Cemento-ossifying fibroma is classified as an osteogenic tumor, defined as a well -differentiated tumor, occasionally encapsulated, comprising fibrous tissue. Abstract. Introduction: Cemento-ossifying fibroma is a benign fibro-osseous maxillary tumor belonging to the same category as fibrous dysplasia and. Background: Cemento-Ossifying Fibroma (COF) is considered by most as relatively rare, benign, non-odontogenic neoplasm of the jaw bones and other.

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June 08, ; Accepted date: June 25, ; Published date: Adv Cancer Prev 1: This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Visit for more related articles at Advances in Cancer Prevention.

Cemento-Ossifying Fibroma COF is considered by most as relatively rare, benign, non-odontogenic neoplasm of the jaw bones and other craniofacial bones characterized by replacement of normal bone by fibrous tissue and varying amounts of newly formed bone or cementum-like material, or both. It commonly affects, adults between the third and fourth decade of life and often shows variations in clinical, radiographic, and histopathologic features, hence require different treatment options.

This paper attempts to diagnose a case of cemento-ossifying fibroma of the jaw not only based on clinical characteristics but also radiographic and histopathologic features as an adjunct. The patient was diagnosed with cemento-ossifying fibroma, presenting its clinical presentation, diagnostic imaging and histopathology features, as well as its surgical treatment. The diagnosis of cemento-ossifying fibroma of the jaw can be established based on clinical, radiographic and histo-pathological features.

It is a benign growth, considered to originate from the periodontal ligament and presents as a slow-growing lesion, but may cause deformity if left untreated. However, these tumors may exhibit variations in their neoplastic behaviours. It is often encapsulated and predominantly located in the mandible, and the definitive diagnosis of these lesions requires integration of its clinical, radiological and histological features. We present a case of cemento-ossifying fibroma in relation to the lower left one-third of the face, and its management.

Fibro-osseous lesions are a heterogeneous group of benign lesions of unknown aetiology affecting the jaws and other craniofacial bones, which are characterized by the replacement of normal bone by fibrous tissue, which contains a newly formed, mineralized product [ 1 ]. Over the last several decades, fibro-osseous lesions have evolved which includes two major entities: Cementoossifying fibroma is considered by most as relatively rare, benign, nonodontogenic neoplasm of the jaw bone.

With female predilection over men 5: Clinically, these tumours manifest as a slow-growing intra-bony asymptomatic mass, over a period of time lesion may become large enough to cause facial asymmetry. Radiologically, cemento-ossifying fibroma shows a number of patterns depending on the degree of maturation of the fibdoma. Histologically, these tumours are composed of well vascularized fibrocellular tissue with the capacity to form immature bone trabeculae and cementoid formations, though these findings are not specific of the lesion and can also be seen in fibrous dysplasia.


A definitive diagnosis therefore requires correlation of the clinical, radiological and histological findings [ 4 ]. A 27 years old female patient reported to the outpatient department with a chief complaint of pain in the lower left back tooth region since a week. She gave history of sudden onset, with lancinating type of pain which is severe in nature. Pain aggravates on chewing food, on taking any hot and cold fluids and relieves on ossiyfing own after sometime.

Pain is associated with mild swelling which she noticed 15 days back and there was no increasing ossifying size since then and not associated with any discharge, trauma or paraesthesia.

On palpation, soft to firm in consistency with no signs of tender, crepitus and non-fluctuant. A single left submandibular lymph node, mobile, non-tender, firm, measuring approximately about 0. On intraoral examination, a deep occlusal wear facet is seen in relation to cmeento which was non tender on percussion Figure 2.

Cemento-ossifying fibroma More C, Thakkar K, Asrani M – Indian J Dent Res

Needle aspiration was negative. Based on the patient’s history and clinical findings, the case was provisionally diagnosed as benign odontogenic tumour in relation to lower left buccal vestibule of Clinical differential diagnosis of radicular cyst ameloblastoma, odontogenic keratocyst, and odontogenic myxoma were considered. An Intra-Oral Periapical Radiograph IOPAR shows, well defined radiolucency involving enamel and dentin in relation to 36 with no abnormality in periodontal ligament space but apical root shows irregularities is seen fibrooma relation to 35 and 36 indicating external root resorption with diffuse radiolucency interspersed radiopaque foci can be appreciated at the periapical region of 35 and 36 Figure 3.

Intra-oral view showing deep occlusal wear facet in relation to 36 and mild obliteration of buccal vestibule. IOPAR view showing external root resorption in relation to 35, 36 and 37 ifbroma mixed periapical radiolucency with radioopacification. Panoramic radiograph shows a well-defined mixed radiolucent and radiopaque lesion on left side of mandible extending from distal root of 34 to mesial root of 37 with radiolucent scalloped border without any cortication is seen.

Case Reports in Dentistry

Root resorption can be appreciated with respect to 34, 35, 36, 37 and inferior alveolar canal has been pushed inferiorly Figure 4. A lateral occlusal mandibular radiograph shows mild buccal cortical plate expansion with respect to 36 and 37 Figure 5. Orthopantamograph view well-defined mixed radiolucent and radiopaque lesion on left side of mandible extending from distal root of 34 to mesial root of 37 with radiolucent scalloped border can be appreciated.

Root resorption can be appreciated in relation to 34, 35, 36, 37 with displacement of inferior alveolar canal. An incisional biopsy was performed, histological examination revealed as tightly cellular connective tissue stroma with abundant spindle shaped hyperchromatic fibroblasts and sparely collagen fibres along ossifynig scattered numerous irregular shaped basophilic cementum like tissue.

Along with this, bone like tissue is also evident in the form of irregular trabeculae with osteocytes in lacunae Figure 6. Histopathological picture showing tightly cellular connective tissue stroma with abundant hyperchromatic fibroblasts and sparely collagen fibres along with scattered irregular shaped basophilic crmento like tissue. Periphery shows few blood vessels and numerous extravasated red blood cells. Based on radiological and histological findings, case was diagnosed as central cemento-ossifying fibroma.


Complete surgical removal of the lesion was done Figures 7 and 8 and patient was reviewed after 4 months Figure 9. Intra-operative view showing extracted tooth with fragmented bone lesion.

Post-operative radiograph showing healed enucleated alveolar bony pattern.

Fibro-osseous lesions of the jaws have been classified by Waldron and Kramer et al. Various classifications were proposed to classify these lesions, Menzel [ 6 ] gave the first description of a variant of ossifying fibroma, which was a benign fibro-osseous neoplasm, calling it as a cemento-ossifying fibroma in Larger lesions with size over 80 mm in their greatest diameter have been termed as giant ossifying fibroma [ 7 ].

The recent WHO edition of the classification of odontogenic neoplasms has replaced the term Cemento-ossifying fibroma with Ossifying Fibroma [ 8 ].

The origin of cemento-ossifying fibroma is not clearly understood, in most of cases reported in literature have found to have history of trauma which is ossifiyng seen in our case. Few authors have considered that these lesions arose either by reactive or developmental origin, from the periodontal membrane which contains multi-potential cells, that under certain pathologic conditions, are capable of producing tumours which are composed of cementum, lamellar bone or fibrous tissue [ 9 ].

Based on their pathogenesis, Waldron, insubclassified cemento-ossifying fibroma as medullary or periodontal ligamentous in origin [ 1 ].

A more aggressive form of COF which occurs in younger individuals has been designated as Juvenile cemento-ossifying fibroma [ 10 ]. The recommended treatment for COF cemennto complete excision of the tumour. The entire tumour should be removed along with the involved site. They are insensitive to radiotherapy and recurrences are uncommon. The aetiology for such type of cases may be because of history of trauma [ 12 ] as it acts a possible triggering factor, postulating the lesion to be a connective tissue reaction rather than a cwmento neoplasm [ 13 ].

An interdisciplinary ossiffying is required [ 14 ] to diagnose a COF from clinical, radiographic and microscopic features. The present case shows all the features related to cement-ossifying fibroma whose aetiology is of unknown origin and added one more incidence of COF and will be helpful in the literature.

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