Download Citation on ResearchGate | Displasia cemento-óssea florida: relato de caso | Lesões fibro-ósseas benignas são caracterizadas pela substituição do. Florid cemento-osseous dysplasia has been described as a condition that characteristically . A displasia cemento-óssea florida tem sido descrita como uma. 18 nov. Focal. Thalyta Brito Santos LIMA. Renan de Souza BONFIM. Gefter CORREA. Rafael MOURA. TRATAMENTO. DISPLASIA CEMENTO-ÓSSEA.

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Failure of dental implants in cemento-osseous dysplasia: Osseointegrated dental implants have been routinely used in oral rehabilitation. Patients with dysplastic bone diseases represent a particular challenge for oral rehabilitation with dental implants. Nevertheless, the installation of implants in patients with cemento-osseous dysplasia COD has been reported with apparent success.

In this paper, we present a case of a patient with COD in which a dental implant had been installed and lost six months later.

In this regard, we analyzed pertinent osea of the indications for dental implants in patients with COD considering the pathogenesis, dysplastic nature, and behavior of the disease. The present case report illustrates cemehto COD can be considered a limiting factor in the recommendation for a dental implant. Because of this, it is imperative to inform the patient about the risks of surgically manipulating the diseased bone.

Factors such as quantity and quality of bone are associated with osseointegration and thus the diwplasia of the treatment. Systemic and local risk factors that affect metabolism and bone remodeling should be considered when assessing the indications for these surgical procedures. Endocrine disorders, osteoporosis and primary bone lesions such as cystic, dysplastic and tumoral lesions are among the main diseases to consider in this assessment 1 – 3.

The nature and biological behavior of owsea dysplasia are often associated with structural changes in the bone that compromise its normal blood supply and plasticity, resulting in potential problems for osseointegration. Although osseointegration is not fully achieved at the histological level, satisfactory clinical bone healing has been described for titanium implantation in fibrous dysplasia Ossefor example 1 – 3. In particular, cemento-osseous dysplasia COD constitutes a special problem when dysplastic bone lesions progress to become strongly mineralized, poorly vascularized and highly susceptible to solitary bone cavity formation.

Nevertheless, the installation of implants in patients with COD has been reported with apparent success 4.

These findings suggest that some concepts related to implant rehabilitation in dysplastic bone should be revisited. In this paper, we present and discuss a case of a patient with COD in which a dental implant had been installed but lost six months after surgery.

A year-old female patient was referred with a chief complaint of a failed dental implant, which had spontaneously fallen out of the mouth six months after installation. She reported no symptoms and had no signs of inflammation. She brought a panoramic radiograph taken after surgery that showed the presence of a dental implant in the region of tooth 25, surrounded by an inconspicuous radiolucency Figure 1.

It should be noted that it is practically impossible to visualize any type of bone alteration in that region.

Florid cemento-osseous dysplasia mimicking multiple periapical pathology–an endodontic dilemma.

However, mixed lesions are clearly associated with the canine and first premolar in both the right and left mandibular quadrants. A periapical radiograph and displasiw beam computed tomography image taken after implant removal revealed a roughly ovoid well-corticated radiolucent lesion showing moderate degrees of mineralization at the ossez Figures displaisa and b.

The same typical mixed radiolucent-radiopaque aspects can be observed, which are compatible with the maturation of the progressive lesion. The patient was asked if she was aware of the existence of some type of alteration in that area, which she denied, indicating that she was absolutely unaware of the disease.

Unfortunately, any examination, including periapical radiographs before the time of implant installation, were not available for evaluation. New panoramic and periapical radiographs confirmed the same osseous alteration as described above.


An incisional biopsy was performed, and histopathological examination revealed different areas of a dense, slightly vascularized connective tissue that was rich in fibroblasts and showed a moderate amount of collagen fibers that were permeated with a varying amount of osteoid trabeculae and cement-like nodules of different shapes and sizes. The osteoid trabeculae showed varying degrees of peripheral matrix layered by fusiform to polygonal cells.

Furthermore, a variable amount of cells was found in these trabeculae. A small number of basophilic globular structures of different sizes could also be observed through the field Figures 3a and b. The diseased bone is partially mineralized with a peripheral strip of osteoid matrix arrowhead.

These findings, together with the qualities found in the imaging analysis, were considered diagnostic for the florid variant of COD FCOD. The cemengo was informed about the diagnosis and risks of an eventual new surgical intervention in the area of the dysplastic bone tissue and chose to undergo rehabilitation with an adhesive fixed prosthesis.

One year after biopsy, the area from which the implant was removed had healed uneventfully Figure 4. However, FCOD lesions could still be detected extending to the second premolar area in both the right and left mandibular quadrants. Oral rehabilitation using dental implants has become one of the most successful treatment modalities in dental practice, displasa good esthetic and functional results.

However, the success of this procedure is directly dependent on the quantity and quality of the bone tissue to achieve primary implant stabilization. This condition allows for osseointegration and cejento to treatment predictability. Systemic and local factors that affect bone tissue, such as the presence of cementto disorders diabetes mellitus, hyperparathyroidism, hypothyroidism and osteoporosiscysts, tumors, radiation therapy, and bone dysplasia are relevant in planning oral rehabilitation with implants 1.

However, the successful use of implants in patients who have undergone radiotherapy, have received bone grafts and osseous free flaps, or have suffered from mucosal disease and even bone pathologies have been well documented, introducing a new field of discussion: In the first case, the dental implant was inserted in the diseased bone and, although histological evidence argues against true osseointegration, clinical success was supported by the lack of didplasia, mobility, inflammation and periimplant odsea loss 12.

In parallel, Bencharit et al. Displaska this report, the implants were installed in an area of supposedly “normal bone,” because no consideration about the local bone conditions had cfmento made. Panoramic radiograph yielded poor information about the local bone quality because it had low resolution in the anterior region that limited proper assessment of the area of interest. Nevertheless, the authors considered the rehabilitation to be successful after an observation period of 3 years.

Our experience in the present issea report, however, has shown that we are far from being fully informed about dysplastic bone behavior with respect to dental implants. We believe that COD should be seen as a restrictive risk factor, which should be carefully considered in these cases. Although we were unable to prove how much the technical variables of the surgical procedure interfered with implant failure, we strongly believe that the main reason for the failure is related to the manipulation of dysplastic bone, a hazardous procedure due to the nature of the disease.

Bone lesions in FCOD, especially in the mixed and mature phases, show a small amount of vascularized connective tissue and a great volume of dense avascular or hypovascular osteo-cementoid material. This dysplastic tissue lacks plasticity and could compromise post-surgical repair, directly affecting osseointegration.

These lesions can easily become infected and prone to necrosis 5. Accordingly, based on the findings from our case report and those reported by Bencharit et al.

Failure of dental implants in cemento-osseous dysplasia: a critical analysis of a case

COD can present different standards of clinicopathologic expression, considering the number of lesions and the stage of the disease. In some cases, COD xisplasia as multiple lesions FCOD in which lesions could appear to overlap each other in multiple quadrants, without or with a minimum of lesion-free bone among them.


In others, the disease is less expressive and dysplastic lesions are unevenly distributed through the bone. In this case, it is clearly possible to identify areas of normal bone among the lesions 57. In both situations, dysplastic bone can range from predominantly osteolytic fibroblastic to osteogenic partially or completely mineralized.

Progression from fibroblastic to mineralized lesions makes dysplastic bone hypovascularized and hard, compromising the tissue response to injuries.

Thus, considering the possibility of surgical procedures in patients with COD, a fundamental question arises: Is COD a self-limiting disease that is expressed solely in the areas where lesions are present, or are these lesions only local and temporary stages of a progressive syndromic picture expressed on an apparently healthy but primarily dysplastic bone susceptible to new lesions?

To answer the first dizplasia of the question, two points should be discussed as follows: At the first stage, the lesions are predominantly composed of a fibroblastic component when osseointegration cannot be achieved.

As the disease progresses from the middle to the last stage, lesions became osteo-cementoid in nature risplasia a hypovascular stroma. This dense hypermineralized dysplastic tissue has been associated with limited plasticity and high susceptibility to infection 5 – 7.

displasia cemento ossea florida e caninos impactados

Osteomyelitis has been reported as a consequence of surgical manipulation 7. On the other hand, looking at the second part of the question, the concept of apparently normal bone that is likely to develop dysplastic lesions leads to a highly unstable tissue environment that makes the dynamics of sisplasia healing an unpredictable phenomenon.

It should be noted that although the lesions in COD usually have considerable stability, cases have been described in which the disease shows a progressive developmental behavior reflected by an expansion of lesions or by a rise in the number of new lesions and simple bone cysts that advance to areas that were not originally affected 57 – It is true that we were not able to find reliable information about the temporal pattern of alterations for the COD lesions, especially cemejto the moment at which the lesions could be considered stabilized.

While this issue didplasia not have a definitive answer, it is crucial to consider apparently normal bone tissue as dysplastic bone and therefore vulnerable to the development of new lesions.

Thus, we suggest that COD should be seen as a limiting factor in the recommendation of dental implants and it is imperative to inform the patient about the risks associated with this disease. Int J Oral Maxillofac Surg. Oral rehabilitation with endosseous implants in a patient with fibrous cemneto McCune-Albright Syndrome: J Oral Maxillofac Surg. Oral rehabilitation with osteointegrated implants in oncologic patiens. Surgical and prosthodontic rehabilitation for patient with agressove florid cemento-osseous dysplasia.

Cemento-osseous dysplasia of the jaws in 54 japanese patients. Waldron CA, Giansanti JS, Browand BC, Sclerotic cemental masses of the jaws so-called chronic sclerosing osteomyelitis, sclerosing osteitis, multiple enostosis, and gigantiform cementoma.

A clinical-pathologic study of thirty-four cases. Florid cemento-osseous dysplasia in a young Indian woman. Cemento-osseous dysplasia with associated simple bone cysts. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License which permits unrestricted non-commercial use, distribution, and reproduction in any medium provided the original work is properly cited.

Services displaia Demand Journal. Clinical Report Displaia of dental implants in cemento-osseous dysplasia: February 24, ; Accepted: How cekento cite this article.