CEMENTO OSSEOUS DYSPLASIA PDF
Periapical cemento-osseous dysplasia (COD) is a very rare benign lesion arising from a group of disorders which are known to originate from undifferentiated. Lesions classified as Cemento-osseous dysplasia (COD) largely encompass three different sub-groups: Florid, focal and periapical lesions. Presentation is said. Cemento-osseous dysplasia (COD) is a benign condition of the jaws that may arise from the fibroblasts of the periodontal ligaments. It is most common in.
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Florid cemento-osseous dysplasia is one of the terms that have been designated by the World Health Organization as cemento-osseous dysplasias of the jaws.
The word ‘florid’ was introduced to describe the wide spread, extensive manifestations of the disease in the jaws. The condition is usually asymptomatic, however, in some cases symptoms of dull pain or signs of infection may be noted in the involved area.
Florid cemento-osseous dysplasia FCOD has been described as a condition that typically affects middle-aged black women, and usually manifests as multiple radiopaque cementum-like masses distributed throughout the jaws. This paper reports a case of a 15 year clinical and radiographic follow up of florid cemento osseous dysplasia. A case of ceento uncomplicated florid cemento-osseous dysplasia occurring in a year-old Jordanian female is reported, which can be considered rare regarding race distribution.
Periapical Cemento-osseous Dysplasia: Clinicopathological Features
The long-term follow-up 15 years shows the different stages of maturation of the lesions and confirms that the condition is self-limited. The diagnosis was based on clinical and radiographic features only. The diagnosis of FOCD mainly relies on radiographic and clinical findings.
Vitality tests of related teeth are an essential addition to the diagnosis in order to avoid unnecessary endodontic therapy. Biopsy should be avoided in asymptomatic lesions as it may precipitate infection which might be difficult to control without surgical intervention. The WHO report describes Cemento-Osseous Dysplasias CODs as a variety of jaw lesions that are characterized histologically by the presence of cementum-like tissue, and which appear to be dysplasias rather than neoplasms.
Florid cemento-osseous dysplasia FCOD is a rare condition presenting in the jaws of unknown aetiology. Clinically FCOD is a known self limited disease. Radiographically, the lesions appear as multiple sclerotic masses in the tooth-bearing regions which usually affect the mandible on both sides in a symmetrical manner, but all four quadrants may be involved, it presents as multiple radiopaque lesions that fuse into lobulated sclerotic masses.
Histological appearance of FCOD showed large sheets or fused globules of cemento-osseous tissue, which may be fused to the roots of one or more teeth or may lay separately. The purpose of this report is to present a case of FCOD which was diagnosed on the basis of clinical and radiographic features with 15 years follow up. This report will present “according to our knowledge” the first documented case of FCOD in Jordan with 15 years clinical and radiographical data follow up.
A year-old Jordanian female patient attended the periodontal clinic at King Hussein Medical Centre in for periodontal assessment. Medical history revealed hyperlipidaemia controlled by statin group anti-lipidemic drugs and no other systemic disorders were reported. Dental history revealed previous periodontal, restorative and endodontic therapies performed by different dentists during the treatment period which reported to be around thirty years; the last fifteen years were followed by the author of the present report.
None of her family reported to have similar conditions. Extra-oral examination was within normal limits. Intra-oral examination revealed normal oral mucosa, good oral hygiene with minimal gingival inflammation, mm periodontal pockets were found proximal to the maxillary posterior teeth with the deepest on the distal aspect of the maxillary left first molar, tooth wear was noticed on the incisal surfaces of the anterior teeth, and multiple restorative treatments mainly in the maxillary teeth.
Orthopantomograph OPT was requested and revealed multiple bilateral radiolucent-radiopaque sclerotic masses apical to the majority of mandibular teeth with no evidence of root resorption, dental caries was noted at the distal surface of the left mandibular first molar, poor endodontic treatment of the maxillary left first molar, generalized mild to moderate horizontal bone loss Figure 1. OPT image shows the bilateral radiolucent-radiopaque lesions around the apical thirds of the mandibular teeth.
The left mandibular first molar was vital despite the radiolucency around the roots. The maxillary left first molar was symptomless. The treatment plan at that time included non-surgical periodontal therapy and restorative treatment of the caries on the mandibular molar in addition to keep the patient on periodontal maintenance and radiographic follow-up of the mandibular lesions.
Blood investigation requested include complete blood count and full chemistry, all results were within normal limits except for cholesterol which was slightly elevated. The patient was informed and reassured about her condition and the possibility of familial pattern, OPT was requested for her son and daughter, but no similar findings were evident.
The patient was followed up for the next 15 years. Figure 2 shows the OPT in which revealed the same symmetrical bilateral sclerotic masses in the mandible but with increasing of the radio-opacity in comparison with the OPT in The lower first left molar appears to serve as a satisfactory amalgam filling.
The symmetrical radiolucency was remarkably reduced as more mineralization occurs at whole mandibular associated lesions.
The radio-opacity keeps increasing with time in comparison with earlier cemeento as shown in Figure 3 which represents OPT images in The mandibular left first molar and osseus maxillary left first premolars were endodontically treated as a result of recurrent caries and crown fracture involving the pulp.
Minor radiolucency could be recognized around the roots while the high dense deposit within the bone is obvious at the mandibular associated lesions. OPT image shows increase in the radio-opacity mainly noticed around the root of the mandibular left first molar. OPT image revealed increased opacities of the lesion mainly in the left molar region. Extractions of the mandibular left third molar and the maxillary left first molar were done in and respectively under antibiotic coverage of Amoxicillin mg three times daily for 5 days dysplaasia periodontal reasons and without any difficulty or complications.
The latest OPG in as revealed in Figure 4 demonstrates similar features with an increased density in comparison to earlier stages of the disease.
No root resorption could be identified, and all the lesions are osseohs the inferior alveolar canal.
Computed Tomography was requested at the same time in which osseohs a slight buccal expansion of the molar region the left side of the mandible as appeared in the horizontal and vertical sections Figure 5. The patient is still under annual observation for periodontal maintenance, and three-yearly radiographic assessments for the mandibular lesions.
Computed tomography showing vertical sections of the mandibular lesions around the roots of the left first molar. Clinical and radiographic features are diagnostic for FCOD, it is almost always asymptomatic and osaeous, usually discovered incidentally on routine dental radiographs.
Periapical Cemento-osseous Dysplasia: Clinicopathological Features
The subsequent radiographic findings follow the maturation pattern of FCOD, and the lesions are confined within the alveolus at a level corresponding to the roots of the osseou, above the inferior alveolar canal. Since this case was asymptomatic and confined to the alveolar bone, the diagnosis of chronic diffuse sclerosing osteomyelitis was excluded.
This condition is a primary inflammatory condition involving the body of the mandible from the alveolus to dysplassia inferior border ossous may extend into the ramus, cyclic episodes of unilateral pain and swelling are features of the condition.
Florid cemento-osseous dysplasia is frequently associated to black women. The patient in this report can be considered as a rare case with regard to race distribution.
Florid osxeous dysplasia may be familial with an autosomal dominant inheritance pattern, but there are only a few examples in the literature in which the familial pattern has been confirmed. The Management of florid cemento-osseous dysplasia for asymptomatic patients consist of regular recalls and observations to ensure that the process is confined within normal limits of the disease and to detect any possible changes, as the disease may persist for indefinite periods of time without causing any symptoms.
The management of our case consisted of conservative treatment and regular recalls, extractions were done due to a periodontal reason and under antibiotic coverage to minimize the risk of infection. Observations of similar asymptomatic radiopaque lesions over a long period enable us to predict their behaviour and ensure there are no negative changes of the lesion except what appears to be normal progression from radiolucency to radio-opacity.
Our findings are in agreement with other studies that reported long term follow up of florid cases without treatment. Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Histologic typing of odontogenic tumours, jaw cysts and allied lesions.
World Health Organization; A clinical-pathologic study of thirty-four cases. Florid osseous dysplasia in Orientals.
Florid cemento-osseous dysplasia gigantiform cementoma in a Caucasian woman.
Periapical cemento-osseous dysplasia: clinicopathological features.
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Speight PM, Carlos R. Clinical, radiographic, biochemical and histological findings of florid Cemento-osseous dysplasia and report of a case. The clinicopathologic spectrum of cementoosseous dysplasia. Oral Radiology – Principles and Interpretation.
Osseous (Cemento-osseous) Dysplasia of the Jaws: Clinical and Radiographic Analysis | jcda
Florid cemento-osseous dysplasia and chronic diffuse osteomyelitis Report of a simultaneous presentation and review of the literature. J Am Dent Assoc.
Multiple oral radiopaque masses leading to Gardner’s syndrome diagnosis. Familial Florid Cemento-Osseous Cementoo A rare manifestation in an Indian family. Case Reports in Dentistry. Familial florid cemento-osseous dysplasia: Clinical, radiographic, and histological findings of florid cemento-osseous dysplasia: Imaging Science in Dentistry.
Sclerotic cemental masses of the jaws so-called chronic. Florid cemento osseous dysplasia: OA Dentistry Oct 01;1 1: Abstract Introduction Florid cemento-osseous dysplasia is one of the terms that have been designated by the World Health Organization as cemento-osseous dysplasias of the jaws. Case report A case of asymptomatic uncomplicated florid cemento-osseous dysplasia occurring in a year-old Jordanian female is reported, which can be considered rare regarding race distribution.
Introduction The WHO report describes Cemento-Osseous Dysplasias CODs as a variety of jaw lesions that are characterized histologically by the psseous of cementum-like tissue, and which appear to be dysplasias rather than neoplasms.
Case report This report will present “according to our knowledge” the first documented case of FCOD in Jordan with 15 years clinical and radiographical data follow up. Discussion Clinical and radiographic features are diagnostic for FCOD, it is almost always asymptomatic and nonexpanding, usually discovered incidentally on routine dental radiographs. Consent Written informed consent was obtained from the patient for publication of this case report and accompanying images.
Conflict of interests None declared. Competing interests None declared.