A path less travelled — Short review on ossifying fibroma and osseous dysplasia

Fibro-osseous lesions (FOL) are characterized by replacement of normal bone by fibrous tissue containing a newly formed mineralized product. The mineralized product may be ossification (sometimes cementum formation) or calcification of fibrous tissue by metaplasia. These lesions have similar radiographic and histopathologic features hence the term fibre- osseous lesion is not a diagnosis, rather a description of the presence of fibrous and calcified tissue. They may be developmental (fibrous dysplasia), reactive (cemento-osseous dysplasia) or neoplastic (ossifying/cementifying fibroma). This article presents the commonly used classification for fibro-osseous lesions and an insight into a few changes that have been introduced in the recent past with emphasis on Ossifying Fibroma and Osseous Dysplasia.Ossifying fibromas are considered as benign fibro-osseous neoplasms which are principally encountered within the jawbones. Cemento-osseous dysplasias are non-neoplastic fibro- osseous lesion. Since 1971, the World Health Organization classified cemental lesions into 4 distinct entities, as follows: Periapical Cemental Dysplasia, Benign Cementoblastoma (true cementoma), Cementifying Fibroma and Gigantiform Cementoma (GC). The term, gigantiform cementoma, may imply a solitary process but it is misleading because the condition typically presents as slow-growing, multifocal/multiquadrant and expansile lesions involving both jaws. WHO classified it in Osseous dysplasia and El-Mofty et al. under Ossifying fibroma.

Survival of dental implants in patients with bone dysplasia: A systematic review

Objective: This study used published studies to assess the survival rate of dental implants placed in patients with bone dysplasia of the maxillofacial region.Material and methods: An electronic search without a specified date range was performed using the MEDLINE, PubMed, EMBASE, Web of Science, and Cochrane databases. No gender or age restrictions were applied.Results: Eighteen publications were found that met the study’s criteria, reporting data on 18 patients with bone dysplasia including cleidocranial dysplasia (CDD), fibrous dysplasia (FD), florid cemento-osseous dysplasia (FCOD), and odonto-maxillary segmental dysplasia (SOMD), who received a total of 130 implants, an average of 7.2 implants/patient (range 1 to 16). The mean age of the patients was 36.7 years (range 15 to 70 years). For implants placed in bone dysplasia, the survival rates were 100% for patients with CDD (n = 8), FD (n = 5), SOMD (n = 2), FCOD with implants inserted far from the lesions (n = 2) and 0% for dental implants inserted within FCOD (n = 1). The mean follow-up was 38.2 months (min 6, max 60).Conclusions: Dental implants placed in patients with dysplastic bone lesions show high survival rates, similar to those in the general population for CDD, FD, and SOMD. For FCOD, the failure rate was 100%.

Impant placement on a Focal Cemento-Osseous Dysplasia : A modified protocol with a successful outcome.

Cemento-Osseous dysplasia(COD) is a condition where normal bone is replaced by fibrous connective tissue and cementum-like deposits. Implant rehabilitation of a posterior mandibular edentulism in presence of a COD can be a challenging situation due to the lack of vascularization and the high risk of infection of such lesions.

Ossifying Fibroma; A Case report and review of literature

Introduction/Objective Ossifying fibroma (OF) is a rare, benign, true neoplasm with growth potential, with the mandible involved more often than the maxilla. There is female predilection in the third and fourth decades of life, with the most common site being the premolar and molar area of the mandible. These lesions are characterized by the replacement of endogenous bone with a highly cellular fibrous neoplasm containing varied amounts of bony trabeculae, and/or cementum-like spherules. Radiographically they present as well defined, unilocular, most are mixed lucent, opaque, some with sclerotic border and root divergence may be seen. Histologically most of the lesions are not encapsulated but are well demarcated from the adjacent bone. Thus radiographic, surgical and histological findings help distinguish OF from other benign fibro-osseous lesions such as fibrous dysplasia and cemento-osseous dysplasia. Distinguishing an accurate diagnosis between the above fibro-osseous neoplasms becomes significant as prognosis and treatment differ. Methods/Case Report Herein we report a case of a 59-year-old female who presented with a symptomatic mandibular lesion that radiographically illustrated a midline well-circumscribed expansile mass of the mandibular symphysis with a sclerotic margin and ground-glass internal matrix measuring 3.1 x 4.9 x 3.9 cm, favored to represent pagetoid changes more likely than neoplastic process. Microscopic examination revealed numerous variably sized islands of ossification within a hypercellular fibrous stroma. Based on the clinical, radiographic and histologic findings, a diagnosis of benign fibro-osseous lesion, favor ossifying fibroma was given. Results (if a Case Study enter NA) NA Conclusion Microscopic examination, as in our case, can resemble a variety of benign fibro-osseous neoplasms. Radiographic and clinical correlation, along with microscopic evaluation, help solidify the accurate diagnosis.

Implant Placement in a Cemento-Osseous Dysplasia: A case report

We present a 45-year-old black woman diagnosed with a florid cemento-osseous dysplasia (FCOD) affecting the right lower quadrant and the anterior mandibular region. The patient requested dental implants to rehabilitate the edentulous central lower incisors area (teeth # 31 and # 41) corresponding to a periapical cemento-osseous dysplasia (PCOD). Successful osseointegration of the two implants was obtained using a two-step procedure in order to limit the risk of complications associated with implant placement. Follow-up at one year showed no recurrence and good implant stability. Due to the abnormal quality of the bone in cemento-osseous dysplasia (COD), implant placement is generally avoided, and no other case reports have been reported in the literature in patients affected by PCOD. The present case suggests that in an appropriate clinical setting, implant placement may be a successful procedure.

The importance of cone-beam computed tomography for the diagnosis and treatment plan of florid cemento-osseous dysplasia: a case report

Cone-beam computed tomography (CBCT) provides images without overlapping anatomical structures, which is important for the diagnosis and assessment of florid cemento-osseous dysplasia. This fibro-osseous lesion that affects the alveolar process without compromising the teeth’ pulp vitality is usually asymptomatic, and bone expansion, cortical disruption, and root resorption are uncommon. Due to its avascular characteristic, surgical procedures are often contraindicated. In this case, a 59-year-old female patient presented with a complaint of pain in the right maxillary central incisor. Panoramic and periapical radiographs showed florid cemento-osseous dysplasia in some regions. The right maxillary central incisor showed an extensive radiolucent image suggestive of root resorption but without fibro- -osseous lesion. For better evaluation and implant planning, CBCT was performed and demonstrated florid cemento-osseous dysplasia adjacent to the right maxillary central incisor, contraindicating implant placement. In other regions, CBCT enabled the identification of the expansive features of this fibro-osseous lesion.

Ossifying Fibroma of Non-odontogenic Origin: A Fibro-osseous Lesion in the Craniofacial Skeleton to be (Re-)considered

In the cranio-facial skeleton, a heterogeneous group of well characterized fibro-osseous lesions can be distinguished. Whereas fibrous dysplasia can affect any skeletal bone, ossifying fibroma and cemento-osseous dysplasia exclusively develop in the cranio-facial region, with most subtypes restricted to the tooth bearing areas of the jaws. Herein we present a series of 20 fibro-osseous lesions that developed mostly in the frontal bone and in the mandible, presenting as expansile intramedullary tumors with a unique histologic appearance and an indolent clinical course. We provide evidence that these tumors are distinct from the categories included in the WHO classification and are therefore currently unclassifiable. The definition of cemento-ossifying fibroma as an odontogenic neoplasm developing only in close proximity to teeth should be re-considered and incorporate also extragnathic lesions as shown here.