Cemento-osseous dysplasia

Hi! My name is Mark Mintline, and I am an oral and maxillofacial pathologist. And I would like to talk to you today about cemento-osseous dysplasia.

Cemento-osseous dysplasia is a non-neoplastic fibro-osseous lesion of the tooth-bearing regions of the jaws. It is the most common benign fibro-osseous lesion of the gnathic bones and is often diagnosed by dentists clinically. Typically, these lesions are non-expansile, but florid cases are an exception. Cemento-osseous dysplasia is most common in black females, but can be found in other races and ethnicities.

Traditionally, cemento-osseous dysplasia is divided into three variants based on anatomic location. Periapical cemento-osseous dysplasia which is associated with mandibular anterior teeth, focal cemento-osseous dysplasia which is associated with a single tooth or site, and florid cemento-osseous dysplasia which has multifocal or multiquadrant involvement.

Ideally, cemento-osseous dysplasia is identified based on clinical and radiographic features. Most periapical and florid cases are diagnosed without a biopsy. However, features of focal cemento-osseous dysplasia may be less specific. Radiographic examination of cemento-osseous dysplasia is essential. Lesions can be radiolucent, mixed, or radiodense depending on maturity.

Here is an example of periapical cemento-osseous dysplasia with increased calcifications. The lesions are associated with vital teeth and the lesions are well-defined with a radiolucent rim. Occasionally, radiolucent lesions are mistaken for odontogenic inflammatory lesions and clinicians unfortunately, endodontically treat that. To reiterate, cemento-osseous dysplasia is associated with vital teeth.

Focal cemento-osseous dysplasia is associated with a single site. Over time, the lesion shows increased density as it matures. Serial radiographs are incredibly helpful to diagnose and monitor lesions. Once a case of periapical or focal cemento-osseous dysplasia has been established, they can be monitored at routine dental appointments. Here is an example of cemento-osseous dysplasia associated with an edentulous site.

Florid cemento-osseous dysplasia is associated with multifocal or multiquadrant involvement. Individual lesions may be radiolucent, mixed, or radiodense. Florid cases may present as expansile lesions and present with pain secondary to infection. Florid cases may require closer clinical follow-up for complications of osteomyelitis.

As a clinician, it is important to recognize areas of cemento-osseous dysplasia do not behave like normal bone. The alveolar bone in areas of cemento-osseous dysplasia tends to be hypovascular and prone to necrosis and secondary inflammation. Dental implants in areas of cemento-osseous dysplasia are not recommended. Trauma including biopsies and extractions may expose sclerotic masses to the oral cavity.