Focal cemento-osseous dysplasia: A clinicopathologic study of 221 cases

doi:10.1016/0030-4220(94)90174-0

Oral Surgery, Oral Medicine, Oral Pathology

Volume 78, Issue 5, November 1994, Pages 611-620

Oral Surgery, Oral M...

https://doi.org/10.1016/0030-4220(94)90174-0 Get rights and content

Abstract

Classification of cemento-osseous lesions of the jaws has long been a dilemma for pathologists. A group of 221 cemento-osseous lesions exhibited sufficiently distinctive clinicopathologic features to be separated into a specific category: focal cemento-osseous dysplasia. This entity presents as an asymptomatic, focal, mixed radiolucent/radiopaque lesion with ill-defined borders in the tooth-bearing areas. It was found to occur with greater frequency in women (88%) and in the posterior mandible (77%). The average age at presentation was 37 years and a relative predilection for black patients was observed. At surgery these lesions were noted to be hemorrhagic, gritty, and adherent to the surrounding bone. The gross appearance of multiple hemorrhagic fragments is of diagnostic significance. Histologic features include a cellular connective tissue stroma punctuated by irregular osseous and/or cementum-like calcifications. Focal cemento-osseous dysplasia is thought to be of periodontal ligament origin and to be non-neoplastic in nature. Further surgical intervention is not necessary, but periodic follow-up is recommended, because occasional cases were observed to progress into florid osseous dysplasia. Care must be taken to differentiate focal cemento-osseous dysplasia from central cementifying and/or ossifying fibromas, which are true neoplasms and require surgical treatment.

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Periapical cemental dysplasia (PCD) is considered a non-neoplastic proliferation of fibrous tissues and cementum-like hard tissues, usually occurring in the periapical regions of teeth. PCD is characterized by the presence of vital pulp and is often accidentally discovered during a general radiographic survey. PCD may arise from the tissue of odontogenic origin or occur as a reactive process in the periapical tissue. Multilocular occurrences in both jaws are rare. However, we encountered a case of multiple PCDs by orthopantomography, which showed different degrees of maturation in the mandible and maxilla by osteodensitometric detection via cone-beam computed tomography (CB-CT) validated by Tc-99m bone-scintigraphy (BS). Biopsies confirmed the radiological results. CB-CT osteodensitometry allows for the categorization and assessment of different stages of PCD maturation from beginning to florid, detection of remittent osseous changes, and evaluation in the clinical follow-up. When using the local cortical bone as a reference value of 100%, periapical dysplasias show density values of 75% in the mandible and 80% in the maxilla. Early classification of PCD is possible with CB-CT osteodensitometry.
A retrospective cone beam computed tomography analysis of cemento-osseous dysplasia
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Radiological 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.
Cone 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.
The 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.
CBCT 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.
The possible pathogenesis of cemento-osseous dysplasia: A case series and discussion
2021, Advances in Oral and Maxillofacial Surgery
Cemento-osseous dysplasias (COD) are peculiar jawbone lesions. They arise in the tooth-bearing areas, mostly in the mandibles of women, and have no known occurrence in the other bones. Neural crest-derived periodontal fibroblasts may form disorganized cemento-osseous structures that have been observed to be radiologically sclerotic.
We performed a retrospective immunohistochemical study on the tissues of 16 patients diagnosed with COD using biopsy. Some patients displayed a history of bruxism and jaw clenching. The selection of beta-catenin, cyclin D1, nestin, estrogen receptor, tubulin, and integrin antibodies was based on factors that may be pathogenetically significant.
COD develops as a consequence of the jawbone-specific cemento-osseous reparative process that far from remodelization. Parafunctional mechanical effects are assumed to form these lesions.
Non-Neoplastic Lesions of the Gnathic Bones
2019, Head and Neck Pathology: A Volume in the Series: Foundations in Diagnostic Pathology
An unusual case of focal cemento-osseous dysplasia occupying nearly the entire maxillary sinus and arising from adjacent tissue of fused teeth
2018, Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology
Cemento-osseous dysplasia (COD) of the jaw is a benign fibro-osseous lesion that is subdivided into three types, periapical, focal, and florid, based on the clinical and radiologic features. Focal COD (FCOD) usually affects the posterior tooth-bearing area or edentulous alveolar process and typically presents as an asymptomatic lesion diagnosed incidentally on dental radiography. In asymptomatic cases, once the diagnosis has been established, invasive treatment is not required. However, routine follow-up is warranted, because some patients develop multiple-site involvement, i.e., florid COD. Symptomatic patients require treatment. We describe the unusual case of a 19-year-old Japanese woman with FCOD in the left maxillary sinus who presented with repeated discomfort in the left side of the cheek. Radiographic examinations showed a mixed radiolucent-radiopaque, well-defined maxillary mass that obliterated nearly the entire left maxillary sinus. We planned to remove the lesion to restore the nasal ostium patency and natural sinus clearance mechanism, because clinical symptoms were considered to result from obliteration of the maxillary sinus by the lesion. The lesion was enucleated via the intraoral approach under general anesthesia. The microscopic examination showed a dense hypocellular sclerotic mass composed of compact bone-like cemento-osseous tissue with irregular lamellar structures. The final diagnosis was determined to be FCOD considering the combination of clinical, radiologic, and histopathological findings. The clinical outcome was satisfactory without postoperative infection or complications.
Differential diagnosis of cemento-osseous dysplasia of the maxilla. A case report
2019, Revista Espanola de Patologia
La displasia cemento-ósea es una lesión frecuente que afecta a los maxilares y no exige tratamiento intensivo. Su principal interés radica en el riesgo de confusión con entidades de comportamiento más agresivo, como los fibromas osificantes y cementificantes, que exigen tratamiento. No existen unos claros criterios de diagnóstico diferencial histopatológico entre ambas entidades. En este trabajo presentamos el caso de un niño de 13 años al que se realizó una biopsia de una lesión en el maxilar, sin diagnóstico clínico de sospecha. El estudio histológico revela un tejido fibroso poco celular en el seno del cual se observan trabéculas óseas sin ribete de osteoblastos y cúmulos de cemento. Nuestro diagnóstico final fue displasia cemento-ósea. Se muestran los principales rasgos de la lesión y se analizan los criterios que pueden ayudar al difícil diagnóstico diferencial de esta entidad.
Cemento-osseous dysplasia is a benign lesion which affects the jaw bones. It is a frequent incidental finding but no aggressive therapy is necessary. However, it may be confused with more aggressive entities, such as ossifying and cementifying fibroma, which do require treatment. There are no clear-cut histopathological criteria to differentiate between these entities. We present a case of a 13-year old boy who underwent a biopsy of a clinically undiagnosed maxillary lesion. Histopathological analysis revealed moderately cellular fibrous tissue with bone trabeculae with no osteoblastic rimming and clusters of intensely basophilic material corresponding to cementum. The final diagnosis was cemento-osseus dysplasia. The main histopathological features important in the distinction of these entities are discussed.

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: Presented in part at the Forty-third Annual Meeting of the American Academy of Oral Pathology, May 1989, Savannah, GA.

^a: Assistant Professor, Oral and Maxillofacial Pathology, Indiana University Medical Center.

^b: Professor, Oral and Maxillofacial Pathology, Indiana University Medical Center.

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Focal cemento-osseous dysplasia: A clinicopathologic study of 221 cases

Abstract

J Oral Maxillofac Surg

Oral Surg Oral Med Oral Pathol

Oral Surg Oral Med Oral Pathol

J Craniomaxillofac Surg

J Oral Maxillofac Surg