Nonneoplastic

Nonneoplastic Diseases of Bone refers to conditions associated with decreased bone mass. These conditions can be localized to specific bones or may affect the entire skeleton, including but not limited to the limb, entire skeleton, and skull.

Cemento-osseous Dysplasias

Cemento-osseous dysplasias are benign conditions classified based on their extent and radiographic appearances into three main groups:

Periapical Cemento-Osseous Dysplasia

• Affects the periapical bone and is often referred to as Cementoma.

• Commonly occurs in the anterior mandible, predominantly found in women, particularly black women, over 30 years of age.

• Early lesions are well-circumscribed and radiolucent; they can mimic periapical disease, leading to diagnostic challenges.

• Teeth in the affected area typically remain vital unless they are carious or traumatized.

• The lesions consist of fibrous connective tissue interspersed with calcifications, giving them a unique appearance in radiographs.

• Diagnosis: Usually asymptomatic; identified via x-rays showing characteristic features, although a biopsy may be needed in uncertain cases.

• Treatment: None required if asymptomatic, but monitoring may be necessary to ensure no changes occur.

Focal Cemento-Osseous Dysplasia

• An asymptomatic fibro-osseous lesion that exhibits distinctive radiographic features.

• Commonly occurs in women aged 30 to 50, with higher prevalence in white individuals, and is most often found in the posterior mandible.

• Appears as an isolated, well-delineated radiolucent-to-radiopaque lesion typically under 1.5 cm in size.

• Diagnosis: A biopsy is required for confirmation; the histological composition consists of both soft and hard tissue components.

• Treatment: Surgical removal is necessary if the diagnosis is confirmed; no further treatment is required after diagnosis.

• Prognosis: Generally excellent; however, there is a risk of progression to florid cemento-osseous dysplasia.

Florid Cemento-Osseous Dysplasia

• Characterized by irregular radiopaque masses, predominantly affecting black women over 40.

• The condition frequently affects multiple quadrants of the maxilla and mandible, primarily in the posterior areas.

• Composed of irregular opacification masses; an early radiolucent phase may occasionally be identified.

• Diagnosis: Based on characteristic clinical and radiographic presentations, including the pattern of lesions.

• Treatment: Often unnecessary, but may require intervention in edentulous patients due to potential complications such as osteomyelitis.

Fibrous Dysplasia

Characterized by the replacement of normal bone with abnormal fibrous connective tissue containing varying amounts of calcification.

• This condition is classified as benign fibro-osseous lesions with distinct borders that blend into the surrounding normal bone.

• Types:

  • Monostotic Fibrous Dysplasia:

    • The most common type, affecting a single bone (often the maxilla).

    • It is more prevalent in children and young adults, typically presenting as painless swelling.

  • Polyostotic Fibrous Dysplasia:

    • Involves multiple bones and is typically seen in children.

    • Associated with skin lesions known as café au lait spots.

    • Can present with Albright syndrome, which includes endocrine abnormalities such as precocious puberty and irregular skeletal development.

Paget Disease of Bone

Also known as Osteitis deformans, this is a chronic metabolic bone disease characterized by phases of resorption, osteoblastic repair, and remineralization:

• Occurs primarily in men over 50 and affects the pelvis and spinal column.

• Symptoms can include severe pain, changes in dental spacing due to bone growth, and potentially headaches or dizziness if the skull is involved.

• Radiographically, Paget disease displays a cotton-wool appearance with an early phase showing hypercementosis of teeth.

• Diagnosis: An elevated serum alkaline phosphatase level is a key diagnostic marker.

• Treatment: Remains mostly experimental with the need for close monitoring due to risks of complications such as the development of malignant tumors.

Central Giant Cell Granuloma

This is a non-neoplastic lesion with an unclear pathogenesis, primarily occurring in the maxilla or mandible among young individuals. Characterized by well-vascularized connective tissue with multinucleated giant cells.

• Radiographically, it presents as a radiolucency with possible unilocular or multilocular features and may show divergence of the roots of adjacent teeth.

• Treatment: Surgical removal of the lesion is necessary, though recurrence is a possibility.

Osteomalacia

Results from calcium deficiency and is particularly prominent in children (referred to as Rickets).

• Osteomalacia leads to delayed tooth eruption and potential periodontal disease, along with the risk of pathologic fractures occurring.

• Treatment: Involves nutritional supplementation with vitamin D and dietary calcium to restore normal bone mineralization, along with addressing any dietary deficiencies.