Florid Cemento-osseous Dysplasia Research Articles

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.

A Case Report & 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.

Cemento-Osseous Dysplasia of the Jaw: Demographic and Clinical Analysis of 191 New Cases

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.

Florid cemento-osseous dysplasia associated with multiple impacted teeth in a Japanese female

Rationale: Florid cemento-osseous dysplasia (FCOD) is a rare, benign, multifocal fibro-osseous dysplastic process affecting the tooth-bearing areas of the jaw. Although FCOD is often symmetrically located in various regions of the jaw, cases associated with impacted teeth are very rare. FCOD most commonly affects females in the fourth and fifth decades of life, and is seen less frequently in Asian populations. Patient concerns: A 39-year-old Japanese female was referred to our department with dull pain in region 28. Intraoral examination revealed that all third molars were completely impacted. Imaging findings revealed multiple periapical sclerotic areas surrounded by radiolucent zones in regions 28, 38, and 48. Diagnosis: Histological appearance was compatible with a diagnosis of FCOD. Interventions: Under general anesthesia, we performed the extraction of the lesions with the impacted third molars. The lesions were gritty and reddish brown, continuous to the roots of 28, 38, and 48. Outcomes: The patient had no complications during the 2-year follow-up period. Lessons: Although FCOD has sex and racial ubiquity, it may occur in the opposite sex and other races. Appropriate treatment should be selected depending on the presence or absence of symptoms.

FLORID CEMENTO-OSSEOUS DYSPLASIA IN A YOUNG ADULT: A CASE REPORT

Florid cemento-osseous dysplasia (FCOD) is a benign fibro-osseous lesion of unknown etiology that most commonly affects the jaw of women over 40 years old. It usually appears in routine imaging exams as multiple asymptomatic mixed radiolucent-radiopaque lesions with limited cortical expansion. A 20-year-old female patient presented with multiple and extensive radiolucent lesions containing radiopaque foci, located bilaterally in the posterior mandible. Two small whitish fragments of hard consistency were removed in a biopsy procedure, and microscopic analysis revealed irregular osseous trabeculae surrounded by cellular connective tissue. The correlation between clinical-radiographic and microscopic features was consistent with FCOD. The patient was advised about the clinical behavior expected for the lesions and long-term follow-up was recommended. FCOD may affect young patients and should be included in the differential diagnosis of multiple mixed radiolucent-radiopaque lesions of gnathic bones. Florid cemento-osseous dysplasia (FCOD) is a benign fibro-osseous lesion of unknown etiology that most commonly affects the jaw of women over 40 years old. It usually appears in routine imaging exams as multiple asymptomatic mixed radiolucent-radiopaque lesions with limited cortical expansion. A 20-year-old female patient presented with multiple and extensive radiolucent lesions containing radiopaque foci, located bilaterally in the posterior mandible. Two small whitish fragments of hard consistency were removed in a biopsy procedure, and microscopic analysis revealed irregular osseous trabeculae surrounded by cellular connective tissue. The correlation between clinical-radiographic and microscopic features was consistent with FCOD. The patient was advised about the clinical behavior expected for the lesions and long-term follow-up was recommended. FCOD may affect young patients and should be included in the differential diagnosis of multiple mixed radiolucent-radiopaque lesions of gnathic bones.

Florid cemento-osseous dysplasia-related osteonecrosis: A series of cases

ObjectiveThe aim of this study was to assess the clinicopathological features of florid cemento-osseous dysplasia (FCOD)-related osteonecrosis highlighting their histopathological aspects and bone structure. MethodsTwenty-two FCOD-related osteonecrosis cases were evaluated retrospectively. Osteonecrosis, osteomyelitis, bacterial colonization, bone resorption, reactive bone, osteon-like structure, lamellar bone, and basophilic lines were analyzed. Specific staining and fluorescence and polarized light microscopy analyses were also performed.Results: The mandible was more affected by FCOD-related osteonecrosis. There was a predominance of African-Brazilian women in the fifth and seventh decades of life. Osteomyelitis was present in 82 % of cases whereas bone resorption and bacterial colonization were present in 100 % of FCOD-related osteonecrosis cases. Thick basophilic lines were seen in all cases (100 %). Actinomycosis and osteoclasts were not often. ConclusionsThis study showed female adult preference, mandibular location, and some findings such as osteomyelitis, bone resorption, and bacterial colonization were histopathological features more frequent in FCOD-related osteonecrosis. In the absence of a close clinical and radiographic correlation, the morphology of the necrotized bone similar to cementum could help to recognize FCOD.

Infected florid cemento-osseous dysplasia: About one clinical observation

BackgroundFlorid cemento-osseous dysplasia is a fibro-osseous benign lesion of the jaws characterized by multifocal lesions that affect many quadrants of the maxilla and the mandible. It predominantly affects the female of African origin, and is often asymptomatic and detected as an incidental finding in a radiograph. Its management depends on the clinical manifestation. When required, it consists on the surgical removal of the lesion. ObjectivesThis study aims to describe an unusual presentation of florid cemento-osseous dysplasia with lesions at different stage of maturation, and its management. Case presentationOur study concerns a case of florid cemento-osseous dysplasia with the lesions on the both quadrant of the mandible presenting with different clinical manifestations. One was symptomatic, secondary to an infection, and the second was diagnosed accidently on the radiographic examination for the exploration of the first lesion that was misdiagnosed as an osteitis. According to the recommendations of the literature, the therapeutic used was thus different for each lesion. The symptomatic lesion was removed surgically, while the asymptomatic lesion was subject to a follow-up. The recovery was without any particularity. ConclusionFlorid cemento-osseous dysplasia is a well-defined clinical and radiological entity that can present with lesions at different stage of maturation, leading to the personalization of the treatment for each patient.

Central ossifying fibroma of mandible arising in association with cemento-osseous dysplasia. An unusual case presentation

<h3>Introduction</h3> Cemento-osseous dysplasia (COD) is known to develop complications including infection, necrosis, and traumatic bone cysts [1]. Neoplastic occurrence with COD has been reported, but is rare [2,3]. We report an unusual case of central ossifying fibroma (COF) of the mandibular symphysis in association with COD in a 46-yearold black female. <h3>Case Description</h3> The patient presented with a mandibular symphysis mass that was associated with difficulty of eating, speaking and paresthesia. The radiographic images showed a predominantly radiopaque mass in the symphysis region, measuring 7 × 6 × 5cm. There were discrete, minimally expansile mixed radiolucentopaque lesions in the posterior mandible and maxilla. The patient underwent mandibular resection due to the symptoms of eating and speaking difficulties as well as paresthesia. Before resection, three incisional biopsies including bilateral posterior regions of mandible and the central mass. Histopathologic examination of posterior specimens revealed similar findings of fragments consisting of cellular fibroblastic tissue intermixed with short bone spicules and cementum-like and hemorrhagic deposits associated with traumatic bone cysts. However, the central specimen showed solid tumor consisting of fibroblastic proliferation supporting spindled fibroblast-like cells. It supported cellular bone trabeculae as well as spherical cementum-like calcified deposits. This framework is interspersed with spaces lined by fibrovascular tissue supporting eosinophilic osteoid, consistent with traumatic bone cysts. <h3>Discussion</h3> COD lacks genetic abnormalities noted in fibrous dysplasia or neoplastic fibro-osseous lesions. We present an unusual association of COF with florid COD. This association has been previously reported in a patient who developed COF with COD and odontoma, and in another who developed peripheral osteoma, odontoma, COF and COD [2,3]. To the best of our knowledge, this presentation describes only the third case report of the association of COF and COD. The co-existence of COF and COD in these cases is unclear, but seems to be very rare.

Survival of dental implants in patients with bone dysplasia: A systematic review

Objective: This study used published studies to assess the survival rate of dental implants placed in patients with bone dysplasia of the maxillofacial region.Material and methods: An electronic search without a specified date range was performed using the MEDLINE, PubMed, EMBASE, Web of Science, and Cochrane databases. No gender or age restrictions were applied.Results: Eighteen publications were found that met the study’s criteria, reporting data on 18 patients with bone dysplasia including cleidocranial dysplasia (CDD), fibrous dysplasia (FD), florid cemento-osseous dysplasia (FCOD), and odonto-maxillary segmental dysplasia (SOMD), who received a total of 130 implants, an average of 7.2 implants/patient (range 1 to 16). The mean age of the patients was 36.7 years (range 15 to 70 years). For implants placed in bone dysplasia, the survival rates were 100% for patients with CDD (n = 8), FD (n = 5), SOMD (n = 2), FCOD with implants inserted far from the lesions (n = 2) and 0% for dental implants inserted within FCOD (n = 1). The mean follow-up was 38.2 months (min 6, max 60).Conclusions: Dental implants placed in patients with dysplastic bone lesions show high survival rates, similar to those in the general population for CDD, FD, and SOMD. For FCOD, the failure rate was 100%.

Implant Placement in a Cemento-Osseous Dysplasia: A case report

We present a 45-year-old black woman diagnosed with a florid cemento-osseous dysplasia (FCOD) affecting the right lower quadrant and the anterior mandibular region. The patient requested dental implants to rehabilitate the edentulous central lower incisors area (teeth # 31 and # 41) corresponding to a periapical cemento-osseous dysplasia (PCOD). Successful osseointegration of the two implants was obtained using a two-step procedure in order to limit the risk of complications associated with implant placement. Follow-up at one year showed no recurrence and good implant stability. Due to the abnormal quality of the bone in cemento-osseous dysplasia (COD), implant placement is generally avoided, and no other case reports have been reported in the literature in patients affected by PCOD. The present case suggests that in an appropriate clinical setting, implant placement may be a successful procedure.

The importance of cone-beam computed tomography for the diagnosis and treatment plan of florid cemento-osseous dysplasia: a case report

Cone-beam computed tomography (CBCT) provides images without overlapping anatomical structures, which is important for the diagnosis and assessment of florid cemento-osseous dysplasia. This fibro-osseous lesion that affects the alveolar process without compromising the teeth’ pulp vitality is usually asymptomatic, and bone expansion, cortical disruption, and root resorption are uncommon. Due to its avascular characteristic, surgical procedures are often contraindicated. In this case, a 59-year-old female patient presented with a complaint of pain in the right maxillary central incisor. Panoramic and periapical radiographs showed florid cemento-osseous dysplasia in some regions. The right maxillary central incisor showed an extensive radiolucent image suggestive of root resorption but without fibro- -osseous lesion. For better evaluation and implant planning, CBCT was performed and demonstrated florid cemento-osseous dysplasia adjacent to the right maxillary central incisor, contraindicating implant placement. In other regions, CBCT enabled the identification of the expansive features of this fibro-osseous lesion.

Bisphosphonate-Related Osteonecrosis in a Patient with Florid Cemento-Osseous Dysplasia

Bisphosphonate-Related Osteonecrosis in a Patient with Florid Cemento-Osseous Dysplasia

A retrospective cone beam computed tomography analysis of cemento-osseous dysplasia

Background/purposeRadiological 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 methodsCone 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. ResultsThe 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. ConclusionCBCT 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.

Florid Cemento-osseous Dysplasia: A Report of Two Cases and Literature Review

This report aims to provide the clinical and radiographic features of two symptomatic Indian patients with florid cemento-osseous dysplasia (FCOD), along with a discussion of the differential diagnosis, potential challenges, and therapeutic implications. FCOD is a rare, multifocal, periapical, and bilateral condition involving the premolar and molar region of the posterior mandible and sometimes the maxilla. The first patient is a 30-year-old female with a recent history of dental pain. The patient was otherwise healthy and the medical history was unremarkable. The second patient is a 50-year-old female with a history of orthodontic therapy. Radiographic evaluation using cone-beam computed tomography (CBCT) revealed bilateral involvement of the posterior mandible, sparing the entire maxilla in both patients Clinical significance: For a pathognomonic condition like FCOD, a radiology survey alone is often sufficient to arrive at the final diagnosis, and therefore surgical interventions should ideally be avoided.

Multiple Odontogenic Keratocysts: A Case Report

Multiple odontogenic keratocysts are a rare, but well recognized condition that characteristically affects the jaws of middle-aged women. The radiographic appearance can vary from areas of radiolucency to mixed lesions and to opaque masses which are often bilaterally. This condition has been classified as sclerosing osteitis, multiple enostoses, diffuse chronic osteomyelitis and gigantiform cementoma. The lesion is usually benign and requires no treatment unless cosmetically concerning or becomes symptomatic. For the asympto- matic patient the best management consists of regular recall examination with prophylaxis and maintenance of good oral hygiene According to the recent review of literature, only five patients of florid cemento-osseous dysplasia from India have been reported (less than 2%). Here presentsuch a rare case occurring in a 38 year – old female who came with dull pain in upper right back teeth region since 6 months. Radiographically, it showed mixed radiolucent / radio-opaque mass in both right and left premolar to molar region.

Multiple Odontogenic Keratocysts: A Case Report

Multiple odontogenic keratocysts are a rare, but well recognized condition that characteristically affects the jaws of middle aged women .The radiographic appearance can vary from areas of radiolucency to mixed lesions and to opaque masses which are often bilaterally. This condition has been classified as sclerosing osteitis, multiple enostoses, diffuse chronic osteomyelitis and gigantiform cementoma. The lesion is usually benign and requires no treatment unless cosmetically concerning or becomes symptomatic. For the asymptomatic patient the best management consists of regular recall examination with prophylaxis and maintenance of good oral hygiene According to the recent review of literature, only five patients of florid cemento-osseous dysplasia from India have been reported (less than 2%). Here present such a rare case occurring in a 38 year –old- female who came with dull pain in upper right back teeth region since 6 months. Radiographically, it showed mixed radiolucent / radio-opaque mass in both right and left premolar to molar region.

Osteosarcoma of the Mandible in a Patient with Florid Cemento-Osseous Dysplasia and Li\u2013Fraumeni Syndrome: A Rare Coincidence

Cemento-osseous dysplasia (COD) is the most common benign fibro-osseous lesion of the jaws and generally considered non-neoplastic and self-limited. Here, we present a 30-year old female who noticed a bilateral swelling of her posterior mandible with irregular periapical mineralization and incomplete root resorption on panoramic radiographs. A biopsy revealed florid COD and no further treatment was initiated. 9 years later, she presented with a progressive expansion of her left posterior mandible after being treated for bilateral breast cancer 4 and 8 years before. CT scans showed expansile and densely mineralized lesions in all four quadrants with the left posterior mandible showing a focal penetration of the buccal cortical bone. Biopsies revealed an osteoblastic high-grade osteosarcoma in the left and a COD in the right mandible, notably with cellular atypia in the spindle cell component. The patient underwent segmental resection of the left mandible with clear margins and adjuvant chemotherapy. Subsequent genetic testing identified a heterozygous germline TP53 mutation (p.V173G) which confirmed the clinically suspected Li–Fraumeni syndrome (LFS). 3 years after the resection, the patient is free of disease and the other foci of COD remained stable in size on follow-up imaging analyses. Our case illustrates LFS-related osteosarcoma developing within florid COD. Given the rarity of this coincidence, a causative relation between the two lesions seems unlikely but in patients with tumor predisposition syndromes it might be advisable to closely monitor even benign lesions like COD.

Success of dental implant osseointegration in a florid cemento-osseous dysplasia: A case report with 8-year follow-up.

Florid cemento-osseous dysplasia (FCOD) is a rare benign fibro-osseous lesion which affects multiple quadrants and predominantly the mandible. This case report presents a successful implant placement with 8-year of follow-up in a 44-yearold woman asking for a fixed restoration in mandibular right posterior edentulous area. Radiographic images showed lobular, irregularly shaped radiopacities and radiolucencies almost symmetrically observed in the premolar-molar area of the right and left regions of the mandible. The findings of Xray images were attributable to FCOD. Minimally invasive two-stage surgery with strict infection control was followed to place two implants in lower right posterior region. The implants demonstrated clinically rigid fixation and restored successfully after 6 months. A direct functional connection between dysplastic bone and the implant load bearing surface was evidenced by the lack of symptoms, and the lack of soft tissues inflammation or peri-implant bone loss up to 8 years follow-up.

Spatial Cone Beam Computed Tomography (CBCT) Radiological Findings of Florid Cemento- Osseous Dysplasia: Case Report and Review of Literature

Florid cemento-osseous dysplasia (FCOD) is a condition that characteristically affects the jaws of middle-aged black women. Cemento-osseous dysplasia also has been classified to periapical, focal, florid and familial cemento-osseous dysplasia. Radiographically, FCOD appears as well defined radiopaque, symmetrical mass lobules, located in the apical part of the teeth with encapsulated margin. Cone-Beam Computed Tomography (CBCT) is a clinical application of ionizing radiation. CBCT is widely used in dental and maxillofacial imaging. This technology has been used for diagnosis and treatment planning for both adult and pediatric patients in orthodontics. It is advantageous being reconstructed in three dimensions, image quality, a 1: 1 ratio that allowed reliable dimensions, the possibility for craniofacial imagining, and lower radiation doses compared to traditional CT.CBCT is beneficial in diagnosis of this lesion with perfect evaluation of the effect on the surrounding structures. This paper presents two cases of black female patients who were radiographically diagnosed with FCOD

FLORID CEMENTO-OSSEOUS DYSPLASIA IN PATIENTS WITH MULTIPLE MYELOMA

Bone disease of multiple myeloma (MM) results in osteolytic lesions. In florid cemento-osseous dysplasia (FCOD), normal bone is replaced by fibrocemento-osseous lesions, resulting mainly in sclerotic aspect. Dental infections in patients with FCOD or MM using bisphosphonates may have important clinical implications. This study reports 2 female individuals with MM, 49 and 59 years old, who were submitted to oral clinical and imaging assessment with panoramic radiograph and cone beam computed tomography. Both patients presented diffuse sclerotic lesions in the 4 quadrants of the jawbones in tooth-bearing areas, suggestive of FCOD. One of the patients also presented multiple irregular osteolytic lesions in the angle and condyle of the mandible, suggestive of plasmacytomas and punched-out lesions of MM. Patients received oral care with scaling, fillings, and endodontic treatment and were followed up for 4.5 years with no complications. Appropriate oral management may have avoided complications in these patients with MM and FCOD.