Residual Cemental Dysplasia — ORE Part 1 MCQ

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HardOral PathologyResidual Cemental DysplasiaORE Part 1

A 25-year-old patient has an incidental radiographic finding during assessment for replacement of a missing lower right first premolar. At the centre of the healed extraction site is a small, well-defined, predominantly radiopaque lesion surrounded by a narrow radiolucent rim. The area is painless, shows no expansion and is not continuous with either adjacent tooth. What is the most likely diagnosis?

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Correct answer: D — Focal cemento-osseous dysplasia

D. Focal cemento-osseous dysplasia is the best diagnosis. It is a benign fibro-osseous dysplasia that is commonly asymptomatic and can occur in a previous extraction site. During maturation, mineralised material accumulates so that the lesion becomes predominantly radiopaque, but a narrow radiolucent peripheral rim remains. The incidental finding, absence of expansion and well-defined appearance are consistent with this process. A residual radicular cyst would be principally radiolucent rather than radiopaque. A peripheral osteoma is an exophytic bony mass arising from the cortical surface, not a lesion centred within a healed extraction site. Cementoblastoma can have a radiopaque centre and radiolucent halo, but it is characteristically fused to a tooth root; the stated lack of root continuity is decisive. A complex odontoma is a developmental lesion, usually related to an unerupted or obstructed tooth, making it less likely here.

Reference: Kumar Y, et al. Focal cemento-osseous dysplasia: A case report with a review of literature. Journal of Oral and Maxillofacial Pathology. 2020. The article describes asymptomatic mature lesions as radiopaque with a thin radiolucent rim. https://pubmed.ncbi.nlm.nih.gov/35491138/