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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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Albagieh H, Aldosari M, Alkhathlan A, Alfawaz N, Almutairi M. Radiolucent lesions that may resemble inflammatory periapical lesions: A review article. Saudi Dent J 2023; 35:916-919. [PMID: 38107039 PMCID: PMC10724350 DOI: 10.1016/j.sdentj.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/02/2023] [Accepted: 11/02/2023] [Indexed: 12/19/2023] Open
Abstract
Non-endodontic lesions (NEL) closely resemble lesions of endodontic origin. Its etiology can be odontogenic, non-odontogenic, neoplastic, or anatomic variations that can resemble inflammatory periapical lesions in the periapical area. Inflammatory periapical lesions are caused by pulpal pathoses and require endodontic treatment. Since numerous NEL may resemble inflammatory periapical lesions, they can lead to misdiagnosis and inappropriate management. Thus, a detailed review of the patients' medical and dental histories with clinical examination, including radiographic findings, is essential for the proper assessment of periapical lesions. Numerous cases of misdiagnoses of NEL have been reported in literature. Thus, this review aimed to strengthen the awareness of clinicians on periapical radiolucency, which may resemble inflammatory periapical lesions.
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Affiliation(s)
- Hamad Albagieh
- Oral Medicine and Diagnostic Sciences Department, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | | | | | - Nawaf Alfawaz
- College of Dentistry, King Saud University, Riyadh, Saudi Arabia
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Ebrahimi F, Ebrahimi F, An J. Surgical Management of Infection Secondary to Cemento-osseous Dysplasia. J Craniofac Surg 2023; 34:e614-e617. [PMID: 37552103 DOI: 10.1097/scs.0000000000009556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 06/01/2023] [Indexed: 08/09/2023] Open
Abstract
Cemento-osseous dysplasia (COD) of the jaws generally has no clinical manifestations when asymptomatic, thus requiring no treatment. However, secondary infection in COD requires surgical intervention. This study was focused on the evaluation of the surgical treatment of COD patients with secondary infections. The clinical data of COD patients with secondary infections, treated at the Peking University, Hospital of Stomatology between March 2021 and June 2022, were retrospectively reviewed. The data included age, sex, lesion characteristics, number of surgeries, and surgical outcomes. Seven COD patients with secondary infections underwent curettage, and the wounds were repaired using local soft tissue flaps, such as the buccal fat pad. Four of the patients had primary wound healing, while 3 presented with wound dehiscence. Healing occurred in 2 of these 3 patients after ~1 month of dressings. The remaining patient showed no improvement after 9 weeks, and underwent a second surgery, which led to primary wound healing. In conclusion, secondary infection in COD is an indication for surgical intervention, which may arrest the disease progression.
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Affiliation(s)
- Farin Ebrahimi
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology South Avenue Zhongguancun, Haidian District, Beijing, PR China
| | - Faraz Ebrahimi
- Department of Prosthodontics, Peking University School and Hospital of Stomatology, Beijing China
| | - Jingang An
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology South Avenue Zhongguancun, Haidian District, Beijing, PR China
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Demyati AK. Florid Cemento-osseous Dysplasia Associated with Secondary Infection - A Case Report. Ann Maxillofac Surg 2023; 13:232-235. [PMID: 38405575 PMCID: PMC10883215 DOI: 10.4103/ams.ams_49_23] [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: 03/12/2023] [Revised: 06/26/2023] [Accepted: 07/31/2023] [Indexed: 02/27/2024] Open
Abstract
Rationale The term cemento-osseous dysplasia (COD) refers to a bony fibro-osseous lesion, in which fibrous tissue and cementum-like tissue replace normal bone. There are three types of COD: periapical, focal and florid. The condition is usually asymptomatic and treatment is unnecessary; however, a secondary infection could occur, which requires treatment. Patient Concern A 58-year-old female patient presented with symptoms in the mandibular posterior region of the right jaw for six months. Diagnosis Infected florid COD (FCOD). Treatment A pre-operative antibiotic, followed by extraction of non-restorable teeth, debridement of the infected tissue and necrotic bone removal. Outcome The patient was followed for one year, during which all previously reported signs and symptoms were resolved. Take-away Lessons Early lesion detection is essential. Treatment depends on the presence or absence of clinical and radiographic manifestations. The current case was treated surgically to minimise complications.
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Affiliation(s)
- Abrar Khalid Demyati
- Department of Oral and Maxillofacial Surgery & Rehabilitation, Faculty of Dental Medicine, Umm Al-Qura University, Mecca, Saudi Arabia
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Seifi S, Ghorbani H, Khakbaz O, Bijani F. Focal Cemento Osseous Dysplasia: A Case Report. JOURNAL OF DENTISTRY (SHIRAZ, IRAN) 2022; 23:151-154. [PMID: 35783499 PMCID: PMC9206700 DOI: 10.30476/dentjods.2022.88067.1309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 12/11/2020] [Accepted: 02/01/2021] [Indexed: 11/20/2022]
Abstract
Focal cemento osseous dysplasia (FCOD) is a subgroup of benign fibro osseous lesions, which occur in a single site of tooth-bearing areas of jaws. It is usually asymptomatic and noticed accidentally through routine radiological exams. There is often no need for treatment of such lesions. This case was a 28-year-old male patient with a mixed radiolucent-radiopaque lesion in posterior part of his mandible. Based on radiographic examination, cemento ossifying fibroma (COF) was the first differential diagnosis. After the surgical removal of the lesion, histopathologic evaluation was made and the case was diagnosed as FCOD. Fortunately, after a few months of operation, there was no complication and complete bone formation was occurred.
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Affiliation(s)
- Safoura Seifi
- Dept. of Oral and Maxillofacial Pathology, Oral Health Research Center, Health Research Institute, Dentistry Faculty, Babol University of Medical Sciences, Babol, Iran
| | - Hakimeh Ghorbani
- Dept. of Oral and Maxillofacial Radiology, Oral Health Research Center, Health Research Institute, Dentistry faculty, Babol University of Medical Sciences, Babol, Iran
| | - Oveis Khakbaz
- Dept. of Oral and Maxillofacial Surgery, Oral Health Research Center, Health Research Institute, Dentistry faculty, Babol University of Medical Sciences, Babol, Iran
| | - Fatima Bijani
- Dept. of Oral and Maxillofacial Pathology, Oral Health Research Center, Health Research Institute, Dentistry Faculty, Babol University of Medical Sciences, Babol, Iran
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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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Shibata N, Inamoto K, Naitoh M, Ariji E. Clinical assessment of cemento-osseous dysplasia based on three-dimensional diagnostic imaging: A case report. AUST ENDOD J 2021; 47:105-112. [PMID: 33523556 DOI: 10.1111/aej.12488] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 12/31/2022]
Abstract
Cemento-osseous dysplasia (COD) is a lesion in which periapical bone is replaced by fibrous tissue, including osseous or cementum-like tissue. In the initial stage of COD, radiolucencies are noted at the root apex on periapical radiography, which can be confused with apical periodontitis. Understanding of correct pathological condition and careful assessment of COD is critical to avoid unnecessary endodontic interventions in healthy teeth. This report describes the ability and usefulness of cone-beam computed tomography (CBCT) and multi-slice computed tomography (MSCT) to detect COD. The findings in this case suggest that MSCT is more appropriate than CBCT, especially for patients with early- to middle-stage COD. However, the radiation dose is higher in MSCT than in CBCT; the application of MSCT should be limited to assessment of whether treatment or surgical management is necessary.
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Affiliation(s)
- Naoki Shibata
- Department of Endodontics, School of Dentistry, Aichi Gakuin University, Aichi, Japan
| | - Kyoko Inamoto
- Department of Endodontics, School of Dentistry, Aichi Gakuin University, Aichi, Japan
| | - Munetaka Naitoh
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Aichi Gakuin University, Aichi, Japan
| | - Eiichiro Ariji
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Aichi Gakuin University, Aichi, Japan
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Bernaola-Paredes WE, Sugaya NN, Bergamini ML, Braz-Silva PH. A distinct fibro-osseous lesion of the jaws affecting the maxilla. J Oral Maxillofac Pathol 2020; 24:S23-S27. [PMID: 32189899 PMCID: PMC7069147 DOI: 10.4103/jomfp.jomfp_333_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 01/16/2020] [Indexed: 11/04/2022] Open
Abstract
The differential diagnosis of fibro-osseous lesions (FOL) presents oral clinician stomatologists with a challenging task because of their similar clinical, radiographic and histopathological behavior that will also hinder the therapeutic planning. Presentation of case to describe the clinical, radiographic and histopathological features of an unusual case of FOL presented by the patient, a Black woman, and the results obtained with the conservative surgical treatment and 3-month follow-up. The presence of cementum in the histopathological analysis of cemento-osseous dysplasias, according to the current literature, is an important factor for the diagnosis of this lesion. Considering the characteristics presented by this particular case, we could suggest another entity that could be named a benign cemento-osseous lesion with adult onset. Some occurrences, as in the present case, do not fit properly into the current World Health Organization classification, thereby generating some doubts concerning the correct management of these patients. Conservative surgical treatment is the first choice in the management of these lesions due to their self-limiting nature, which show a behavior of clinical involution.
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Affiliation(s)
| | - Norberto Nobuo Sugaya
- Department of Oral Diagnosis, School of Dentistry, University of Sao Paulo, São Paulo, Brazil
| | - Mariana Lobo Bergamini
- Department of Oral Pathology, School of Dentistry, University of Sao Paulo, São Paulo, Brazil
| | - Paulo Henrique Braz-Silva
- Department of Stomatology, School of Dentistry, University of Sao Paulo, Brazil.,Department of Virology, Institute of Tropical Medicine of São Paulo, University of São Paulo, São Paulo, Brazil
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Ravikumar SS, Vasupradha G, Menaka TR, Sankar SP. Focal cemento-osseous dysplasia. J Oral Maxillofac Pathol 2020; 24:S19-S22. [PMID: 32189898 PMCID: PMC7069129 DOI: 10.4103/jomfp.jomfp_209_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 09/07/2019] [Indexed: 11/04/2022] Open
Abstract
Focal cemento-osseous dysplasia (FCOD) is a benign fibro-osseous lesion of bone characterized by the replacement of normal bone by fibrous tissue and subsequently followed by its calcification with osseous and cementum-like material. It is mostly asymptomatic in nature and requires no treatment. When secondarily infected, it becomes symptomatic and intervention is required. Here, we report a case of symptomatic FCOD of mandible in a 52-year-old female patient. Histopathological evaluation of the biopsy specimen by ground sections and decalcified sections aided in the final diagnosis of the case.
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Affiliation(s)
- S Shamala Ravikumar
- Department of Oral and Maxillofacial Pathology, Adhiparasakthi Dental College and Hospital, Kanchipuram, Tamil Nadu, India
| | - G Vasupradha
- Department of Oral and Maxillofacial Pathology, Adhiparasakthi Dental College and Hospital, Kanchipuram, Tamil Nadu, India
| | - T R Menaka
- Department of Oral and Maxillofacial Pathology, Adhiparasakthi Dental College and Hospital, Kanchipuram, Tamil Nadu, India
| | - S Pradeep Sankar
- Department of Oral and Maxillofacial Pathology, Adhiparasakthi Dental College and Hospital, Kanchipuram, Tamil Nadu, India
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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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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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