Periapical cemento-osseous dysplasia

Asymptomatic condition that is discovered on routine radiography

Etiology: It is possibly derived from the PDL

Epidemiology: Poorly understood predilection for black female patients, 5th and 6th decades


  • Lower anterior region
  • Associated teeth usually – vital pulps
  • Common complication: Osteomyelitis after extractions – due to poor vascularity of bone

Clinical subtypes:

  • Single (< 1.5 cm diameter)
  • Multiple
  • Florid (familial tendency)


  • Early – Circumscribed radiolucencies involving apical area of anterior teeth.
  • Late – Mixed radiolucency to ”cotton wool” appearance

Histology: Trabecular/sclerotic areas of lamellar bone OR cementum-like material interspersed in fibrous matrix

Management: Surgical curettage with care, the lesions does not separate clearly from bone


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