Distinguishing features of focal cemento-osseous dysplasia and cemento-ossifying fibromas: II. A Clinical and radiologic spectrum of 316 cases

• Published in: Oral surgery, oral medicine, oral pathology, oral radiology and endodontics Vol. 84; no. 5; pp. 540 - 549
• Main Authors: Su, Lan, Weathers, Dwight R, Waldron, Charles A
• Format: Journal Article
• Language: English
• Published: St. Louis, MO Mosby, Inc 01-11-1997; Elsevier
• Subjects: Adolescent; Adult; Age Factors; Aged; Biological and medical sciences; Bone Diseases, Developmental - diagnostic imaging; Bone Diseases, Developmental - pathology; Chi-Square Distribution; Child; Dental Cementum - diagnostic imaging; Dental Cementum - pathology; Dentistry; Diagnosis, Differential; Female; Fibroma, Ossifying - diagnostic imaging; Fibroma, Ossifying - pathology; Fibrous Dysplasia of Bone - diagnostic imaging; Fibrous Dysplasia of Bone - pathology; Humans; Investigative techniques, diagnostic techniques (general aspects); Jaw Diseases - diagnostic imaging; Jaw Diseases - pathology; Jaw Neoplasms - diagnostic imaging; Jaw Neoplasms - pathology; Logistic Models; Male; Mandibular Diseases - diagnostic imaging; Mandibular Diseases - pathology; Mandibular Neoplasms - diagnostic imaging; Mandibular Neoplasms - pathology; Medical sciences; Middle Aged; Multivariate Analysis; Odontogenic Tumors - diagnostic imaging; Odontogenic Tumors - pathology; Otorhinolaryngology. Stomatology. Orbit; Periapical Diseases - diagnostic imaging; Periapical Diseases - pathology; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Radiography; Sensitivity and Specificity; Sex Factors; Tooth Apex - diagnostic imaging; Tooth Apex - pathology; Tooth Extraction; Human; Radiodiagnosis; Stomatology; Odontogenic fibroma; Dental disease; Diseases of the osteoarticular system; Characteristic; Clinical form; Fibrous dysplasia of jaws; Exploration; Radiography; Symptomatology; Odontogenic tumor; Ossifying fibroma; Benign neoplasm; Maxillary disease; Cementum; Dental dysplasia
• ISSN: 1079-2104; 1528-395X
• DOI: 10.1016/S1079-2104(97)90271-7

The distinguishing histopathologic features of focal cemento-osseous dysplasia (FCOD) (including lesions occurring in both anterior and posterior jaws) and cemento-ossifying fibroma (COF) (ossifying fibroma and cementifying fibroma) were demonstrated in our earlier work. The aim of the current study was to further refine their clinical and radiographic features. We have assessed 18 clinical and radiographic parameters by univariate comparisons (chi-squared and Student
t tests), and a multivariate assessment (logistic regression) in 241 cases of FCOD and 75 of COF. These cases were diagnosed from a combination of clinical, radiographic, and histopathologic information. FCOD was seen predominantly in black women, with a peak incidence in the fourth and fifth decades, whereas COF showed no female predilection except in the fourth decade (
p < 0.005). COF occurred in patients an average of 10 years younger than patients with FCOD (
p < 0.0001). Most patients with FCOD were asymptomatic (62%); the average lesion size was 1.8 cm. More than half of patients with COF displayed jaw expansion and a considerably larger size lesion (mean 3.8 cm,
p < 0.001). The mandible was the most frequent site for both FCOD (86%) and COF (70%). Radiographically, a well-defined border was observed in 53% of cases of FCOD and 85% of cases of COF (
p < 0.01). Cases of FCOD mostly demonstrated an irregularly mixed radio-opacity (69%), whereas 53% of COFs presented as a radiolucency (
p < 0.005). In FCOD, there was a close association with tooth apices (70.6%,
p < 0.0001) or with previous extraction sites (21%,
p < 0.05); however, the majority of COF cases (86%) showed no relationship with either. Combining the radiographic feature of a periapical location with the pathology of multiple curetted fragments and “ginger root” bony trabeculae, allowed 90% sensitivity and 89% specificity in a logistic regression model to predict the lesion to be an FCOD. These findings provide guidelines not only to distinguish these two entities clinically, but also to aid in reaching an accurate diagnosis histopathologically.