Complex Therapeutic Process due to Diagnostic Error in the Periapical Fibro-Osseous Lesion of Mandibular First Molar. A Case Report with Successful Implant Placement

Abstract

Cemento-osseous dysplasia (COD) present radiographically as radiolucent lesions that are frequently misdiagnosed as endodontic lesions. The following case report involves a 42-year-old female that was treated for a molar endodontic lesion. The typically benign lesion, post endodontic therapy caused pain and chewing discomfort. The tooth was extracted a year later and biopsy samples confirmed the initial lesion was focal cemento osseous dysplasia (FCOD). The site was rehabilitated with dental implants and supplemented with bone graft material. The histological evidence of the extraction site revealed osteoporotic large bony marrow spaces with an inflammatory cell infiltrate, supplemented with cells of hematopoietic origin. Typically, sites that have abnormal bone quality, with confirmed diagnosis of cemento-osseous dysplasia are not considered ideal sites to receive implant placements. The present case report demonstrates a sequence of events for the management of FCOD in the posterior mandible with successful implant and bone graft treatment. Typically asymptomatic, FCOD benign lesions are not ideal candidates for implant placement, the following case reports depicts favorable outcomes in terms of osteointegration of the dental implant and subsequent oral rehabilitation for improved function.