Focal cemento-osseous dysplasia (FCOD) is a benign fibro-osseous lesion which changes cancellous bone tissue with each fibrous tissue and. 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 African-American females. The three types are periapical cemental dysplasia ( common in those of African descent), focal cemento-osseous. The distinguishing histopathologic features of focal cemento-osseous dysplasia ( FCOD) (including lesions occurring in both anterior and posterior jaws) and.
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Focal cemento-osseous dysplasia FCOD is a cementl-osseous fibroosseous condition that can be seen in dentulous and edentulous patients. It is an asymptomatic lesion and needs no treatment; however, follow-up is essential due to the possibility that it can progress to a condition called florid cemento-osseous dysplasia.
We report a case of FCOD of mandible in a year-old female. Clinically, the lesion resembled periapical pathosis of odontogenic origin. An attempt has been made to discuss the clinical and histopathologic features along with differential diagnosis of cemento-osseous dysplasia. The high incidence and broad spectrum of conditions causing periapical radiolucencies make it imperative that cemebto-osseous dental clinicians cemenot-osseous a broad and comprehensive working knowledge.
Some of these periapical radiolucencies present innocent anatomic variations whereas others are a cemento-osseouw of benign or malignant conditions. Focal cemento-osseous dysplasia FCOD in the tooth-bearing areas of the jaws is an asymptomatic benign condition, belonging to the spectrum of fibroosseous lesions. Usually, it affects two or more mandibular anterior teeth, and the radiographic appearance varies depending on the state of development. In rare cases, the lesion may affect only one tooth and thus mimics an apical granuloma or a cyst.
A year-old female patient reported to the Department of Oral and Maxillofacial Surgery with a chief complaint of swelling and dysplaska in the right mandibular region since 1 month. Intraoral examination revealed a firm well-defined swelling in the 46 region. Clinically, 46 was missing and 47, 48 were carious.
The overlying mucosa was non-ulcerated and pink in color. Intraoral periapical radiograph revealed a radiolucent lesion in the 46 region approximately 9 mm in diameter with well-corticated borders [ Figure 1 ].
On the basis of clinical and radiographic findings, the differential diagnosis of residual cyst, condensing osteitis, ossifying fibroma intermediate stage and idiopathic osteosclerosis was made. Intraoral periapical radiograph showing a well-corticated radiolucent lesion in the 46 region.
A surgical excision of the periapical lesion was performed. On the basis of the intraoperative findings during the curettage, it was suspected that the lesion was not a periapical granuloma or cyst of endodontic origin because the small fragments were gritty and hemorrhagic. The curetted material was submitted for histopathological examination [ Figure 2 ].
Histopathologic examination revealed proliferating fibrous connective tissue with moderate cellularity, rich vascularity and hemorrhage [ Figure 3 ]. Trabeculae of woven bone and cementum-like material were interspersed throughout the fibrous framework [ Figure 4 ].
Fragments of cellular mesenchymal tissue composed of spindle-shaped fibroblasts and collagen fibers with numerous small blood vessels were observed. The fibrous tissue was devoid of any inflammatory component dyzplasia Figure 5 ]. Based on the above features, a diagnosis of FCOD was made. FCOD was first suggested by Summerlin and Tomich, primarily according to the location of dysplastic areas of the bone i. FCOD is usually asymptomatic and occurs in the periapical area of teeth with vital pulps or in regions of extractions.
Local jaw expansion and mild discomfort may be reported in about one-third of the patients. FCOD is seen predominantly in African-American black women, with a peak incidence in the fourth and fifth cemento-sseous.
The lesion was symptomatic and was detected in the 46 region, which was the site of a previous extraction. FCOD is usually found during routine radiographic examination. It is seen most frequently in the anterior and in the premolar areas of the mandible. Seventy percent of the FCOD cases display an intimate relationship to the periapex. The lesions usually begin as cystic areas of radiolucency and tend to become progressively more opaque internally over time, but normally do not exhibit extension into adjacent bone or cause cortical expansion.
FCOD has been described as having three developmental stages, each cemnto-osseous specific radiographic features. Dysplaisa the early or osteolytic stage, radiographs show a well-defined radiolucent area with loss of periodontal ligament and lamina dura.
Focal cemento-osseous dysplasia of mandible
In the intermediate or cementoblastic stage, small opacities appear within the radiolucent area, which consequently displays a mixture of radiolucent cementi-osseous radioopaque architecture. This is because of the deposition of cementum-like droplets in the fibrous tissue.
At this stage, the lesion could be histopathologically misdiagnosed as cemento-ossifying fibroma. Histopathologically, FCOD is a heterogenous lesion consisting of a benign fibrous stroma containing irregular trabeculae of mature and immature bone and cementum-like material. The etiology of FCOD is unknown.
The hypothesis of a periodontal ligament origin of this lesion seems to be the most widely accepted. The role of trauma, caries, periodontal disease, infection or systemic diseases as triggering factors is still to be elucidated. The diagnosis of typical FCOD is usually based on clinical and radiological features. No treatment is required for FCOD and follow-up is required to confirm the diagnosis. Some authors have hinted on the possibility of transformation of FCOD into florid cemento-osseous dysplasia and emphasized on the importance of recall visits.
Periapical pathoses presents as a wide spectrum of lesions that may mimic and masquerade each other. Solitary FCOD is usually found in the periapical region. The case presented is unusual because it was found at the site of the previous extraction as a residual cyst.
It is imperative to judiciously differential diagnose FCOD, which may present a difficult diagnosis for the dental practitioner.
This case highlights the necessity to make a careful differential diagnosis in doubtful cases. National Center for Biotechnology InformationU. Journal List Contemp Clin Dent v. Rajat BhandariSimarpreet V. Author information Copyright and License information Disclaimer. This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.
Osseous (Cemento-osseous) Dysplasia of the Jaws: Clinical and Radiographic Analysis | jcda
This article has been cited by other articles in PMC. Abstract Focal cemento-osseous dysplasia FCOD is fcoal benign fibroosseous condition that can be seen in dentulous and edentulous patients. Fibroosseous lesion, focal cemento-osseous dyplasia, periapical pathoses, residual cyst. Introduction The high incidence and broad spectrum of conditions causing periapical radiolucencies make it imperative that all dental clinicians acquire a broad and comprehensive working knowledge.
Case Report A year-old female patient reported to the Department of Oral and Maxillofacial Surgery with a chief complaint of swelling and pain in the right mandibular region since 1 month. Open in a separate window. dysplasiw
Rare disease: Focal cemento-osseous dysplasia of mandible
Curetted material consisting of multiple small gritty and hemorrhagic fragments. Discussion FCOD was first suggested by Summerlin and Tomich, primarily according to the location of dysplastic areas of the bone i. Conclusion Periapical pathoses presents as a wide spectrum of lesions that may mimic and masquerade each other. Footnotes Source dusplasia Support: A clinico-pathologic study of cases. Oral and Maxillofacial Pathology.
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Focal cemento-osseous dysplasia involving a mandibular lateral incisor. Osseous cemento-osseous dysplasia of the jaws: Clinical and radiographic analysis.