• Focal vs Periapical vs Florid
• Most common fibro-osseous lesion
• Arise in close approximation with PDL ang have histopathologic similarities with the structure
• Histopathology: fragments of cellular mesenchymal tissue composed of spindle-shaped fibroblasts and collagen fibers with numerous small blood vessels
• Treatment: regular recall exam; unless symptomatic due to chronic osteomyelitis involving dysplastic bone and cementum, then saucerization of sequestrum

Focal: single site of involvement

Fragments of cellular fibrovascular connective tissue with scattered hemorrhage and a variable mixgture of woven bone, lamellar bone, and cementum-like particules. As the lesion matures, the ratio of fibrous connective tissue to mineralized material decreases.

Incidence: middle age to older adults; 90% black women

Location: posterior mandible, with synchronous involvement of anterior mandible

Clinical Presentation: marked tendency for bilateral and often quite symmetrical involvement

Radiographic Features: Initially, the lesions are predominantly radiolucent but with time become mixed, then predominantly radiopaque with only a thin peripheral radiolucent rim; fusion with tooth root surface may be observed in end-stage

Compare to:

Histopathology:

Treatment:

Incidence: 90% occur in females; 3rd to 6th decade of life, mean age 38

Location: posterior mandible

Radiographic Features: completely radiolucent to densely radiopaque with a think peripheral radiolucent rim; most commonly a mixed radiolucent and radiopaque pattern; well-defined but irregular margins

Compare to: ossifying fibroma

Before the final sclerotic stage, cemento-osseous dysplasia consists of easily fragmented and gritty tissue that can be curetted easily from the defect but does not separate cleanly from the adjacent normal bone. In contrast, ossifying fibromas tend to separate cleanly from the bone and are removed in one or several large masses.

AKA: Osseous Dysplasia, Cemental Dysplasia, Cementomas

Incidence: 3rd to 5th decade and never before 20; female > male; 70% affect blacks

Location: periapical region of anterior mandible

Radiographic Features: early lesions are circumscribed radiolucent areas involving apical area of tooth; with time adjacent lesions can fuse to form a linear patter of radiolucency that envelops apices of several teeth; mature lesions are circumscribed dense calcifications surrounded by a narrow radiolucent rim with PDL intact

Compare to: periapical granuloma or periapical cyst