Findings of Florid Cemento-Osseous Dysplasia: a Report of Three Cases
Identifieur interne : 001E94 ( Pmc/Corpus ); précédent : 001E93; suivant : 001E95Findings of Florid Cemento-Osseous Dysplasia: a Report of Three Cases
Auteurs : Taha Emre Köse ; Onur Dincer Köse ; Hulya Cakir Karabas ; Tamer Lutfi Erdem ; Lknur ÖzcanSource :
- Journal of Oral & Maxillofacial Research [ 2029-283X ] ; 2014.
Abstract
Florid cemento-osseous dysplasia (FCOD) is a benign jaw lesion originating from periodontal ligament tissues usually asymptomatic and diagnosed accidentally at routine dental radiographic examination. The purpose of this paper is to report three cases diagnosed as FCOD with their clinical, radiographic and histological findings.
Radiologic and clinical symptoms of three cases diagnosed as FCOD are presented. Serum alkaline phosphatase test and biopsy taken from two of the patients are discussed to eliminate the Paget's disease.
Three patients diagnosed as FCOD and called for routine follow-up. Because of no sign of infection or osteomyelitis, conservative treatment was applied.
Radiographic examination is significant for the diagnosis of florid cemento-osseous dysplasia, especially in the asymptomatic cases. The roles of the dentist are to ensure the follow-up of the diagnosed patients and to take the necessary measures for preventing from the infections.
Url:
DOI: 10.5037/jomr.2013.4404
PubMed: 24478914
PubMed Central: 3904730
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Findings of Florid Cemento-Osseous Dysplasia: a Report of Three Cases</title><author><name sortKey="Kose, Taha Emre" sort="Kose, Taha Emre" uniqKey="Kose T" first="Taha Emre" last="Köse">Taha Emre Köse</name><affiliation><nlm:aff id="aff1"><institution>Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Istanbul University, Istanbul</institution><country>Turkey.</country></nlm:aff></affiliation></author><author><name sortKey="Kose, Onur Dincer" sort="Kose, Onur Dincer" uniqKey="Kose O" first="Onur Dincer" last="Köse">Onur Dincer Köse</name><affiliation><nlm:aff id="aff2"><institution>Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Istanbul University, Istanbul</institution><country>Turkey.</country></nlm:aff></affiliation></author><author><name sortKey="Karabas, Hulya Cakir" sort="Karabas, Hulya Cakir" uniqKey="Karabas H" first="Hulya Cakir" last="Karabas">Hulya Cakir Karabas</name><affiliation><nlm:aff id="aff1"><institution>Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Istanbul University, Istanbul</institution><country>Turkey.</country></nlm:aff></affiliation></author><author><name sortKey="Erdem, Tamer Lutfi" sort="Erdem, Tamer Lutfi" uniqKey="Erdem T" first="Tamer Lutfi" last="Erdem">Tamer Lutfi Erdem</name><affiliation><nlm:aff id="aff1"><institution>Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Istanbul University, Istanbul</institution><country>Turkey.</country></nlm:aff></affiliation></author><author><name sortKey="Ozcan, Lknur" sort="Ozcan, Lknur" uniqKey="Ozcan " first=" Lknur" last="Özcan"> Lknur Özcan</name><affiliation><nlm:aff id="aff1"><institution>Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Istanbul University, Istanbul</institution><country>Turkey.</country></nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">24478914</idno><idno type="pmc">3904730</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3904730</idno><idno type="RBID">PMC:3904730</idno><idno type="doi">10.5037/jomr.2013.4404</idno><date when="2014">2014</date><idno type="wicri:Area/Pmc/Corpus">001E94</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">001E94</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Findings of Florid Cemento-Osseous Dysplasia: a Report of Three Cases</title><author><name sortKey="Kose, Taha Emre" sort="Kose, Taha Emre" uniqKey="Kose T" first="Taha Emre" last="Köse">Taha Emre Köse</name><affiliation><nlm:aff id="aff1"><institution>Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Istanbul University, Istanbul</institution><country>Turkey.</country></nlm:aff></affiliation></author><author><name sortKey="Kose, Onur Dincer" sort="Kose, Onur Dincer" uniqKey="Kose O" first="Onur Dincer" last="Köse">Onur Dincer Köse</name><affiliation><nlm:aff id="aff2"><institution>Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Istanbul University, Istanbul</institution><country>Turkey.</country></nlm:aff></affiliation></author><author><name sortKey="Karabas, Hulya Cakir" sort="Karabas, Hulya Cakir" uniqKey="Karabas H" first="Hulya Cakir" last="Karabas">Hulya Cakir Karabas</name><affiliation><nlm:aff id="aff1"><institution>Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Istanbul University, Istanbul</institution><country>Turkey.</country></nlm:aff></affiliation></author><author><name sortKey="Erdem, Tamer Lutfi" sort="Erdem, Tamer Lutfi" uniqKey="Erdem T" first="Tamer Lutfi" last="Erdem">Tamer Lutfi Erdem</name><affiliation><nlm:aff id="aff1"><institution>Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Istanbul University, Istanbul</institution><country>Turkey.</country></nlm:aff></affiliation></author><author><name sortKey="Ozcan, Lknur" sort="Ozcan, Lknur" uniqKey="Ozcan " first=" Lknur" last="Özcan"> Lknur Özcan</name><affiliation><nlm:aff id="aff1"><institution>Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Istanbul University, Istanbul</institution><country>Turkey.</country></nlm:aff></affiliation></author></analytic><series><title level="j">Journal of Oral & Maxillofacial Research</title><idno type="eISSN">2029-283X</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><title>ABSTRACT</title><sec sec-type="background"><title>Background</title><p>Florid cemento-osseous
dysplasia (FCOD) is a benign jaw lesion originating from periodontal
ligament tissues usually asymptomatic and diagnosed accidentally at
routine dental radiographic examination. The purpose of this paper is to
report three cases diagnosed as FCOD with their clinical, radiographic
and histological findings.</p></sec><sec sec-type="methods"><title>Methods</title><p>Radiologic and clinical
symptoms of three cases diagnosed as FCOD are presented. Serum alkaline
phosphatase test and biopsy taken from two of the patients are discussed
to eliminate the Paget's disease.</p></sec><sec sec-type="results"><title>Results</title><p>Three patients diagnosed as
FCOD and called for routine follow-up. Because of no sign of infection
or osteomyelitis, conservative treatment was applied.</p></sec><sec sec-type="conclusions"><title>Conclusions</title><p>Radiographic examination
is significant for the diagnosis of florid cemento-osseous dysplasia,
especially in the asymptomatic cases. The roles of the dentist are to
ensure the follow-up of the diagnosed patients and to take the necessary
measures for preventing from the infections.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Gerlach, Rc" uniqKey="Gerlach R">RC Gerlach</name></author><author><name sortKey="Dixon, Dr" uniqKey="Dixon D">DR Dixon</name></author><author><name sortKey="Goksel, T" uniqKey="Goksel T">T Goksel</name></author><author><name sortKey="Castle, Jt" uniqKey="Castle J">JT Castle</name></author><author><name sortKey="Henry, Wa" uniqKey="Henry W">WA Henry</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sarmento, Dj" uniqKey="Sarmento D">DJ Sarmento</name></author><author><name sortKey="Monteiro, Bv" uniqKey="Monteiro B">BV Monteiro</name></author><author><name sortKey="De Medeiros, Am" uniqKey="De Medeiros A">AM de Medeiros</name></author><author><name sortKey="Da Silveira, Ej" uniqKey="Da Silveira E">EJ da Silveira</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kim, Jh" uniqKey="Kim J">JH Kim</name></author><author><name sortKey="Song, Bc" uniqKey="Song B">BC Song</name></author><author><name sortKey="Kim, Sh" uniqKey="Kim S">SH Kim</name></author><author><name sortKey="Park, Ys" uniqKey="Park Y">YS Park</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Neville, Bw" uniqKey="Neville B">BW Neville</name></author><author><name sortKey="Damm, Dd" uniqKey="Damm D">DD Damm</name></author><author><name sortKey="Allen, Cm" uniqKey="Allen C">CM Allen</name></author><author><name sortKey="Bouquot, Je" uniqKey="Bouquot J">JE Bouquot</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sanjai, K" uniqKey="Sanjai K">K Sanjai</name></author><author><name sortKey="Kumarswamy, J" uniqKey="Kumarswamy J">J Kumarswamy</name></author><author><name sortKey="Kumar, Vk" uniqKey="Kumar V">VK Kumar</name></author><author><name sortKey="Patil, A" uniqKey="Patil A">A Patil</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Peter, Ar" uniqKey="Peter A">AR Peter</name></author><author><name sortKey="Philipsen, Ha" uniqKey="Philipsen H">HA Philipsen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Paul, Ms" uniqKey="Paul M">MS Paul</name></author><author><name sortKey="Roman, C" uniqKey="Roman C">C Roman</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Minhas, G" uniqKey="Minhas G">G Minhas</name></author><author><name sortKey="Hodge, T" uniqKey="Hodge T">T Hodge</name></author><author><name sortKey="Gill, Ds" uniqKey="Gill D">DS Gill</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="White, Sc" uniqKey="White S">SC White</name></author><author><name sortKey="Pharoah, Mj" uniqKey="Pharoah M">MJ Pharoah</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bhandari, R" uniqKey="Bhandari R">R Bhandari</name></author><author><name sortKey="Sandhu, Sv" uniqKey="Sandhu S">SV Sandhu</name></author><author><name sortKey="Bansal, H" uniqKey="Bansal H">H Bansal</name></author><author><name sortKey="Behl, R" uniqKey="Behl R">R Behl</name></author><author><name sortKey="Bhullar, Rk" uniqKey="Bhullar R">RK Bhullar</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Rao, Ka" uniqKey="Rao K">KA Rao</name></author><author><name sortKey="Shetty, Sr" uniqKey="Shetty S">SR Shetty</name></author><author><name sortKey="Babu, Sg" uniqKey="Babu S">SG Babu</name></author><author><name sortKey="Castelino, Rl" uniqKey="Castelino R">RL Castelino</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="case-report"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">J Oral Maxillofac Res</journal-id><journal-id journal-id-type="iso-abbrev">J Oral Maxillofac Res</journal-id><journal-id journal-id-type="publisher-id">JORM</journal-id><journal-title-group><journal-title>Journal of Oral & Maxillofacial Research</journal-title></journal-title-group><issn pub-type="epub">2029-283X</issn><publisher><publisher-name>Stilus Optimus</publisher-name><publisher-loc>Kaunas, Lithuania</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">24478914</article-id><article-id pub-id-type="pmc">3904730</article-id><article-id pub-id-type="publisher-id">v4n4e4ht</article-id><article-id pub-id-type="doi">10.5037/jomr.2013.4404</article-id><article-categories><subj-group subj-group-type="heading"><subject>Case Report</subject></subj-group></article-categories><title-group><article-title>Findings of Florid Cemento-Osseous Dysplasia: a Report of Three Cases</article-title></title-group><contrib-group><contrib id="contrib1" contrib-type="author" corresp="yes"><name><surname>Köse</surname><given-names>Taha Emre</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib id="contrib2" contrib-type="author"><name><surname>Köse</surname><given-names>Onur Dincer</given-names></name><xref ref-type="aff" rid="aff2">2</xref></contrib><contrib id="contrib3" contrib-type="author"><name><surname>Karabas</surname><given-names>Hulya Cakir</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib id="contrib4" contrib-type="author"><name><surname>Erdem</surname><given-names>Tamer Lutfi</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib id="contrib5" contrib-type="author"><name><surname>Özcan</surname><given-names>İlknur</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib></contrib-group><aff id="aff1" rid="aff1"><sup>1</sup><institution>Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Istanbul University, Istanbul</institution><country>Turkey.</country></aff><aff id="aff2" rid="aff2"><sup>2</sup><institution>Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Istanbul University, Istanbul</institution><country>Turkey.</country></aff><author-notes><corresp>Taha Emre Köse,
<institution>Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Istanbul University</institution><addr-line>34093, Capa/Fatih, Istanbul</addr-line><country>Turkey</country><phone>+90 555 479 80 72</phone>Fax: +90 212 621 42 44<email>tahaemre@gmail.com</email></corresp></author-notes><pub-date pub-type="collection"><season>Oct-Dec</season><year>2013</year></pub-date><pub-date pub-type="epub"><day>1</day><month>1</month><year>2014</year></pub-date><volume>4</volume><issue>4</issue><elocation-id>e4</elocation-id><history><date date-type="received"><day>19</day><month>12</month><year>2013</year></date><date date-type="accepted"><day>29</day><month>12</month><year>2013</year></date></history><permissions><copyright-statement> Copyright © Köse TE, Köse OD, Karabas HC, Erdem TL, Özcan İ. Published in the JOURNAL OF ORAL & MAXILLOFACIAL
RESEARCH (http://www.ejomr.org), 1 January 2014.</copyright-statement><copyright-year>2013</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc-nd/3.0/"><license-p><pmc-comment>CREATIVE COMMONS</pmc-comment>This is an open-access article, first published in the JOURNAL OF
ORAL & MAXILLOFACIAL RESEARCH, distributed under the terms of the
Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 Unported
License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc-nd/3.0/">http://creativecommons.org/licenses/by-nc-nd/3.0/</ext-link>), which permits unrestricted non-commercial use, distribution, and
reproduction in any medium, provided the original work and is properly
cited. The copyright, license information and link to the original
publication on <ext-link ext-link-type="uri" xlink:href="http://www.ejomr.org">http://www.ejomr.org</ext-link> must be included.</license-p></license></permissions><self-uri xlink:type="simple" xlink:href="http://www.ejomr.org/JOMR/archives/2013/4/e4/v4n4e4ht.htm"></self-uri><abstract><title>ABSTRACT</title><sec sec-type="background"><title>Background</title><p>Florid cemento-osseous
dysplasia (FCOD) is a benign jaw lesion originating from periodontal
ligament tissues usually asymptomatic and diagnosed accidentally at
routine dental radiographic examination. The purpose of this paper is to
report three cases diagnosed as FCOD with their clinical, radiographic
and histological findings.</p></sec><sec sec-type="methods"><title>Methods</title><p>Radiologic and clinical
symptoms of three cases diagnosed as FCOD are presented. Serum alkaline
phosphatase test and biopsy taken from two of the patients are discussed
to eliminate the Paget's disease.</p></sec><sec sec-type="results"><title>Results</title><p>Three patients diagnosed as
FCOD and called for routine follow-up. Because of no sign of infection
or osteomyelitis, conservative treatment was applied.</p></sec><sec sec-type="conclusions"><title>Conclusions</title><p>Radiographic examination
is significant for the diagnosis of florid cemento-osseous dysplasia,
especially in the asymptomatic cases. The roles of the dentist are to
ensure the follow-up of the diagnosed patients and to take the necessary
measures for preventing from the infections.</p></sec></abstract><kwd-group><kwd>lorid cemento-osseous dysplasia</kwd><kwd>panoramic radiography</kwd><kwd>bone diseases.</kwd></kwd-group></article-meta></front><body><sec><title>INTRODUCTION</title><p>Florid cemento-osseous dysplasia (FCOD) is
one of the subgroups of cemento-osseous dysplasia (COD) which was first
described by Melrose [<xref rid="B1" ref-type="bibr">1</xref>],
Abrams and Mills in 1976 [<xref rid="B2" ref-type="bibr">2</xref>].
FCOD was also reported as multiple cemento-ossifying fibroma, sclerosing
osteomyelitis, sclerosing osteitis, multiple osteomas, periapical
cementoblastoma, Paget's disease of the mandible, multiple enostosis,
gigantiform cementoma, florid osseous dysplasia [<xref rid="B1" ref-type="bibr">1</xref>,<xref rid="B3" ref-type="bibr">3</xref>].</p><p>The exact etiology of FCOD is still unknown
[<xref rid="B2" ref-type="bibr">2</xref>]. Most authorities
suggest that pathogenesis of these lesions come from periodontal
ligament, because they are seen close to it and have similar
histopathology [<xref rid="B4" ref-type="bibr">4</xref>,<xref rid="B5" ref-type="bibr">5</xref>].
Therefore, few authors believe that remains of cementum in bone after
extraction might be a reason of FCOD [<xref rid="B6" ref-type="bibr">6</xref>,<xref rid="B7" ref-type="bibr">7</xref>].</p><p>FCOD affects mostly middle aged to older
black women. Male:female ratio reported as 1:2,6 [<xref rid="B4" ref-type="bibr">4</xref>,<xref rid="B5" ref-type="bibr">5</xref>].
FCOD is usually asymptomatic and diagnosed accidentally at routine
dental radiographic examination. Dull pain, drainage, exposure of the
lesion in oral cavity, focal expansion and facial deformities are
present when infection occurs [<xref rid="B3" ref-type="bibr">3</xref>,<xref rid="B8" ref-type="bibr">8</xref>].</p><p>Radiographic image of FCOD is lobular
radiopacities that grow with the maturation of lesion surrounded with
radiolucent area and located mostly in mandibular premolar-molar region
[<xref rid="B2" ref-type="bibr">2</xref>,<xref rid="B9" ref-type="bibr">9</xref>].
This image is named "cotton wool" appearance and is also seen in Paget's
disease of bone [<xref rid="B9" ref-type="bibr">9</xref>].</p><p>The purpose of this paper is to report three
cases diagnosed as cemento-osseous dysplasia with their clinical,
radiographic and histological findings.</p></sec><sec><title>CASE DESCRIPTION AND RESULTS</title><p><bold>Case 1</bold></p><p>25 year-old Caucasian woman was referred to
a dentist, because of periodontal complaints. Bilateral radiopaque
lesions were revealed by dental radiographic examination and
consequently, the patient, without any related clinical complaint, was
directed to Istanbul University, Faculty of Dentistry.</p><p>Panoramic radiograph showed ovoid radiopaque
masses in wide radiolucent spaces in the periapical areas of all the
molars in both quadrants of the mandible and in the maxillary right
quadrant.</p><p>The lesion, which located at the apex of #27
showed no internal calcification (<xref ref-type="fig" rid="fig1">Figure
1</xref>). There was no expansion of jaws. Electric pulp tests were
applied to the involved teeth: teeth were vital except right mandibular
first molar at which a big composite restoration and a poor root canal
therapy was observed. It was recommended to patient that retreat her #46
tooth's root canal therapy in order to prevent a possible infection. The
result of the requested serum alkaline phosphatase (ALP) test was 88
IU/L (N: 25-94 IU/L). We diagnosed present pathology as FCOD lesion and
decided to follow the patient without taking biopsy. For the patient,
who did not have any clinical complaints, radiographic control was
recommended twice a year.</p><fig id="fig1" orientation="portrait" position="float"><label>Figure 1</label><caption><p>Panoramic radiograph of the patient shows
radiopaque masses inside wide radiolucent areas at right
maxillary and right and left mandibular molar areas. A
radiolucent area is present around #27 tooth's roots.</p></caption><graphic xlink:href="jomr-04-e4-g001"></graphic></fig><p>Patient's follow-up radiograph, which was taken 6 months later, showed the same condition with the previous one (<xref ref-type="fig" rid="fig2">Figure 2</xref>).</p><fig id="fig2" orientation="portrait" position="float"><label>Figure 2</label><caption><p>Follow-up radiograph taken 6 months later, no
recognizable change is seen.</p></caption><graphic xlink:href="jomr-04-e4-g002"></graphic></fig><p><bold>Case 2</bold></p><p>71 year-old Caucasian female patient applied
to Istanbul University, Faculty of Dentistry, because of the pain in
posterior region of the left mandible when using her total dentures
during mastication. She was systemically healthy and had no extraoral
symptoms. Intraoral examination showed totally edentulous jaws and
normal mucosa. Panoramic radiograph was taken and radiopaque masses
were seen at four quadrants, no sign of infection or osteomyelitis (<xref ref-type="fig" rid="fig3">Figure
3</xref>). Initial diagnosis was FCOD, but there was no clinical
explanation for the pain. Therefore, dental volumetric tomography was
taken. In cross sectional images of the dental volumetric tomography a
bone spine was detected and we considered that this spine was the reason
of pain (<xref ref-type="fig" rid="fig4">Figure 4</xref>).
Alveoloplasty was performed on left posterior mandible and during the
surgical process, the biopsy was performed owing to lesion's close
adjacency to surgical area. The result of the histopathological
examination was FCOD. No other treatment was thought. The patient was
called for follow-up 6 months later.</p><fig id="fig3" orientation="portrait" position="float"><label>Figure 3</label><caption><p>Panoramic radiograph of the patient shows
radiopaque masses at four quadrants.</p></caption><graphic xlink:href="jomr-04-e4-g003"></graphic></fig><fig id="fig4" orientation="portrait" position="float"><label>Figure 4</label><caption><p>Cross-sectional image showing the FCOD lesion
and the spine on the top of the crest.</p></caption><graphic xlink:href="jomr-04-e4-g004"></graphic></fig><p><bold>Case 3</bold></p><p>41 year-old systemically healthy Caucasian
female patient was referred to Istanbul University, Faculty of
Dentistry, Department of Oral and Maxillofacial Radiology for dental
care. Panoramic radiograph obtained due to dental caries and prosthetic
indications. Radiopaque ovoid masses were seen at left and right
mandibular quadrants (<xref ref-type="fig" rid="fig5">Figure 5</xref>).
To eliminate the diagnosis of Paget's disease of bone, serum alkaline
phosphatase level examination test was performed. Decayed roots of right
second molar seen at radiography.</p><fig id="fig5" orientation="portrait" position="float"><label>Figure 5</label><caption><p>Panoramic radiograph of the patient shows
radiopaque masses at both mandibular quadrants.</p></caption><graphic xlink:href="jomr-04-e4-g005"></graphic></fig><p>Biopsy was performed at right left molar
region. In histopathological examination, trabecular and compact bone
tissue in collagen rich connective tissue stroma was seen. In some area
spheroidal hard tissue islands like cementum was detected. Based on the
result of the histopathological examination diagnosis the FCOD was
established (<xref ref-type="fig" rid="fig6">Figure 6</xref>).
#24 and #47 were extracted and patient was disposed for routine dental
treatments.</p><fig id="fig6" orientation="portrait" position="float"><label>Figure 6</label><caption><p>Trabecular and compact bone seen between loose
connective tissue (hematoxylin and eosin stain, original
magnification x40.</p></caption><graphic xlink:href="jomr-04-e4-g006"></graphic></fig><p>After 6 months patient was recalled for
clinical and radiographic examination. Panoramic radiograph revealed no
significant difference (<xref ref-type="fig" rid="fig7">Figure 7</xref>).</p><fig id="fig7" orientation="portrait" position="float"><label>Figure 7</label><caption><p>Follow-up radiograph taken 6 months later.</p></caption><graphic xlink:href="jomr-04-e4-g007"></graphic></fig></sec><sec sec-type="discussion"><title>DISCUSSION</title><p>FCOD classified by World Health Organization
in 2005 as bone related lesions and is a non-neoplastic fibro-osseous
lesion [<xref rid="B2" ref-type="bibr">2</xref>,<xref rid="B5" ref-type="bibr">5</xref>].
FCOD is one of the subgroups of cemento-osseous dysplasia (COD) [<xref rid="B1" ref-type="bibr">1</xref>,<xref rid="B2" ref-type="bibr">2</xref>].
The other COD lesions are focal cemento-osseous dysplasia and periapical
cemento-osseous dysplasia [<xref rid="B1" ref-type="bibr">1</xref>].
This classification based on clinical characteristic, location and
radiographic features [<xref rid="B2" ref-type="bibr">2</xref>,<xref rid="B4" ref-type="bibr">4</xref>].
These clinical features include lesions' localization and diffuseness.</p><p>Periapical cemental dysplasia usually
locates area of apices of anterior teeth and mostly doesn't grow more
than 1 cm, focal cemeto-osseous dysplasia usually appears at two or more
mandibular anterior teeth or at the apices of molar region, and rarely
grow more than 2 cm [<xref ref-type="fig" rid="fig5">5</xref>,<xref rid="B10" ref-type="bibr">10</xref>].
FCOD appears bilateral, often quite symmetrical location [<xref rid="B3" ref-type="bibr">3</xref>].
The density of the lesion has a wide range from radiolucent to almost
complete radiopacity [<xref rid="B9" ref-type="bibr">9</xref>].
The term "florid" refers to its excessive and widespread location [<xref rid="B5" ref-type="bibr">5</xref>,<xref rid="B11" ref-type="bibr">11</xref>].</p><p>All types of COD lesions have similar
histopathology. In dysplastic period normal bone is replaced with
fibrous connective tissue [<xref rid="B1" ref-type="bibr">1</xref>].
This fibrous connective tissue contains woven bone, lamellar bone and
cementum like particles [<xref rid="B4" ref-type="bibr">4</xref>].
As the lesions mature, calcification degree increases [<xref rid="B1" ref-type="bibr">1</xref>].</p><p>FCOD have three developmental stages and all
stages have different radiographic images. First or osteolytic stage is
seen as well-defined radiolucent area with loss of lamina dura and
periodontal ligament. In the second or cementoblastic stage, small
radioopacities appears in radiolucent area, because of deposition of
cementum-like droplets in fibrous tissue. Last stage is described as
definite radioopacity present in majority of the lesion [<xref rid="B10" ref-type="bibr">10</xref>].</p><p>Diagnosis is made by clinical and
radiographic examination. If the radiological and clinical findings are
enough to diagnose, biopsy should be avoided because of infection,
sequestrum formation and osteomyelitis risks [<xref rid="B2" ref-type="bibr">2</xref>].
Generally, infection risk relies on poor vascularization of the lesion [<xref rid="B1" ref-type="bibr">1</xref>].
This condition requires surgical treatment of the lesion. Because of the
poor healing, fracture or infection risks, extraction and excision of
the lesion are not recommended [<xref rid="B2" ref-type="bibr">2</xref>].
For asymptomatic patients the treatment is not necessary and best choice
is routine follow-ups and protection from infection [<xref rid="B2" ref-type="bibr">2</xref>,<xref rid="B4" ref-type="bibr">4</xref>].
Treatment options of the symptomatic patients are antibiotic therapy and
sequestrectomy [<xref rid="B4" ref-type="bibr">4</xref>].
Another possible complication is difficult to control infections due to
insufficient antibiotics concentration in the lesion area owing to
reduced blood flow [<xref rid="B1" ref-type="bibr">1</xref>].
In our cases, there were no infections. Therefore we recommended routine
follow-ups and to increase oral hygiene in order to prevent possible
infections. Biopsies were taken in case two and three, since the
operation areas were adjacent to the lesions.</p><p>Differential diagnosis of FCOD must be made
with Paget's disease of bone, chronic diffuse osteomyelitis, Gardner's
syndrome, familial gigantiform cementoma [<xref rid="B5" ref-type="bibr">5</xref>,<xref rid="B9" ref-type="bibr">9</xref>].
FCOD is not seen with skin tumours, dental anomalies and skeletal
changes like Gardner's Syndrome [<xref rid="B3" ref-type="bibr">3</xref>].
In Paget's disease of bone, no radiolucent capsule is present around the
radiopaque masses, also it is usually polyostatic and causes raised
alkaline phosphatase level [<xref rid="B3" ref-type="bibr">3</xref>,<xref rid="B9" ref-type="bibr">9</xref>].
Chronic diffuse osteomyelitis is not limited in tooth bearing areas and
cause unilateral pain and swellings [<xref rid="B3" ref-type="bibr">3</xref>].</p><p>Familial gigantiform cementoma has familial
basis and from this point it is differentiated from FCOD [<xref rid="B5" ref-type="bibr">5</xref>].
In our cases, serum alkaline phosphatese levels were in normal ranges
and there were no signs of infection. Our cases had neither dental
anomalies nor skin tumours and the patients had no familial history.</p></sec><sec sec-type="conclusions"><title>CONCLUSIONS</title><p>Radiographic examination is significant for
the diagnosis of florid cemento-osseous dysplasia, especially in the
asymptomatic cases. The roles of the dentist are to ensure the follow-up
of the diagnosed patients and to take the necessary measures for
preventing from the infections.</p></sec></body><back><ack><sec sec-type="acknowledgments and disclosure statements"><title>ACKNOWLEDGMENTS AND DISCLOSURE STATEMENTS</title><p>There are no relevant conflicts of interest to disclose.</p></sec></ack><ref-list><title>REFERENCES</title><ref id="B1"><label>1</label><element-citation publication-type="other"><person-group person-group-type="author"><name><surname>Gerlach</surname><given-names>RC</given-names></name><name><surname>Dixon</surname><given-names>DR</given-names></name><name><surname>Goksel</surname><given-names>T</given-names></name><name><surname>Castle</surname><given-names>JT</given-names></name><name><surname>Henry</surname><given-names>WA</given-names></name></person-group><source>Case presentation
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