CBCT findings of periapical cemento-osseous dysplasia: A case report
A 45-year-old Iranian woman was referred to the private clinic in the city of Hamadan for implant consultation. Her past medical history was not notable, and there was no evidence of systemic disease. She had no history of trauma to the mandible. In the extra-oral examination, no abnormal symptoms were observed. Intra-oral examination revealed normal oral mucosa, the absence of soft tissue expansion, and teeth of a normal color. Periodontal tissues were normal. All of the teeth were asymptomatic, with no pain or tenderness on percussion or palpation. The involved teeth were vital in an electric stimulation test.\nFor assessment before implant insertion, CBCT had been ordered. During evaluation of the implant insertion areas on Promax3D CBCT (Planmeca OY, Helsinki, Finland), a radiolucent-radiopaque mixed lesion located on the apices of the lower incisors was observed. On the axial, sagittal, and coronal CBCT images, the extension of the lesion was observed from the mesial side of the right mandibular lateral incisor to the distal side of the left mandibular lateral incisor. It was a multifocal lesion in which solitary lesions were reached together and made a larger lesion. The total dimension of the lesion was about 16.6 mm in the mesiodistal direction and 6.9 mm in the longest superior-inferior direction. On the panoramic reconstructed CBCT image, the lesion associated with the left mandibular lateral incisor was radiolucent, whereas the lesion on the apex of the left central incisor was mixed radiolucent-radiopaque and the lesion associated with the right central incisor was radiopaque with a radiolucent rim around the lesion of this tooth ().\nBy using the CBCT, the state of the lesion relative to the buccal and lingual cortical plates could be assessed, which might not be possible on the conventional radiographs. On the axial image, two expansion and thinning areas of the buccal cortex were revealed. One of them was located at the mesial side of the right canine and the other between the left central and lateral incisors (). On the axial and cross-sectional images, the discontinuity of the lingual cortex was found at the area between the two central incisors on several consecutive sectional images (). This cortical discontinuity was more obvious on the three-dimensional (3D) CBCT images (). However, it should be considered that the cortical bone could be seen to have destruction on 3D images, even though it would have been thin without discontinuity on the cross-sectional images.\nOn the digital periapical radiograph that was taken for further follow-up, a typical feature of PCOD was observed (). There was no root resorption or tooth displacement. The lamina dura surrounding the apical areas of the involved teeth was lost. Periodontal ligament space widening was found, especially around the root of the left lateral incisor.\nBased on the patient clinical and radiographic findings, a diagnosis of multifocal periapical cemento-osseous dysplasia was made. No treatment was considered. The only recommendation was periodic radiographic follow-up.