Cemento-osseous dysplasia of the jaw bones: key radiographic features

Abstract

Objective: The purpose of this study is to assess possible diagnostic differences between general dentists (GPs) and oral and maxillofacial radiologists (RGs) in the identification of pathognomonic radiographic features of cemento-osseous dysplasia (COD) and its interpretation. Methods: Using a systematic objective survey instrument, 3 RGs and 3 GPs reviewed 50 image sets of COD and similarly appearing entities (dense bone island, cementoblastoma, cemento-ossifying fibroma, fibrous dysplasia, complex odontoma and sclerosing osteitis). Participants were asked to identify the presence or absence of radiographic features and then to make an interpretation of the images. Results: RGs identified a well-defined border (odds ratio (OR) 6.67, P , 0.05); radiolucent periphery (OR 8.28, P , 0.005); bilateral occurrence (OR 10.23, P , 0.01); mixed radiolucent/radiopaque internal structure (OR 10.53, P , 0.01); the absence of nonconcentric bony expansion (OR 7.63, P , 0.05); and the association with anterior and posterior teeth (OR 4.43, P , 0.05) as key features of COD. Consequently, RGs were able to correctly interpret 79.3% of COD cases. In contrast, GPs identified the absence of root resorption (OR 4.52, P , 0.05) and the association with anterior and posterior teeth (OR 3.22, P 5 0.005) as the only key features of COD and were able to correctly interpret 38.7% of COD cases. Conclusions: There are statistically significant differences between RGs and GPs in the identification and interpretation of the radiographic features associated with COD (P , 0.001). We conclude that COD is radiographically discernable from other similarly appearing entities only if the characteristic radiographic features are correctly identified and then correctly interpreted.

Cemento-Osseous Dysplasias: Imaging Features Based on Cone Beam Computed Tomography Scans

“…In this study, CODs were more common in women, with a mean age between the 5th and 6th decades of life, similar to the findings of other studies (3,11,12). The present study did not include the data on ethnicity of each patient because they were not recorded in the radiological reports, although most studies have found higher predilection for black patients (3,4,13).…”

“…These findings are similar to those of previous reports (3,12) and are in disagreement with the data found by de Noronha Santos Netto et al (11) who, out of a total of 100 cases of COD, found 65 florid COD, 18 focal COD and only 17 periapical COD. This result may be related to the fact that florid COD is more often symptomatic than the other types of COD, besides their study included only cases with histopathological diagnosis.…”

“…The diagnosis based on these features is essential because the affected bone tissue is more susceptible to infections and invasive procedures such as biopsies could cause this effect (12). In this sense, cone beam computed tomography (CBCT) has been shown a valuable tool for identifying these lesions, as it allows accurate evaluation of bone tissue.…”

Florid osseous dysplasia causing sensory disturbances in the area supplied by the inferior alveolar nerve

“…Although the etiology and the triggering factors were not identified [8], Florid osseous dysplasia could result from abnormal activity of the periodontal ligament explaining its near-exclusive location in the dental region, with cemento-osseous lesions identified in relation to dental apices and dental anatomy in radiographic examinations [9]. It is generally asymptomatic and the teeth in relation to the lesions are unaffected Med Buccale Chir Buccale 2017; 23:196-199 A.-C. Melka et al [10][11][12]. Florid osseous dysplasia becomes symptomatic when lesions are accompanied by infection, or if cortical fenestrations occur [3].…”

“…The diagnosis is radiological with the presence of mixed multilobular well-defined images of the alveolar bone, respecting the basilar bone. Any rhizalysis are reported [11]. Other diagnoses are ossifying fibroma, Paget disease, diffuse chronic osteomyelitis, Gardner syndrome, and endodontic lesions [12].…”