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Periapical Cemental Dysplasia — MFDS Part 1 MCQ

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HardRadiologyPeriapical Cemental DysplasiaMFDS Part 1

A 48-year-old woman has an incidental radiographic finding associated with the mandibular incisors. The teeth are unrestored and asymptomatic, respond normally to pulp sensibility testing and show no mobility or tenderness. Periapical radiographs demonstrate several well-defined periapical radiolucencies with thin sclerotic margins; one contains a small central radiopaque focus. There is no root resorption or bony expansion. What is the most likely diagnosis?

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Correct answer: A — Periapical cemento-osseous dysplasia

The diagnosis is periapical cemento-osseous dysplasia. Its characteristic setting is an incidental, often multifocal lesion around vital mandibular anterior teeth. Early lesions are radiolucent and may have a sclerotic margin; small internal radiopacities develop as the lesion enters its mixed maturation stage. Normal pulp sensibility and the absence of an infective cause distinguish it from a radicular cyst or periapical granuloma, which ordinarily arise from pulpal necrosis. A benign cementoblastoma is usually a solitary radiopaque or mixed mass fused to a tooth root, often with expansion and a radiolucent halo. Hypercementosis produces bulbous thickening continuous with the root rather than a separate periapical radiolucency.

Reference: Li Y et al. Why was the concordance rate of imaging and clinical diagnosis in cemento-osseous dysplasia low? A retrospective study of 55 cases. BMC Oral Health. 2026;26:537. https://pubmed.ncbi.nlm.nih.gov/41723446/