Periapical Cemento-Osseous Dysplasia with Suspected Secondary Infection

A 39-year-old male was referred by a general dentist for evaluation of pain in the mandibular anterior teeth. The radiographic findings were suggestive of intermediate-stage periapical cemento-osseous dysplasia on teeth #23 through #27, with suspected perforations in the adjacent cortices. The radiologist noted that with these findings, the possibility of secondary infection should be considered. When this fibro-osseous lesion becomes exposed to the oral environment, secondary infection with concomitant sequestration of the internal dense mass may occur, often leading to intense pain. This changes the clinical approach from treating it as a lesion that generally does not require intervention to one requiring prompt surgical removal of infected tissue by an oral surgeon. The radiologist noted that many general dentists may not be fully aware of the potential complications associated with this lesion, since it typically does not require treatment, and this lack of awareness may lead to delayed action.