Resident University of Texas at Houston Brownsville, Texas, United States
Focal cemento-osseous dysplasia is a benign fibro-osseous lesion characterized by replacement of bone with fibrous tissue followed by its calcification with cementum and osseous-like material. Most cases are asymptomatic and don’t require treatment, but intervention is required when lesions are secondarily infected. This case is from the University of Texas Health Science Center at Houston of focal cemento-osseous dysplasia palatal to #7 encased in a periapical granuloma originating from #8, then removed. A 46-year-old female patient was referred to the school for evaluation of tooth #8. The patient was asymptomatic and a periapical radiograph of #8 revealed a 3 mm overextension of gutta-percha with a periapical radiolucency. The diagnosis for #8 was determined to be previously treated with symptomatic apical periodontitis and the adjacent teeth tested within normal limits. A limited FOV CBCT scan (Carestream Dental; Atlanta, GA) of #8 was taken determine the periapical radiolucency extension. The CBCT revealed a radio dense lesion palatal to #7 and encased within the periapical radiolucency of #8. #8 was retreated orthograde initially and then underwent endodontic microsurgery where the radiopaque mass was removed and submitted for histopathologic examination. The pathology report of the lesion revealed a diagnosis of focal cemento-osseous dysplasia with concomitant periapical granuloma. At the post-treatment evaluations tooth #7 remained vital. This case demonstrates a rare presentation of focal cemento-osseous dysplasia in the maxilla.
