Fibroosseous lesions 3
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Fibroosseous lesions 3
- 1. DISEASES OF BONE INDIAN DENTAL ACADEMY Leader in continuing Dental Education www.indiandentalacademy.com
- 2. Learning Objectives At the end of the lecture student should be able toAt the end of the lecture student should be able to describe Clinical features, oral manifestations, radiographic features, histopathological features,& surgical management of Periapical Cemento-osseous Dysplasias, Focal Cemento-osseous Dysplasias, & Florid Cemento-osseous Dysplasias www.indiandentalacademy.com
- 3. PERI APICAL CEMENTO OSSEOUS DYSPLASIA. The definition of periapical cemental dysplasia in WHO classification “Nonneoplastic lesion affecting the periapical tissues of one or more teeth,’’ implies the inclusion of this entity occurring in both anterior and posterior apical areas of jaws. www.indiandentalacademy.com
- 4. PCOD is a reasonably well-defined clinical- radiologic entity. Predominantly involving the apical areas of vital mandibular incisors. Striking predilection for female and Black patients. www.indiandentalacademy.com
- 5. Most patients are over 30 years of age and seldom the lesion is seen in patients younger than 20 years. Invariably an asymptomatic lesion Discovered on routine radiographic examination. www.indiandentalacademy.com
- 6. RADIOGRAPHIC FEATURES: 1. Well circumscribed 2. Mixed radiolucent or radio – opaque 3. Involves apices of one or more teeth 4. Individual lesions are seldom more than 1 cm in diameter and most are less than 0.5 cm. www.indiandentalacademy.com
- 9. Serial radiographic studies have shown that the lesions are initially circumscribed and radiolucent, over the course of several years show increasing degrees of calcification. www.indiandentalacademy.com
- 10. Management: there is general agreement that PCOD does not require treatment. A biopsy may be performed in less typical clinical – radiologic situation. www.indiandentalacademy.com
- 11. FOCAL CEMENTO–OSSEOUS DYSPLASIA Almost invariably an asymptomatic lesion There is no cortical expansion in most instances. Lesions are solitary. www.indiandentalacademy.com
- 12. RADIOGRAPHIC FEATURES: 1. Well circumscribed, may have radio opaque edge. 2. May have a faint grainy texture. 3. Mixed radio opaque/ radiolucent appearance, presence of one or more sclerotic masses. 4. Located in the tooth bearing areas and may reach up to 2 cm in size. www.indiandentalacademy.com
- 14. DIFFERENTIAL DIAGNOSIS: Central cemento–ossifying fibroma. www.indiandentalacademy.com
- 15. An absolute key in differentiation is the gross appearance during surgery: No capsule, continuous with the medullary bone and cortex. Gritty, haemorrhagic tissue that fragments easily. www.indiandentalacademy.com
- 16. FLORID CEMENTO – OSSEOUS DYSPLASIA. Melrose: (1976) Florid osseous dysplasia. Prior to this FLCOD was reported as gigantiform cementoma, chronic sclerosing osteomyelitis, sclerotic cemental masses, and multiple endostosis. www.indiandentalacademy.com
- 17. Multi-focal involvement Marked tendency for bilateral & often symmetrical involvement May present as extensive lesions in all four posterior quadrants Patients may complain of dull ache Radiographically, identical pattern of maturation noted in other two forms www.indiandentalacademy.com
- 19. HISTOLOGIC FEATURES: All three patterns demonstrate similar histopathologic features Fragments of cellular mesenchymal tissue composed of spindle-shaped fibroblasts & collagen fibers with numerous small blood vessels Free haemorrhage Mixture of woven bone, lamellar bone & cementum-like particles www.indiandentalacademy.com
- 24. Proportion of mineralized material varies As lesions mature- the ratio of fibrous connective tissue to mineralized materials decreases. Bony trabeculae become thick curvilinear structures- resemble shape of ginger roots Individual trabeculae fuse & form lobular masses www.indiandentalacademy.com
- 26. Summary Clinical features, oral manifestations, radiographic features, histopathological features,& surgical management of Periapical Cemento-osseous Dysplasias, Focal Cemento-osseous Dysplasias, & Florid Cemento-osseous Dysplasias www.indiandentalacademy.com
- 27. BIBLIOGRAPHY Text book of oral pathology Shafer's, 5 & 6th edition Oral & Maxillofacial Pathology A Rationale for Diagnosis & Treatment. R E Marx 1st edition Color Atlas of Oral Diseases Cawson, R. 2nd & 5th edition Oral and Maxillofacial Pathology Neville, Brad W. 2nd Lucas’s Pathology Of Tumor’s of the Oral Tissues www.indiandentalacademy.com
Editor's Notes
- It is a well defined clinical radiologic entity.
- It is a well defined clinical radiologic entity.
- Paients are subjected to endodontic therapy for the mistaken diagnosis of periapical cyst or granuloma.
- The microscopic features reported are therefore reported for a limited number of cases and are identical with those of FCOD.
- Cemento – ossifying fibromas are sharply well demarcated, encapsulated tumors.edge is clearly separate from the surrounding bone.
- Histologic features of FCOD are essentially the same as that of PCOD. Attachment to the cortex is reminiscent of the situation seen in FD.
- A, FCOD reveals anastomosing, thick curvilinear acellular bony trabeculae (ginger roots, Fig. 3) with interspersed hemorrhage (arrows). B. Thick curvilinear bony trabeculae (ginger roots. Fig. 3) with basophilic outlines. Ginger roots show thick curvilinear branching and resemble anastomosing acellular bony trabeculae in FCOD