Fibro-osseous Lesions
Ossifying Fibroma
aka Cemento-ossifying Fibroma · COF
Benign well-demarcated encapsulated fibro-osseous neoplasm of tooth-bearing regions of the jaws; unlike fibrous dysplasia, it can be shelled out.
§ figuresFigures (5)
Fig. 1Well-defined fibrous connective tissue with calcified droplets and woven bone trabeculae, bordered by native lamellar bone.
“Ossifying fibroma 2” · Shqynq · CC BY-SA 4.0 · Wikimedia Commons
Verified open-access images only, reproduced for education under their stated licences · no AI-generated or illustrative artwork · Ossifying Fibroma figures pending faculty review.
§ overviewOverview
Benign encapsulated fibro-osseous neoplasm composed of cellular fibrous tissue with variable bone/cementum-like mineralisation.
§ epidemiologyEpidemiology
Adults 20–40 y; F > M; mandibular premolar/molar region most common site.
§ clinicalClinical Features
- 01Slow-growing painless jaw swelling with bucco-lingual expansion
- 02Displacement of teeth
- 03Well-defined lesion — key distinction from fibrous dysplasia
§ differentialDifferential Diagnosis
- 01Fibrous dysplasia (poorly demarcated, ground-glass)
- 02Cemento-osseous dysplasia (multifocal, no capsule)
- 03Ameloblastoma
§ histopathHistopathology
- 01Fibrous stroma with variable cellularity
- 02Trabeculae of woven bone and basophilic cementum-like calcifications
- 03True capsule (allows enucleation)
§ radiographicRadiographic Features
- 01Well-defined unilocular radiolucent-to-mixed lesion with thin sclerotic border
- 02Progressive centripetal mineralisation
- 03Downward bowing of inferior mandibular border
§ investigationsInvestigations
- 01OPG, CBCT to define margins
- 02Incisional biopsy for diagnosis
§ classificationClassification
- 01Conventional (cemento-)ossifying fibroma
- 02Juvenile trabecular OF
- 03Juvenile psammomatoid OF
§ treatmentTreatment
- 01Complete surgical enucleation with curettage of the bony cavity — curative
- 02Segmental resection for large or recurrent juvenile variants
§ complicationsComplications
- 01Recurrence <10% for adult OF, higher for juvenile variants
§ prognosisPrognosis
Excellent for classical OF; juvenile variants more aggressive with higher recurrence.
§ examKey Examination Points
- 01Well-circumscribed vs FD's diffuse border
- 02Cortical bowing on CBCT
§ revisionQuick Revision Summary
- 01Encapsulated · enucleation curative · JOF more aggressive
§ vivaBDS Viva Questions
- 01Differentiate OF from fibrous dysplasia.
- 02Juvenile variants?
- 03Treatment approach?
§ mcqsMCQs — Assessment (3)
Question 1
Key feature separating OF from FD:
Question 2
Treatment of choice:
Question 3
Most aggressive variant:
§ 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 — 3
- 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.
Vered M, Wright JM. Head and neck pathology · 2022 · 16(1):63-75
Summary of odontogenic and maxillofacial bone tumour changes in the 5th edition WHO classification.
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 Head & Neck Tumours 2022
Draft — pending faculty review. Educational use only; verify against current guidelines and primary sources before clinical application.