Fibro osseous lesions /certified fixed orthodontic courses by Indian dental academy

FIBRO-OSSEOUS LESIONS OF
THE JAWS & ITS SURGICAL
MANAGEMENT

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INDIAN DENTAL ACADEMY
Leader in continuing dental education



CONTENTS
 INTRODUCTION
 CLASSIFICATION
 FIBROUS DYSPLASIA
 CEMENTO OSSEOUS DYSPLASIA
 OSSIFYING FIBROMA
 JUVENILE OSSIFYING FIBROMA
 MISCELLANEOUS LESIONS
 CONTROVERSIES
 CONCLUSION
 REFERENCES

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.


CLASSIFICATIONS
 Pindborg and Kramer s classification
 Charles Waldron (1993)
 Brannon and fowler

 Slootweg and Muller (1996)


FIBROUS DYSPLASIA


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)


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

CLINICAL FEATURES
 Monostotic type


CLINICAL FEATURES
 Polyostotic type


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


HISTOPATHOLOGY


DIFFERENTIAL DIAGNOSIS
 Ossifying fibroma
 Pagets disease
 Chronic osteomyelitis

 Osteosarcoma


TREATMENT
 Medical management


TREATMENT
 Surgical management


Surgical approach
Weber- Ferguson incision

Altemir incision / Lynch’s
modification


CEMENTO-OSSEOUS DYSPLASIA


TYPES
 Based on clinical & radiological features Periapical COD




Focal COD
Florid COD


PERIAPICAL COD
PCOD is defined by WHO classification as “a nonneoplatic lesion affecting the periapical lesions of one
or more teeth”

 CLINICAL FEATURES


Periapical COD
 Radiological features


Differential diagnosis
 Radiolucent lesions-

radicular cyst
odontogenic keratocyst
Radio-opaque lesions
odontoma
chronic osteomyelitis
osteoblastoma

FOCAL COD
 Clinical features


Differential diagnosis
 Odontoma
 Cementoblastoma
 Osteoblastoma

 Ossifying fibroma
 Condensing osteitis


FLORID COD


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
background to mineralized material decreases.

TREATMENT


OSSIFYING FIBROMA


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


OSSIFYING FIBROMA


OSSIFYING FIBROMA
 Radiographic features


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
dysplasia.

 Treatment and prognosis


JUVENILE OSSIFYING FIBROMA


 Radiographic features


 Histopathology


Miscillaneous lesions
 Osteoblastoma
 Osteiod osteoma
 cementoblastoma


Conclusion


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








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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

References
 8.D.Summerlin, Diagnosis of fibro-osseous lesions of the jaw . JOMS ;64(9):1
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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

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