Difficulties in the diagnosis of periapical translucencies and in the classification of cemento-osseous dysplasia

Abstract

Background Cemento-osseous dysplasia is a benign fibro-osseous lesion of the tooth-bearing region of the jaws with a periodontal ligament origin. It appears predominantly in Black and Asian middle-aged females. Its importance is that it could mimic a periapical lesion in the early, translucent stage. Case presentation In this report a rare case of familial cemento-osseous dysplasia is presented: a 50-years old Caucasian woman with labial paraesthesia and radiological translucency around the roots of the mandibular incisors and the first molar teeth. The lesion around the first molar was diagnosed as periapical granuloma and a root canal treatment was carried out. The diagnosis of florid cemento-osseous dysplasia and the treatment plan based on two- and three-dimensional radiographic examinations were certified histologically after surgical removal of the lesion. We screened the family members - including the patient’s mother, daughter and son - and identified a periapical version of cemento-osseous dysplasia in the daughter. Our case highlights the difficulties of differential diagnosis of cemento-osseous dysplasia and other periapical pathologies. The inconsistencies in the present classification of cemento-osseous dysplasia are also discussed with a proposal for a different classification based on new aspects that would be very helpful in setting up a correct treatment plan. Conclusion Differentiation of endodontic and non-endodontic origin of radiolucency and distinguishing it from anatomical landmarks by appropriate clinical evaluation and using vitality testing can give an opportunity to prevent unnecessary endodontic treatment. The current categories of cemento-osseous dysplasia classification do not cover the early stage of a hereditary florid form of cemento-osseous dysplasia. Instead of anatomical location of the lesion, clinical and genetic features may be recommended as parameters of cemento-osseous dysplasia classification.

Clinical assessment of cemento‐osseous dysplasia based on three‐dimensional diagnostic imaging: A case report

“…Therefore, COD must be differentiated from apical periodontitis in the early stage (5,7,8,15). In the middle to late stage, COD must be differentiated from ossifying fibroma (5,8,9,17), which is categorised as a fibro‐osseous and osteochondromatous lesion, and cemento‐ossifying fibroma (4,14,17) and cementoblastoma (4,14,15), which are categorised as benign mesenchymal odontogenic tumours, according to the 4th edition of the WHO classification (3). COD must also be differentiated from chronic sclerosing osteomyelitis (4,7,14,17), and sclerosing osteitis (18).…”

“…In the initial stage of COD, radiolucencies are noted at the root apex on periapical radiography, which can be confused with apical periodontitis. Therefore, it is important to perform accurate differential diagnosis to avoid futile root canal treatment (4‐7).…”

Vulnerability and Weaknesses of Eating Habits of Overweight School Children as an Entry Risk for COVID-19

“…The most affected site in the oral cavity is the anterior portion of the mandible (incisor and canine region) and the teeth involved remain vital [11]. The lesions may be solitary or multiple, asymptomatic and do not involve alteration to the periodontal tissues [11], [12]. Radiographically, in the osteolytic phase, a well-defined radiolucent lesion is seen at the apex of the root; in the cementoblastic stage, the radiolucent lesion assumes a mixed appearance and in the final or mature stage gives rise to a completely radiopaque lesion [1], [11].…”

“…The majority of cases occur in the periapical area of posterior mandibular teeth with vital pulps or in regions of dental extractions [10], [11]. It is linked to one tooth and causes no symptoms and is detected only on routine radiographic examinations [1], [12]. Radiographically, in the early stage, it is seen as a well-defined radiolucency, in the intermediate stage also is seen as a radiolucentopaque lesion with a well-defined radiolucent halo and in the late stage, the lesion is characterized by a definite radiopacity surrounded by a uniform radiolucent rim [1], [10].…”

Concomitant cemento-osseous dysplasia and aneurysmal bone cyst of the mandible: a rare case report with literature review

“…Cemento-osseous dysplasia (COD) is a fibro-osseous lesion occurring in the tooth-bearing area of the jaws [ 1 – 3 ]. The etiology and pathogenesis are unknown, but it is thought to arise from the periodontal ligament because of the proximity of the lesions to the teeth and the formation of cementum-like calcifications [ 1 , 3 ]. The lesions usually are asymptomatic, so COD is discovered in routine panoramic radiographs, and in most cases, no treatment is necessary [ 4 ].…”