Florid Cemento-osseous Dysplasia Associated with Secondary Infection - A Case Report

Abstract

Rationale: The term cemento-osseous dysplasia (COD) refers to a bony fibro-osseous lesion, in which fibrous tissue and cementum-like tissue replace normal bone. There are three types of COD: periapical, focal and florid. The condition is usually asymptomatic and treatment is unnecessary; however, a secondary infection could occur, which requires treatment.

Patient concern: A 58-year-old female patient presented with symptoms in the mandibular posterior region of the right jaw for six months.

Diagnosis: Infected florid COD (FCOD).

Treatment: A pre-operative antibiotic, followed by extraction of non-restorable teeth, debridement of the infected tissue and necrotic bone removal.

Outcome: The patient was followed for one year, during which all previously reported signs and symptoms were resolved.

Take-away lessons: Early lesion detection is essential. Treatment depends on the presence or absence of clinical and radiographic manifestations. The current case was treated surgically to minimise complications.

Keywords: Cemento-osseous dysplasia; florid; focal; infection; periapical.

Figure 1

The right lower quadrant with grossly decayed right lower molars. (a) Occlusal view with areas of suppuration (white solid arrow); (b) Lateral view showing the swelling (white solid arrow)

Figure 2

Pre-operative orthopantomogram. Radio-opaque lesions in the mandible localized on the periapical area of tooth #46 (solid arrow) and in the edentulous area corresponding to tooth #37 (hollow arrow). Multiple carious non-restorable teeth and periodontal disease can also be seen

Figure 3

Pre-operative panoramic radiograph reveals a radio-opaque lesion with radiolucent margin associated with grossly decayed tooth #46 (solid arrow). Radio-opaque lesion was related to the edentulous area of tooth #37 (hollow arrow)

Figure 4

(a) Cone-beam computed tomography of the coronal cross section shows a well-defined radio-opacity with the greatest dimension of 9.86 mm × 6.25 mm in the right lower area. (b) A well-defined radio-opacity with the greatest dimension of 6.37 mm × 5.32 mm in the left lower area

Figure 5

(a) Extracted teeth with the associated lesion. (b) Granulation tissue. (c) Immediate panoramic radiograph after surgical debridement. (d) Haematoxylin – eosin staining of a medium-power histologic cut revealing a transition of bone mass; the adjacent fibrous tissue presents an inflammatory infiltrate

Figure 6

(a) Clinical follow-up after six months. (b) Radiographic follow-up after six months. (c) Lower interim removable partial denture. (d) Upper metallic partial denture