Dysplasia florida.
Patient referred for treatment of tooth 37 due to a periapical radiolucent image. Black patient, 43 years old, reported no pain. On clinical examination, occlusal caries and endodontic tests were normal in relation to adjacent teeth. Radiographic examination showed a mixed lesion in the periapical region of tooth 37. A panoramic radiograph was then requested and revealed similar lesions in other areas of the mandible.
The main diagnostic hypothesis was florid cemento-osseous dysplasia. The pulp diagnosis of 37, normal pulp.
Caries removal, restoration and proservation were indicated.
Dysplasia florida In: Monti et al. Odonto 2012; 20(40): 95-100
INTRODUCTION
Dysplasia florida: Cemento-osseous dysplasia florida (DCOF) is a non-neoplastic condition limited to the maxillary bones, characterized by the presence of scattered diffuse radiopaque masses consisting of dense cementum and bone that when infected can lead to suppuration and sequestrum formation, thus resulting in a picture of osteomyelitis.
In recent years, fibro-osseous lesions have attracted increasing interest from pathologists, with the aims of definitively distinguishing these pathologies and putting an end to diagnostic discussions arising from the overlapping of their characteristics.
Lesions containing cementum and/or bone form a complex group of lesions associated with the dentate areas of the jaws, formerly classified as odontogenic tumors, are now considered non-neoplastic lesions by Kramer et al. in (1992) and fibro-osseous lesions by Waldron (1993).
DCOF is a multifocal dysplastic lesion, limited to the maxillary bones, which consists of fibrous connective tissue cellular with bone and cementum-like tissue. Variable numbers of inflammatory cells may be present in biopsy specimens from
symptomatic patients, and it is well recognized as predominant in black women over the age of 40. Other terms have been applied to DCOF, such as sclerosing osteitis, sclerosing osteomyelitis and diffuse chronic sclerosing osteomyelitis, giant cementoma, familial multiple cementoma.
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The radiographic findings are represented by lobular, irregular, radiopaque masses surrounded by radiolucent areas resembling the appearance of Paget's disease of bone, with a clear tendency to be bilaterally symmetrical, affecting the mandible more than the maxilla, both in dentate and edentulous areas, and there may be the presence of single or multiple associated simple bone cysts. There is no apparent cause and the lesions are asymptomatic, except when the complication of osteomyelitis occurs, due to exposure of the calcified sclerotic masses to the oral environment as a result of progressive alveolar atrophy under prosthesis or after tooth extraction in the area involved by the process. The pathogenesis of this osteomyelitis could be related to the scarce blood supply in the affected bone and the avascular sclerotic masses, particularly
susceptible to secondary infection.
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The radiolucent borders and spaces surrounding the DCOF are quite regular and well defined. If the lesions are asymptomatic there is no need for treatment. Treatment of the disease requires only controls such as radiographic examinations, hygiene and prophylaxis if asymptomatic. However, when associated with an inflammatory component and with
exposure of the sclerotic masses, antibiotic therapy is necessary, as well as the removal of the bone sequestrums.
Dysplasia florida.
