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    Cemento Osseous Dysplasias

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    huma
    Cemento-osseous dysplasias are fibro-osseous lesions that occur in tooth-bearing areas and are divided into focal, periapical, and florid types. Focal lesions involve a single site and are misdiagnosed as ossifying fibromas, while periapical lesions occur in the anterior mandible and may be asymptomatic. Florid lesions have multifocal involvement and predominantly affect black women. Ossifying fibromas are true neoplasms that commonly involve the mandibular posterior region. Juvenile ossifying fibromas occur in younger patients and can be either trabecular or psammamatoid. Osteomas are benign bone tumors restricted to the

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    Cemento Osseous Dysplasias

    Uploaded by

    huma
    132 views54 pages
    Cemento-osseous dysplasias are fibro-osseous lesions that occur in tooth-bearing areas and are divided into focal, periapical, and florid types. Focal lesions involve a single site and are misdiagnosed as ossifying fibromas, while periapical lesions occur in the anterior mandible and may be asymptomatic. Florid lesions have multifocal involvement and predominantly affect black women. Ossifying fibromas are true neoplasms that commonly involve the mandibular posterior region. Juvenile ossifying fibromas occur in younger patients and can be either trabecular or psammamatoid. Osteomas are benign bone tumors restricted to the

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    cementoosseous dysplasia

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    Cemento-osseous dysplasias are fibro-osseous lesions that occur in tooth-bearing areas and are divided into focal, periapical, and florid types. Focal lesions involve a single site and are misdiagnosed as ossifying fibromas, while periapical lesions occur in the anterior mandible and may be asymptomatic. Florid lesions have multifocal involvement and predominantly affect black women. Ossifying fibromas are true neoplasms that commonly involve the mandibular posterior region. Juvenile ossifying fibromas occur in younger patients and can be either trabecular or psammamatoid. Osteomas are benign bone tumors restricted to the

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    132 views54 pages

    Cemento Osseous Dysplasias

    Uploaded by

    huma
    Cemento-osseous dysplasias are fibro-osseous lesions that occur in tooth-bearing areas and are divided into focal, periapical, and florid types. Focal lesions involve a single site and are misdiagnosed as ossifying fibromas, while periapical lesions occur in the anterior mandible and may be asymptomatic. Florid lesions have multifocal involvement and predominantly affect black women. Ossifying fibromas are true neoplasms that commonly involve the mandibular posterior region. Juvenile ossifying fibromas occur in younger patients and can be either trabecular or psammamatoid. Osteomas are benign bone tumors restricted to the

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 54

    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

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