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Kim J, Yoo SR, Yeom HG, Lim HJ, Kim BC. Implant in the Area of Cemento-osseous Dysplasia: Secondary Infection After Osseointegration and Loading. J Craniofac Surg 2024:00001665-990000000-01489. [PMID: 38709022 DOI: 10.1097/scs.0000000000010198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 03/07/2024] [Indexed: 05/07/2024] Open
Abstract
This case report presents the clinical details of a 60-year-old woman who experienced a secondary infection 5 years postimplant placement and loading in a region affected by cemento-osseous dysplasia (COD). We conducted the simultaneous removal of the implant and the COD mass, which had become osseointegrated with the implant. Healing of the affected area was successful. Caution is paramount during implant placement in COD-affected areas, particularly during the intermediate and osteosclerotic stages, due to compromised vascularity.
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Affiliation(s)
- Jeseong Kim
- Department of Oral and Maxillofacial Surgery
| | | | - Han Gyeol Yeom
- Department of Oral and Maxillofacial Radiology, Daejeon Dental Hospital, College of Dentistry, Wonkwang University, Daejeon, Korea
| | - Hun Jun Lim
- Department of Oral and Maxillofacial Surgery
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2
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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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3
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Nishimura S, Oda M, Habu M, Takahashi O, Tsurushima H, Otani T, Yoshiga D, Wakasugi-Sato N, Matsumoto-Takeda S, Nishina S, Yoshii S, Sasaguri M, Yoshioka I, Morimoto Y. Imaging Characteristics of Embedded Tooth-Associated Cemento-Osseous Dysplasia by Retrospective Study. Tomography 2024; 10:231-242. [PMID: 38393286 PMCID: PMC10891647 DOI: 10.3390/tomography10020018] [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: 12/20/2023] [Revised: 01/30/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Since there are many differential diagnoses for cemento-osseous dysplasia (COD), it is very difficult for dentists to avoid misdiagnosis. In particular, if COD is related to an embedded tooth, differential diagnosis is difficult. However, there have been no reports on the characteristics of the imaging findings of COD associated with embedded teeth. The aim of the present study was to investigate the occurrence and imaging characteristics of cemento-osseous dysplasia (COD) associated with embedded teeth, in order to appropriately diagnose COD with embedded teeth. METHODS The radiographs with or without histological findings of 225 patients with COD were retrospectively analyzed. A retrospective search through the picture archiving and communication system (PACS) of the Division of Oral and Maxillofacial Radiology of Kyushu Dental University Hospital was performed to identify patients with COD between 2011 and 2022. RESULTS Fifteen COD-associated embedded mandibular third molars were identified in 13 patients. All 13 patients were asymptomatic. On imaging, COD associated with embedded mandibular third molars appeared as masses that included calcifications around the apex of the tooth. On panoramic tomography, COD showed inconspicuous internal calcification similar to that of odontogenic cysts or simple bone cysts, especially in patients with COD only around the mandibular third molar region. Those with prominent calcification resembled cemento-ossifying fibroma, calcifying epithelial odontogenic tumor, calcifying odontogenic cyst, adenomatoid odontogenic tumor, and so on, as categories of masses that include calcifications on panoramic tomography and computed tomography. CONCLUSIONS The current investigation is the first to report and analyze the imaging characteristics of COD associated with embedded teeth. It is important to consider the differences between COD and other cystic lesions on panoramic tomography, and the differences between COD and masses that include calcifications on CT.
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Affiliation(s)
- Shun Nishimura
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu 803-8580, Japan; (S.N.); (M.O.); (N.W.-S.); (S.M.-T.); (S.N.)
| | - Masafumi Oda
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu 803-8580, Japan; (S.N.); (M.O.); (N.W.-S.); (S.M.-T.); (S.N.)
| | - Manabu Habu
- Division of Maxillofacial Surgery, Kyushu Dental University, Kitakyushu 803-8580, Japan; (M.H.); (O.T.); (M.S.)
| | - Osamu Takahashi
- Division of Maxillofacial Surgery, Kyushu Dental University, Kitakyushu 803-8580, Japan; (M.H.); (O.T.); (M.S.)
| | - Hiroki Tsurushima
- Division of Oral Medicine, Kyushu Dental University, Kitakyushu 803-8580, Japan; (H.T.); (T.O.); (D.Y.); (I.Y.)
| | - Taishi Otani
- Division of Oral Medicine, Kyushu Dental University, Kitakyushu 803-8580, Japan; (H.T.); (T.O.); (D.Y.); (I.Y.)
| | - Daigo Yoshiga
- Division of Oral Medicine, Kyushu Dental University, Kitakyushu 803-8580, Japan; (H.T.); (T.O.); (D.Y.); (I.Y.)
| | - Nao Wakasugi-Sato
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu 803-8580, Japan; (S.N.); (M.O.); (N.W.-S.); (S.M.-T.); (S.N.)
| | - Shinobu Matsumoto-Takeda
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu 803-8580, Japan; (S.N.); (M.O.); (N.W.-S.); (S.M.-T.); (S.N.)
| | - Susumu Nishina
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu 803-8580, Japan; (S.N.); (M.O.); (N.W.-S.); (S.M.-T.); (S.N.)
| | - Shinji Yoshii
- Division of Promoting Learning Design Education, Department of Physical Function, Kyushu Dental University, Kitakyushu 803-8580, Japan;
| | - Masaaki Sasaguri
- Division of Maxillofacial Surgery, Kyushu Dental University, Kitakyushu 803-8580, Japan; (M.H.); (O.T.); (M.S.)
| | - Izumi Yoshioka
- Division of Oral Medicine, Kyushu Dental University, Kitakyushu 803-8580, Japan; (H.T.); (T.O.); (D.Y.); (I.Y.)
| | - Yasuhiro Morimoto
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu 803-8580, Japan; (S.N.); (M.O.); (N.W.-S.); (S.M.-T.); (S.N.)
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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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Decolibus K, Shahrabi-Farahani S, Brar A, Rasner SD, Aguirre SE, Owosho AA. Cemento-Osseous Dysplasia of the Jaw: Demographic and Clinical Analysis of 191 New Cases. Dent J (Basel) 2023; 11:dj11050138. [PMID: 37232789 DOI: 10.3390/dj11050138] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 05/27/2023] Open
Abstract
Cemento-osseous dysplasia (COD) is a form of benign fibro-osseous lesion of the jaw. We sought to evaluate the demographic and clinical presentations of COD by collecting and analyzing the demographic, clinical, radiographic, and pathologic data of COD diagnosed in our institution from 2017 to 2022. Over this six-year period, the records of 191 patients with COD were reviewed. Most patients were African American and female. Eighty-five patients were diagnosed with florid COD (FLCOD), 63 with periapical COD (PCOD), and 43 with focal COD (FCOD). Twenty-eight (14.7%) patients presented symptoms. The most common symptom was pain. All the symptomatic cases of COD that were histopathologically diagnosed were osteomyelitis in the setting of COD. Symptomatic patients were older (mean of 61.3 years) than the asymptomatic patients (mean of 51.2 years). Due to the radiographic appearance of a radiolucency or a mixture of radiolucency and radiopacity, forty-five asymptomatic patients were biopsied. Most of the asymptomatic patients biopsied were patients with FCOD (n = 19, 54.3%), followed by PCOD (n = 16, 25.8%), and FLCOD (n = 10, 15.2%). FLCOD is the most common form of COD to present with symptoms. Due to the significant overlap in clinical and radiographic presentation with other entities, FCOD and PCOD remain a diagnostic challenge to dentists. In conclusion, we analyzed the demographic and clinical features of 191 new cases of COD, which reaffirms that cemento-osseous dysplasia is a condition that primarily affects middle-aged females of African descent and occurs more frequently in the mandible.
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Affiliation(s)
- Katherine Decolibus
- Department of Diagnostic Sciences, College of Dentistry, The University of Tennessee Health Sciences Center, Memphis, TN 38163, USA
| | - Shokoufeh Shahrabi-Farahani
- Department of Diagnostic Sciences, College of Dentistry, The University of Tennessee Health Sciences Center, Memphis, TN 38163, USA
| | - Anmol Brar
- Department of Diagnostic Sciences, College of Dentistry, The University of Tennessee Health Sciences Center, Memphis, TN 38163, USA
| | - Shane D Rasner
- Department of Diagnostic Sciences, College of Dentistry, The University of Tennessee Health Sciences Center, Memphis, TN 38163, USA
| | - Sarah E Aguirre
- Department of Diagnostic Sciences, College of Dentistry, The University of Tennessee Health Sciences Center, Memphis, TN 38163, USA
| | - Adepitan A Owosho
- Department of Diagnostic Sciences, College of Dentistry, The University of Tennessee Health Sciences Center, Memphis, TN 38163, USA
- Department of Otolaryngology-Head & Neck Surgery, College of Medicine, The University of Tennessee Health Sciences Center, Memphis, TN 38163, USA
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Arsan B. Cone beam computed tomography analysis of mandibular inferior cortical thickness and bone texture in cemento-osseous dysplasia. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 134:110-118. [PMID: 35400627 DOI: 10.1016/j.oooo.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 02/11/2022] [Accepted: 02/20/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study compared mandibular cortical thickness (CTh) and fractal dimension (FD) in patients with cemento-osseous dysplasia (COD) and controls, as measured with cone beam computed tomography. STUDY DESIGN In total, 28 female patients with COD and 28 age-matched controls were selected retrospectively. Inferior cross-sectional CTh was measured at the symphysis (sCTh), anterior (aCTh), mental foramen (mfCTh), molar (mCTh), and posterior (pCTh) regions. The alternate measurement of mean CTh of the volume including buccal, lingual, and inferior cortices between the mental foramina (alternate CTh) was measured in ImageJ. FD was calculated in cortical and trabecular bone. Data were analyzed for significance of differences in CTh and FD between patient groups and for correlation of inferior and alternate CTh measurements. RESULTS Inferior CTh values were lower overall in the patients with COD than in the controls (P = .01), specifically at sCTh, mCTh, and pCTh (P ≤ .042). Alternate CTh was also significantly lower in the COD group (P = .005). There was a significant correlation between inferior and alternate CTh measurements (r = 0.636, P < .001). No significant differences were observed in cortical or trabecular FD between groups (P ≥ .072). CONCLUSIONS Female patients with COD had significantly lower inferior and alternate CTh than healthy controls. Both groups had similar cortical and trabecular bone textures.
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Affiliation(s)
- Belde Arsan
- Faculty of Dentistry, Dentomaxillofacial Radiology Department, Istanbul Medeniyet University, Istanbul, Turkey.
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7
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Nam I, Ryu J, Shin SH, Kim YD, Lee JY. Cemento-osseous dysplasia: clinical presentation and symptoms. J Korean Assoc Oral Maxillofac Surg 2022; 48:79-84. [PMID: 35491138 PMCID: PMC9065647 DOI: 10.5125/jkaoms.2022.48.2.79] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/29/2021] [Accepted: 10/12/2021] [Indexed: 12/02/2022] Open
Abstract
Objectives The purpose of this study was to evaluate risk factors and symptoms in cemento-osseous dysplasia (COD) patients. Materials and Methods In this study, 62 patients who were diagnosed histologically with COD were investigated from 2010 to 2020 at the author's institution. We compared clinical and radiological characteristics of symptomatic and asymptomatic patients. The factors were sex, age, lesion size, site, radiologic stage of lesion, apical involvement, sign of infection, and history of tooth extraction. Statistical analysis was performed using Fisher's exact test and the chi-square test. Results COD was more prevalent in female patients. With the exception of three cases, all were focal COD. The majority of patients presented with symptoms when the lesion was smaller than 1.5 cm in size. Symptoms were observed when the apex of the tooth was included in the lesion or there was a local infection around the lesion. The history of tooth extraction and previous endodontic treatment were evaluated, and history was not a significant predictor for the onset of symptoms. Conclusion In this study, risk factors associated with symptomatic patients were size of lesion, apical involvement, and local infection.
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Affiliation(s)
- Inhye Nam
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University, Yangsan, Korea
| | - Jihye Ryu
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University, Yangsan, Korea
| | - Sang-Hun Shin
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University, Yangsan, Korea
| | - Yong-Deok Kim
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University, Yangsan, Korea
| | - Jae-Yeol Lee
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University, Yangsan, Korea
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8
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Berberi AN, Aoun GT, Aad GP, Khalaf EN. Benign mesenchymal odontogenic tumors of the maxillofacial bones: A report of 3 cases with 3 years follow-up. J Oral Maxillofac Pathol 2022; 26:S46-S50. [PMID: 35450255 PMCID: PMC9017847 DOI: 10.4103/jomfp.jomfp_94_21] [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: 03/27/2021] [Accepted: 09/05/2021] [Indexed: 11/12/2022] Open
Abstract
Benign mesenchymal odontogenic tumors are lesions derived from the mesenchymal components of the tooth-forming apparatus and are consequently found within the jawbone. Benign fibro-osseous tumors are part of this category of lesions in which normal bone is substituted, initially by fibrous tissue and within time become infiltrated by osteoid and cementoid elements. They are asymptomatic, slow-growing lesions and remain undiagnosed until swelling of the face becomes prominent and they share similar radiological characteristics. Herein, we report three cases of ossifying fibroma, cemento-osseous fibroma and periapical cemento-osseous dysplasia and analyze all the correlating factors, clinical history, radiological and histological features, intraoperative appearance, and treatment with a 3-year follow-up period. Despite the advances in the identification of these pathologies, clinicians still face difficulties in their classification and the diagnosis due to overlap in both histological and radiographic findings. An accurate final diagnosis is essential for appropriate treatment and an informative prognosis.
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Affiliation(s)
- Antoine N Berberi
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, Lebanese University, Beirut, Lebanon
| | - Georges T Aoun
- Oral Medicine and Maxillofacial Radiology, Faculty of Dental Medicine, Lebanese University, Beirut, Lebanon
| | - Georges P Aad
- Oral Medicine and Maxillofacial Radiology, Faculty of Dental Medicine, Lebanese University, Beirut, Lebanon
| | - Emile N Khalaf
- Department of Oral Surgery, Beirut Arab University, Beirut, Lebanon
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9
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Pick E, Schäfer T, Al-Haj Husain A, Rupp NJ, Hingsammer L, Valdec S. Clinical, Radiological, and Pathological Diagnosis of Fibro-Osseous Lesions of the Oral and Maxillofacial Region: A Retrospective Study. Diagnostics (Basel) 2022; 12:diagnostics12020238. [PMID: 35204329 PMCID: PMC8870765 DOI: 10.3390/diagnostics12020238] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 12/30/2021] [Accepted: 01/17/2022] [Indexed: 12/27/2022] Open
Abstract
Background: Fibro-osseous lesions (FOL) of the jaw represent a rare, benign group of lesions that share similar clinical, radiological, and histopathological features and are characterized by progressive, variable replacement of healthy bone tissue by fibrous connective tissue. Methods: This retrospective study aimed to evaluate the incidence of fibro-osseous lesions and to reassess the efficacy of case-specific treatment management from a clinical, radiological, and histopathological perspective based on 14 years of data. Results: Forty-four patients with a radiological and/or histopathological diagnosis of benign FOLs were identified and re-evaluated. Cemento-osseous dysplasia was the most common group of FOLs present in our patient cohort (45%), followed by ossifying fibroma (39%) and fibrous dysplasia (16%). The diagnostic imaging technique of choice was CBCT (68%), followed by PAN (18%), with most patients (95 %) additionally undergoing biopsy. The mean age of the patients at the time of diagnosis was 40.54 ± 13.7 years, with most lesions being located in the mandible (86%), with females being predominantly affected (73%). Conclusion: An interdisciplinary approach that analyzes all case-specific factors, including demographic data, medical history, intraoperative findings, and, most importantly, histopathological and radiological features, is essential for an accurate diagnosis and key to avoiding inappropriate treatment.
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Affiliation(s)
- Ellen Pick
- Clinic of Cranio-Maxillofacial and Oral Surgery, Center of Dental Medicine, University of Zurich, 8032 Zurich, Switzerland; (E.P.); (T.S.); (A.A.-H.H.)
| | - Tobias Schäfer
- Clinic of Cranio-Maxillofacial and Oral Surgery, Center of Dental Medicine, University of Zurich, 8032 Zurich, Switzerland; (E.P.); (T.S.); (A.A.-H.H.)
| | - Adib Al-Haj Husain
- Clinic of Cranio-Maxillofacial and Oral Surgery, Center of Dental Medicine, University of Zurich, 8032 Zurich, Switzerland; (E.P.); (T.S.); (A.A.-H.H.)
| | - Niels J. Rupp
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland;
| | - Lukas Hingsammer
- Department of Oral and Maxillofacial Surgery, Medical University of Vienna, 1090 Vienna, Austria;
| | - Silvio Valdec
- Clinic of Cranio-Maxillofacial and Oral Surgery, Center of Dental Medicine, University of Zurich, 8032 Zurich, Switzerland; (E.P.); (T.S.); (A.A.-H.H.)
- Department of Stomatology, Division of Periodontology, Dental School, University of São Paulo, Butantã 2227, SP, Brazil
- Correspondence: ; Tel.: +41-44-634-32-90
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Mlouka M, Tlili M, Khanfir F, Hamrouni A, Khalfi MS, Ben Amor F. Implant placement in a focal cemento-osseous dysplasia: A modified protocol with a successful outcome. Clin Case Rep 2022; 10:e05307. [PMID: 35079398 PMCID: PMC8777049 DOI: 10.1002/ccr3.5307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/09/2021] [Accepted: 12/11/2021] [Indexed: 11/12/2022] Open
Abstract
Cemento-osseous dysplasia (COD) is defined as a condition in which normal bone is replaced by fibrous connective tissue and cementum-like deposits. It is generally asymptomatic and occurs mostly in female patients. Radiologically, it appears as an opaque, lobulated mass. When facing such lesions, it is advised to avoid performing any surgical procedures due to the decreased vascularization and healing potential. The main reported complications being poor healing, sequestrum formation, risk of infection, and fracture of the jaw. Treating posterior mandibular edentulism in presence of a COD can be a challenging situation especially when the patient requires an implant-supported fixed rehabilitation. The aim of this paper is to describe a three-stage modified protocol for implant placement in a compromised site presenting a focal cemento-osseous dysplasia.
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Affiliation(s)
- Mootaz Mlouka
- Anatomy and Oral SurgeryResearch Laboratory of Oral Health and Oro Facial RehabilitationFaculty of Dental MedicineUniversity of MonastirMonastirTunisia
| | - Mohamed Tlili
- Anatomy and Oral SurgeryResearch Laboratory of Oral Health and Oro Facial RehabilitationFaculty of Dental MedicineUniversity of MonastirMonastirTunisia
| | - Faten Khanfir
- AnatomyResearch Laboratory of Oral Health and Oro Facial RehabilitationFaculty of Dental MedicineUniversity of MonastirMonastirTunisia
| | - Ali Hamrouni
- Anatomy and Oral SurgeryResearch Laboratory of Oral Health and Oro Facial RehabilitationFaculty of Dental MedicineUniversity of MonastirMonastirTunisia
| | - Mohamed Salah Khalfi
- AnatomyResearch Laboratory of Oral Health and Oro Facial RehabilitationFaculty of Dental MedicineUniversity of MonastirMonastirTunisia
| | - Faten Ben Amor
- AnatomyResearch Laboratory of Oral Health and Oro Facial RehabilitationFaculty of Dental MedicineUniversity of MonastirMonastirTunisia
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11
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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: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/14/2021] [Accepted: 03/15/2021] [Indexed: 11/26/2022] Open
Abstract
Background/purpose Radiological examination is indispensable in the diagnosis and follow-up of cemento-osseous dysplasia (COD). The aim of this retrospective study was to describe a series of COD cases, identify the frequencies of COD subtypes, and investigate the demographic and radiological characteristics in relation to subtypes. Materials and methods Cone beam computed tomography (CBCT) images/reports of patients with a diagnosis of COD were included in the study. The data collected included information on the age, sex, subtype of COD, location of COD, and region involved. Information regarding the internal density, effects on surrounding structures, and presence of concomitant lesions was also collected. The data obtained were evaluated statistically. Results The study group included CBCT images of 142 patients (130 females (91.5%) and 12 males (8.5%)) with a mean age of 46.97 ± 10.57 years. The mandible was involved in almost all cases (99.3%). The most common subtype was florid COD (51.4%) and lesions with hyperdense internal density (81.7%) were more commonly observed. Cortical thinning (78.2%) was a prominent feature. The frequency of root resorption in periapical COD cases (57.1%) was observed to be significantly higher (p < 0.05). All hypercementosis cases were associated with florid subtype (p < 0.05). In a minority of cases (6.3%), the lesions were associated with bone cysts and osteomyelitis. Conclusion CBCT images clearly demonstrated the effect of COD lesions on surrounding structures. CBCT is an appropriate imaging modality for the diagnosis and follow-up of COD which is the most common fibro-osseous lesion in clinical practice.
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Affiliation(s)
- Birsay Gumru
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Marmara University, Istanbul, Turkey
| | - Melda Pelin Akkitap
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Marmara University, Istanbul, Turkey
| | - Sevilay Deveci
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Marmara University, Istanbul, Turkey
| | - Ender Idman
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Marmara University, Istanbul, Turkey
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Farah CS, Matias MAT. Natural history of florid osseous dysplasia of the jaws with important clinical implications. AUST ENDOD J 2021; 47:684-689. [PMID: 34062036 DOI: 10.1111/aej.12530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 05/09/2021] [Accepted: 05/13/2021] [Indexed: 11/30/2022]
Abstract
Osseous dysplasia (OD) is the most common fibro-osseous lesion of the jaws. A number of cases of florid osseous dysplasia (FOD) have been described; however, to our knowledge none have shown radiographic disease progression for a single case involving multiple regions of the jaws over an extended period of time. This report presents the 18-year history and radiographic disease progression of a patient diagnosed with FOD demonstrating progression from the osteolytic phase through the osteoblastic phase and to maturation phase at different intervals. Additionally, it outlines the importance of cone beam computed tomography (CBCT) in diagnostic workup to avoid unnecessary and invasive treatment such as bone biopsy, endodontic treatment or tooth extraction due to misdiagnosis of FOD. Dental practitioners should establish a correct diagnosis themselves by making use of important clinical and radiographic cues such as tooth vitality of affected teeth, or by referral to an appropriate specialist before commencing irreversible dental treatment.
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Affiliation(s)
- Camile S Farah
- The Oral Medicine Clinic, Hollywood Private Hospital, Nedlands, Western Australia, Australia.,Qscan Radiology Clinics, Brisbane, Queensland, Australia
| | - Marie Anne T Matias
- Qscan Radiology Clinics, Brisbane, Queensland, Australia.,Perth Radiological Clinic, Subiaco, Western Australia, Australia
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13
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Abdel Razek AAK. Bone-related disorders of the jaw: A clinico-radiological diagnostic algorithm. Neuroradiol J 2021; 34:289-299. [PMID: 33678062 DOI: 10.1177/1971400921998967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Bone-related disorders of the jaw (BRDJ) include a spectrum of non-neoplastic and neoplastic lesions of the maxillofacial region that have been recently classified into fibro-osseous lesions, giant cell lesions and osseous tumours. The histopathological features of BRDJ can be similar and overlie each other. Imaging is important in order to reach a specific diagnosis. However, the appearance of BRDJ on imaging is non-specific in some cases. Computed tomography (CT) and magnetic resonance imaging (MRI) are used for accurate localisation, characterisation of the tumour matrix, delineation of the lesion extension and establishment of the relation of BRDJ to the surrounding structures. Imaging is usually done to detect the relationship with the adjacent surrounding vital structures and to diagnose aggressive forms, malignant transformation and associated syndromes. The correlation of the demographic findings, the location and the clinical presentations with the imaging features are important for the diagnosis of BRDJ. The proposed clinico-radiological diagnostic algorithm with CT and MRI helps a specific diagnosis to be reached in some cases.
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14
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Kato CDNADO, Barra SG, Amaral TMP, Silva TA, Abreu LG, Brasileiro CB, Mesquita RA. Cone-beam computed tomography analysis of cemento-osseous dysplasia-induced changes in adjacent structures in a Brazilian population. Clin Oral Investig 2020; 24:2899-2908. [PMID: 32076867 DOI: 10.1007/s00784-019-03154-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 11/11/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To describe the effects of cemento-osseous dysplasia (COD) on anatomical structures. METHODS CBCT scans were retrospectively selected from a database of individuals who attended an Oral Medicine service. Cases with a confirmed diagnosis of periapical, focal, or florid COD were included. Two oral and maxillofacial radiologists assessed the scans. Frequencies of the variables were described according to COD case, lesion areas, and teeth. RESULTS Sixty COD cases affected 244 areas and 426 teeth. Florid COD was the most common (n = 48). Cortical bone (buccal, lingual, palatine, or mandibular) (n = 42) and the maxillary sinus (n = 13) were the structures most frequently affected by displacement or perforation. Thinning (n = 80), expansion (n = 62), and perforation (n = 60) of the cortical bone were common effects. The median size of the lesions was 12 mm in the mesiodistal direction, 8 mm in the buccal-lingual/palatal direction, and 9 mm in the superior-inferior direction. Root resorption was observed in 18.1% of all teeth, while tooth displacement was uncommon (0.6%). All teeth affected by COD had a discontinuous lamina dura and non-uniformly visible periodontal ligament space. CONCLUSIONS CBCT images revealed that cortical bone, lamina dura, and periodontal ligament space were the structures most affected by COD and the effects of COD on anatomical structures were more frequent than previously described. CLINICAL RELEVANCE CODs are fibro-osseous lesions common in the clinical practice, and relationship with anatomical structures is poorly described. CBCT is an appropriate method for the diagnosis and follow-up of patients with COD.
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Affiliation(s)
- Camila de Nazaré Alves de Oliveira Kato
- Department of Oral Pathology and Surgery, School of Dentistry, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil.
| | - Sâmila Gonçalves Barra
- Department of Oral Pathology and Surgery, School of Dentistry, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Tânia Mara Pimenta Amaral
- Department of Oral Pathology and Surgery, School of Dentistry, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Tarcília Aparecida Silva
- Department of Oral Pathology and Surgery, School of Dentistry, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Lucas Guimarães Abreu
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Cláudia Borges Brasileiro
- Department of Oral Pathology and Surgery, School of Dentistry, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Ricardo Alves Mesquita
- Department of Oral Pathology and Surgery, School of Dentistry, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
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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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Abstract
Florid cemento-osseous dysplasia, a benign fibro-osseous condition, is diagnosed based on characteristic radiographic appearances of multifocal round or lobulated sclerotic lesions associated with the teeth in multiple quadrants of the jaws. We report a case of a 73-year-old woman who presented with a painless sharp bony area on the right side of her maxilla. SPECT/CT of facial bones demonstrated multifocal intense increased uptake in both the maxilla and mandible, corresponding to ill-defined florid sclerotic periapical lesions seen on CT, in keeping with a classical appearance of florid cemento-osseous dysplasia.
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17
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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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Fernández-Aceñero MJ, Vázquez Á, Vela S, Suárez J, Jiménez-Ayala B. [Differential diagnosis of cemento-osseous dysplasia of the maxilla. A case report]. REVISTA ESPANOLA DE PATOLOGIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ANATOMIA PATOLOGICA Y DE LA SOCIEDAD ESPANOLA DE CITOLOGIA 2019; 52:120-124. [PMID: 30902376 DOI: 10.1016/j.patol.2018.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 02/26/2018] [Accepted: 03/07/2018] [Indexed: 11/22/2022]
Abstract
Cemento-osseous dysplasia is a benign lesion which affects the jaw bones. It is a frequent incidental finding but no aggressive therapy is necessary. However, it may be confused with more aggressive entities, such as ossifying and cementifying fibroma, which do require treatment. There are no clear-cut histopathological criteria to differentiate between these entities. We present a case of a 13-year old boy who underwent a biopsy of a clinically undiagnosed maxillary lesion. Histopathological analysis revealed moderately cellular fibrous tissue with bone trabeculae with no osteoblastic rimming and clusters of intensely basophilic material corresponding to cementum. The final diagnosis was cemento-osseus dysplasia. The main histopathological features important in the distinction of these entities are discussed.
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Affiliation(s)
| | - Ángel Vázquez
- Servicio de Anatomía Patológica, Hospital Nuestra Señora del Rosario, Instituto Jiménez-Ayala, Madrid, España
| | - Sara Vela
- Servicio de Anatomía Patológica, Hospital Nuestra Señora del Rosario, Instituto Jiménez-Ayala, Madrid, España
| | - Judith Suárez
- Servicio de Anatomía Patológica, Hospital Nuestra Señora del Rosario, Instituto Jiménez-Ayala, Madrid, España
| | - Beatriz Jiménez-Ayala
- Servicio de Anatomía Patológica, Hospital Nuestra Señora del Rosario, Instituto Jiménez-Ayala, Madrid, España
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Abstract
Benign fibro-osseous lesions (BFOLs) are a particularly challenging set of diagnoses for the pathologist. This diverse collection of diseases includes fibrous dysplasia, ossifying fibroma and cemento-osseous dysplasia. While all three conditions have similar microscopic presentations, their treatment and prognosis differ, demanding an accurate and definitive diagnosis. A practical and systematic approach considering the patient's history, demographics, intraoperative presentation, and gross appearance with an emphasis on radiology and histology will be discussed.
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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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