CBCT features of florid cemento-osseous dysplasia with coexisting lesions at different maturation stages: a case report and literature review

Florid cemento-osseous dysplasia (FLCOD) is a begin fibro-osseous lesion occurring in the tooth-bearing regions of the jaws and is characterized by replacement of normal bone with fibrous connective tissue and cementum-like mineralized material. Most patients are asymptomatic and are diagnosed incidentally during radiographic examinations, and the condition may be misdiagnosed because of overlapping imaging features with other jaw lesions. Because the disease is usually asymptomatic and exhibits imaging features that overlap with those of several odontogenic and inflammatory lesions, accurate diagnosis remains challenging. Cone-beam computed tomography (CBCT) provides high-resolution three-dimensional imaging that facilitates assessment of lesion extent, internal mineralization, and relationships with adjacent anatomical structures. We report a case of FLCOD exhibiting lesions at different maturation stages and emphasize the diagnostic value of CBCT in clinical decision-making. A 41-year-old female presented with pain in the left mandibular posterior region for one week. Clinical examination revealed deep carious destruction of tooth 36 and occlusal caries involving teeth 46 and 47. Pulp vitality testing demonstrated loss of vitality in tooth 36, whereas all teeth associated with the cemento-osseous lesions responded normally. CBCT revealed bilateral multifocal mixed radiolucent–radiopaque lesions involving the posterior mandible characterized by well-defined borders, thin radiolucent rims, and variable internal mineralization corresponding to different maturation stages without obvious root resorption or cortical perforation or significant expansion. Based on the clinical findings, pulp vitality testing, and characteristic CBCT features, the patient was diagnosed with irreversible pulpitis of tooth 36, caries of teeth 46 and 47, and the cemento-osseous lesions were managed conservatively with periodic clinical and radiographic follow-up. CBCT plays a pivotal role in the diagnosis of FLCOD by accurately demonstrating lesion distribution, internal mineralization, and maturation stage. When interpreted together with pulp vitality testing, CBCT facilitates differentiation of FLCOD from inflammatory periapical lesions, reduces unnecessary invasive procedures, and supports appropriate long-term management.