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.
§ figuresFigures (3)
Fig. 1Source: Cemento osseous dysplasia. (n.d.). https://www.dentalknowledge.in/2022/01/cemento-osseous-dysplasia.html
“Focal COD” · Unknown authorUnknown author · Public domain · Wikimedia Commons
Fig. 2Source: Komabayashi, T., et al.(2011). Cemento-osseous dysplasia in an elderly Asian male: a case report. Journal of oral science. 53. 117-20. 10.2334/josnusd.53.117.
“Periapical COD” · Komabayashi, T. · Public domain · Wikimedia Commons
Verified open-access images only, reproduced for education under their stated licences · no AI-generated or illustrative artwork · Cemento-osseous Dysplasia figures pending faculty review.
§ 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:
§ evidenceReferences & Evidence
Current Classification
WHO Classification of Head and Neck Tumours
5th Edition — Volume 9
WHO Classification of Tumours Editorial Board · 2022
The authoritative international classification of head and neck, odontogenic and salivary gland tumours. Current terminology on this site follows this edition.
Evidence summary
Highest level of evidence linked to this page: WHO / Official Classification.
- L1 · Classification — 2
- L6 · Textbook — 3
1 linked source was published from 2024 onwards. Where guidance is limited or contested, rely on the higher-level sources above rather than this summary. Educational use only — not a substitute for clinical judgement.
Content last reviewed
September 2026
Evidence last reviewed
September 2026
Next scheduled review
September 2027
Review status
EVIDENCE REVIEWED
Search latest PubMed evidence
Last literature search: 7 September 2026
Current Classification
WHO Classification of Tumours Editorial Board. IARC / World Health Organization · 2022
The authoritative international classification of head and neck, odontogenic and salivary gland tumours. Current terminology on this site follows this edition.
IARC / WHO. IARC · 2022
Continuously updated online edition of the WHO head and neck tumour classification.
Histopathology References
Barnes L. CRC Press · 2008
Detailed histopathological reference for head and neck diagnostic criteria.
Textbook References
Neville BW, Damm DD, Allen CM et al.. Elsevier · 2024
Standard reference textbook of oral and maxillofacial pathology used throughout this atlas.
Rajendran R, Sivapathasundharam B. Elsevier · 2020
Undergraduate and postgraduate oral pathology textbook widely used in BDS and FCPS curricula.
Additional sources cited on this page
- WHO Classification of Head & Neck Tumours 2022
Draft — pending faculty review. Educational use only; verify against current guidelines and primary sources before clinical application.