POD Multiple Lower Anterior — ORE Part 1 MCQ

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ModerateRadiology & ImagingPOD Multiple Lower AnteriorORE Part 1

A patient has an incidental, well-defined radiolucency around the apices of several vital lower anterior teeth. The lesion extends between adjacent roots, causes no root resorption or tooth displacement, and is unchanged on serial radiographs obtained over 3 years. What is the most likely diagnosis?

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Correct answer: B — Periapical cemento-osseous dysplasia

The diagnosis is periapical cemento-osseous dysplasia (PCOD), in its early radiolucent stage. PCOD characteristically occurs around the apices of vital mandibular anterior teeth, is often asymptomatic, and evolves from radiolucent to mixed and then radiopaque appearances. The absence of root resorption, tooth displacement and radiographic progression supports a benign dysplastic process. Periapical granulomas and radicular cysts are inflammatory lesions associated with pulpal necrosis, so are not expected around multiple vital teeth. Ameloblastoma usually enlarges progressively and commonly produces expansion, root resorption or displacement. Langerhans cell histiocytosis is destructive rather than a stable, non-expansile periapical lesion. Pulp sensibility testing is therefore a key discriminator before considering endodontic treatment.

Reference: Consolaro A, Hadaya O, Consolaro RB. A contraindication to orthodontic and endodontic treatment: periapical cemento-osseous dysplasia. Dental Press Journal of Orthodontics. 2020. https://pubmed.ncbi.nlm.nih.gov/7898799/