Displasia Cemento Ósea Florida: Reporte de un caso

La Displasia Cemento Ósea Florida corresponde a un tipo de lesión fibro ósea caracterizada por presentar un hueso trabecular con apariencia de tejido conectivo fibroso con áreas similares al cemento radicular. Afecta principalmente a mandíbula, a mujeres y a personas de etnia africana entre la cuarta a la quinta década. Posee crecimiento limitado, presentación de forma simétrica, bilateral y capacidad de afectar de uno a más cuadrantes. Tiene tres etapas de desarrollo, que se presentan con aspecto radiográfico diferente. En la primera etapa se aprecia un área radiolúcida, en la segunda etapa se visualizan radiopacidades circunscritas al área radiolúcida; y en la tercera etapa se observa una clara radiopacidad alrededor de la lesión. Para su correcto diagnóstico se necesita una cuidadosa correlación de los hallazgos clínicos, imagenológicos, de laboratorio e histopatológicos. Se presenta el caso de una paciente de género femenino de 70 años diagnosticada con Displasia Cemento Ósea Florida.

Florid Cemento-Osseous Dysplasia is a type of fibro-osseous lesion characterized by a trabecular bone with the appearance of fibrous connective tissue with areas similar to root cement. It mainly affects the jaw, women and people of African ethnicity between the fourth and fifth decades. It has limited growth, a symmetrical, bilateral presentation and the ability to affect one or more quadrants. It has three stages of development, with different radiographic appearance. The first stage shows a radiolucent area, the second stage shows radiopacities circumscribed to the radiolucent area; and in the third stage a clear radiopacity is observed around the lesion. For its correct diagnosis, a careful correlation of clinical, imaging, laboratory and histopathological findings is needed. The case of a 70-year-old female patient diagnosed with Florid Cemento-Osseous Dysplasia is presented.

Florid Osseous Dysplasia in Edentulous Maxilla and Mandible: A Rare Case Report

Introduction: Florid osseous dysplasia (FOD) has been described as a reactive fibro-osseous lesion affecting the jaw bones especially the tooth bearing areas. Usually, this lesion is asymptomatic unless accidentally detected during radiographic examination for any other purpose. Although the etiology is unclear, several theories suggests that its origin was related to reactive or dysplastic changes within the periodontal ligament. Case Presentation: Presenting a case of Florid Osseous Dysplasia within the edentulous maxilla and mandible of 65-year-old female patient. Patient reported with a diffuse swelling in the edentulous maxillary and mandibular posterior regions intraorally. Radiographically, multiple radiopaque lesions were noted bilaterally in the posterior mandible and also in the right posterior side of the maxilla. On microscopic examination, the lesion was composed of spicules of bony trabeculae with osteocytes in lacunae and intervening fibro-fatty connective tissue with plump fibroblasts. Management and prognosis: After the incisional biopsy, surgical recontouring was done along with further regular follow up and observation. Conclusion: Diagnosis of the jaw lesions is based on clinical findings, radiographic features, and histological picture, whereas FOD can be diagnosed based on its clinical and radiographical features. Even though the surgical approach may lead to many complications like osteomyelitis, infection, fracture etc., a biopsy may be done to confirm the diagnosis.

A contraindication to orthodontic and endodontic treatment: periapical cemento-osseous dysplasia

ABSTRACT Introduction: The dental pulp is completely normal in teeth with periapical cemento-osseous dysplasia. However, orthodontic and endodontic treatments are contraindicated in cases with this injury. Objective: Present some biological, clinical and imaging reasons opposing these contraindications and questioning which are the real ones impediments and the reasons for the lack of research on the disease, analyzing cases submitted to orthopedic treatment under controlled and ethically approved conditions. Conclusion: The clinician can act safely based in available knowledge and aware of the possible consequences of orthodontic movement in teeth with periapical cemento-osseous dysplasia, as well as in the proper way of making a safe and definitive diagnosis.

RESUMO Introdução: A polpa dentária é completamente normal nos dentes com displasia cemento-óssea periapical. Porém, os tratamentos ortodônticos e endodônticos estão contraindicados nos casos com essa lesão. Objetivo: Apresentar algumas razões biológicas, clínicas e imagiológicas, contrapondo-se essas contraindicações e questionando quais seriam os reais impedimentos e os motivos da falta de pesquisa sobre a doença, analisando casuísticas submetidas ao tratamento ortodôntico sob condições controladas e eticamente aprovadas. Conclusão: O clínico pode agir de forma segura embasado no conhecimento disponível e consciente das possíveis consequências da movimentação ortodôntica nos dentes com displasia cemento-óssea periapical, bem como na forma adequada de se fazer o diagnóstico seguro e definitivo da doença.

DISPLASIA ÓSSEA FLORIDA EXPANSIVA: RELATOS DE DOIS CASOS INCOMUNS / EXPANSIVE FLORID OSSEOUS DYSPLASIA: REPORTS OF TWO UNUSUAL CASES

A displasia óssea geralmente é um achado radiográfico, por não apresentar, em sua maioria, alterações clínicas. Contudo, um novo subtipo de displasia, que afeta preferencialmente mulheres negras de meia-idade e promove expansão do osso cortical envolvido, tem sido relatada como Displasia Óssea Expansiva. O objetivo deste artigo é relatar dois casos de Displasia Óssea Florida com expressivo aspecto expansivo e perfuração das corticais ósseas envolvidas. O primeiro relata uma paciente negra, 46 anos, que compareceu à Odontoclínica Central da Marinha necessitando de restauração indireta em um dente. O exame clínico demonstrou um aumento de volume duro na face lingual do rebordo alveolar dos incisivos inferiores. Na radiografia panorâmica, foram observadas duas imagens de densidades mistas com predomínio de áreas radiopacas nas regiões apicais dos dentes anteroinferiores e do primeiro molar inferior esquerdo. A tomografia computadorizada mostrou expansão, adelgaçamento da cortical vestibular e perfuração da cortical lingual na região dos incisivos. O segundo caso apresenta uma paciente de meia idade, feoderma, que buscou atendimento para acompanhamento de lesão mista na mandíbula, nas regiões apicais dos dentes anteriores, pré-molares e na região correspondente ao terceiro molar direito. Na tomografia computadorizada por feixe cônico observaram-se expansão e adelgaçamento da cortical vestibular nos dentes anteroinferiores. Com base na literatura atual e nas características de ambas as lesões, a hipótese diagnóstica para ambos os casos foi de Displasia Óssea Florida com aspecto expansivo. As pacientes foram orientadas sobre a importância da higiene bucal adequada e da necessidade de um acompanhamento clínico imagiológico anual destas lesões.

Osseous dysplasia generally is a radiographic finding because, for the most part, it does not cause clinical changes. However, a new subtype of dysplasia that affects primarily middle-aged black women and promotes expansion of the involved cortical bone has been reported as Expansive Osseous Dysplasia. The aim of this article is to report two cases of Florida Osseous Dysplasia with expressive expansion and perforation of the osseous cortex involved. The first case reports a 46-year-old black female patient whom was attended at the Naval Dental Center requiring indirect restoration in one tooth. Clinical examination showed a hard and increased volume at lingual portion of alveolar ridge in the region of the lower incisors. In the panoramic radiography two mixed density images were observed with predominance of radiopaque areas in the apical region of the anterior inferior teeth and in the first lower left molar. The computed tomography showed the buccal cortex thinning and the expansion and perforation of the lingual cortex in the incisor region. The second case presents a middle-aged brown skin patient who sought dental care to monitor a mixed lesion in the apical region of the anterior inferior teeth, lower premolars on both sides and in the third right lower third molar. In cone beam computed tomography, expansion and thinning of the vestibular cortex in the anterior inferior teeth were observed. Based on the current literature and the characteristics of both lesions, the diagnostic hypothesis was Florida Osseous Dysplasia with expansive aspect. The patients were advised on the importance of oral hygiene and the need for an annual follow-up of these lesions

Análise de imagem de lesões fibro-ósseas / Fibro-osseous lesions image analysis

As lesões fibro-ósseas (LFOs) caracterizam-se pela substituição do osso normal por tecido conjuntivo fibroso e material mineralizado. Displasia fibrosa, fibroma ossificante e displasia cemento-óssea (DCO) compõem este grupo, que além da semelhança histopatológica, pode sobrepor características radiográficas. A correlação de dados clínicos, radiográficos e histopatológicos é necessária para o diagnóstico definitivo. Este trabalho teve como objetivo descrever e avaliar exames odontológicos de imagem de indivíduos diagnosticados com LFOs. Foram desenvolvidos três estudos com metodologias independentes. O primeiro estudo avaliou os efeitos da displasia cemento-óssea em estruturas anatômicas adjacentes por meio de tomografia computadorizada de feixe cônico (TCFC). Foram avaliados 60 casos de DCO, com 244 áreas de lesão envolvendo 426 dentes. A maioria das lesões apresentou aproximadamente 10 mm de diâmetro. Afilamento (n=80) expansão (n=62) e perfuração (n=60) foram os efeitos comuns na cortical óssea. A lâmina dura e o espaço do ligamento periodontal foram descontínuos em todos os dentes. No segundo estudo, 50 radiografias panorâmicas de mulheres com diagnóstico de DCO foram pareadas por idade com 50 radiografias panorâmicas de mulheres sem DCO. Os grupos DCO e não-DCO foram comparados através do índice de espessura da cortical mandibular (ECM), a dimensão fractal (DF) da região de osso trabecular e cortical e o índice cortical mandibular (ICM). O índice de ECM do grupo DCO foi de 3,12 mm (2,15-4,55) e do grupo não-DCO foi 3,52 mm (1,90- 4,70) com diferença estatística entre os grupos (p=0,034). A DF do trabeculado ósseo alveolar normal foi semelhante nos dois grupos, enquanto que menores médias de DF no osso cortical foram encontradas no grupo DCO (p=0,046). A classificação C3 do ICM foi mais comum no grupo DCO (p=0,009). O terceiro foi um estudo preliminar que avaliou a DF em imagens bidimensionais e tridimensionais de TCFC de seis casos de displasia fibrosa e seis de fibroma ossificante. Cortes de reconstrução panorâmica, axial, coronal e sagital foram selecionados em quatro espessuras: 0,25; 5; 15 e 25 mm, e avaliados em 3 formatos de regiões de interesse (RI). Duas metodologias compararam quatro formatos de volumes do interior das lesões. A média de DF das imagens bidimensionais de reconstrução panorâmica e axiais, com 0,25 mm de espessura mostrou diferença significativa entre displasia fibrosa e fibroma ossificante (p<0.05), independente do formato da RI (p>0,05). A média da DF de imagens tridimensionais foi diferente entre os grupos de lesões para a maioria das comparações (p<0.05), independente da metodologia usada. Informações detalhadas sobre a lesão e o envolvimento de estruturas adjacentes podem ser visualizadas em TCFC. Métodos não invasivos como os índices radiomorfométricos e análise fractal podem ser úteis na detecção de baixa densidade mineral óssea, ou mesmo como possível ferramenta de estudo da complexidade de imagens de LFOs.

Fibro-osseous lesions (FOLs) are characterized by the replacement of normal bone with fibrous connective tissue and mineralized material. The group includes the fibrous dysplasia, ossifying fibroma and cemento-osseous dysplasia (COD). These three lesions show similar histopathological and radiographic features. Clinical, radiographic and histopathological data correlation is necessary for the definitive diagnosis. This study aimed to describe and to evaluate dental imaging exams of individuals diagnosed with FOLs. Three studies with independent methodologies were developed. The first study evaluated the effects of COD on the adjacent anatomical structures by means of cone beam computed tomography (CBCT). Sixty cases of COD were evaluated. The assessment of the 60 cases involved 244 lesion areas and 426 teeth. Most lesions presented nearly 10 millimeters (mm) of diameter. Thinning (n=80), expansion (n=62) and perforation (n=60) were common effects on the cortical bone. All 426 teeth presented discontinuation of the lamina dura and of the periodontal ligament space. In the second study, 50 panoramic radiographies of women diagnosed with COD were matched with 50 panoramic radiographies of women without COD according to the individuals' age. Comparisons between groups regarding the mandibular cortical width index (MCW), the fractal dimension (FD) of the region of the trabecular and the cortical bone and the mandibular cortical index (MCI) were carried out. The MCW of the COD group was 3.12 mm (2.15-4.55) and the MCW of the non-COD group was 3.52 mm (1.90-4.70). A significant difference between groups was observed (p=0.034). FD of the normal trabecular alveolar bone was similar in both groups. For the cortical bone, a lower mean FD was observed in the COD group (p=0.046). The MCI C3 was more common in the COD group (p=0.009). The third was a preliminary study, in which the FD was evaluated on twodimensional and three-dimensional CBCT images of six cases of fibrous dysplasia and six cases of ossifying fibroma. Panoramic reconstruction, axial, coronal and sagittal slices were selected in four thicknesses (0.25, 5, 15 and 25 mm) and evaluated in three shapes of regions of interest (ROI). Two methodologies compared four volume formats from inside the lesions. A significant difference between fibrous dysplasia and ossifying fibroma was observed for the mean FD of the twodimensional images of panoramic reconstruction and axial slices with a thickness of 0.25 mm (p<0.05), regardless of the ROI shape (p>0.05). The mean DF of threedimensional images was different between lesion groups for most comparisons (p <0.05), regardless of the methodology used. Detailed information on lesions and involvement of adjacent structures can be viewed in CBCT. Non-invasive methods, such as radiomorphometric indices and fractal analysis may be useful in the detection of low bone mineral density or as a helpful tool for the differentiation of distinct types of FOLs.

Florid cemento-osseous dysplasia: a contraindication to orthodontic treatment in compromised areas

ABSTRACT Florid cemento-osseous dysplasia is a sclerosing disease that affects the mandible, especially the alveolar process, and that is, in most cases, bilateral; however, in some cases it affects up to three or even four quadrants. During the disease, normal bone is replaced with a thinly formed, irregularly distributed tissue peppered with radiolucent areas of soft tissue. Newly formed bone does not seem to invade periodontal space, but, in several images, it is confused with the roots, without, however, compromising pulp vitality or tooth position in the dental arch. There is no replacement resorption, not even when the images suggest dentoalveolar ankylosis. Orthodontists should make an accurate diagnosis when planning treatments, as this disease, when fully established, is one of the extremely rare situations in which orthodontic treatment is contraindicated. This contraindication is due to: (a) procedures such as the installment of mini-implants and mini-plaques, surgical maneuvers to apply traction to unerupted teeth and extractions should be avoided to prevent contamination of the affected bone with bacteria from the oral microbiota; and (b) tooth movement in the areas affected is practically impossible because of bone disorganization in the alveolar process, characterized by high bone density and the resulting cotton-wool appearance. Densely mineralized and disorganized bone is unable to remodel or develop in an organized way in the periodontal ligaments and the alveolar process. Organized bone remodeling is a fundamental phenomenon for tooth movement.

RESUMO A displasia cemento-óssea florida é uma doença óssea esclerosante exclusiva dos maxilares, relacionada ao osso do processo alveolar e, na maioria dos casos, envolvendo bilateralmente a mandíbula; mas há casos em que envolve três ou até os quatro quadrantes. Nesse processo, troca-se o osso normal por um tecido densamente formado, irregularmente distribuído e salpicado por áreas radiolúcidas com tecido mole. O osso neoformado parece não invadir o espaço periodontal, mas, em muitas imagens, confunde-se com as raízes, sem comprometer a vitalidade pulpar e a posição dentária na arcada. Não há reabsorção dentária por substituição, mesmo quando as imagens sugerem anquilose alveolodentária. Um diagnóstico preciso por parte do ortodontista deve ser feito em seus planejamentos, visto que essa doença, quando se encontra plenamente instalada, representa uma das raríssimas situações em que o tratamento ortodôntico está contraindicado. Nesses casos, o tratamento ortodôntico está contraindicado porque: a) alguns procedimentos, como a aplicação de mini-implantes e miniplacas, manobras cirúrgicas para tracionamento de dentes não irrompidos e exodontias, devem ser evitados, para se impedir a entrada de bactérias da microbiota bucal no osso comprometido; e b) a possibilidade de movimentação dos dentes nas áreas comprometidas praticamente inexiste, pela desorganização óssea no processo alveolar, caracterizada por elevada densidade óssea, que gera as imagens tipo flocos de algodão. O osso densamente mineralizado e desorganizado não é capaz de se remodelar e desenvolver organizadamente, nos ligamentos periodontais e no osso do processo alveolar. A remodelação óssea organizada é fundamental como um dos fenômenos necessários para o deslocamento dos dentes.

Cemento-Osseous Dysplasias: Imaging Features Based on Cone Beam Computed Tomography Scans

Abstract Imaging exams have important role in diagnosis of cemento-osseous dysplasia (COD). Cone beam computed tomography (CBCT) stands out for allowing three-dimensional image evaluation. This study aimed to assess the prevalence of cases diagnosed as COD on CBCT scans, as well identify the main imaging features related to these lesions. An analysis was performed in a database containing 22,400 radiological reports, in which all cases showing some type of COD were initially selected. These CBCT exams were reevaluated to confirm the radiographic diagnosis and determine the prevalence and distribution of the types of COD with regard to gender, age and preferred location, while describing its most common imaging aspects. Data were presented using descriptive analyses. There were 82 cases diagnosed as COD in the CBCT images (prevalence of 0.4%). The distribution of patients was 11 (13.4%) male and 71 (86.6%) female, with a mean age of 49.8 years (age-range 17-85 years). There were 47 (57.3%) cases of periapical COD, 23 (28%) of focal COD and 12 (14.6%) of florid COD. The mandible was more affected than the maxilla. In most cases, the lesions were mixed or hyperdense. All COD had well-defined limits and there were no cases of tooth displacement. In conclusion, periapical COD was the most common type and the most affected bone was the mandible. Imaging evaluation is critical for diagnosis and dentists should bear in mind all possible radiographic presentations of COD in order to prevent misleading diagnoses and consequently, inadequate treatments.

Resumo Os exames por imagem têm papel importante no diagnóstico da displasia cemento-óssea (DCO). A tomografia computadorizada por feixe cônico (TCFC) se destaca por permitir a avaliação tridimensional da imagem. O objetivo neste estudo foi avaliar a prevalência de casos diagnosticados como DCO nos exames de TCFC, bem como identificar as principais características de imagem relacionadas a essas lesões. Uma análise foi realizada em um banco de dados contendo 22.400 laudos radiológicos, no qual todos os casos que apresentavam algum tipo de DCO foram inicialmente selecionados. Estes exames foram reavaliados para confirmar o diagnóstico radiográfico e determinar a prevalência e distribuição dos tipos de DCO em relação ao sexo, idade e localização preferencial, além de descrever seus aspectos imaginológicos mais comuns. Os dados foram apresentados por meio de análise descritiva. Oitenta e dois casos foram diagnosticados como DCO nas imagens de TCFC (prevalência de 0,4%). A distribuição dos pacientes foi de 11 (13,4%) homens e 71 (86,6%) mulheres, com idade média de 49,8 anos (faixa etária de 17 a 85 anos). Houve 47 (57,3%) casos de DCO periapical, 23 (28%) de DCO focal e 12 (14,6%) de DCO florida. A mandíbula foi mais afetada que a maxila. Na maioria dos casos, as lesões foram mistas ou hiperdensas. Todas as DCO apresentaram limites bem definidos e não houve casos de deslocamento dentário. Em conclusão, a DCO periapical foi o tipo mais comum e o osso mais afetado foi a mandíbula. A avaliação da imagem é crítica para o seu diagnóstico e os dentistas devem ter em mente todas as possíveis apresentações radiográficas da DCO, a fim de prevenir diagnósticos enganosos e, conseqüentemente, tratamentos inadequados.

Recurrent symptomatic cemento-osseous dysplasia: A case report

Cemento-osseous dysplasia (COD) is a benign fibro-osseous lesion of bone, in which normal bone is replaced by fibrous tissue, followed by calcification with osseous and cementum-like tissue. COD is classified into 3 categories according to its location: periapical, focal, and florid COD (FCOD). On radiography, FCOD appears radiolucent in its early stages. As it matures, radiopacities appear within the lesion, causing them to show a mixed appearance of radiolucency and radiopacity. Because FCOD is usually asymptomatic and grows in a self-limited manner, it does not require treatment. Secondary infection is the most frequent cause of symptomatic cases. We report a case of FCOD with symptoms that appeared after a dental restoration procedure and persisted after repeated operations. The purpose of this report is to emphasize the importance of thorough radiological evaluations of patients with FCOD before treatment.

Progress in the diagnosis of florid cemento-osseous dysplasia / 中华口腔医学杂志

Florid cemento-osseous dysplasia (FLCOD) is a rare, extensive bone metabolism disorder, which occurs only in the jaw bone. It is usually asymptomatic for a long time and discovered incidentally during a radiological examination. The characteristics of FLCOD in the initial stages are similar to those of periapical granuloma or jaw cyst, which may lead to misdiagnosis. After the lesion is mature, the imaging findings show that radiopaque with a thin radiolucent peripheral halo, which is crucial for the diagnosis of FLCOD, but other jaw lesions have similar imaging findings. Due to the poor blood supply of the lesion, the alveolar bone of root apices of vital teeth is slow to heal after trauma, increasing the chance of infection, which can lead to the osteomyelitis of the jaws and emerge sequestrum. This paper reviews the aspects of pathogenesis, clinical characteristics, diagnosis, differential diagnosis and treatment.

Florid Cemento-osseous Dysplasia.

Florid cemento-osseous dysplasia is a condition of the bone which is rare and usually affects jaw bones. It is classified as sclerosing osteitis, multiple exostoses, diffuse chronic osteomyelitis, and gigantiform cementoma. The age group varies from 19 to 76 years and mostly presents in the fourth and fifth decade. Most commonly affects middle-aged women. It is identified on radiographic examination and manifested as diffuse irregularly shaped radiopacities in the alveolar processes. It usually presents as a bilaterally symmetrical lesion. This lesion is benign and requires treatment only if symptomatic or for cosmetic reasons. We report a case of an uncomplicated florid cemento-osseous dysplasia in a 35-year-old woman the diagnosis of our case was made radiographically.

Displasia cemento-óssea florida: uma das poucas contraindicações de implantes osseointegráveis / Florid cemento-osseous dysplasia:one of the few contraindications to osseointegrated implants

A Displasia Cemento-Óssea Florida representa uma das poucas situações clínicas de contraindicação para a colocação de implantes osseointegráveis. Como qualquer outro procedimento cirúrgico, inclusive a biópsia, se realizada, a colocação de implante pode abrir as portas para as bactérias acessarem o ambiente ósseo. O osso altamente esclerosado e irregular representa um meio adequado para a proliferação bacteriana e constituição de exuberantes biofilmes microbianos, impedindo o acesso ao local das células e moléculas da defesa orgânica, assim como de antibióticos que, por ventura, venham a ser administrados para o tratamento de uma Osteomielite Crônica Purulenta Secundária, muito comumente vista em pacientes com Displasia Cemento-Óssea Florida. A doença representa um distúrbio dos maxilares no processo de remodelação óssea e, apesar de sua elevada frequência, ainda não se sabe suas causas ou fatores associados, exceto sua predominância em pessoas com alguma afrodescendência, especialmente em mulheres de meia idade...

Florid cemento-osseous dysplasia represents one of the few clinical contraindications to osseointegrated implant placement. As in any other surgical procedure, including biopsy, implant placement might open up the doors to bacteria access to the bone environment. Highly sclerosed irregularbone is appropriate for bacteria proliferation and formation of exuberant microbial biofilm, thereby hindering access not only of local cells and molecules of organic defense, but also of antibiotics potentially administered to treat secondary purulent chronic osteomyelitis commonly found inflorid cemento-osseous dysplasia patients. The disease is a disorder of the maxilla, established during the process of bone remodeling; and despite its high frequency, its causes or associated factors remain unknown, except for its predominance among afrodescendents, especially middle-aged women...

Misdiagnosis of florid cemento-osseous dysplasia leading to unnecessary root canal treatment: a case report

This case report demonstrates an unnecessary endodontic treatment of teeth with florid cemento-osseous dysplasia (FCOD) due to a misdiagnosis as periapical pathosis and emphasizes the importance of correct diagnosis to avoid unnecessary treatment. A 30-year-old woman was referred to our institution for apicoectomies of the mandibular left canine and both the lateral incisors. The periapical lesions associated with these teeth had failed to resolve after root canal treatment over a 3-year period. Radiographic examinations revealed multiple lesions on the right canine, the second premolar, and both first molars as well as the anterior region of the mandible. Based on clinical, radiographic and histological evaluations, the patient condition was diagnosed as FCOD. The patient has been monitored for 2 years. To avoid unnecessary invasive treatment, accurate diagnosis is essential before treatment is carried out in managing FCOD.

Florid cemento-osseous dysplasia and osteomyelitis: a case report of a simultaneous presentation / Displasia cemento-óssea florida e osteomielite: relato de caso de uma apresentação simultânea

PURPOSE: To report a case of florid cemento-osseous dysplasia (FCOD) and chronic diffuse sclerosing osteomyelitis (CDSO) in a simultaneous presentation, emphasizing the significance of differential diagnosis and appropriate management of these conditions. CASE DESCRIPTION: A female, 69 years old, black patient had a complaint of itching and pain in posterior left mandibular region. The patient had a yellowish hard mass throughout all quadrants of the jaws. A panoramic radiograph showed a lobular, diffuse and irregular radiopaque lesion. Based on clinical and histopathological findings, the diagnosis was FCOD associated with secondary osteomyelitis. CONCLUSION: This report reinforces the need of accurate assessment of clinical, radiographic and histopathological aspects for the diagnosis and correct selection of treatment in cases of combined lesions.

OBJETIVO: relatar um caso de displasia cemento-óssea florida (DCOF) e osteomielite esclerosante difusa crônica (OEDC) em uma apresentação simultânea, enfatizando a importância do diagnóstico diferencial e adequado manejo dessas condições. DESCRIÇÃO DO CASO: Uma paciente do sexo feminino, 69 anos de idade, de cor negra, tinha uma queixa de dor e coceira na região esquerda da mandíbula. A paciente apresentava uma massa dura amarelada envolvendo todos os quadrantes dos maxilares. Foi obtida uma radiografia panorâmica, revelando lesão radiopaca lobular, difusa e irregular. Com base nos aspectos clínicos e histopatológicos, o diagnóstico foi de DCOF associada com osteomielite secundária. CONCLUSÃO: esse relato reforça a necessidade de uma avaliação precisa dos aspectos clínicos, radiográficos e histopatológicos para o diagnóstico e seleção correta de tratamento em casos de lesões combinadas.

Florid osseous dysplasia: report of two cases and a review of the literature / Displasia ósea florida: reporte de dos casos y revisión de la literatura

Florid osseous dysplasia (FOD) is a benign condition of the jaws in which the normal architecture of bone is replaced by a fibrous tissue containing a variable amount of bone and cementum-like tissue. This lesion is most commonly seen in middle aged black women. FOD appears as dense, lobulated masses, often symmetrically located in the mandible, rarely in the maxilla. The lesion is usually asymptomatic and benign. However, a secondary infection may occur and its treatment can be difficult and complicated. This paper reports the case of two patients. The first one is a white woman aged 65 and the second one is a black woman aged 70, both diagnosed with FOD, revealed by secondary infections. The diagnosis was based on clinical and radiographic findings, as biopsy is contraindicated. Radiological and clinical features of FOD and its management will be also discussed on the basis of recent literature.

La displasia ósea florida (DOF) es una patología benigna del maxilar y mandíbula en la que se sustituye la arquitectura normal del hueso por un tejido fibroso que contiene una cantidad variable de tejido óseo y cementoide. Esta lesión es más frecuente en mujeres negras de edad media. La DOF aparece como una masa densa, lobulada, a menudo situada simétricamente en la mandíbula, rara vez en el maxilar. La lesión suele ser asintomática y benigna. Sin embargo, una infección secundaria puede ocurrir y su tratamiento puede ser difícil y complicarse. Este artículo reporta el caso de dos pacientes. La primera es una mujer blanca de 65 años y la segunda es una mujer negra de 70 años, ambas diagnosticadas con DOF, revelada por infecciones secundarias. El diagnóstico se basó en los hallazgos clínicos y radiológicos, ya que la biopsia está contraindicada. Las características clínicas y radiológicas de la DOF y su manejo son discutidos en base a la literatura reciente.

Immunolocalization of bmp2/4, tgfβ-1 and osteonectin in fibro-osseous lesions of the jaws / Imunolocalização de bmp2/4, tgfß-1 e osteonectina em lesões-fibro-óssea benignas

Objetivo: as lesões fibro-ósseas benignas (LFOB) correspondem a um grupo diverso de patologias caracterizadas pela substituição do tecido ósseo por tecido conjuntivo e matriz extracelular mineralizada. Pouco se conhece a respeito da etiologia desse grupo de lesões. Propomo-nos a analisar por meio da técnica imunohistoquímica a expressão de 3 moléculas (osteonectina, TGFβ-1 e BMP 2/4) envolvidas no metabolismo ósseo. Métodos: Trinta e dois casos diagnosticados como osso normal (ON,8), displasia fibrosa (DF,8), displasia cemento-óssea (DCO,8) e fibroma cemento-ossificante (FCO,8) foram selecionados. Resultados: A osteonectina e a BMP2/4 foram positivas em todos os casos. O TGFβ-1 revelou positividade em 1 caso de DCO e FCO. Conclusão: Os achados imunohistoquímicos sugerem que as LFOB tem processos diferentes de produção de tecido ósseo.

Background: Benign fibro-osseous lesions (BFOL) comprise a diverse group of pathologies characterized by the replacement of normal bone by fibrous tissue and a mineralized product. Little is known about the biology of this group of lesions. We have analyzed the immunohistochemical expression of three molecules involved in bone metabolism, namely osteonectin, TGF-b1, and BMP2/4. Methods: Thirty-two cases diagnosed as normal jaw bone (NJB, 8 cases), fibrous dysplasia (FD, 8 cases), cemento-osseous dysplasia (COD, 8 cases), and cemento-ossifying fibroma (COF, 8 cases) were selected. Results: Osteonectin and BMP2/4 antibodies were positive in all cases. TGFb-1 labeling was seen in one case of COD and COF. Conclusion: The immunohistochemistry findings suggest that BFOL have different processes of osseous tissue production.

Florid cemento-osseous dysplasia: a report of two cases

Cemento-osseous dysplasia occurs in the tooth bearing areas of the jaws and is probably the most common fibro-osseous manifestation. They are usually classified into three main groups according to their extent and radiographic appearance: periapical (surrounds the periapical region of teeth and are bilateral), focal (single lesion) and florid (scleroticsymmetrical masses) cemental-osseous dysplasias. Florid cemento-osseous dysplasia clearly appears to be a form of bone and cemental dysplasia that is limited to the jaws. Patients do not have laboratory or radiologic evidence of bone disease in other parts of the skeleton. For asymptomatic patients, the best management consists of regular recall examinations with prophylaxis and the reinforcement of good home hygiene care to control periodontal disease and prevent tooth loss. The treatment of symptomatic patients is more difficult. At this stage, there is an inflammatory component caused by the disease and the process is basically a chronic osteomyelitis involving dysplastic bone and cementum. Antibiotics might be suggested, but are not always effective. Two cases of florid cemento-osseous dysplasia diagnosed in two Korean females are reported with a review of the relevant literature.

Clinical, radiographic, and histological findings of florid cemento-osseous dysplasia: a case report

Cemento-osseous dysplasias are a group of disorders known to originate from periodontal ligament tissue and involve, essentially, the same pathological process. They are usually classified into three main groups: periapical, florid, and focal cemental dysplasias depending on their extent and radiographic appearances. Radiographically, florid cementoosseous dysplasia (FCOD) appears as dense, lobulated masses, often symmetrically located in various regions of the jaws. The best management for the asymptomatic FCOD patient consists of regular recall examinations with prophylaxis. The management of the symptomatic patient is more difficult. A case of FCOD occurring in a 52-year-old edentulous Korean female is reported which is rare with regard to race and sex.

Florid cemento-osseous dysplasia: a case report

Florid cemento-osseous dysplasia (FCOD) has been described as a condition that characteristically affects the jaws of middle-aged black women. It usually exhibits as multiple radiopaque cemetum-like masses distributed throughout the jaws. Radiographically, FCOD appears as dense, lobulated masses, often symmetrically located in various regions of the jaws. Computed tomography, because of its ability to give axial, sagittal, and frontal views, is useful in the evaluation of these lesions. This paper presents the case of a patient who was diagnosed with FCOD on the basis of clinical and radiographic findings.

A displasia cemento-óssea florida (DCOF) tem sido descrita como uma condição que afeta tipicamente os maxilares de mulheres negras de meia idade, geralmente exibindo massas radiopacas semelhantes ao cemento, distribuídas nos ossos maxilares. Radiograficamente, a DCOF apresenta-se como densas masas lobuladas, frequentemente distribuídas simetricamente em diversas regiões dos maxilares. A tomografia computadorizada, que oferece vistas axial, sagital e frontal, é útil na avaliação dessas lesões. Este artigo apresenta o caso de uma paciente em que a DCOF foi diagnoasticada com base nos achados clínicos e radiográficos.

3 Types of Cemento-Osseous Dysplasia: Case Reports

Cemento-osseous dysplasias are a group of disorders known to originate from periodontal ligament tissues and involve, essentially, the same pathological process. They are usually classified, depending on their extent and radiographic appearances, into three main groups. Periapical cemental dysplasia predominantly involves the periapical region of the anterior mandible. Florid cemento-osseous dysplasia presents with multifocal lesions in the tooth bearing or edentulous areas of the maxilla and mandible, often occurring bilaterally with symmetric involvement. Focal cemento-osseous dysplasia exhibits a single site of involvement in any tooth bearing or edentulous area of the mandible or maxilla, with the posterior mandible representing the most common site. We report the clinical, radiographic and histological findings of 3 types of cemento-osseous dysplasia with a review of literatures.

An immunohistochemical study on calcifying tissues of the florid cemento-osseous dysplasia easily involving chronic diffuse sclerosing osteomyelitis

Florid cemento-osseous dyspalasia (FCOD) is a benign, non-neoplastic lesion characterized by multiple sclerosing masses only within jawbones. It is frequently confused with chronic diffuse sclerosing osteomyelitis (CDSO) in previous literatures. In our study, two cases of FCOD were examined to know the characteristics of their calcifying tissues. The first case was non-infected, while the second case was severely infected, displaying the typical features of CDSO in clinico-radiologic findings. The infected FCOD case showed a lot of bacterial colonies in the main lesion with relatively rare inflammatory reaction. The globular cementum-like materials of FCOD showed woven bone pattern and was positive for Alcian blue stain, and also positive for the antibodies of ameloblastin, bone morphogenetic protein (BMP) -2 and -4. On the other hands, in the immunostains of matrix metalloproteinase (MMP) -3, -9, -10, and TNF- alpha, macrophage infiltrated in the FCOD lesion was rarely observed. These data suggest that the cementum-like materials of FCOD contain various matrix proteins, and that the cementum-like materials are relevant to the overgrowth of the bacterial colonies by inhibition of the regional inflammatory reactions.