FIBRO-OSSEOUS LESIONS OF
THE JAWS & ITS SURGICAL
MANAGEMENT

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INDIAN DENTAL ACADEMY
Leader in continuing dental education

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CONTENTS
 INTRODUCTION
 CLASSIFICATION
 FIBROUS DYSPLASIA
 CEMENTO OSSEOUS DYSPLASIA
 OSSIFYING FIBROMA
 JUVENILE OS...
INTRODUCTION
 Fibro-osseous lesions are diverse group of processes
that are characterized by replacement of normal bone
b...
CLASSIFICATIONS
 Pindborg and Kramer s classification
 Charles Waldron (1993)
 Brannon and fowler

 Slootweg and Mulle...
FIBROUS DYSPLASIA

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FIBROUS DYSPLASIA
 Fibrous dysplasia is a benign lesion, presumably
developmental in nature, characterized by a presence
...
TYPES
 Philip et al (1997) classified fibrous dysplasia into

1. Monostotic F.D
Juvenile

Juvenile, aggressive

Adult
...
CLINICAL FEATURES
 Monostotic type

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CLINICAL FEATURES
 Polyostotic type

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RADIOGRAPHIC APPEARANCES
 Depends upon the degree of lesions maturation
1.Radiolucent
2.Radiopaque
3.Mixed Radiolucent-Ra...
HISTOPATHOLOGY

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DIFFERENTIAL DIAGNOSIS
 Ossifying fibroma
 Pagets disease
 Chronic osteomyelitis

 Osteosarcoma

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TREATMENT
 Medical management

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TREATMENT
 Surgical management

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Surgical approach
Weber- Ferguson incision

Altemir incision / Lynch’s
modification

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CEMENTO-OSSEOUS DYSPLASIA

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TYPES
 Based on clinical & radiological features Periapical COD




Focal COD
Florid COD

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PERIAPICAL COD
PCOD is defined by WHO classification as “a nonneoplatic lesion affecting the periapical lesions of one
or ...
Periapical COD
 Radiological features

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Differential diagnosis
 Radiolucent lesions-

radicular cyst
odontogenic keratocyst
Radio-opaque lesions
odontoma
chronic...
FOCAL COD
 Clinical features
 Radiological features

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Differential diagnosis
 Odontoma
 Cementoblastoma
 Osteoblastoma

 Ossifying fibroma
 Condensing osteitis

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FLORID COD
 Clinical features
 Radiological features

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HISTOPATHOLOGY
 All the three exhibit similar features.
 The tissue consists of fragments of cellular

mesenchymal tissu...
TREATMENT

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OSSIFYING FIBROMA

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Pindborg J.J11 (1965) defines ossifying fibroma as a
sharply demarcated, intraosseous benign tumour that
occurs in a singl...
OSSIFYING FIBROMA
 Clinical features

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OSSIFYING FIBROMA
 Radiographic features

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OSSIFYING FIBROMA
 Histopathology
The lesion consists of fibrous tissue that
exhibits varying degrees of cellularity and
...
 Treatment and prognosis

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JUVENILE OSSIFYING FIBROMA

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 Clinical features

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 Radiographic features

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 Histopathology

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 Treatment and prognosis

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Miscillaneous lesions
 Osteoblastoma
 Osteiod osteoma
 cementoblastoma

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Conclusion

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References
 A.E. Abdullai, Benign fibro-osseous lesions of the facial skeleton: analysis of
52 cases seen at the korle bu...
References
 8.D.Summerlin, Diagnosis of fibro-osseous lesions of the jaw . JOMS ;64(9):1












9. Faizan ...
Thank you
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Fibro osseous lesions /certified fixed orthodontic courses by Indian dental academy

  1. 1. FIBRO-OSSEOUS LESIONS OF THE JAWS & ITS SURGICAL MANAGEMENT www.indiandentalacademy.com
  2. 2. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  3. 3. CONTENTS  INTRODUCTION  CLASSIFICATION  FIBROUS DYSPLASIA  CEMENTO OSSEOUS DYSPLASIA  OSSIFYING FIBROMA  JUVENILE OSSIFYING FIBROMA  MISCELLANEOUS LESIONS  CONTROVERSIES  CONCLUSION  REFERENCES www.indiandentalacademy.com
  4. 4. INTRODUCTION  Fibro-osseous lesions are diverse group of processes that are characterized by replacement of normal bone by fibrous tissue containing a newly formed mineralized product. www.indiandentalacademy.com
  5. 5. CLASSIFICATIONS  Pindborg and Kramer s classification  Charles Waldron (1993)  Brannon and fowler  Slootweg and Muller (1996) www.indiandentalacademy.com
  6. 6. FIBROUS DYSPLASIA www.indiandentalacademy.com
  7. 7. FIBROUS DYSPLASIA  Fibrous dysplasia is a benign lesion, presumably developmental in nature, characterized by a presence of fibrous connective tissue with a characteristic whorled pattern and containing trabeculae of immature bone. (W.H.O )  Marx and Stern(2003) www.indiandentalacademy.com
  8. 8. TYPES  Philip et al (1997) classified fibrous dysplasia into 1. Monostotic F.D Juvenile  Juvenile, aggressive  Adult 2. Polyostotic F.D  Craniofacial type  Jaffe s type  Albright syndrome www.indiandentalacademy.com
  9. 9. CLINICAL FEATURES  Monostotic type www.indiandentalacademy.com
  10. 10. CLINICAL FEATURES  Polyostotic type www.indiandentalacademy.com
  11. 11. RADIOGRAPHIC APPEARANCES  Depends upon the degree of lesions maturation 1.Radiolucent 2.Radiopaque 3.Mixed Radiolucent-Radiopaque www.indiandentalacademy.com
  12. 12. HISTOPATHOLOGY www.indiandentalacademy.com
  13. 13. DIFFERENTIAL DIAGNOSIS  Ossifying fibroma  Pagets disease  Chronic osteomyelitis  Osteosarcoma www.indiandentalacademy.com
  14. 14. TREATMENT  Medical management www.indiandentalacademy.com
  15. 15. TREATMENT  Surgical management www.indiandentalacademy.com
  16. 16. Surgical approach Weber- Ferguson incision Altemir incision / Lynch’s modification www.indiandentalacademy.com
  17. 17. CEMENTO-OSSEOUS DYSPLASIA www.indiandentalacademy.com
  18. 18. TYPES  Based on clinical & radiological features Periapical COD   Focal COD Florid COD www.indiandentalacademy.com
  19. 19. PERIAPICAL COD PCOD is defined by WHO classification as “a nonneoplatic lesion affecting the periapical lesions of one or more teeth”  CLINICAL FEATURES www.indiandentalacademy.com
  20. 20. Periapical COD  Radiological features www.indiandentalacademy.com
  21. 21. Differential diagnosis  Radiolucent lesions- radicular cyst odontogenic keratocyst Radio-opaque lesions odontoma chronic osteomyelitis osteoblastoma www.indiandentalacademy.com
  22. 22. FOCAL COD  Clinical features  Radiological features www.indiandentalacademy.com
  23. 23. Differential diagnosis  Odontoma  Cementoblastoma  Osteoblastoma  Ossifying fibroma  Condensing osteitis www.indiandentalacademy.com
  24. 24. FLORID COD  Clinical features  Radiological features www.indiandentalacademy.com
  25. 25. HISTOPATHOLOGY  All the three exhibit similar features.  The tissue consists of fragments of cellular mesenchymal tissue composed of spindle shaped fibroblasts and collagen fibres with numerous small blood vessels and free hemorrhage.  Within this background, a mixture of woven bone, lamellar bone and cementum like material is seen.  With maturation the ratio of fibrous tissue www.indiandentalacademy.com background to mineralized material decreases.
  26. 26. TREATMENT www.indiandentalacademy.com
  27. 27. OSSIFYING FIBROMA www.indiandentalacademy.com
  28. 28. Pindborg J.J11 (1965) defines ossifying fibroma as a sharply demarcated, intraosseous benign tumour that occurs in a single bone and shows gradual transformation of a cell rich connective tissue in to bone www.indiandentalacademy.com
  29. 29. OSSIFYING FIBROMA  Clinical features www.indiandentalacademy.com
  30. 30. OSSIFYING FIBROMA  Radiographic features www.indiandentalacademy.com
  31. 31. OSSIFYING FIBROMA  Histopathology The lesion consists of fibrous tissue that exhibits varying degrees of cellularity and contains mineralized material in the form of trabeculae of osteoid, bone or cementum. The trabeculae vary in size and frequently show a mixture of woven & lamellar patterns, peripheral osteoid and osteoblastic rimming, peripheral brush borders that blend into adjacent bone. Variation in the type of mineralized material differentiates it from fibrous www.indiandentalacademy.com dysplasia.
  32. 32.  Treatment and prognosis www.indiandentalacademy.com
  33. 33. JUVENILE OSSIFYING FIBROMA www.indiandentalacademy.com
  34. 34.  Clinical features www.indiandentalacademy.com
  35. 35.  Radiographic features www.indiandentalacademy.com
  36. 36.  Histopathology www.indiandentalacademy.com
  37. 37.  Treatment and prognosis www.indiandentalacademy.com
  38. 38. Miscillaneous lesions  Osteoblastoma  Osteiod osteoma  cementoblastoma www.indiandentalacademy.com
  39. 39. Conclusion www.indiandentalacademy.com
  40. 40. References  A.E. Abdullai, Benign fibro-osseous lesions of the facial skeleton: analysis of 52 cases seen at the korle bu teaching hospital. Ghana medical journal sept        2004;vol38: no 3 2. Alper Sari, Juvenile ossifying fibroma: report of a case. Gazi Medical Journal 2001;12:62-71 3.. ARAKI MASAO Classification of Radiographic Patterns of Fibro-osseous Lesions in the Jaws Dental Radiology VOL.43;NO.3;PAGE.121-129(2003). 4. Brannon, Robert B.; Fowler, Craig B Benign Fibro-Osseous Lesions: A Review of Current Concepts Advances in Anatomic Pathology: May 2001 - Volume 8 - Issue 3 - pp 126-143 5. CA. Waldren , Fibro-osseous lesions of the Jaws, JOMS,1985; 43:249-62. 6. CA. Waldren ,Fibro-osseous lesions of jaws, -, JOMS, 1993. 7. D.S. MacDonald-Jankowski, Fibro-osseous lesions of the face and jaws. Clinical Radiology (2004) 59, 11–25 www.indiandentalacademy.com
  41. 41. References  8.D.Summerlin, Diagnosis of fibro-osseous lesions of the jaw . JOMS ;64(9):1           9. Faizan Alawi, DDS, Benign Fibro-osseous Diseases of the Maxillofacial Bones. Am J Clin Pathol 2002;118(Suppl 1):S50-S70 10. Fibro osseous lesions- Dental clinics of North America 11. Maxillo facial surgery- Peter Ward Booth 12. Necdet DOĞAN, Fibro-Osseous Lesions of the Jaws: Report of Three CasesTurkiye Klinikleri J Dental Sci 2007, 13:146-152 13. Oral and maxillofacial surgery - Daniel M Laskin 14. Surgical pathology - Fonseca vol. 5. 15. TB of Differential diagnosis –Wood and Goaz 16. TB of Oral and maxillofacial pathology – Brad Nivelle 17. TB of Oral pathology - William Shafer www.indiandentalacademy.com
  42. 42. Thank you www.indiandentalacademy.com

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