Fibro-osseous Lesions
Cemento-osseous Dysplasia
aka COD · Periapical/Focal/Florid COD
Benign non-neoplastic fibro-osseous lesion of tooth-bearing regions arising from the periodontal ligament; teeth remain vital.
§ overviewOverview
Reactive/dysplastic fibro-osseous lesion of the jaws in which normal bone is replaced by cellular fibrous tissue with cementum-like and osseous calcifications.
§ etiologyEtiology
- 01Unknown; reactive process of PDL origin
§ epidemiologyEpidemiology
Middle-aged women, especially African descent; three variants: periapical (anterior mandible), focal (single posterior), florid (multi-quadrant).
§ pathogenesisPathogenesis
Metaplastic replacement of periapical bone by fibrous tissue producing progressive maturation from radiolucent → mixed → radiopaque phases.
§ clinicalClinical Features
- 01Asymptomatic incidental radiographic finding
- 02Teeth vital (key differentiator from periapical granuloma/cyst)
- 03Florid form may cause jaw expansion and secondary infection
§ differentialDifferential Diagnosis
- 01Periapical granuloma/cyst (non-vital tooth)
- 02Ossifying fibroma
- 03Chronic osteomyelitis
- 04Paget disease
§ histopathHistopathology
- 01Cellular fibrous stroma
- 02Curvilinear trabeculae of woven bone and basophilic cementum-like droplets
- 03No capsule (blends with surrounding bone)
§ radiographicRadiographic Features
- 01Early: well-defined periapical radiolucency
- 02Mixed stage: radiolucent with radiopaque foci
- 03Mature: dense radiopaque mass with thin radiolucent rim
§ investigationsInvestigations
- 01Vitality testing (positive)
- 02OPG/CBCT to define extent
- 03Biopsy avoided unless diagnosis unclear (risk of osteomyelitis in florid form)
§ treatmentTreatment
- 01No treatment needed if asymptomatic — observation with periodic radiographs
- 02Meticulous oral hygiene to prevent secondary infection
- 03Debridement/saucerisation for infected florid COD
- 04Avoid unnecessary extractions in involved areas
§ complicationsComplications
- 01Secondary infection → chronic osteomyelitis
- 02Diagnostic confusion with periapical pathology leading to unnecessary endodontics
§ prognosisPrognosis
Excellent; not neoplastic; no malignant potential.
§ examKey Examination Points
- 01Confirm tooth vitality before surgical intervention
- 02Recognise florid pattern to avoid iatrogenic osteomyelitis
§ revisionQuick Revision Summary
- 01Vital teeth · anterior mandible (periapical) or multi-quadrant (florid) · observation
§ vivaBDS Viva Questions
- 01Differentiate COD from periapical cyst.
- 02Why avoid biopsy in florid COD?
- 03Which population is affected?
§ mcqsMCQs — Assessment (3)
Question 1
Key differentiator from periapical pathology:
Question 2
Most common patient profile:
Question 3
Treatment of asymptomatic COD:
References
- WHO Classification of Head & Neck Tumours 2022
Draft — pending faculty review. Educational use only; verify against current guidelines and primary sources before clinical application.