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BONE DISEASES. FINAL. 2. Cemento-osseous dysplasia. A - Periapical cemento -osseous dysplasia . B. Focal cemento -osseous dysplasia . C. Florid cemento -osseous dysplasia.

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2 cemento osseous dysplasia
2. Cemento-osseous dysplasia

A - Periapicalcemento-osseous dysplasia .

B. Focal cemento-osseous dysplasia .

C. Florid cemento-osseous dysplasia .

a periapical cemento osseous dysplasia
A -Periapicalcemento-osseous dysplasia.
  • It involves the periapical region of the anterior mandible .
  • Solitary lesions may occur ,but multiple foci are present more frequently .
  • Females are more affected in a rati 10 :1to
  • 14 : 1
  • 70 % of the cases affect blacks .
  • The ages ranging from 30 to 50 .
  • Associated with vital teeth .

It is asymptomatic and discovered when radiographs are taken for other purposes .

Early lesions appear as circumscribed areas of radiolucency involving the periapical

Area of a tooth

So at this stage , it can not be differentiated from periapical granuloma or cyst.


With time ,adjacent lesions often fuse to form a linear pattern of radiolucency that envelopes the apices of several teeth .

The lesions tend to mature over times to create a mixed radiolucent and radiopaque appearance .

AT the end stage the lesions show a circumscribed radiopaque surrounded by a narrow radiolucent rim .

b focal cemento osseous dysplasia
B. Focal cemento-osseous dysplasia
  • It exhibits single site of involvement .
  • About 90 %of cassesoccure in females
  • Mean age is 38 and a predilection for

the third to sixth decades .

  • Higher percentageof cases have been diagnosed in whites .
  • ( this is in contrast to the periapical& florid variants ) .

a symptomatic

  • It may occur in any area of the jows, but the posterior mandible is the predominant site .
  • It is typically a symptomatic , and detected only on a radiographic examination .
  • Most lesions are smaller than 1 . 5 cm in diameter .
  • The lesion varies from completely radiolucent to densely radiopaque with athin peripheral radiolucent rim .
  • Most commonly there is a mixed radiolucent and radiopaque pattern .
  • The lesion tend to be well defined , but the borders are usually slightly irregular .

Lesions occur in dentulous and edentulous areas ,with many examples noted in extraction sites .

  • Occasionally , focal lesion may represent an early stage in the transition to multifocal involvement this is seen most frequently in black females .
c florid cemento osseous dysplasia
C. Florid cemento-osseous dysplasia .

It appears with multifocal involvement

Not limited to the anterior mandible .

Although many cases demonestrate multifocal lesions only in the posterior portion of the jows .many patients also reveal involvement of the anterior mandible

It involves Black women .


Bilateral and often quite symmetric involvement .

  • Not unusual to demonestrates extensive lesions all four posterior quadrants .
  • The lesions may be completely asymptomatic and discovered only when x- ray taken for some other purpose .
  • In other instances , some degree of expansion may be noted in one or more of the involved areas .

radiolucent but ,with time become mixed ,

Then predominantly radiopaque with only a thin peripheral radiolucent rim .

  • Initially , the lesions are predominantly

On occasion , a lesion can become totally radiopaque and blend with the adjacent

noraml appearing bone


Both dentulous and edentulous areas are affected and the involvement appears to be unrelated to the presence or absence of teeth .

histopathplogical features
Histopathplogical Features
  • All three patterns of cemento –osseous dysplasia demonestrate similar histopathplogical features .
  • The tissue consists of fragment of cellular mesenchymal tissue copmosed of spindel –shaped fibroblastsand collagen fibers with numerous small blood vesseles .
  • Free hemorrhage is typically noted interspersed throughout the lesion.

Within the fibrous c. t background

Is a mixture of woven bone , lamellar bone and cememtum –like particles .

As the lesions mature and become more sclerotic , the ratio of fibrous c . T to mineralized material decreases and the bone trabecule become more thicker and fuse to each other .

treatment prognosis
Treatment & Prognosis
  • The various forms of Cemento-osseous dysplasia do not appear neoplastic: therefore, they generally do not require removal .
  • In other instances, symptoms begin after exposure of the sclerotic masses to the oral cavity as a result of progressive alveolar atrophy under a denture .

Management of the symptomatic patient is more difficult . At this stages , there is an inflammatory component to the disease and the process is typically a chronic Osteomyelitis involving dysplastic bone and cementum .

  • Antibiotics may be indicated .
  • Saucerization of dead bone may speed healing .
prognosis of cemento osseous dysplasia
Prognosis of cemento – osseous dysplasia
  • Although asingle case of a malignant fibrous histiocytoma arising within a focus of florid cemento – osseous dysplasia
  • Has been reported , such neoplastic trasformation appears unique ,and the prognosis for patients with
  • cemento – osseous dysplasia is good