A case of florid cemento-osseous dysplasia with radiolucent and radiopaque lesions incidentally discovered resembling periapical disease

Yu Zhang ^* Yizhan Li Yabo Li Fangze Guo Shang Tang Jingjing Zheng Changqing Yuan

• The Affiliated Hospital of Qingdao University, Qingdao, China

Background: Florid cemento-osseous dysplasia (FLCOD), a rare and extensive disor-der of bone metabolism, exclusively occurs in the jaws. Patients typically have no obvi-ous self-perceived symptoms and are mostly identified incidentally through oral X-ray examinations. The initial stage of the disease presents as radiolucent or radiopaque le-sions and is prone to be confused with periapical granuloma, jaw cysts, and other condi-tions, leading to a high risk of misdiagnosis. Here, we report a case of FLCOD initially misdiagnosed as periapical disease. Case presentation: A 34-year-old Han Chinese woman who sought evaluation of her wisdom teeth in preparation for pregnancy. After X-ray examinations, radiolucent le-sions were incidentally found in the periapical areas of several teeth. Since the patient had never experienced symptoms such as toothache, she visited our hospital for further diagnostic workup and treatment. Cone-beam computed tomography (CBCT) and clini-cal examinations in our hospital confirmed the diagnosis of FLCOD, and regular obser-vation was suggested. The patient remained asymptomatic throughout the one-year ob-servation period. Conclusion: In clinical practice, FLCOD is frequently mistaken for a chronic periapical disease, leading to root canal therapy. Dentists, especially endodontists and oral and maxillofacial surgeons, should be familiar with these conditions to avoid misdiagnosis or inappropriate intervention.