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1. Cemento-osseus dysplasia
Definition
• Cemento-osseous dysplasia (COD) is a non-neoplastic fibro-osseous
lesion of the tooth-bearing regions of the gnathic bones.
Eepidemiology
• Midle aged black women

2. 1-Periapical cemento-osseous dysplasia (PCOD)
2-Focal cemento-osseous dysplasia (FCOD)
two different terms for the same reactive lesion, that represent the
most common fibro-osseous lesions of the jaws
All of the cemento-osseous dysplasias have similar/same
microscopic appearance

3. 3-Florid cemento-osseous dysplasia (Fl.COD)
denotes an extensive process with multifocal involvement of the jaws
by lesional tissue
• Bbasically When lesions with radiologic and microscopic features
similar to FCOD/PCOD extend to two or more quadrants of the jaw,
the disease is termed florid cemento-osseous dysplasia

4. divided into three variants
(largely on the basis on anatomical location):
periapical COD is associated with the apical areas of mandibular
anterior teeth. Anterior mandibule
focal COD is associated with a single tooth. Posterior mandibule
florid COD has multifocal (multiquadrant) involvement. Posterior
mandibule

5. Clinically
• Asymptomatic. Except, Florid if inflamed lead to pain and discharge
• Associated with vital teeth ‘might be found in edentulous areas’
• All are non-expansive. Except, Florid variant
• Tooth bearing region of jaw
• 1.5 cm
• Mandible 86%
• Bilateral in FlCOD

6. Radiograph ‘essential’
A focus of COD is generally well defined and demonstrates a thin
radiolucent rim. The periodontal ligament should appear intact, and
the lesion should not be fused to the roots
• If identified clinically and radiographically, biopsy might not be
needed

7. Three stages of Radiographic appearance
• Early stage: well-defined radiolucency at the apices of mandibular teeth
• intermediate stage: mixed radiolucent-opaque pattern with a well defined
radiolucent rim around the radiopacity
• late stage: diffuse radiopacity often with ill-defined borders.

8. (a) Periapical Cemental Dysplasia (PACD), a subtype of focal cemento-
osseous dysplasia of the anterior mandible begins as a periapical
radiolucency.
(b) PACD opacifies forming aradiographic ‘‘target lesion’’ in later stages of
the disease.

9. (a) Multiple confluent opacities in all four jaw quadrants.
(b). Bilateral radiolucent and mixed lucent/opaque

10. Histopathology
• characterized by a cellular fibrous stroma that have swirling and/or loose
collagen and areas of vascularity
• the stroma are mineralizing tissues:
1-osteoid trabeculae that is occasionally surrounded by osteoblasts ,
2-bone
3-cementum like material “cementicles’’ or ‘‘bonicles”
• As the lesions mature, they become increasingly calcified displaying very
little fibrotic stroma with thick curvilinear trabeculae
(‘‘ginger root’’ pattern) or irregularly shaped cementum-like masses

11. fibrous tissue to dense mineralized bone trabeculae with
peripheral osteoblasts and cementum-like deposits

12. (a) Early stage lesion with
hemorrhagic foci
(b) Early region with
fibroosseous pattern
(c) Mid stage lesion with
progressively more trabeculae

13. mature lesion with a trabecular
bone pattern
predominantly fibroblastic
proliferative stroma associated with
sparse bone deposition
Florid osseous dysplasia: area of
dense bone, inflammation
and hemorrhage

14. Changes might occur in florid
• hypocellular sclerotic masses may form
• Inflammation
• Cystic changes resembling simple bone cyst may occur

15. Refrances:
• (Eversole, Su and ElMofty, 2008; Zegalie, Speight and Martin, 2015)Eversole, R., Su, L. and
ElMofty, S. (2008) ‘Benign fibro-osseous lesions of the craniofacial complex a review’, Head and
Neck Pathology, 2(3), pp. 177–202. doi: 10.1007/s12105-008-0057-2.
• De Noronha Santos Netto, J. et al. (2013) ‘Benign fibro-osseous lesions: Clinicopathologic features
from 143 cases diagnosed in an oral diagnosis setting’, Oral Surgery, Oral Medicine, Oral
Pathology and Oral Radiology. Elsevier, 115(5), pp. e56–e65. doi: 10.1016/j.oooo.2012.05.022.
• Zegalie, N., Speight, P. M. and Martin, L. (2015) ‘Ossifying fibromas of the jaws and craniofacial
bones’, Diagnostic Histopathology. Elsevier Ltd, 21(9), pp. 351–358. doi:
10.1016/j.mpdhp.2015.07.004.
• WHO Classification of Head and Neck Tumours, 4ed, (2017)