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Table of Contents   
CASE REPORT  
Year : 2021  |  Volume : 32  |  Issue : 1  |  Page : 134-136
Florid cemento-osseous dysplasia: A case report


1 Department of Oral Pathology and Microbiology, Government Dental College and Hospital, Mumbai, Maharashtra, India
2 Department of Oral Medicine and Radiology, Government Dental College and Hospital, Mumbai, Maharashtra, India

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Date of Submission06-Oct-2018
Date of Decision12-Nov-2019
Date of Acceptance06-Jan-2020
Date of Web Publication13-Jul-2021
 

   Abstract 


Cemento-osseous dysplasia is non-neoplastic, reactive fibro-osseous lesions that affect the tooth-bearing areas of the jaws. Osseous dysplasia is further divided into three subtypes: Periapical osseous dysplasia, focal osseous dysplasia, and florid osseous dysplasia. We hereby, present a case of florid cemento-osseous dysplasia occurring in a 40-year old dentulous Indian woman. The patient presented with lesions involving the mandibular right and left quadrant.

Keywords: Cementum, dysplasia, florid, mandible

How to cite this article:
Thakur A, Gaikwad S, Tupkari JV, Ramaswami E. Florid cemento-osseous dysplasia: A case report. Indian J Dent Res 2021;32:134-6

How to cite this URL:
Thakur A, Gaikwad S, Tupkari JV, Ramaswami E. Florid cemento-osseous dysplasia: A case report. Indian J Dent Res [serial online] 2021 [cited 2021 Nov 27];32:134-6. Available from: https://www.ijdr.in/text.asp?2021/32/1/134/321384



   Introduction Top


Cemento osseous dysplasias are the benign fibro-osseous lesion in the jaw bones known to originate from periodontal ligament. Osseous dysplasia is further divided into three subtypes: Periapical osseous dysplasia, focal osseous dysplasia, and florid osseous dysplasia depending on their extent and radiographic appearances. The histologic appearance of osseous dysplasia varies depending on the stage of the lesion. They are almost exclusively confined to the alveolar process; in the mandible they are found superior to the inferior dental canal.[1],[2],[3]

Florid cemento-osseous dysplasia (FCOD) shows multifocal involvement of the jaws by lesional tissue with the same microscopic appearance as is encountered with FCOD and FCOD. The term “florid” which refers to the widespread and extensive manifestations of the disease was coined by Melrose et al. in 1976. Although FCOD is commonly seen in middle-aged black females, the same is not uncommon in Caucasians and Asians.[4],[5],[6]

Biopsy for histopathological examination may not be required to confirm the diagnosis due to their characteristic radiological features. Also, biopsy increases the risk of infection and fracture of the jaw and hence will adversely affect the patient's health.[6]


   Case Report Top


A 40-year old, female patient reported to the Department of Oral Pathology and Microbiology in our institute with the chief complaint of numbness in lower left back jaw region since 1 week. Past dental history revealed extraction of grossly carious right lower first molar four to five years ago. Medical history, family history and habit history were non-contributory. On extraoral and intraoral examination no abnormality was detected. However, root pieces of lower left third molar were seen.

On radiological examination, the orthopantomogram (OPG) showed multifocal radiopaque mass in periapical area of 44, 45, 47 and 35 [Figure 1]. Radiopaque lesion in periapical area of 35 surrounded by well-defined radiolucent capsule. Cone beam computed tomography (CBCT) examination was done to know the exact extent of the lesion and possibility of other areas being affected. On CBCT multifocal hyperdense lesions were seen in the mandible. Radiographic density of the lesions was comparable to bone. An hyperdense mass is attached to 35 surrounded by hypodense area attached to root of 35 [Figure 2] and [Figure 3]a, [Figure 3]b.
Figure 1: OPG showed multifocal radiopaque mass in periapical area of 44, 45, 47 and 35

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Figure 2: CBCT, coronal section shows hyperdense lesion surrounded by hypodense area in 35 tooth region

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Figure 3: (a) CBCT showing inferior alveolar nerve canal tracing (red line). (b) Para-axial section (slice thickness 1 mm) hyperdense lesional mass seen impinging on superior border of the inferior alveolar canal in 35 tooth region (red dot

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For detail examination inferior alveolar nerve canal tracing was done to assess the relation of hyperdense lesion with the nerve canal. On reducing the slice thickness till 1 mm it was noticed that the lesion was impinging on the superior border of the nerve canal in 35 regions.

As left side was symptomatic, after routine blood investigation excision of lesion along with extraction of 35 was done. Gross specimen showed two pieces of hard tissue and one piece of hard tissue attached to root of 35. Before processing decalcification was done.

Decalcified section under hematoxylin and eosin (H and E) stained slides showed apical root portion with attached sclerotic mass of cemento-osseous material. Other piece showed fibrous connective tissue and multiple basophilic cementum-like areas. Fibro-vascular connective tissue stroma also seen [Figure 4]a and [Figure 4]b.
Figure 4: (a) Decalcified section showing apical root portion with attached sclerotic mass of cemento-osseous material. Areas of fibro-vascular connective tissue stroma also noted. (Black arrow root apex). H and E × 40, (b) Decalcified section showing fibrous connective tissue and multiple basophilic cementum-like areas. H and E × 100

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On the basis of clinical, radiographic, and histopathology a final diagnosis of florid osseous dysplasia was given.


   Discussion Top


The term FCOD was first suggested by Melrose et al. in 1976 to describe a condition of exuberant multiquadrant masses of cementum and/or bone in both jaws.[5],[6]

FCOD is a non-neoplastic, reactive fibro-osseous lesion confined to the alveolar areas of the jaws and seen to have a typical female predilection affecting black women in fourth-fifth decades with a mean age of 42 years. Similar lesions were found in oriental population and Caucasian females with identical age groups but a definite female predilection of the condition has not been explained.[6] In our case patient was a 40-year-old female.

Radiographic appearance of FCOD depends upon the maturation of lesion. Proliferative, immature FCOD lesions appear radiolucent, later stages of maturation are characterized by dense radiopaque masses. In our case, multiple radio-dense lesion seen on CBCT. The hyperdense mass in 35 tooth region was surrounded by hypodense area and attached to root of 35.

The pathogenesis of the condition still remains largely obscure. Some authors accredit to the proliferation of the fibroblastic mesenchymal stem cells in the apical periodontal ligament, which are cementoblastic precursor stem cells, while others hold the view that it may arise from the remnants of the cementum left after tooth extraction.[7]

Waldron proposed that reactive or dysplastic changes in PDL might be the cause.[4] Some authors attribute to the trauma from deep bite or heavy bite causing attrition of the teeth that may activate and cause proliferation of the fibroblasts in PDL causing FCOD.

The diagnosis of FCOD is principally based on clinical findings, localization of the lesion, patient's age, gender and ethnicity as well as radiological features. The patients usually remain asymptomatic except when the disease is complicated by chronic osteomyelitis.[7],[8],[9]

Differential diagnosis includes diffuse chronic sclerosing osteomyelitis, Gardner's syndrome, osteoma, complex odontome.[10]

Biopsy is usually not done as the lesion is asymptomatic and can be diagnosed clinico-radiologically. Most authors have reported that biopsy and extraction leads to poor healing, osteomyelitis and sequestrum formation thus complicating the condition.[3],[5],[6] In our case as the patient was symptomatic, complete enucleation of lesion along with extraction of 45 was done. Postoperative follow-up shows no complication.


   Conclusion Top


FCOD is a type of osseous dysplasia with multifocal involvement of the jaws, diagnosed principally by its characteristic clinico-radiological features. As most of the condition remains asymptomatic, no surgical treatment is required. However, long-term follow-up is carried out to assess the progress of the condition. Lesion which become symptomatic requires surgical intervention.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Eversole R, Su L, ElMofty S. Benign fibro-osseous lesions of the craniofacial complex a review. Head Neck Pathol 2008;2:177-202.  Back to cited text no. 1
    
2.
El-Mofty SK. Fibro-osseous lesions of the craniofacial skeleton: An update. Head Neck Pathol 2014;8:432-44.  Back to cited text no. 2
    
3.
Kim JH, Song BC, Kim SH, Park YS. Clinical, radiographic and histological findings of florid cemento-osseous dysplasia: A case report. Imaging Sci Dent 2011;41:139-42.  Back to cited text no. 3
    
4.
Waldron CA. Fibro-osseous lesions of the jaws. J Oral Maxillofac Surg 1985;43:249-62.  Back to cited text no. 4
    
5.
Das BK, Das SN, Gupta A, Nayak S. Florid cemento-osseous dysplasia. J Oral Maxillofac Pathol 2013;17:150.  Back to cited text no. 5
[PUBMED]  [Full text]  
6.
Reichart PA, Philipsen HP. Odontogenic Tumors and Allied Lesions. London: Quintessence Publishing Co Ltd.; 2004. p. 301-8.  Back to cited text no. 6
    
7.
Gündüz K, Avsever H, Karaçayli U, Senel B, Pişkin B. Florid cemento-osseous dysplasia: A case report. Braz Dent J 2009;20:347-50.  Back to cited text no. 7
    
8.
Mehta RV, Khan S. Florid cement-osseous dysplasia: A case report. Indian Dent Res Rev 2011;3:22-3.  Back to cited text no. 8
    
9.
Bansa S, Shetty S, Bablani D, Kulkarni S, Kumar V, Desai R. Florid osseous dysplasia. J Oral Maxillofac Pathol 2011;15:197-200.  Back to cited text no. 9
    
10.
Wood KN, Gauz PW. Differential Diagnosis of Oral and Maxillofacial Lesion. 5th ed. Mosby, St. Louis; 1997. p. 503-4.  Back to cited text no. 10
    

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Correspondence Address:
Dr. Arush Thakur
Department of Oral Pathology and Microbiology, Government Dental College and Hospital, St. George Campus, Near CST Station, Mumbai - 400 001, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijdr.IJDR_754_18

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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    Abstract
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