other bone diseases

lecture given 6/2/2026

bone dysplasias

fibrous dysplasia, cemento osseous dysplasia (COD)

other lesions of bone

central giant cell granuloma, aneurysmal bone cyst, cherubism, paget’s disease

fibrous dysplasia

normal bone metabolism replaced by fibrous tissue containing varying amounts of abnormal appearing bone

solitary/monostotic ~70%

most common sites are ribs, femur, tibia, maxilla, mandible

older age group individuals

multiple/polystotic more common in ~10 yo

what are radiographic features of fibrous dysplasia?

maxilla > mandible 2:1, posterior aspect and unilateral more often

ill defined, blending of the trabseculae into abnormal pattern, in young lesions it will appear corticated

density and trabecular pattern varies considerable, radiolucent, mixed and radiopaque, short/thin/irregularly shaped trabeculae

small lesions have no effects on surrounding structures, larger lesions can expand, thin the cortex, PDL space may be decreased/displace/or interfere with eruption, in rare cases root resorption, displace the canal in superior direction

DD: hyperparathyroidism, paget’s, PCD

fibrous dysplasia

fibrous dysplasia

fibrous dysplasia

fibrous dysplasia

what is this, and how can you tell?

fibrous dysplasia

shape is maintained, it just grows bigger

fibrous dysplasia

fibrous dysplasia

cemento-osseous dysplasias

periapical cemento-osseous dysplasia, florid osseous dysplasia

periapical cemento-osseous dysplasia

aka cementoma, fibrocementoma, sclerosing cementoma, periapical fibrocementoma, periapical osteofibrosis, periapical fibrous dysplasia

localized change in normal bone metabolism, resulting in cancellous bone replaced by fibrous tissue and cementum like material

middle aged women, females > males, more common in asians, blacks, and hispanics

radiographic features of periapical cemento-osseous dysplasia

apical to the root apex, mandibular anteriors more often but can occur at any tooth

well defined, corticated, round, or oval, sometimes irregular, secondary infection sclerotic

early stage radiolucent, intermediate mixed, mature stage radiopaque

loss of PDL space, widened PDL, expansion

DD: rarefying osteitis, inflammatory lesions, cementoblastoma

periapical cemento-osseous dysplasia

periapical cemento-osseous dysplasia

periapical cemento-osseous dysplasia

periapical cemento-osseous dysplasia

focal cemento osseous dysplasia

focal cemento osseous dysplasia

florid osseous dysplasia

florid cemento-osseous dysplasia, gigantiform cementoma, familial multiple cementoma

FCOD is wide spread PCD, normal cancellous bone replaced by fibrous tissue and cemento-osseous tissue, poorly vascularized

same clinical features as PCD, females > males, asians, blacks, hispanics, occasionally involved with SBC

what are radiographic features of florid osseous dysplasia?

bilateral and in both jaws or throughout in one jaw, apical to the teeth (>/= 2 quadrants)

well defined, corticated borders

radiolucent, radiopaque and mixed depending on the stage of the lesion, irregular amorphous calcifications

can displace IAN, expansile

DD: paget’s, sclerosing osteomyelitis

*

florid osseous dysplasia

*low vascularity

florid osseous dysplasia

florid osseous dysplasia

florid osseous dysplasia

central giant cell granuloma

aka giant cell reparative granuloma, giant cell lesion, giant cell tumor

thought to be a reactive lesion, w/ unknown stimulus

60% in young individuals ~20’s, slow growing with some rapid growth

what are the radiographic features of central giant cell granuloma?

mandible > maxilla 2:1, anterior to the 1st molar

periphery may not have cortication, the lesion is well defined in the mandible, maybe ill defined in the maxilla

radiolucent, wispy septa

displace and resorb teeth and roots, expansile, missing lamina dura, displaced IAC, may have an uneven undulating appearance

DD: ameloblastoma, odontogenic myxoma, aneurysmal bone cyst

central giant cell granuloma

central giant cell granuloma

central giant cell granuloma

aneurysmal bone cyst

believed to represent an exaggerated localized proliferative response of vascular tissue in bone

rapid bony swelling, tenderness on palpation, pain occasionally

what are radiographic features of aneurysmal bone cyst?

mandible > maxilla, ramus and molar > anterior region

well defined and circular or hydraulic

small lesion, no internal structure evidence, larger lesions have mutlilocular appearance, septa are at right angle to outer cortex

as the lesion expands the cortical plates expand, can displace and resorb teeth

DD: giant cell granuloma

aneurysmal bone cyst

aneurysmal bone cyst

aneurysmal bone cyst

aneurysmal bone cyst

what is this and what is the white arrow pointing at?

aneurysmal bone cyst

blood

cherubism

*aka familial fibrous dysplasia

rare inherited autosomal dominant disease

age 2-6, bilateral enlargement of lower face

what are the radiographic features of cherubism?

bilateral affecting both jaws, when it is present in one jaw most often in mandible

well defined with some corticated borders

septated, wispy septa, multilocular appearance

expand the cortical plates, displace teeth in some instances tooth buds are destroyed

DD: fibrous dysplasia, BCNS

cherubism

cherubism

paget’s disease

aka osteitis deformans

abnormal resorption and apposition of osseous tissue in one or more bones

males > females 2:1, older than 40 yo, ill defined neurologic pain

what are the radiographic features of paget’s disease?

pelvis, femur, skull and vertebrae, infrequently jaws, maxilla > mandible 2:1

depending on the stage of development of the disease internal structure can vary from radiolucent to mixed to radiopaque, increased bone density

pagetoid skull 3 to 4x the normal skull thickness

*what is this, and how do you know?

paget’s disease

cotton wool appearance of skull

paget’s disease

paget’s disease