OSSIFYING FIBROMA REVISITED: AN UPDATE ON CLASSIFICATION, PATHOGENESIS & MANAGEMENT

ABSTRACT Ossifying fibroma (OF) is a benign fibro-osseous neoplasm characterized by the replacement of normal bone with a fibrous stroma containing mineralized material in the form of bone and cementum-like tissue. It commonly affects the jaws, particularly the mandible, and originates from the periodontal ligament, which has the potential to form both osseous and cementum-like structures. Clinically, OF presents as a slow-growing, painless swelling causing facial asymmetry and tooth displacement. Radiographically, it appears as a well-circumscribed unilocular or multilocular radiolucent lesion that gradually becomes mixed radiopaque as calcification progresses. The lesion’s well-defined margins help distinguish it from fibrous dysplasia and other fibro-osseous pathologies. Histopathologically, the lesion consists of fibro cellular tissue containing trabeculae of woven or lamellar bone and cementum-like spherules. Based on clinical and histologic characteristics, OF is classified into conventional Cemento-Ossifying Fibroma (COF), Juvenile Trabecular Ossifying Fibroma (JTOF), and Psammomatoid Ossifying Fibroma (POF). Conventional COF is slow-growing and well-encapsulated, whereas the juvenile form exhibits aggressive behaviour with rapid expansion and a higher recurrence rate. Treatment primarily involves surgical excision, and recurrence is uncommon in conventional types but more frequent in juvenile variants. Early diagnosis through clinical, radiographic, and histopathological correlation is essential for effective management. Although prognosis is generally favourable, long-term follow-up is recommended to monitor for recurrence, especially in juvenile cases. Understanding the biological behaviour of each variant aids in selecting appropriate surgical strategies and improving patient outcomes. Keywords: Ossifying fibroma, Cemento-ossifying fibroma, Juvenile ossifying fibroma, Fibro-osseous lesion, Jaw tumors.