Ghaliani Parichehr1, Farimah Sardari2, Tavakoli Payam3, Saberi Zahra4
How to CITE:
Parichehr G, Sardari F, Payam T, Zahra S. Florid Cemento Osseous Dysplasia in two young Persian women. Two case reports. J PakDentAssoc. 2012 (1): 50 – 52
Abstract
Implant supported prostheses have been used extensively to rehabilitate completely edentulous arches.
Florid cemento-osseous dysplasia clearly appears to be a form of bone and cemental dysplasia which is limited to jaws. Fcod is more common in middle aged black women (3). In some cases, the lesion is totally asymptomatic and is found when radiography is performed for other purpose. Radiographically this lesion occurs in two or more quadrants as multiple masses with noticeable tendency for bilateral and usually in tooth bearing regions. We present two rare cases of Floride cement-osseous dysplasia.The first case occurs in a 20 and second in a 25 years oldPersianwoman that is rarewith regard to this race and sex.
KEYWORDS:
Asymptomate FlorideCemento-Osseous dysplasia, Race, Radiographically, Sex.
Introduction
Cemento-osseous dysplasia is a group of disorders that have been suggested to originate from periodontal ligament. Because these lesions are in close approximation to the PDL and their histopathologic findings are similar.1 CODs are usually classified based on their clinical and histopathologic features into three main groups: 1- Focal (single lesion in any area of the jaw but posterior mandible is more common) 2-periapical (single or multiple lesions at apices of the anteriormandibular teeth) 3-Florid (multiple lesions in posterior portion of jaws).2
Florid cemento-osseous dysplasia clearly appears to be a form of bone and cemental dysplasia which is limited to jaws. Fcod is more common in middle age black women3 . Radiographically this lesion occurs in two or more quadrants as multiple masses with noticeable tendency for bilateral and usually in tooth bearing regions4
However, it is not extraordinary to come across involvement of all four posterior quadrants. In some cases, the lesion is totally asymptomatic and is foundwhen radiography is performed for other purpose.Nevertheless, itmight have symptoms such as dull pain and alveolar sinus tract to the oral cavity . Radiographically the lesion demonstrates an identical pattern of maturation; in the beginning the lesion is predo minantly radiolucent which gradually becomes mixed radiolucent- radiodense and finally appears as sclerotic mass with a thin peripheral radiolucent rim.
We present two rare cases of Florid cement-osseous dysplasia. The first case occurred in a 20 and second in a 25 yearsOld Persianwoman that is rare with regard to this race and sex.
Case 1
A 20 years old Persian Woman was referred by her general dental practitioner to the department of Oral medicine at Isfahan University of medical science for evaluation of her panoramic radiography. The patient had a past medical history of Rheumatoid Arthritis since the age of 19.She had taken prednisolone , calcium and zinc sulfate. The extra-oral exam was within normal limits. Her intra oral examination revealed an apparently caries free dentition with no periodontal disease. All teeth were vital and were not tender to percussion. The radiograph showed four radiolucent lesions in the periapical region of teeth 46, 44, 42, 37 and 36. (Fig.1)
Figure1: Radiograph showing radiolucent lesions in the periapical region of teeth 46, 44, 42, 36 and 37
Our suggestion was that these lesions represent florid cemento-osseous dysplasia. To confirm the diagnosis, we performed an incisional biopsy.Histopathological finding showed spindle-shape fibroblasts and collagen fiberswith a few small blood vessels.Within this fibrous connective tissue background there was amixture of woven bone and cemented like particles. (Fig.2)
Figure2: Within this fibrous connective tissue background there was a mixture of woven bone and cemented like particles.
Figure 3: Some elements of maturation are visible within radiolucent lesions. The mixed lesions have opaque appearance surrounded by a thin radiolucent border.
Another panoramic radiograph was performed after 6 months for follow-up. The lesions were of similar size radiographically. Some elements of maturation were visible within radiolucent lesions. The mixed lesions had opaque appearance surrounded by a thin radiolucent border. (Fig.3)
Case 2
A 20 years old Persian Woman presented for routine dental check-up. She had no significant past medical history. Intraoral examination revealed a slight expansion of the buccal plate in the lower left first premolar area. Radiological examination revealed two sclerotic masses with radiolucent border in periapical of the teeth 34, 35 and two radiolucent lesions in periapical of 36 and 37. (fig.4) All lesions were well defined on radiography. Complete blood count and other laboratory data were within normal limits. Biopsy was not performed as we diagnosed the case as FCOD according to the characteristic features observed on the radiographs. Moreover, any biopsy in this case raises the risk of infection or could bring about jaw fractures.
Figure 4: panoramic radiograph showing two well defined radiopaque lesions and two Well defined radiolucent lesions in the periapical of the mandibule, above the inferior alveolar canal.
No active treatment was initiated at this time but annual follow up was suggested for the patient. 6 months follow-up had no infiltration of the periodontal ligaments. Variable degrees of maturation of the lesions was observed. (Fig.5)
Figure 5: Maturation of the lesions have observed.
Discussion
Florid cemento-osseous dysplasia was first described byMelrose et al. in 197661. Cemento-osseous dysplasia depicts similar histological features; composed of anastomosing bone trabeculae and layers of cementum like calcifications embedded in fibroblastic background7 . Such histological featureswere seen in our first case report.
Mcdonald and Kowoski showed that the mean age of FCOD is 47-49. However, two of reported cases were young adults.
Biopsy is not essential to confirm the diagnosis of Fcod and usually is based on radiographic findings. In fact, Biopsy could increase the risk of infection as well as fracture of the jaw9. We performed biopsy for the first case since diagnosis was at first rather doubtful.Moreover, the lesion seemed to be in an early stage. In the second case, diagnosis was confirmed radiographically . Fcod must be differentiated from other benign fibroosseous lesions such as fibrous dysplasia10 , ossifying fibroma11, Paget disease , sclerosing osteomyelitis and Gardner syndrome. Fcod does not seem to be a developmental anomaly like fibrous dysplasia. Also, it does not show the characteristic features of a neoplasic lesion such as ossifying fibroma . Chronic diffuse sclerosing osteomyelitis is commonly located in mandible .Symptoms are cyclic episodes of unilateral pain and swelling. Single area of diffuse sclerosis containing small and ill defined osteolytic region is observed on radiographs. Nonetheless, histologically they are similar12 . Fcod may have similarities with Gardner syndrome. FCODhas no other skeletal abnormality, skin lesions, and dental anomalies. Thus FCOD can be distinguishable from Gardner syndrome13 .Another radiographic differential diagnosis is Paget’s disease. Diagnosis keys are that dysplastic changes in Paget’s disease are frequently polyostotic and the disease depicts biochemical serum changes as well14
Fcod does not require any treatment unless secondary infection ensues or for cosmetic reasons15
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