Cemento-osseous Dysplasia Research Articles

P-72082825-1341 - Management of Florid Cemento Osseous Dysplasia Case Series

P-72082825-1341 - Management of Florid Cemento Osseous Dysplasia Case Series

Focal Osseous Dysplasia

Abstract Focal cemento-osseous dysplasia (COD) is a benign fibro-osseous condition that can be seen in dentate and edentulous patients. It is an asymptomatic lesion, and follow-up is essential due to the possibility that focal COD can progress to a condition called florid osseous dysplasia (OD) that involves multiple sites. In this case report, a focal OD is presented, which is located in the edentulous area between the second premolar and the second molar on the left side mandible of a 38-year-old female patient. The lesion caused expansion of the alveolar bone. The diagnosis, treatment and follow-up after surgery are reported.

Cemento osseous dysplasia(COD) of the mandibular teeth misdiagnosed as periapical lesion; cone beam CT-based case report

Cemento osseous dysplasia (COD) is a lesion that occurs in the periapical and tooth-bearing area where normal bone tissue is replaced by fibrous tissue and metaplastic bone. The cause is not clearly known. COD is often discovered incidentally without any symptoms. It is more common in females and mandibular molars. The involved tooth is vital. In radiological imaging, the lesion has a well defined border. The internal density of the lesion depends on the maturity of the lesion. Radiolucent and mixed lesions of COD are sometimes mistaken for periapical lesions and root canal treatment is performed. Because COD has limited growth, no special treatment is required. Accordingly, The author reports cases of COD in mandibular teeth region referred from other clinics for accurate diagnosis or removal of the lesions and presents the cone beam computed tomography images of the cases to help clinicians make an accurate diagnosis.

Comparative study of cemento-ossifying fibroma and focal cemento-osseous dysplasia in the jaw – 15 year retrospective inquiry and literature review

BackgroundCemento-ossifying fibroma (COF) and focal cemento-osseous dysplasia (FCOD) are benign neoplasms occurring in the mandible and maxilla; histologically, they both show normal bone replacement by a fibrous stroma containing variable amounts of calcified fragments resembling bone and cementum. FCOD is relatively common and requires observation; COF is rare and its growth over time can lead to deformity in the head and neck region. Surgical removal of COF at an early stage is critical to prevent recurrence and deformity. Therefore, distinguishing COF from FCOD is important for proper further management. Methods and MaterialsTo determine the parameters differentiating COF from FCOD, we retrospectively analyzed 15 COF cases and 27 FCOD cases reviewed between 2005 and 2020 at Temple University Hospital. Demographic, radiographic and histopathologic characteristics were compared by using Student’s t test for continuous variables and Chi-square test for categorical variables. ResultsIn the non-histopathologic spectrum, COF occurred at a younger age (average age-31yo versus FCOD 43 yo). FCOD showed female predilection compared with COF. No significant difference was observed regarding location and radiographic density. However, COF was significantly associated with radiographic cortical expansion. In the histopathologic spectrum, FCOD was more frequently associated with significant intralesional hemorrhage, increased vascularity, osteoblastic rimming of trabeculae, and ginger roots –like bone trabeculae. DiscussionWe demonstrated 7 clinical, radiographic, and pathologic parameters that can help differentiate COF from FCOD. Comprehensive assessment of the distinguishing characteristics is valuable for accurate diagnosis and treatment of these two entities, aiding in minimizing unnecessary procedures for FCOD and averting facial deformities caused by COF.

Osteosarcoma associated with cemento-osseous dysplasia: co-incidence or two related entities?

BackgroundOsteosarcoma 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 ReportA 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.ConclusionThe 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.

Case report– Periapical cemento-osseous dysplasia–CBCT findings

Case report– Periapical cemento-osseous dysplasia–CBCT findings

Implant in the Area of Cemento-osseous Dysplasia: Secondary Infection After Osseointegration and Loading.

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.

Adenomatoid odontogenic tumor: A histopathologic profile of 43 cases with evidence supporting a mixed odontogenic origin

BackgroundAdenomatoid Odontogenic Tumor (AOT) accounts for 3% of all odontogenic tumors. It has been classified by WHO as an odontogenic tumor of purely epithelial origin. The current study attempts to establish the origin of the tumor along with detailed histopathological and clinicoradiographic analysis of 43 cases of AOT. Material and methodsForty-three cases were reviewed from the departmental archives for demographic data, radiographic features and histological features. Further, histopathological slides were stained with Picrosirius Red (PSR) and observed under polarised light. ResultsA majority of the cases were seen in the anterior jaws (76.7%), and were less than 3 cms (76.7%) in greatest dimension. Equal number of cases were of follicular and extra-follicular location while one was peripheral. Predominantly solid histological pattern was noted in 53.5%. Varied sub-patterns were observed with most cases exhibiting solid nodules and strands of tumor cells. Few cases showed melanin pigmentation. Over a third of cases (37.2%) showed dentigerous cyst like areas and one case each showed features of ossifying fibroma and focal cemento-osseous dysplasia. Tumor droplets, hyaline rings within duct-like structures, dentinoid material and osteodentin showed reddish yellow birefringence when observed under polarised microscopy post PSR staining. ConclusionThis study highlights the diverse histopathological variation of AOT with evidence to reclassify it as a mixed odontogenic tumor based on the polarising microscopic findings with PSR staining.

Differential diagnosis of cemento-osseous dysplasia and periapical cyst using texture analysis of CBCT

BackgroundRadiolucencies found at the root apex in patients with cemento-osseous dysplasia (COD) may be mistaken for periapical cysts (PC) of endodontic origin. The purpose of this study was to examine the utility of quantitative texture analysis using cone-beam computed tomography (CBCT) to differentiate between COD and PC.MethodsPatients who underwent CBCT at Wonkwang University Daejeon Dental Hospital between January 2019 and December 2022 and were diagnosed with COD and PC by clinical, radiologic, and, if necessary, histopathologic examination were included. Twenty-five patients each were retrospectively enrolled in the COD and PC group. All lesions observed on axial CBCT images were manually segmented using the open-access software MaZda version 4.6 to establish the regions of interest, which were then subjected to texture analysis. Among the 279 texture features obtained, 10 texture features with the highest Fisher coefficients were selected. Statistical analysis was performed using the Mann-Whitney U-test, Welch’s t-test, or Student’s t-test. Texture features that showed significant differences were subjected to receiver operating characteristics (ROC) curve analysis to evaluate the differential diagnostic ability of COD and PC.ResultsThe COD group consisted of 22 men and 3 women, while the PC group consisted of 14 men and 11 women, showing a significant difference between the two groups in terms of sex (p=0.003). The 10 selected texture features belonged to the gray level co-occurrence matrix and included the sum of average, sum of entropy, entropy, and difference of entropy. All 10 selected texture features showed statistically significant differences (p<0.05) when comparing patients with COD (n=25) versus those with PC (n=25), osteolytic-stage COD (n=11) versus PC (n=25), and osteolytic-stage COD (n=11) versus cementoblastic-stage COD (n=14). ROC curve analysis to determine the ability to differentiate between COD and PC showed a high area under the curve ranging from 0.96 to 0.98.ConclusionTexture analysis of CBCT images has shown good diagnostic value in the differential diagnosis of COD and PC, which can help prevent unnecessary endodontic treatment, invasive biopsy, or surgical intervention associated with increased risk of infection.

Radiological follow-up of cemento-osseous dysplasia on cone-beam computed tomography

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.

Histomorphometric and molecular characterization of stromal and mineralized components in fibro-osseous lesions.

Indistinct and analogous histopathological features of various fibro-osseous lesions make establishing a definitive diagnosis a challenge. There is a need for additional molecular and histochemical tools to support and differentiate these lesions in order to establish a concrete diagnosis. A retrospective analysis of biopsied lesions in formalin-fixed paraffin-embedded sections (10 cases each of fibrous dysplasia, ossifying fibroma, and cement-osseous dysplasia) retrieved from the archives was studied for immunoexpression of osteocalcin (quantitative analysis in osteocytes), collagen characterization using Azan, Picrosirus, and Toluidine blue stain for evaluating intensity and localization of collagen fibers, and morphometric analysis of vasculature (for evaluating mean vessel density as square microns). Positive immunostaining of osteocalcin suggested mutations of the GNAS-1 gene found in fibrous dysplasia indirectly, as it is a negative regulator of bone formation. Osteocalcin immunopositivity was quantitatively measured in the fibro-osseous lesions, with fibrous dysplasia measuring 14.47 ± 3.628 as compared to ossifying fibroma measuring 5.23 ± 1.33, followed by cemento-osseous dysplasia measuring 2.30 ± 1.409. Toluidine blue suggests the presence of oxytalan fibers (resistant to acid hydrolysis) in ossifying fibroma and cemento-osseous dysplasia, pointing toward the pathogenesis of the lesion. Azan stain and Picrosirus (under a polarizing microscope) helped in distinguishing hard tissue characteristics (70% of cases of fibrous dysplasia showed only a magenta component followed by intermixed magenta with a blue component in 20% of cases and only 10% of cases showed magenta with blue borders whereas for ossifying fibroma, 40% of cases depicted magenta with blue borders along with the other 40% with intermixed magenta with blue component). The mean vessel density was also highest in fibrous dysplasia measuring 7.90 ± 1.079 (in Sq. micron area), followed by ossifying fibroma and cemento-osseous dysplasia. The diagnosis of fibro-osseous lesions by hematoxylin and eosin alone is confusing and thus should be supported by relatively simple histomorphometric analysis for better treatment outcomes. At the diagnostic stage of fibro-osseous lesions, evaluation of intralesional vessel size, reliable molecular marker, and histochemical nature can aid in differentiating fibrous dysplasia from central ossifying fibroma and cemento-osseous dysplasia alongside, other clinical, radiographic and pathological criteria. These parameters help in the diagnostic decision-making of fibro-osseous lesions.

Imaging Characteristics of Embedded Tooth-Associated Cemento-Osseous Dysplasia by Retrospective Study.

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. 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. 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. 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.

Dilemma with implant placement in patients with florid cemento-osseous dysplasia: A literature review.

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. 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.

Idiopathic Mandibular Osteosclerosis: A Case of Complex Diagnosis

The purpose of this study is to report a case of idiopathic osteosclerosis of the mandible and to discuss the differential diagnosis of this lesion. A 17-year-old female was referred to the University Hospital of Geneva by her orthodontist following the fortuitous finding of a radio-opaque lesion in the right posterior mandible at the apex of tooth 44. Intraoral clinical examination revealed no abnormalities of the oral mucosa. Tooth 44 was asymptomatic and reacted positively to the sensitivity test. The orthopantomogram revealed a well-defined unilocular radiodense lesion, surrounded by a thin radiolucent border, measuring 10 × 33 mm, located in the IV quadrant, related to the apex of tooth 44. Differential diagnoses mainly included cementoblastoma, focal cemento-osseous dysplasia, ossifying fibroma, condensing osteitis and idiopathic osteosclerosis. The biopsy material allowed a diagnosis of idiopathic osteosclerosis. The proposed treatment was therefore a “wait and see” approach. After 2 years of follow-up, the patient was asymptomatic, and healing was complete without any neurosensory complications. Our case underlines the differential diagnosis complexity of radio-opaque lesions associated with teeth.

Retrospective radiological analysis of cemento-osseous dysplasia.

Osseous dysplasia (OD) is a form of fibro-osseous lesion located in the jaws that may interfere with the adjacent anatomical structures. The aim of the present study was to evaluate the distribution of radiographic imaging features, the morphological characteristics and the lesion volume of OD with the use of cone-beam computed tomography (CBCT). The study included radiologically diagnosed lesions followed up for at least 1 year. The prevalence and distribution of the OD types were defined in terms of age, sex, lesion location, teeth, relationship with the anatomical structures, and lesion volume. The mean age gradually increased from the periapical group to the florid group (p = 0.018). It was observed that the mandible was the most frequently affected bone (85.5%) (p < 0.05). The margins of the lesions were well defined, and had an irregular or circular shape. The buccal cortical bone was the most affected structure (84.5%), and the damage in the cortical bone increased with an increase in the lesion volume. With regard to teeth, the most frequent disorder was a discontinuous lamina dura (83.0%). Osseous dysplasia lesions affect a wide range of different anatomical areas, and show different volume and morphometric characteristics.

Florid osseous dysplasia mimicking odontogenic infections: A report of two cases and literature review

Abstract Florid cemento-osseous dysplasia (FCOD) is an uncommon fibro-osseous lesion that can affect the jaws. It involves the deposition of dense, acellular amorphous bone on a foundation of fibrous connective tissue, replacing normal cancellous bone. This condition often affects middle-aged women, with a mean age of 42. The lesion’s epicenter is at the teeth apices and typically appears posterior to the canines. We present two cases of female patients, aged 49 and 26, who were both initially misdiagnosed with periapical infection and underwent root canal treatments while the lesions remained. Both patients visited our clinic. After careful history taking and clinical and radiographic examination, FCOD was diagnosed, and both patients were treated conservatively.

Surgical Management of Infection Secondary to Cemento-osseous Dysplasia.

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.

A Case Report &amp; Review of Literature of Florid Cemento-Osseous Dysplasia (FCOD)

Florid cemento-osseous dysplasia (FCOD) is a rare, multifocal fibro-osseous dysplasia affecting tooth-bearing areas of the jaw, characterized by replacement of normal trabecular bone with disorganized osseous tissue and dense acellular cementum in a fibrous stroma. It is one of the variants of non-neoplastic fibro-osseous lesions known as cemento-osseous dysplasias (CODs), thought to arise from elements of the periodontal ligament. The word 'florid' relates to extensive, wide spread presentation of the disease in the jaws. FCOD is most commonly found in middle-aged, black women with the prevalence of 5.5%. It is even rarer based on the reports Indian Population. It predominantly affects middle-aged women of African descent, less frequently in Caucasian and Asian groups. Generally florid cemento-osseous dysplasia is asymptomatic, and is usually detected during radiological examination. In this report, we present a case of a 46-year-old female patient diagnosed with diffuse sclerosing osteomyelitis later on histopathological examination revealed FCOD.

Focal Cemento- Osseous Dysplasia - A Case Report

Cemento- osseous dysplasia is a reactive benign fibro-osseous lesion with the most commonly occurring type being Focal cemento-osseous dysplasia (FCOD). It is categorized by the replacement of normal bone with fibrous tissue along with calcification resembling cementum like structures. Most of the lesions were asymptomatic and no treatment was required. When the lesion is infected with any secondary local or systemic agent, it becomes symptomatic and intervention is required. Here, we report a case of asymptomatic FCOD of the mandible in a 29-year-old female patient. Histopathological evaluation of the biopsy specimen by decalcified sections aided in the final diagnosis of the case.

Study of Ki67 in odontogenic benign tumors

The aim of the present study was to investigate the Ki67 expression level and to measure the cell proliferation index (Ki67) in odontogenic benign tumors.This was an analytical cross-sectional study of odontogenic benign tumors. The sampling was non-probabilistic with an exhaustive recruitment including all biopsy or surgical excision specimen of odontogenic benign tumors. Ki67 immunohistochemistry was performed on histological sections of paraffin-fixed tissues of 3µ thickness with the Ki67 (MM1) monoclonal antibody. The studied variables were sociodemographic, clinical and histopathological. The data have been analysed with SPSS 20.0 software.: Ameloblastoma represented 50.9% of cases and cemento-osseous dysplasia 36.4%. Among the 28 ameloblastoma cases, the 15 (53.6%) were plexiform type, the 7 (25%) follicular type and the 6 (21.4%) unicystic type. The percentage of Ki67 labelled cells was less than 1% in 74.6% (n=41) of the tumors and was equal to 5% in 12.7% (n=7) of cases. A Ki67 law labelling was found in 87.3% (n=48) of tumours and a negative labelling in 12.7% (n=7) of cases. The odontogenic benign tumors had a weak Ki67 expression level and a low epithelial cell proliferation index. The Ki67 could not therefore be used as a predictive biomarker of tumor cell proliferation and the risk of recurrence in odontogenic benign tumors.