MALABAR DENTAL COLLEGE MALABAR ACADEMIC CITY

1. OSSIFYING
FIBROMA
AND
CEMENTAL
DYSPLASIA
DR SHABIL MOHAMED MUSTAFA
ASSOCIATE PROFESSOR
MALABAR DENTAL COLLEGE AND RESEARCH CENTRE

2. OSSIFYING FIBROMA
– Other terms: cemento ossifying fibroma , cementifying fibroma
– Is a true neoplasm with significant growth potential.
– It resemble focal cemento-osseous dysplasia radiographically and
histopathologically.
– Ossifying fibromas are relatively rare.

3. – Most authorities consider it to be an odontogenic neoplasm.
– This tumour consist of highly cellular, fibrous tissue that contains
varying amount of abnormal bone or cemental like tissue.
– In the past this lesion was classified as 2 different entities
depending on whether bone or cementum was predominant
calcified product.
– When the histologic appearance of most of the calcified tissue was
of irregular trabeculae of woven bone, the term ossifying fibroma
was used.
– .

4. – When predominant calcified component was cementum term
cementifying fibroma was used
– Since microscopic appearance of an ossifying fibroma and
cementifying fibroma can be very similar, these are combined
under the name cemento-ossifying fibroma.
– Juvenile ossifying fibroma is a very aggressive form of cemento-
ossifying fibroma that occurs in first 2 decade of life.

6. CLINICAL FEATURES
– Occurs over a broad age range
– Peak in third and fourth decade of life.
– Female predilection.
– Mandible is involved far more than maxilla.
– Mandibular premolar and molar area is most common site
– Maxillary lesion tends to involve antrum
– Displacement of teeth may be an early clinical feature.

7. – Small lesion are often asymptomatic and may be detected by
radiographic examination.
– Larger tumour produce painless jaws swelling and facial
asymmetry.
– Some lesions may become massive and cause considerable
deformity.
– Pain and paraesthesia are rare.
– .

8. – Most lesions are solitary however multiple synchronous lesion
have been reported very rarely-either as an isolated finding or as a
component of hyperparathyroidism- jaw tumour syndrome

9. RADIGRAPHIC FEATURES
LOCATION
– appears exclusively in facial bones and most commonly
mandible,inferior to premolar and molars and superior to inferior
alveolar canal.
– in maxilla –canine fossa and zygomatic arch area

10. PERIPHERY
– Borders are well defined.
– A thin radiolucent line representing fibrous capsule may separate
it from surrounding bone.
– Sometimes bone next to lesion develops sclerotic border.

11. INTERNAL STRUCTURE
– Is a mixed radiolucent- radiopaque density with a pattern that
depends on amount and form of manufactured calcified material.
– In some instance internal structure may appear almost totally
radiolucent with a hint of calcified material.
– In the type that mainly contain abnormal bone the pattern may be
similar to that seen in fibrous dysplasia , or a wispy( stretched tuft
of cotton) or flocculant pattern(similar to large heavy snowflakes).
– Lesion that produces a more cementum like material may contain
solid amorphous radioopacities(cementicles)

13. EFFECT ON SURRONDING
STRUCTURE
– Can result in displacement of teeth or inferior alveolar canal and
expansion of outer cortical plate of bone.
– Outer cortical plate is displaced and thinned.
– Outer cortical plate remains intact.
– The lamina dura of involved tooth is usually missing and resorption of
teeth may occur.
– The lesion occupy entire maxilla, expands its wall outward however a
bony partition always exist between internal aspect of remaining aspect
of sinus and tumor.

14. DIFFERENTIAL DIAGNOSIS
– Fibrous dysplasia
– Periapical cemental dysplasia
– Calcifying odontogenic cyst
– Calcifying epithelial odontogenic (pindborg tumor)
– Adenomatoid odontogenic tumor
– Osteogenic sarcoma

15. TREATMENT
– Surgical enucleation or resection.
– Large lesion that have caused considerable bone destruction
surgical resection and bone grafting,.
– Recurrance after complete removal is uncommon.
– Good prognosis
– No apparent potential for malignant transformation

16. CEMENO –OSSEOUS DYSPALSIA(OSSEOUS
DYSPLASIA)
– Most common fibro osseous lesion.
– Occurs in tooth bearing area of jaws.
– Based on clinical and radiographic feature following variants are
seen:
1. Focal
2. Periapical
3. florid

17. FOCAL CEMENTO-OSSEUOS
DYSPLASIA
– CLINICAL FEATURES
– Involves single site
– 90% cases occur in females
– Mean age 41 years
– Predilection for third to sixth decade
– Seen Most often in American-blacks followed by east-Asian and
whites
– It most commonly involves posterior mandible

18. – Disease is asymptomatic and detected by radiographic
examination
– Lesion is smaller than 1.5cm in diameter

20. PERIAPICAL CEMENTO-
OSSEOUS DYSPLASIA
2. Predominantly involves periapical region of anterior mandible.
– Solitary lesion may occur , but multiple foci typically are present.
– Marked female predilection
– Female to male ratio 10:1 to 14:1

21. – 70% of cases affects blacks.
– Most patients are diagnosed between 30 and 50 years of age.
– The associated teeth are usually vital.

23. RADIOGRAPHIC FEATRURES
LOCATION
– Epicentre usually lies at apex of a tooth.
– In rare cases the epicentre is slightly higher and over the apical
third of the tooth.
– Has predilection for periapical bone of mandibular anterior teeth.
– Most cases lesion is multiple and bilateral.
– Occasionally a solitary lesion arises.

26. PERIPHERY AND SHAPE
– Periphery is well defined .
– Often a radiolucent border of varying width is present ,
surrounded by a band of sclerotic bone of varying width.
– This sclerotic bone represent the reaction of immediate
surrounding bone.
– The lesion may be irregulary shaped or overall round or oval
shaped centered over the apex of teeth.

28. EFFECT IN SURROUNDING
STRUCTURE
– Lamina dura of teeth involved is lost , making pdl space either less
apparent or giving it a wider appearance.
– Rarely root resorption my occur.
– Occasionally hypercementosis occur on the root of a tooth positioned
within the lesion.
– Some lesion stimulate a sclerotic bone reaction from the surounding
bone .
– Small lesion do not cause expansion of jaw.
– Larger lesion may cause expansion of jaw thin, intact outer cortex.

29. INTERNAL STRUCTURE
– Varies depending on maturity of the lesion .
3 stages :
1. Early stage
2. Mixed stage
3. Mature stage
– In early stage normal bone is resorbed and replaced with fibrous tissue
that usually is continuous with the pdl ligament
– Radiographicaly this appears as a radiolucency at the apex of involved
tooth

30. – In mixed stage radiopaque tissue appear in the radiolucent
structure
– This material usually is amorphous ; has a round , oval or irregular
shape and is composed of cementum or abnormal bone this
structures are sometimes called cementicles.
– In mature stage the internal aspect may be totally radiopaque
without obvious pattern.
– Usually a thin, radiolucent margin can be periphery because this
lesion matures from center outward.

31. – The internal structure may appear radiolucent if cavities
resembling simple bone cyst form within the cemental lesion.
– In some cases this simple bone cyst extent beyond the margin of
the cemental lesion.

32. DIFFERENTIAL DIAGNOSIS
– Periapical rarefying osteitis(in early pcd)
– Benign cemento-blastoma(in mixed and late form)
– odontoma

33. MANAGEMENT
– Diagnosis is based on radiologic and clinical characteristics.
– Possible complication of biopsy is secondary infection, which may
occur in lesions that have abundant cementum formation and
poor vascularity and treatment is not required.
– If considerable atrophy of alveolar ridge has occurred, the
segments of cementum may reach the mucosal surface,which can
perforate the mucosa when positioned under denture.
– If this occur the pieces of cementum have to be removed surgically
because they can act as sequestra in osteomylitis

34. 3.FLORID CEMENTO OSSEOUS
DYSPLASIA
– Exhibit multifocal involvement not limited anterior mandible.
– Predominantly affects black females.
– Marked predilection for middle age to older adults.
– Show a tendency for bilateral and fairly symmetrical involvement
of mandible.

35. – Occasionally extensive involvement in all four quadrants
– The disease may be asymptomatic.
– In other cases the patient may have dull pain , alveolar sinus tract
and exposure of yellowish avascular bone to oral cavity.
– Some jaw expansion may be evident.
– Both dentulous and edentulous area may be affected.
– Involvement unrelated to presence or absence of teeth

37. RADIOGRAPHIC FEATURES
– LOCATION
– Bilateral and present in both jaws.
– When they are present only in one jaw mandible is most common
location.
– The epicentre is apical to the teeth within the alveolar process and
usually posterior to the cuspid .
– In mandible the lesion occurs above inferior alveolar canal.
–

39. PERIPHERY
– It is well defined and has sclerotic border that vary in width.
– The soft tissue capsule may not be apparent in mature lesions .

40. EFFECT ON SURROUNDING
STRUCTURE
– Large lesion can displace the inferior alveolar nerve canal in
inferior direction.
– FOD can displace the floor of antrum in superior direction and
cause enlargement of alveolar bone by displacement of buccal and
lingual cortical plate.
– The associated teeth root may have considerable amount of
hypercementosis which may fuse with the abnormal surrounding
cemental tissue of the lesion.

41. INTERNAL STRUCTURE
– It can vary from and equal mixture of radiolucent and radiopaque
region to almost complete radio-opacity.
– The radiopaque region can vary from small oval and circular
regions(cotton wool appearance) to large irregular amorphous of
calcification.
– Some prominent radiolucent regions may be present which usually
represent development of simple bone cyst.
– These cyst may enlarge with time or may fill in with abnormal
dysplastic cemento-osseous tissue.

42. DIFFERENTIAL DIAGNOSIS
– Paget’s disease
– Chronic sclerosing osteomyelitis
– Secondary osteomyelitis

43. MANGEMENT
– Under normal circumstances FOD does not require treatment.
– Because of the propensity to develop secondary infection , the
patient should be encourage to maintain an effective oral hygiene.
– Program to avoid odontogenic infection
– If the teeth are extracted and severe atrophy of alveolar process
occur , cementum masses emerge and the pressure of the
overlying denture may cause dehiscence in the mucosa resulting in
osteomyelitis which may spread.

44. – It may be necessary to remove large areas of cemental tissue
leaving very little residual bone for prosthetic treatment

45. THANKYOU