Cemento-osseous dysplasia: a retrospective clinico-pathological study

A research report submitted to the Faculty of Health sciences, University of the Witwatersrand, In conformity with the requirements for the degree of Master of Science in the branch of Oral Pathology School of Oral Health Science, Faculty of Health Sciences University of the Witwatersrand, South Africa Johannesburg, 2018.Background: Cemento-osseous dysplasia (COD) is a non-neoplastic fibro-osseous lesion which occurs in the tooth-bearing regions of the jaw bones. In many instances the diagnosis of COD is based on the distinctive clinical and radiographic features of this disease. Since the affected bone in COD progressively becomes poorly vascularized, dental prophylaxis is of paramount importance to prevent pulpal and periodontal infection which typically trigger sequestrum formation in the affected bone. The aim of this study was to determine the clinico-pathological characteristics of COD in a South African population sample and to relate this to findings in the literature. Materials and methods: The study comprised a retrospective record review of archived documentation of COD. The histopathology reports of patients diagnosed with COD over the period spanning 1996 to 2015 were reviewed from the files of the Department of Oral Pathology, School of Oral Health Sciences, University of the Witwatersrand, Johannesburg. Results: Of the 23, 288 specimens submitted for histopathological examination 237 (1.02%) cases of COD were found. The mean age of the patients were 53.4 years ± 14.2 years with a 93.2% female predilection. COD mainly affected the mandible (62.4%), followed by involvement of both the maxilla and the mandible (24.5%), and maxilla (13.1%). Of the 143 patients with known COD subtypes florid COD predominated (65%) showing a clear trend of increasing with age, peaking in the 51-60 year age group and then decreasing thereafter. Cases of infected COD comprised 73.8% (174/237) of the COD study sample. Further 33% of all cases of chronic suppurative osteomyelitis (CSOM) in this study were seen in patients with COD. There was no significant association between any of the COD subtypes and CSOM (p > 0.05). Simple bone cysts presented as a complication of COD in 4.6% of cases. Conclusion: This study comprises the largest sample of COD cases thus far reported from South Africa. It showed a higher frequency of CSOM occurring as a complication of COD compared to earlier studies. No significant association was shown between any of the COD subtypes and CSOM.LG201