We present a case of a 48-year-old Hispanic female with a fibro-osseous lesion consistent with cemento-osseous dysplasia (COD) that was located on the periapical aspect of an impacted mandibular canine inferior to a compound odontoma. COD is a non-neoplastic fibro-osseous lesion of the tooth bearing regions of the jaws. COD is traditionally divided into three clinical variants: periapical, focal, and florid. COD is associated with vital teeth and may be seen in edentulous areas. However, cemento-osseous dysplasia associated with the periapical region of an impacted tooth and adjacent to an odontoma is rare. We believe this is the first reported case of COD around the periapical aspect of an impacted tooth. The radiographic, surgical, and microscopic findings suggest that the compound odontoma and COD developed coincidentally as distinct lesions. But a common developmental origin for the odontoma and COD cannot be ruled out due to the proximity of the lesions. No recurrence has been recorded after one year. Additional case reports of COD arising adjacent to or in association with odontogenic tumors are needed.