Restor Dent Endod.  2013 Aug;38(3):160-166.

Misdiagnosis of florid cemento-osseous dysplasia leading to unnecessary root canal treatment: a case report

• Huh JK
• Shin SJ

Abstract

This case report demonstrates an unnecessary endodontic treatment of teeth with florid cemento-osseous dysplasia (FCOD) due to a misdiagnosis as periapical pathosis and emphasizes the importance of correct diagnosis to avoid unnecessary treatment. A 30-year-old woman was referred to our institution for apicoectomies of the mandibular left canine and both the lateral incisors. The periapical lesions associated with these teeth had failed to resolve after root canal treatment over a 3-year period. Radiographic examinations revealed multiple lesions on the right canine, the second premolar, and both first molars as well as the anterior region of the mandible. Based on clinical, radiographic and histological evaluations, the patient condition was diagnosed as FCOD. The patient has been monitored for 2 years. To avoid unnecessary invasive treatment, accurate diagnosis is essential before treatment is carried out in managing FCOD.

Keyword

Diagnostic error; Florid cemento-osseous dysplasia (FCOD); Periapical disease; Root canal treatment

MeSH Terms

Apicoectomy
Bicuspid
Dental Pulp Cavity
Diagnostic Errors
Female
Fibrous Dysplasia of Bone
Humans
Incisor
Mandible
Molar
Osteomyelitis
Periapical Diseases
Tooth
Fibrous Dysplasia of Bone
Osteomyelitis

Figure

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  Figure 1 A series of panoramic radiographs obtained during a previous dental consultation. (a) A panoramic radiograph obtained in February, 2005 (4 years before the initial visit to our institution) when the patient's dentist initiated orthodontic treatment. Slight periapical radiolucency on #32, 33, and 42 was detected; (b) A panoramic radiograph obtained in October, 2005 when the root canal therapies were performed on #32, 33, and 42; (c) A panoramic radiograph obtained in 2007; (d) A panoramic radiograph obtained in 2008. Compared with the radiographs in 2005, the size of the lesion in the mandibular incisors increased, and a mixed radiopaque and radiolucent area was clearly distinguishable in the apical areas of the right first molar, right second molar, and left first molar.

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  Figure 2 Radiographic examinations performed at the initial visit (in April, 2009) of the patient. (a) A panoramic radiograph showing multiple mixed radiopaque and radiolucent areas at the apices of the mandibular teeth; (b) A periapical radiograph of the lower anterior teeth. Two incisors and left canine were endodontically treated and an implant was included in the apical lesion.

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  Figure 3 Computed tomography (CT) images at the initial visit. (a) A panoramic reconstruction of the CT images at the level of the apices. Multiple lesions bony lesions were detected; (b) Axial images of #42, 32, and 46 at the apical level. Mixed radiopaque and radiolucent lesions as well as cortical bone perforation were observed; (c) Vertical images showing thinning and perforation of the cortical plate without any expansion.

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  Figure 4 Results of examination of the excisional biopsy specimens. (a) Gross appearance of the specimens. The largest specimen was 7.0 × 5.0 × 5.0 mm; (b) A histologic examination showed bony trabeculae mixed with cellularity in the stroma (hematoxylin-eosin stain, ×50).

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  Figure 5 Radiographic examinations performed in 2011. A panoramic reconstructed image of cone-beam computed tomography (CBCT) obtained in September, 2011 (21 months after the biopsy).

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