Fibrous Dysplasia vs. Segmental Odontomaxillary Dysplasia on Implant Evaluation

A 46-year-old female was referred by a general dentist for evaluation of the right maxillary edentulous area for implant placement. The patient had a history of multiple supernumerary teeth in the area when she was younger, along with a prior surgery in which she reported that "cement" was placed. During full-volume review, the radiologist identified a well-localized, high-density, mildly expansile lesion with a largely dense, amorphous bone appearance, but also areas of dense ground glass pattern and cotton-wool pattern. Vertically-oriented, thick trabeculae were also appreciated. The radiographic findings were suggestive of fibrous dysplasia versus segmental odontomaxillary dysplasia, though bone grafting could not be ruled out in a portion of the lesion. The radiologist noted that segmental odontomaxillary dysplasia is a rare condition that was considered due to the vertically-oriented trabeculae combined with the observed and reported tooth abnormalities, including external root resorption and partly calcified pulp spaces. These pathologic conditions are characterized by abnormal bone, and the radiographically dense appearance likely suggests decreased blood supply. The radiologist recommended caution with any surgical procedures in the area, as the findings would likely change the referring dentist's treatment plan. Comparison with prior imaging and consideration of surgical history was also recommended to further delineate between the two conditions.