Cemento-Osseous

Dysplasias
 Occurs in tooth bearing areas
Most common fibro-osseous lesion
Divided into 3 groups
i. Focal
ii. Periapical
iii. florid
 Focal cemento-osseous
dysplsia
Exhibits single site involvement
Misdiagnosed as a variant of
ossifying fibroma
Mostly in females
Mean age 38 years (30-60)
Higher percentage in whites
Posterior mandible is predominant
site
Lesion small upto 1.5cm in diameter
Expansive focal cemento-osseous
dysplasia
 Focal cemento osseous dysplasia
Radiographic features
Completely radiolucent to densely
radiopaque with a thin peripheral
radiolucent film
Well defined
Borders usually irregular
Lesions in dentulous, eduntulous and
in extraction sites
 Periapical cemento osseous dysplasia
(osseous dysplasia, cemental dysplasia, cementomas)

Predominant in periapical region of

anterior mandible
Solitary lesions may occur
Multiple foci are present
Higher in females
Asymptomatic, discovered on
radiographs
Lesions are self limiting
Doesnot typically expand the cortex
 Radiographic features

Progressive periapical cemento-osseous dysplasia over a 23-

year period

Early lesions:
I. circumscribed areas of radiolucency involving the apical
area of a tooth
II. Resembles periapical granuloma or periapical cyst
III. With time adjacent lesions fuse to form a linear pattern of
radiolucency that envelopes the apices of several teeth
Mature lesions
I. Mixed radiolucent and radiopaque
appearance
End stage
II. Circumscribed dense calcification
surrounded by a narrow radiolucent
rim
III. PDL is intact
 Florid cementoosseous
dysplasia
Multifocal involvement
Not limited to anterior mandible
Predominantly involves black women
Marked predilection in middle aged
to older adults
 Marked tendency
for bilateral lesions
Quite symmetrical
involvement
Extensive lesions in
all four posterior
quadrants may be
present
In some case may
be asymptomatic
Familial florid cemento-osseous
dysplasia
 Patient may complain of dull pain
Alveolar sinus tract may be present
Exposure of yellowish avascular bone
to the oral cavity
Some degree of expansion may be
noted
Dentulous and edentulous areas
main mahy be affected
 Radiographic features

Initially predominantly radiolucent

Then become mixed
Later radiopaque with a thin peripheral
radiolucent film
Occasionally, lesions may become totallt
radiopaque and blend with adjacent normal
 Radiographic features
In endstage lesions, fusion of
cementoosseous lesions directly to
the tooth root surface may be
observed
Hypercementosis like appearance
 Treatment
Asymptomatic patient
Regular recall examinitions
Prophylaxis
Oral hygiene maintenance to control
periodontal disease and prevent
tooth loss
 Treatment
Symptomatic patient
Antibiotics
Saucerization of dead bone
Curretage if cysts arise in the
effected region
Familial Gigantiform
Cementoma
 Familial gigantiform
cementoma
It is disorder of gnathic bone that
ultimately leads to the formation of
massive sclerotic masses of
disorganized mineralized material
 Uncommon hereditary disorder
Different from conventional cemento-
osseous dysplasia
Autosomal dominant
Osseous pathosis limited to the jaw
Multifocal involvement of maxilla and
mandible
 Gnathic involvemnt leads to
I. Facial deformity
II. Impactions
III. Malpositions
IV. Malocclusion
 At mature stage
I. bone sensitive to inflammatory
stimuli
II. may become necrotic at slight
provocation
. Increased serum alkaline
phosphatase
 Radiographic features
Early lesioan appear as mutliple
radiolucenies in periapical regions
Later, affected sites expand
replacing much of the normal bone.
Mixed radiolucent and radioopaque
pattern
On maturation, radiopaque with a
thin radiolucent rim
 Treatment
Extensive resection of the altered
bone
Reconstruction of the facial skeleton
 Ossifying Fibroma

Cementifying fibroma
Cemento-ossifying fibroma
 Ossifying fibroma
True neoplasm
Osteogenic neoplasm
Mainly seen in third to fourth decade of life
Female predilection
Dominant mandibular involvement
Common in posterior region (premolar and
molar)
Painless swelling of involved bone
Facial asymmetry
Cemento-ossifying fibroma of
mandible
 Radiographic features
Well defined
Unilocular
Completely radiolucent
Root divergence
Root resorption
Downward bowing of inferior cortex of mandible
 Treatment
Enucleation
Surgical resection
Bone grafting
Juvenile ossifying fibroma

Juvenile active ossifying

fibroma
Juvenile aggressive ossifying
fibroma
 Distinguished from larger group of
ossifying fibroma on the basis of:
I. age
II. Site
III. Clinical behavior
 2 patterns

I. Trabecular
II. Psammamatoid

Trabecular juvenile osifying

fibroma
 Most lesions involving
craniofacial skeleton
are psammamtoid
Rapid growth
Well-circumscribed
Lack continuity with
the adjacent normal
bone
Trabecular pattern
diagnosed initially in
younger patients
 Male predilection
Maxillary predominance
Cortical expansion
 Complications
Lesions arising in paranasal sinuses may
penetrate:
I. Orbital
II. Nasal
III. Cranial cavities
. Nasal obstruction
. Exophthalamus
. Ptosis
. Temporary or permanent blindness
. May be accompanied by aneurysmal bone cyst
 Radiographic features
Circumscribed radiolucencies
Central radiopacity
Ground glass opacification
Within sinus radiodense
Clouding (maybe confused with sinusitis)

Psammamatoid juvenile aggressive fibroma

 Treatment
Smaller lesion
I. Local excision
II. Curettage
. Rapidly growing lesion
I. resection
 Osteoma
Benign tumors
Composed of compact or cancellous
bone
Restricted to cranio-facial skeleton
 May arise on the surface of bone as:
I. Periosteal
II. Peripheral
III. Exophytic
 Maybe located In medullary
bone as:
i. Endosteal or central
osteoma
. Soft tissue maybe involved
(osteoma cutis)
. Common in young adults
. Asymptomatic
. Solitary lesions
. Occurs mostly in:
i. Paranasal sinuses
ii. Body of the mandible
iii. Condyle
 Periosteal osteomas:
i. Slowly growing masses
ii. May increase to large size
iii. May caus facial deformity
 Endosteal osteoma:
i. Asymptomatic
ii. Large lesion
iii. Enlargement of affected area
 Condylar osteomas may cause:
i. Shift in occlusion
ii. Deviation of midline of the chin towards
uneffected side
iii. Limited mouth opening
. Condylar osteomas are:
i. True neoplasm
ii. Hyperostoses
iii. Lobulated
Panoramic image showing the osteoma located
at the anterior surface of mandibular condyle
Osteoma present in the left angle of
the mandible
 Paranasal sinus
osteomas
i. Mostly in frontal sinus
ii. Asymptomatic
iii. Nasal discharge
. Orbital floor involvement
may causes
i. Proptosis
ii. Diplopia
iii. Decreased visual acuity
 Intracanial extensions may cause:
i. Meningitis
ii. Cerebral abcesses
iii. Intracranial mucoceles
 Radiographic features
Circumscribed sclerotic mases
Periosteal osteoma
i. Uniform sclerotic pattern OR
ii. Sclerotic periphery with a central trabecular
pattern
 Treatment
Larger osteomas --- surgical
excision
Smaller osteomas --- observation
Condylars osteomas --- removed
surgically
i. Condylectomy in case of large
lesion
ii. Local resection in case of peripheral
osteoma