Florid cemento-osseous dysplasia: review of an uncommon fibro-osseous lesion of the jaw with important clinical implications

Abstract

Florid cemento-osseous dysplasia (FCOD) is a rare, benign, multifocal fibro-osseous dysplastic process affecting tooth-bearing areas of the jaw, characterized by replacement of normal trabecular bone with osseous tissue and dense acellular cementum in a fibrous stroma. It is one clinicopathologic variant in a spectrum of related non-neoplastic fibro-osseous lesions known as cemento-osseous dysplasias (CODs), thought to arise from elements of the periodontal ligament. Diagnosis primarily relies upon radiographic and clinical findings; unnecessary biopsy should be avoided, as inoculation with oral pathogens may precipitate chronic infection in these hypovascular lesions. Appropriate management of uncomplicated FCOD consists of periodic radiographic follow-up. Accordingly, it is important that both radiologists and clinicians performing endodontic interventions possess familiarity with this entity in order to prevent misdiagnosis and inappropriate intervention, which may result in a protracted clinical course. Lesions are usually asymptomatic in the absence of infection, typically discovered on routine dental radiographs or imaging performed for unrelated indications. Radiographically, the condition typically manifests as widespread non-expansile intraosseous masses of varying internal lucency and sclerosis that surround the root apices of vital teeth or edentulous areas in the posterior jaw. While all CODs share similar microscopic features, FCOD is distinguished by its multifocal distribution, involving two or more quadrants of the maxilla and mandible, often in a bilateral symmetric fashion. The vast majority of cases are sporadic, though few exhibit an autosomal dominant familial inheritance pattern. In this pictorial review, we discuss the radiologic characteristics of this entity, pertinent clinical and histologic features, differential diagnoses, and management options.

Oral management of a patient with cemento-osseous dysplasia: a case report

“…There are some cases of FCOD in which the patients report mild and intermittent pain in the affected area, especially after trauma or secondary infection [3,8,9,16]. In this case report, the patient has been followed up for a long period (thirteen years) and she has reported no symptoms associated with the lesion.…”

“…Fibro-osseous lesions are conditions that may affect the bones of the maxillofacial region. In general, the normal bone is replaced by cellular fibroblastic tissue containing calcified structures (osseous or cementumlike structures) [1][2][3]. According to the World Health Organization, the ossifying fibroma, familial gigantiform cementoma, fibrous dysplasia and cemento-osseous dysplasia have been included in the group of fibro-osseous lesions [4].…”

Florid Cemento-Osseous Dysplasia of Osteolytic Stage Showing Cyst-Like Findings on CT and MRI: A Case Report

“…COD is a lesion of histologically benign in which normal bone is replaced by fibro-osseous tissue. Histopathological analysis of COD revealed a cellular fibrous connective tissue including cementum-like structure and abnormal bone, accumulating over time (2,7). COD mature and become larger and more radiopaque with time.…”

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

“…In the absence of symptomatology, it is recommended to conduct annual clinical and radiological monitoring and to maintain rigorous oral hygiene to avoid infections [13]. However, because of their sclerotic and vascular nature, lesions are particularly susceptible to infection after mucosal trauma, dental procedures, biopsy or cystic enucleation [14,15]. This risk of iatrogenic infection can justify an antibiotic prophylaxis in any surgical procedure [16].…”

“…This risk of iatrogenic infection can justify an antibiotic prophylaxis in any surgical procedure [16]. The infection is accompanied by soft-tissue swelling and pain but without any hypoesthesia in the territory of the inferior alveolar nerve [13,15,[17][18][19].…”