Accidental Finding on the Radiograph: Periapical Cemento-osseous Dysplasia

Abstract

Periapical cemento-osseous dysplasia (PCOD) is an uncommon type of fibro-osseous lesion (FOL) that affects the anterior mandible in middle-aged women. The affected patients are usually asymptomatic but can present with vague pain or discomfort involving the affected area. Radiographic investigations are essential to establish a definitive diagnosis. PCOD arises from the periodontal ligament and affects the tooth-bearing, cancellous areas of the jaw bones. PCOD is associated with vital teeth and rarely manifests any significant clinical symptoms. Majority of these cases are accidentally diagnosed during radiographic examination which is ordered for other reasons. PCOD manifests radiographically as a radiolucent, radiopaque or a mixed lesion. In the early stages, a PCOD may mimic a periapical granuloma or a cyst. The characteristic radiographic appearance is the presence of calcifications within a radiolucent lesion that involves multiple vital teeth. These lesions progressively mature to form an increasing number of radiopaque areas with a lobular, ginger root-like appearance surrounded by a radiolucent rim. PCOD does not require any active treatment. It is recommended to keep the patients on long-term follow-up.