Skip to main content

Advertisement

SpringerLink
Log in

Florid cemento-osseous dysplasia: review of an uncommon fibro-osseous lesion of the jaw with important clinical implications

  • Review Article
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

Florid cemento-osseous dysplasia (FCOD) is a rare, benign, multifocal fibro-osseous dysplastic process affecting tooth-bearing areas of the jaw, characterized by replacement of normal trabecular bone with osseous tissue and dense acellular cementum in a fibrous stroma. It is one clinicopathologic variant in a spectrum of related non-neoplastic fibro-osseous lesions known as cemento-osseous dysplasias (CODs), thought to arise from elements of the periodontal ligament. Diagnosis primarily relies upon radiographic and clinical findings; unnecessary biopsy should be avoided, as inoculation with oral pathogens may precipitate chronic infection in these hypovascular lesions. Appropriate management of uncomplicated FCOD consists of periodic radiographic follow-up. Accordingly, it is important that both radiologists and clinicians performing endodontic interventions possess familiarity with this entity in order to prevent misdiagnosis and inappropriate intervention, which may result in a protracted clinical course. Lesions are usually asymptomatic in the absence of infection, typically discovered on routine dental radiographs or imaging performed for unrelated indications. Radiographically, the condition typically manifests as widespread non-expansile intraosseous masses of varying internal lucency and sclerosis that surround the root apices of vital teeth or edentulous areas in the posterior jaw. While all CODs share similar microscopic features, FCOD is distinguished by its multifocal distribution, involving two or more quadrants of the maxilla and mandible, often in a bilateral symmetric fashion. The vast majority of cases are sporadic, though few exhibit an autosomal dominant familial inheritance pattern. In this pictorial review, we discuss the radiologic characteristics of this entity, pertinent clinical and histologic features, differential diagnoses, and management options.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11

Similar content being viewed by others

References

  1. Coleman H, Altini M, Kieser J, Nissenbaum M. Familial florid cemento-osseous dysplasia—a case report and review of the literature. J Dent Assoc S Afr. 1996;51(12):766–70.

    CAS  PubMed  Google Scholar 

  2. Slootweg PJ. Maxillofacial fibro-osseous lesions: classification and differential diagnosis. Semin Diagn Pathol. 1996;13:104–12.

    CAS  PubMed  Google Scholar 

  3. Waldron CA. Fibro-osseous lesions of jaws. J Oral Maxillofac Surg. 1993;51:828–35.

    Article  CAS  PubMed  Google Scholar 

  4. Kramer IRH, Pindborg JJ, Shear M. Neoplasm and other lesions related to bone. In: WHO, editor. Histologic typing of odontogenic tumours. Berlin: Springer; 1992.

    Chapter  Google Scholar 

  5. Summerlin DJ, Tomich CE. Focal cemento-osseous dysplasia: a clinicopathologic study of 221 cases. Oral Surg Oral Med Oral Pathol. 1994;78:611–20.

    Article  CAS  PubMed  Google Scholar 

  6. Neville BW, Damm DD, Allen CM, Bouquot JE. Cemento-osseous dysplasia. 3rd ed. Saunders; 2009. p. 635–648.

  7. Miyauchi M, Ogawa I, Takata T, Ito H, Nikai H, Ijuhin N, et al. Florid cemento-osseous dysplasia with concomitant simple bone cysts: a case in a Japanese woman. J Oral Pathol Med. 1995;24(6):285–7.

    Article  CAS  PubMed  Google Scholar 

  8. Ong ST, Siar CH. Florid cemento-osseous dysplasia in a young Chinese man. Case report. Aust Dent J. 1997;42(6):404–8.

    Article  CAS  PubMed  Google Scholar 

  9. Ariji Y, Ariji E, Higuchi Y, Kubo S, Nakayama E, Kanda S. Florid cemento-osseous dysplasia. Radiographic study with special emphasis on computed tomography. Oral Surg Oral Med Oral Pathol. 1994;78(3):391–6.

    Article  CAS  PubMed  Google Scholar 

  10. Singer SR, Mupparapu M, Rinaggio J. Florid cemento-osseous dysplasia and chronic diffuse osteomyelitis. Report of a simultaneous presentation and review of the literature. J Am Dent Assoc. 2005;136:927–31.

    Article  PubMed  Google Scholar 

  11. Jerjes W, Banu B, Swinson B, Hopper C. Florid cemento-osseous dysplasia in a young Indian woman. A case report. Br Dent J. 2005;198:477–8.

    Article  CAS  PubMed  Google Scholar 

  12. MacDonald-Jankowski DS. Fibro-osseous lesions of the face and jaws. Clin Radiol. 2004;59(1):11–25.

    Article  CAS  PubMed  Google Scholar 

  13. Higuchi Y, Nakamura N, Tashiro H. Clinicopathologic study of cemento-osseous dysplasia producing cysts of the mandible. Report of four cases. Oral Surg Oral Med Oral Pathol. 1988;65:339–42.

    Article  CAS  PubMed  Google Scholar 

  14. Mahomed F, Altini M, Meer S, Coleman H. Cemento-osseous dysplasia with associated simple bone cysts. J Oral Maxillofac Surg. 2005;63:1549–54.

    Article  PubMed  Google Scholar 

  15. Gonçalves M, Píspico R, Alves Fde A, Lugão CE, Gonçalves A. Clinical, radiographic, biochemical and histological findings of florid cemento-osseous dysplasia and report of a case. Braz Dent J. 2005;16:247–50.

    Article  PubMed  Google Scholar 

  16. Young SK, Markowitz NR, Sullivan S, Seale TW, Hirschi R. Familial gigantiform cementoma: classification and presentation of a large pedigree. Oral Surg Oral Med Oral Pathol. 1989;68:740–7.

    Article  CAS  PubMed  Google Scholar 

  17. Melrose RJ, Abrams AM, Mills BG. Florid osseous dysplasia. A clinical-pathologic study of thirty-four cases. Oral Surg Oral Med Oral Pathol. 1976;41:62–82.

    Article  CAS  PubMed  Google Scholar 

  18. Waldron CA. Bone pathology. In: Neville BW, Damm DD, Allen CM, Bouquot JE, editors. Oral & maxillofacial pathology. 2nd ed. Philadelphia: Saunders; 2002. p. 533–87.

    Google Scholar 

  19. Barnes L, Eveson JW, Reichart P, Sidransky D. World Health Organization classification of tumours: pathology and genetics of head and neck tumours. Lyon: IARC press; 2005.

    Google Scholar 

  20. Beylouni I, Farge P, Mazoyer JF, Coudert JL. Florid cementoosseous dysplasia: report of a case documented with computed tomography and 3D imaging. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998;85:707–11.

    Article  CAS  PubMed  Google Scholar 

  21. Eversole R, Su L, ElMofty S. Benign fibro-osseous lesions of the craniofacial complex. A review. Head Neck Pathol. 2008;2(3):177–202.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Damm DD, Fantasia JE. Multifocal mixed radiolucencies. Florid cemento-osseous dysplasia. Gen Dent. 2001;49:461–538.

    Google Scholar 

  23. Resnick CM, Novelline RA. Cemento-osseous dysplasia, a radiological mimic of periapical dental abscess. Emerg Radiol. 2008;15(6):367–74.

    Article  PubMed  Google Scholar 

  24. Alawi F. Benign fibro-osseous diseases of the maxillofacial bones. A review and differential diagnosis. Am J Clin Pathol. 2002;118(Suppl):S50–70.

    PubMed  Google Scholar 

  25. MacDonald-Jankowski DS. Florid cemento-osseous dysplasia: a systematic review. Dentomaxillofac Radiol. 2003;32:141–9.

    Article  CAS  PubMed  Google Scholar 

  26. White SC, Pharoah MJ. Disease of bone manifested in the jaws. In: White SC, Pharoah MJ, editors. Oral radiology. 4th ed. St. Louis: Mosby; 2000. p. 444–71.

    Google Scholar 

  27. Kim JH, Song BC, Kim SH, Park YS. Clinical, radiographic and histological findings of florid cemento-osseous dysplasia: a case report. Imaging Sci Dent. 2011;41:139–42.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Potochny EM, Huber AR. Focal osseous dysplasia. Head Neck Pathol. 2011;5(3):265–7.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Scholl JR, Kellet HM, et al. Cysts and cystic lesions of the mandible: clinical and radiologic-histopathologic review. Radiographics. 1999;19(5):1107–24.

    Article  CAS  PubMed  Google Scholar 

  30. Su L, Weathers DR, Waldron CA. Distinguishing features of focal cemento-osseous dysplasia and cemento-ossifying fibromas. II. A clinical and radiologic spectrum of 316 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997;84:540–9.

    Article  CAS  PubMed  Google Scholar 

  31. Miyake M, Nagahata S. Florid cemento-osseous dysplasia report of a case. Int J Oral Maxillofac Surg. 1999;28(1):56–7.

    Article  CAS  PubMed  Google Scholar 

  32. Neville BW, Albenesius RJ. The prevalence of benign fibro-osseous lesions of periodontal ligament origin in black women: a radiographic survey. Oral Surg Oral Med Oral Pathol. 1986;62:340–4.

    Article  CAS  PubMed  Google Scholar 

  33. Toffanin A, Benetti R, Manconi R. Familial florid cementoosseous dysplasia: a case report. J Oral Maxillofac Surg. 2000;58:1440–6.

    Article  CAS  PubMed  Google Scholar 

  34. Ogunsalu C, Miles D. Cemento-osseous dysplasia in Jamaica: review of six cases. West Indian Med J. 2005;54(4):264–7.

    CAS  PubMed  Google Scholar 

  35. Philipsen HP, Reichart PA, Slootweg PJ, Slater LJ. Odontogenic tumours. In: Barnes L, Eveson JW, Reichart P, Sidransky D, editors. Pathology and genetics: head and neck tumours. Lyon: IARC Press; 2005. p. 323.

    Google Scholar 

  36. Abdelsayed RA, Eversole LR, Singh BS, Scarbrough FE. Gigantiform cementoma: clinicopathologic presentation of 3 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001;91(4):438–44.

    Article  CAS  PubMed  Google Scholar 

  37. Sedano HO, Kuba R, Gorlin RJ. Autosomal dominant cemental dysplasia. Oral Surg Oral Med Oral Pathol. 1982;54(6):642–6.

    Article  CAS  PubMed  Google Scholar 

  38. Cannon JS, Keller EE, Dahlin DC. Gigantiform cementoma: report of two cases (mother and son). J Oral Surg. 1980;38:65–70.

    CAS  PubMed  Google Scholar 

  39. Oikarinen K, Altonen M, Happonen RP. Gigantiform cementoma affecting a Caucasian family. Br J Oral Maxillofac Surg. 1991;29:194–7.

    Article  CAS  PubMed  Google Scholar 

  40. Thorawat A, Kalkur C, Naikmasur VG, Tarakji B. Familial florid Cemento-osseous dysplasia—case report and review of literature. Clin Case Rep. 2015;3(12):1034–7.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Srivastava A, Agarwal R, Soni R, Sachan A, Shivakumar GC, Chaturvedi TP. Familial florid cemento-osseous dysplasia: a rare manifestation in an Indian family. Case Rep Dent. 2012;2012:574125.

    PubMed  PubMed Central  Google Scholar 

  42. Lopes MA, Kim HS, Mariano FV, Correa MB, Rabelo NT, Vargas PA. Clinico-pathologic conference: case 1. High-grade osteosarcoma (OS) and florid cemento-osseous dysplasia (FCOD). Head Neck Pathol. 2010;4:329–33.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Schneider L, Dolinsky H, Grodjesk J, Mesa M, Doyle J. Malignant spindle cell tumor arising in the mandible of a patient with florid osseous dysolasia. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999;88:69–73.

    Article  CAS  PubMed  Google Scholar 

  44. Lee L. Inflammatory lesions of the jaws. In: White SC, Pharoah MJ, editors. Oral radiology. 4th ed. St. Louis: Mosby; 2000. p. 338–54.

    Google Scholar 

  45. Suei Y, Tanimoto K, Miyauchi M, Ishikawa T. Partial resection of the mandible for the treatment of diffuse sclerosing osteomyelitis: report of four cases. J Oral Maxillofac Surg. 1997;55:410–4.

    Article  CAS  PubMed  Google Scholar 

  46. Payne M, Anderson JA, Cook J. Gardner’s syndrome—a case report. Br Dent J. 2002;193(7):383–4.

    Article  CAS  PubMed  Google Scholar 

  47. Lew D, DeWitt A, Hicks RJ, Cavalcanti MG. Osteomas of the condyle associated with Gardner’s syndrome causing limited mandibular movement. J Oral Maxillofac Surg. 1999;57(8):1004–9.

    Article  CAS  PubMed  Google Scholar 

  48. Costa AG, Costa RO, Oliveira LR, Grossmann SM. Multiple oral radiopaque masses leading to Gardner’s syndrome diagnosis. Gen Dent. 2013;614:e12–4.

    Google Scholar 

  49. Kubo K, Miyatani H, Takenoshita Y, Abe K, Oka M, Iida M, et al. Widespread radiopacity of jaw bones in familial adenomatosis coli. J Craniomaxillofac Surg. 1989;17(8):350–3.

    Article  CAS  PubMed  Google Scholar 

  50. Wolf J, Heitamen J, Sane J. Florid cemento-osseous dysplasia (gigantiform cementoma) in a Caucasian woman. Br J Oral Maxillofac Surg. 1989;27:46–52.

    Article  CAS  PubMed  Google Scholar 

  51. Loh FC, Yeo JF. Florid cemento-osseous dysplasia in Orientals. Oral Surg Oral Med Oral Pathol. 1989;68:748–53.

    Article  CAS  PubMed  Google Scholar 

  52. Jacobsson S. Diffuse sclerosing ostemyelitis of the mandible. Acta Otolaryngol Suppl. 1979;360:61–3.

    CAS  PubMed  Google Scholar 

  53. Johannsen A. Chronic sclerosing osteomyelitis of the mandible. Radiographic differential diagnosis from fibrous dysplasia. Acta Radiol Diagn. 1977;18:360–8.

    Article  CAS  Google Scholar 

  54. Schneider LC, Mesa ML. Differences between florid osseous dysplasia and chronic diffuse sclerosing osteomyelitis. Oral Surg Oral Med Oral Pathol. 1990;70:308–12.

    Article  CAS  PubMed  Google Scholar 

  55. Rabe WC, Angelillo JC, Leipert DW. Chronic sclerosing osteomyelitis: treatment considerations in an atypical case. Oral Surg Oral Med Oral Pathol. 1980;49:117–21.

    Article  CAS  PubMed  Google Scholar 

  56. Groot RH, van Merkesteyn JP, Bras J. Diffuse sclerosing osteomyelitis and florid osseous dysplasia. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996;81:333–42.

    Article  CAS  PubMed  Google Scholar 

  57. Orpe EC, Lee L, Pharoah MJ. A radiological analysis of chronic sclerosing osteomyelitis of the mandible. Dentomaxillofac Radiol. 1996;25:125–9.

    Article  CAS  PubMed  Google Scholar 

  58. Eversole LR, Leider AS, Corwin JO, Karian BK. Proliferative periostitis of Garre: its differentiation from other neoperiostoses. J Oral Surg. 1979;37:725–31.

    CAS  PubMed  Google Scholar 

  59. Kawai T, Murakami S, Sakuda M, Fuchihata H. Radiographic investigation of mandibular periostitis ossificans in 55 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996;82:704–12.

    Article  CAS  PubMed  Google Scholar 

  60. Kawai T, Hiranuma H, Kishino M, Murakami S, Sakuda M, Fuchihata H. Gross periostitis ossificans in mandibular osteomyelitis. Review of the English literature and radiographic variation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998;86:376–81.

    Article  CAS  PubMed  Google Scholar 

  61. Nortje CJ, Wood RE, Grotepass F. Periostitis ossificans versus Garre’s osteomyelitis. Part II: radiologic analysis of 93 cases in the jaws. Oral Surg Oral Med Oral Pathol. 1988;66:249–60.

    Article  CAS  PubMed  Google Scholar 

  62. Larheim TA, Aspestrand F, Trebo S. Periostitis ossificans of the mandible. The value of computed tomography. Dentomaxillofac Radiol. 1993;22:93–6.

    Article  CAS  PubMed  Google Scholar 

  63. Jacobson HL, Baumgartner JC, Marshall JG, Beeler WJ. Proliferative periostitis of Garre: report of a case. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002;94:111–4.

    Article  PubMed  Google Scholar 

  64. Belli E, Matteini C, Andreano T. Sclerosing osteomyelitis of Garre periostitis ossificans. J Craniofac Surg. 2002;13:765–8.

    Article  PubMed  Google Scholar 

  65. Jacobsson S, Hollender L, Lindberg S, Larsson A. Chronic sclerosing osteomyelitis of the mandible. Scintigraphic and radiographic findings. Oral Surg Oral Med Oral Pathol. 1978;45:167–74.

    Article  CAS  PubMed  Google Scholar 

  66. El-Mofty S. Chronic diffuse sclerosing osteomyelitis. Oral Surg Oral Med Oral Pathol. 1973;36:898–904.

    Article  CAS  PubMed  Google Scholar 

  67. Keen EG, Sammartino CA, Johnson ES. Chronic sclerosing osteomyelifis of the mandible. J Am Dent Assoc. 1968;76:597–9.

    Article  CAS  PubMed  Google Scholar 

  68. Shafer WG. Chronic sclerosing osteomyelitis. J Oral Surg. 1957;15:138–42.

    CAS  PubMed  Google Scholar 

  69. Towns TL. Chronic diffuse sclerosing osteomyelitis of the maxilla and the mandible. J Oral Surg. 1972;30:903–5.

    CAS  PubMed  Google Scholar 

  70. MacDonald-Jankowski D. Fibrous dysplasia: a systematic review. Dentomaxillofac Radiol. 2009;38(4):196–215.

    Article  CAS  PubMed  Google Scholar 

  71. Petrikowski CG et al. Radiographic differentiation of osteogenic sarcoma, osteomyelitis, and fibrous dysplasia of the jaws. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1995;80(6):744–50.

    Article  CAS  PubMed  Google Scholar 

  72. Eversole LR, Sabes WR, Rovin S. Fibrous dysplasia: a nosologic problem in the diagnosis of fibro-osseous lesions of the jaws. J Oral Pathol. 1972;1:189–220.

    Article  CAS  PubMed  Google Scholar 

  73. Hirshberg A, Shnaiderman-Shapiro A, Kaplan I, Berger R. Metastatic tumours to the oral cavity—pathogenesis and analysis of 673 cases. Oral Oncol. 2008;44(8):743–52.

    Article  PubMed  Google Scholar 

  74. Nawale KK, Vyas M, Kane S, Patil A. Metastatic tumors in the jaw bones: a retrospective clinicopathological study of 12 cases at tertiary cancer center. J Oral Maxillofac Pathol. 2016;20(2):252–5.

    Article  PubMed  PubMed Central  Google Scholar 

  75. D’Silva NJ, Summerlin DJ, Cordell KG, Abdelsayed RA, Tomich CE, Hanks CT, et al. Metastatic tumors in the jaws: a retrospective study of 114 cases. J Am Dent Assoc. 2006;137(12):1667–72.

    Article  PubMed  Google Scholar 

  76. van der Waal RI, Buter J, van der Waal I. Oral metastases: report of 24 cases. Br J Oral Maxillofac Surg. 2003;41:3–6.

    Article  PubMed  Google Scholar 

  77. Nishimura Y, Yakata H, Kawasaki TT, Nakajima T. Metastatic tumors of the mouth and jaws. A review of the Japanese literature. J Oral Maxillofac Surg. 1982;10:253–8.

    CAS  Google Scholar 

  78. Zachariades N. Neoplasms metastatic to the mouth, jaws and surrounding tissues. J Cranio-Maxillofac Surg. 1989;17:283–90.

    Article  CAS  Google Scholar 

  79. Hirshberg A, Leibovich P, Buchner A. Metastatic tumors to the jawbones: analysis of 390 cases. J Oral Pathol Med. 1994;23(8):337–41.

    Article  CAS  PubMed  Google Scholar 

  80. Hirshberg A, Buchner A. Metastatic tumours to the oral region. An overview. Eur J Cancer B Oral Oncol. 1995;31B(6):355–60.

    Article  CAS  PubMed  Google Scholar 

  81. Kumar G, Manjunatha B. Metastatic tumors to the jaws and oral cavity. J Oral Maxillofac Pathol. 2013;17(1):71–5.

    Article  PubMed  PubMed Central  Google Scholar 

  82. Meyer I, Shklar G. Malignant tumors metastatic to the mouth and jaws. Oral Surg Oral Med Oral Pathol. 1965;20:350–62.

    Article  CAS  PubMed  Google Scholar 

  83. Muttagi SS, Chaturvedi P, D’Cruz A, Kane S, Chaukar D, Pai P, et al. Metastatic tumors to the jaw bones: retrospective analysis from an Indian tertiary referral center. Indian J Cancer. 2011;48(2):234–9.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Temple University Hospital, 3401 N. Broad St., Philadelphia, PA, 19140, USA

    Sarah Fenerty, Wei Shaw, Rahul Verma, Ali B. Syed, Riya Kuklani, Jie Yang & Sayed Ali

Authors
  1. Sarah Fenerty
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wei Shaw
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rahul Verma
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ali B. Syed
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Riya Kuklani
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jie Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Sayed Ali
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sarah Fenerty.

Ethics declarations

Disclosure

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fenerty, S., Shaw, W., Verma, R. et al. Florid cemento-osseous dysplasia: review of an uncommon fibro-osseous lesion of the jaw with important clinical implications. Skeletal Radiol 46, 581–590 (2017). https://doi.org/10.1007/s00256-017-2590-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-017-2590-0

Keywords

Search

Navigation