Cemento-Osseous Dysplasia

Cemento-osseous dysplasias are a group of benign fibro-osseous lesions that arise from periodontal ligament tissues in the tooth-bearing regions of the mandible and maxilla. Cemento-osseous dysplasias can be classified as periapical, focal, and florid based on location and extent (see below).

Early in the course of the disease radiographs and CT reveal a predominantly lucent lesion with multiple closely apposed or confluent, round or ovoid cystic areas. There is a narrow zone of transition with adjacent normal bone. As the disease progresses, the lesions become progressively more opaque internally. There is usually no extension into adjacent bone or cortical expansion. Infection in overlying teeth (spontaneous or post biopsy) may spread across the lesion and evolving into osteomyelitis with sequestration.

Small, discrete lesions may mimic apical periodontitis, while larger lesions can look similar to ossifying fibromas.

Cemento-osseous dysplasia can be classified as:

• Periapical: Also known as cementoma, periapical cementoma, periapical cemental dysplasia, and periapical fibrous dysplasia. Predominantly involves the apical areas of mandibular incisors.
• Focal: Essentially the same entity as periapical cemento-osseous dysplasia, but predominantly involving the tooth-bearing areas of the posterior jaws, particularly in sites of former extraction. Some have proposed that both periapical and focal cemento-osseous dysplasia be known as focal cemento-osseous dysplasia.
• Florid (shown above): A more extensive version of focal cemento-osseous dysplasia that involves two or more quadrants of the jaw. Most cases have bilateral mandibular molar/premolar involvement with or without maxillary involvement. Florid cemento-osseous dysplasia is usually asymptomatic, with pain being the most common symptom in symptomatic patients.

Special thanks to Dr. Carla Ross for the case.

References

• Eversole R, Su L, ElMofty S. Benign fibro-osseous lesions of the craniofacial complex. A review. Head Neck Pathol. 2008 Sep;2(3):177-202.
• Scholl RJ, Kellett HM, Neumann DP, Lurie AG. Cysts and cystic lesions of the mandible: clinical and radiologic-histopathologic review. Radiographics. 1999 Sep-Oct;19(5):1107-24.