multiple sclerotic masses in 2 or more quadrants, usually in tooth-bearing regions. METHODS A 32-year-old woman diagnosed with Apert syndrome was seen in our department for a routine dental examination. Radiographic evaluation showed multiple radiopaque lesions in the mandible. All teeth with radiopaque lesions gave positive responses to vitality tests, and the patient did not report any symptoms. Based on the clinical and radiographic findings, the diagnosis of florid osseous dysplasia in a patient with Apert syndrome was made. Because there were no signs of an intraoral infectious process or endodontic needs, the patient was followed during revisions for Apert syndrome, and the only treatment provided was conservative management of the many carious lesions observed during the clinical examination. CONCLUSIONS To our knowledge, this is the first study reporting the occurrence of florid osseous dysplasia in a patient with Apert syndrome. Conservative management should be performed in asymptomatic cases. Although rare, our case report highlights the importance of florid osseous dysplasia as a condition that may mimic lesions with an endodontic origin in patients with Apert syndrome.
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Abstract
Florid cemento-osseous dysplasia (FCOD) is one of the uncommon dysplasias affecting the maxillofacial region. The age group may vary from 19 to 76 years and typically presents in the 4th and 5th decades. In most cases patients do not have hereditary basis of disease, and only a few familial cases have been documented. As far as we know this is the 1st reported case of familial FCOD in an Indian family. The mother and son exhibited multiple sclerotic masses in both jaws. The mode of transmission appeared to be autosomal dominant with variable phenotypic expression.
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Gerlach RC, Dixon DR, Goksel T, Castle JT, Henry WA. Case presentation of florid cemento-osseous dysplasia with concomitant cemento-ossifying fibroma discovered during implant explantation. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 115:e44-52. [PMID: 22858018 DOI: 10.1016/j.oooo.2012.05.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Revised: 05/13/2012] [Accepted: 05/17/2012] [Indexed: 11/18/2022]
Abstract
A 39-year-old African American woman presented for treatment of a symptomatic mandibular right first molar with a large, periapical radiolucency. After initial attempts at endodontic therapy, this tooth was ultimately extracted owing to unabated symptoms. The extraction site underwent ridge preservation grafting, implant placement, and restoration. After 26 months of implant function, the patient returned with clinical symptoms of pain, buccal swelling, and the sensation of a "loose" implant. This case report details a diagnosis of 2 distinct disease entities associated with the implant site, a cemento-ossifying fibroma and florid cemento-osseous dysplasia of the mandible. This diagnosis was determined from clinical, surgical, radiographic, and histopathologic evidence after biopsy and removal of the previously osseointegrated implant following postinsertion failure by fibrous encapsulation. Before implant therapy, it is essential to conduct a thorough radiographic evaluation of any dental arch with suspected bony lesions to prevent implant failure.
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Affiliation(s)
- Robert C Gerlach
- US Army Advanced Education Programs in Periodontic, Oral Surgery, and Oral Pathology, Fort Gordon, Georgia 309058, USA.
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Concurrent cemento-osseous dysplasia and osteogenic sarcoma: report of two cases. Case Rep Med 2012; 2012:180561. [PMID: 22474452 PMCID: PMC3310281 DOI: 10.1155/2012/180561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2011] [Revised: 12/23/2011] [Accepted: 01/02/2012] [Indexed: 01/14/2023] Open
Abstract
Aim. Cemento-osseous dysplasia (COD) represents a rare group of benign fibroosseous disorders, while osteogenic sarcoma (OS) on the hand, is a malignant tumour of ominous prognosis. A combination of COD and OS is rare and sparsely reported in literature. There are only four reported cases known to the authors. The aim of this paper is to report additional cases of COD occurring concurrently with OS. Materials and Methods. The clinicoradiologic findings and histological analysis of mandibular lesions in two patients who reported at the Dental Centre of the University College Hospital, Ibadan, Nigeria, are presented. Results. The two patients were diagnosed of mandible osteosarcoma occurring concurrently with bilateral mandibular focal cemento-osseous dysplasia. Conclusion. The simultaneous occurrence of osteosarcoma and cemento-osseous dysplasia raises the question of whether COD has transformed into OS or a collision tumour has occurred and their simultaneous occurrence is just a coincidence.
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Imaging characteristics of benign, malignant, and infectious jaw lesions: a pictorial review. AJR Am J Roentgenol 2011; 197:W412-21. [PMID: 21862767 DOI: 10.2214/ajr.10.7225] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The purpose of this article is to describe the indications and appropriate imaging studies for various jaw tumors and tumorlike lesions, the imaging findings, the differential diagnosis, and appropriate treatment options. CONCLUSION It is important for radiologists to recognize the indications and appropriate imaging studies for various jaw lesions. Radiography is typically used for first-line imaging. If necessary, it is followed by CT for evaluation of osseous lesions and MRI for characterization of soft-tissue lesions.
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Rao KA, Shetty SR, Babu SG, Castelino RL. Co-occurence of florid cemento-osseous dysplasia and simple bone cyst: a case report. EJOURNAL OF ORAL MAXILLOFACIAL RESEARCH 2011; 2:e5. [PMID: 24421997 PMCID: PMC3886077 DOI: 10.5037/jomr.2011.2305] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Accepted: 04/14/2011] [Indexed: 11/27/2022]
Abstract
Background The purpose of this report is to present a rare case of co-occurrence of
florid cemento-osseous dysplasia with simple bone cyst in a middle aged
Asian woman. Most of the reported cases are isolated cases of simple bone
cyst or florid cemento-osseous dysplasia, but co-occurrence of these two
entities is extremely rare. Methods The authors report a 41 year old female patient with co-occurrence of
mandibular florid cemento-osseous dysplasia with simple bone cyst. A
thorough clinical and radiological examination was carried out. Results It was diagnosed mandibular cyst with possible co-occurrence of florid
cemento-osseous dysplasia. Surgical exploration of the multilocular lesion
was applied. Since, the patient was symptomatic at the time of presentation
utmost caution was taken during the surgical procedure as florid
cemento-osseous dysplasia is associated with hypo-vascularity of the
affected bone. Based on histopathological, as well as supporting
clinico-radiological findings a confirmative diagnosis of florid
cemento-osseous dysplasia co-occurring with simple bone cyst was made.
Patient was followed-up for a period of six months and was reported to be
asymptomatic. Conclusions Timely diagnosis and well planned treatment is important to obtain a good
prognosis when a rare co-occurrence of two or more bone lesions affects the
jaws.
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Affiliation(s)
- Kumuda Arvind Rao
- Department of Oral and Maxillofacial Radiology, AB Shetty Memorial Institute of Dental Sciences, Nitte University Deralakatte, Mangalore, Karnataka India
| | - Shishir Ram Shetty
- Department of Oral and Maxillofacial Radiology, AB Shetty Memorial Institute of Dental Sciences, Nitte University Deralakatte, Mangalore, Karnataka India
| | - Subhas G Babu
- Department of Oral and Maxillofacial Radiology, AB Shetty Memorial Institute of Dental Sciences, Nitte University Deralakatte, Mangalore, Karnataka India
| | - Renita Lorina Castelino
- Department of Oral and Maxillofacial Radiology, AB Shetty Memorial Institute of Dental Sciences, Nitte University Deralakatte, Mangalore, Karnataka India
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Smith MH, Harms PW, Newton DW, Lebar B, Edwards SP, Aronoff DM. Mandibular Actinomyces osteomyelitis complicating florid cemento-osseous dysplasia: case report. BMC Oral Health 2011; 11:21. [PMID: 21777471 PMCID: PMC3151221 DOI: 10.1186/1472-6831-11-21] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2011] [Accepted: 07/21/2011] [Indexed: 11/18/2022] Open
Abstract
Background Apart from neoplastic processes, chronic disfiguring and destructive diseases of the mandible are uncommon. Case Presentation We report, perhaps for the first time, the simultaneous occurrence of two such conditions in one patient, in a case that emphasizes the importance of bone biopsy in establishing the correct diagnosis. Florid cemento-osseous dysplasia (FCOD) is a chronic, disfiguring condition of the maxillofacial region. This relatively benign disease is primarily observed in middle-aged women of African ancestry. Cervicofacial actinomycosis is an uncommon and progressive infection caused by bacilli of the Actinomyces genus that typically involves intraoral soft tissues but may also involve bone. The accurate diagnosis of actinomycosis is critical for successful treatment. A diagnosis of osteomyelitis caused by Actinomyces bacteria was diagnosed by bone biopsy in a 53 year-old African-American woman with a longstanding history of FCOD after she presented with a new draining ulcer overlying the mandible. Conclusions Clinicians should be aware of the possibility of actinomycosis arising in the setting of FCOD, and the importance of bone biopsy and cultures in arriving at a definitive and timely diagnosis.
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Affiliation(s)
- Miller H Smith
- Department of Oral and Maxillofacial Surgery, University of Michigan Medical School, 1150 W. Medical Center Drive, Ann Arbor, MI, 48109, USA
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Sanjai K, Kumarswamy J, Kumar VK, Patil A. Florid cemento osseous dysplasia in association with dentigerous cyst. J Oral Maxillofac Pathol 2011; 14:63-8. [PMID: 21731265 PMCID: PMC3125062 DOI: 10.4103/0973-029x.72503] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
We present a case of florid cemento-osseous dysplasia occurring in a 20-year-old Indian woman. The subject presented with three lesions involving the maxillary right quadrant, maxillary left quadrant and mandibular left quadrant. The mandibular left quadrant also demonstrated a cyst.The diagnosis was made by correlating the clinical presentation with that of the radiological and histopathological findings. This is a rare entity because of an unusual combination of Asian race along with the association of dentigerous cyst.
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Affiliation(s)
- Karpagaselvi Sanjai
- Department of Oral Pathology and Microbiology, Vydehi Institute of Dental Sciences and Research Center, #82, EPIP Area, Nallurahalli, Whitefield, Bangalore - 560 066, Karnataka, India
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Kim NK, Kim HS, Kim J, Nam W, Cha IH, Kim HJ. Florid cemento-osseous dysplasia: a report of two cases. J Korean Assoc Oral Maxillofac Surg 2011. [DOI: 10.5125/jkaoms.2011.37.6.515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Nam-Kyun Kim
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, Korea
| | - Hyun-Sil Kim
- Department of Oral Pathology, Oral Cancer Research Institute, College of Dentistry, Yonsei University, Seoul, Korea
| | - Jin Kim
- Department of Oral Pathology, Oral Cancer Research Institute, College of Dentistry, Yonsei University, Seoul, Korea
| | - Woong Nam
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, Korea
| | - In-Ho Cha
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, Korea
| | - Hyung-Jun Kim
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, Korea
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Use of cone-beam computerized tomography for evaluation of bisphosphonate-associated osteonecrosis of the jaws. ACTA ACUST UNITED AC 2010; 109:753-64. [DOI: 10.1016/j.tripleo.2009.12.005] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2009] [Revised: 12/01/2009] [Accepted: 12/05/2009] [Indexed: 11/20/2022]
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Eversole R, Su L, ElMofty S. Benign fibro-osseous lesions of the craniofacial complex. A review. Head Neck Pathol 2008; 2:177-202. [PMID: 20614314 PMCID: PMC2807558 DOI: 10.1007/s12105-008-0057-2] [Citation(s) in RCA: 206] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2008] [Accepted: 04/22/2008] [Indexed: 10/22/2022]
Abstract
Benign fibro-osseous lesions of the craniofacial complex are represented by a variety of disease processes that are characterized by pathologic ossifications and calcifications in association with a hypercellular fibroblastic marrow element. The current classification includes neoplasms, developmental dysplastic lesions and inflammatory/reactive processes. The definitive diagnosis can rarely be rendered on the basis of histopathologic features alone; rather, procurement of a final diagnosis is usually dependent upon assessment of microscopic, clinical and imaging features together. Fibrous dysplasia and osteitis deformans constitute two dysplastic lesions in which mutations have been uncovered. Other dysplastic bone diseases of the craniofacial complex include florid osseous dysplasia, focal cemento-osseous dysplasia and periapical cemental dysplasia, all showing a predilection for African descent individuals; although no specific genetic alterations in DNA coding have yet to be uncovered and most studies have been derived from predominant high African descent populations. Ossifying fibromas are neoplastic lesions with four subtypes varying with regard to behavior and propensity for recurrence after surgical excision. The clinicopathologic and molecular features of this unique yet heterogeneous group of diseases are reviewed.
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Affiliation(s)
- Roy Eversole
- Department of Pathology and Medicine, Arthur Dugoni School of Dentistry, University of the Pacific, San Francisco, CA, USA.
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