Clínica, epidemiología e imagenología del fibroma osificante y la displasia fibrosa del territorio cráneo-maxilofacial: revisión narrativa / Clinical, epidemiology and imaging of ossifiying fibroma and fibrous dysplasia of the cranio-maxillofacial territory: narrative review

Introducción: El fibroma osificante (FO) y la displasia fibrosa (DF) tienen características imagenológicas e histopatológicas similares que dificultan el diagnóstico diferencial. El propósito de la presente revisión narrativa es analizar las características clínicas, epidemiológicas e imagenológicas del FO y la DF, y evaluar la relación entre las características imagenológicas y las variantes histopatológicas del FO, en reportes y series de casos publicados.Materiales y métodos:Se realizó una búsqueda de reportes y series de casos de FO y DF entre 2017-2021 en PubMed, Scopus y Web of Science. Los casos debían tener suficiente información clínica, epidemiológica, histopatológica e imagenológica.Resultados:Se incluyeron 23 artículos con 25 lesiones: 17 FO y 8 DF. El tiempo de evolución de DF es más prolongado que FO. FO se ubica con mayor tendencia en complejo osteomeatal en comparación con DF. Sólo FO presentó alteraciones en piel, radiolucidez/hipodensidad periférica, perforación ósea y rizalisis externa, además, tuvo mayor tendencia al avance a espacios anatómicos adyacentes y a generar asimetría facial y/o craneal. FO psammomatoide y FO trabecular comparten patrones imagenológicos y tienen límites definidos corticalizados. FO convencional tuvo mayor tendencia a perforar corticales. DF puede tener límites mal definidos y definidos corticalizados. El FO mostró características imagenológicas de mayor agresividad que la DF.Conclusiones:La histología e imagenología por sí solas no son decisivas en el diagnóstico de FO y DF. Es imprescindible considerar conjuntamente clínica, imagenología e histopatología, enfatizando en las características que orienten el diagnóstico diferencial.(AU)

Introduction: Ossifying fibroma (OF) and fibrous dysplasia (FD) have similar imaging and histopathological characteristics, which make differential diagnosis difficult. The aim of this narrative review was to analyze the clinical, epidemiological and imaging characteristics of OF and FD, as well as to evaluate the relationship between imaging characteristics and histopathologic variants of OF, in reports and case series published.Materials and methods:A search of reports and case series of OF and FD between 2017-2021 in PubMed, Scopus and Web of Science was performed. The cases had to have enough clinical, epidemiological, histopathological and imaging information.Results:23 articles with 25 lesions were included: 17 OF and 8 FD. FD had a longer time of evolution than OF. OF is more likely to be in osteomeatal complex compared to FD. Only OF had skin alterations, peripheral radiolucency/hypodensity, bone perforation and external root resorption, in addition, it had a greater tendency to advance to adjacent anatomical spaces and generate facial and/or cranial asymmetry. Psammomatoid OF and trabecular OF share imaging patterns and have defined and corticated margins. Conventional OF had a greater tendency to cortical perforation. DF can have ill-defined and defined and corticated margins. OF has imaging characteristics of greater aggressiveness than FD.Conclusion:Histology and imaging alone are not decisive in OF and FD diagnosis. It is essential to consider clinical, imaging and histopathological evaluations as a whole, emphasizing in the characteristics that guide the differential diagnosis.(AU)

A large-cohort study of 2971 cases of epulis: focusing on risk factors associated with recurrence.

BACKGROUND: To analyze the clinicopathological features of different histological subtypes of epulis, and evaluate the risk factors associated with recurrence. MATERIALS AND METHODS: A retrospective study including 2971 patients was performed. The patients' sex, age, location, size, histological subtypes, recurrence information, oral hygiene habits, periodontitis symptoms and smoking history were retrieved from the patient medical records and follow-up information. RESULTS: Among the 2971 cases, focal fibrous hyperplasia (FFH) was the most common lesion (60.92%), followed by peripheral ossifying fibroma (POF) (29.32%), pyogenic granuloma (PG) (8.08%) and peripheral giant cell granuloma (PGCG) (1.68%). The peak incidence of epulis was in the third and fourth decade of life, with a mean age of 45.55 years. Female predominance was found in all types of lesions with a female to male ratio of 1.71:1. PG had the highest recurrence rate (17.18%), followed by POF (12.98%), FFH (9.55%) and PGCG (8.82%). Histological subtypes were significantly correlated with the recurrence of epulis (P = 0.013). Regular supportive periodontal therapy (P = 0.050) had a negative correlation with recurrence, whereas symptoms of periodontitis (P < 0.001) had a positive correlation with the recurrence of epulis. CONCLUSIONS: Controlling the periodontal inflammation and regular supportive periodontal therapy might help reduce the recurrence of epulis.

Gingival and alveolar mucosal reactive hyperplastic lesions: a retrospective clinical and histological study of 996 cases.

BACKGROUND: gingival/alveolar mucosal reactive hyperplastic lesions (GRHL), including fibrous hyperplasia (FH), pyogenic granuloma (PG), peripheral ossifying fibroma (POF) and peripheral giant cell lesion (PGCL), are a common group of oral diseases. The aim of the present study was to access the frequency and distribution of the clinical and histological features of these disorders in a Brazilian population. MATERIAL AND METHODS: all specimens diagnosed as GRHL in three Oral Pathology laboratories were selected for the study. Clinical information was retrieved from the laboratory biopsy forms and hematoxylin and eosin stained histological slides were reviewed for analysis of the histological characteristics. RESULTS: final sample was composed of 996 specimens, including 463 FH (47%), 280 PG (28%), 183 POF (18%) and 70 PGCL (7%). Females were more affected by FH, PG, and POF, and most cases affected adults with mean ages ranging from 40 to 53 years. FH, PG, and POF were more common in the upper gingiva/alveolar mucosa. Most PG, POF and PGCL were pedunculated, in contrast with FH (p<0.001). PG, FH and POF were mostly red or normal mucosal in color, while PGCL were mostly red/purple (p<0.001). PGCL were larger, followed by POF, FH and PG (p<0.001). Some histological features were characteristically found in some conditions, but they were also encountered in other lesions with variable frequencies. CONCLUSIONS: Oral medicine specialists, oral pathologists and periodontists are usually the professionals in contact with patients presenting GRHL and it is of upmost relevance that they should be familiarized with their clinical and histological profile.

Clínica, epidemiología e imagenología del fibroma osificante y fibroma cemento osificante: revisión de casos reportados en la literatura / Clinic, epidemiology and imagenology of the ossifying fibroma and cemento ossifying fibroma: a review of cases reported in the literature

Introducción: El fibroma osificante (FO) y el fibroma cemento osificante (FCO) son patologías distintas, que hasta el 2017 se consideraban como una. A la fecha no se han comparado las características del FO y el FCO. La presente revisión tuvo como objetivo analizar características clínicas, epidemiológicas e imagenológicas del FO y FCO en los casos publicados. Materiales y métodos: Se realizó una búsqueda de casos clínicos de FO y FCOpublicados desde el año 2015 en PubMed, Scopus y Web of Science, mediante la estrategia de búsqueda ("Ossifying Fibroma" OR "Cemento Ossifying Fibroma") AND (Craniofacial OR Jaws). Los casos debían presentar información clínica, imagenológica e histológica suficientes para confirmar su diagnóstico, patrón histológico y comparar sus características. Revisión: Se incluyeron 32 artículos, con 32 casos y 34 lesiones, siendo 6 FCO y 28 FO. Los FO y FCO se diferencian por su edad y ubicación: mientras los FCO se presentan en edades adultas, exclusivamente en los maxilares y en relación con tejidos dentarios, los FO lo hacen principalmente en niños y jóvenes, y en cualquier hueso. Los FO y FCO tienen las mismas características imagenológicas: son lesiones uniloculares o multiloculares, con distintos grados de radiodensidad, límites definidos y una radiolucidez periférica. Sin embargo, los casos de FO trabecular pueden no presentar esta radiolucidez periférica. Conclusión: Los FO y FCO son patologías, clínica y epidemiológicamente similares, y con las mismas características imagenológicas. Por lo que establecer diferencias histológicas es esencial para un correcto diagnóstico. (AU)

Introduction: Ossifying fibroma (OF) and cemento ossifying fibroma (COF) are different pathologies, which until 2017 where considered as one. To date, the features of OF y COF have not been compared. This aim of this review was to analyze clinical, epidemiological and imaging features of OF and COF in published case reports. Materials and methods: A search of clinical cases of OF and COF published since 2015 was performed on PubMed, Scopus and Web of Science, using the search strategy ("Ossifying Fibroma" OR "Cemento Ossifying Fibroma") AND (Craniofacial OR Jaws). The cases had to haveenough clinical, imaging and histological information to confirm their clinical diagnosis, histological pattern and compare their features. Review: 32 articles were included, with 32 cases and 34 lesions, being 28 OF and 6 COF. OF and COF differ by age and location: while COF occur in adult ages, exclusively in the jaws and in relation to dental tissues, OF occur mainly in children and young people, and in any bone. OF and COF have the same imaging characteristics: they are unilocular or multilocular lesions, with different degrees of radiodensity, defined limits and a peripheral radiolucent area. However, cases of trabecular OF may not present this peripheral radiolucent area. Conclusions: OF and COF are similar pathologies clinically and epidemiologically, with the same imaging characteristics. So, establishing histological differences is essential for an accurate diagnosis. (AU)

The importance of clinical and radiological findings for the definitive histopathologic diagnosis of benign fibro-osseous lesions of the jaws: Study of 276 cases.

PURPOSE: Benign fibro-osseous lesions (BFOLs) are heterogeneous intraosseous disease processes sharing overlapping histopathologic features and demonstrate a wide range of biological behavior. The aim of this study is to highlight the importance of clinical and radiological findings for the definitive histopathologic diagnosis of benign fibro-osseous lesions of the jaws. MATERIALS AND METHODS: This is a cross-sectional retrospective study evaluating the three main groups of BFOLs: Cemento-osseous dysplasia, ossifying fibromas, and fibrous dysplasia. Previously diagnosed BFOL cases were searched for thoroughly from the archives of Istanbul University, Institute of Oncology, Department of Tumor Pathology in between 2005 and 2015. Clinical and radiological data of these cases were identified and recorded. The histopathologic features were reevaluated from the H&E-stained slides. RESULTS: A total of 276 BFOL cases were identified and reevaluated for the study. The most common BFOL type was cemento-osseous dysplasia (n = 135), followed by cemento-ossifying fibroma (n = 77), fibrous dysplasia (n = 53) and juvenile ossifying fibroma (n = 11). The female/male ratio was 3.4:1 with a strong predilection for the 4th decade (n = 102). The mandible (n = 209) was the predominantly affected jaw. Prominent osteoblastic rimming around the bony lesion was commonly observed for cemento-ossifying fibroma (n = 60/77), followed by cemento-osseous dysplasia (n = 23/135). Predominant ossification patterns showed some differences among the groups. The most common radiological feature was the mixed radiolucent/radiopaque internal structure. CONCLUSION: Our results document various clinical, radiological and histopathologic findings of BFOLs. Even some histopathologic differences are observed, clinical and radiographic correlation is mandatory prior to the definitive histopathologic diagnosis of BFOLs for the prevention of possible misdiagnoses or inappropriate treatments.

A Clinical Audit of Histopathologically Diagnosed Ossifying Fibroma of the Jaws in a Nigerian Population.

BACKGROUND: Ossifying fibroma (OF) is a benign tumor of the jaws, which belongs to the group of fibro-osseous lesions, and exhibits slowly progressive growth leading to jaw expansion with well-defined borders. OBJECTIVE: To evaluate the clinical and radiological characteristics of OFs and their treatment. MATERIALS AND METHODS: A 5-year retrospective study was done. The case notes of subjects were retrieved, analyzed, and evaluated. Relevant information about patients was categorized into bio-data, clinical, and radiological. The diagnosis of lesion was made histopathologically by the oral pathologist. RESULTS: Forty- five patients' case notes were retrieved and analyzed and the patients' age ranged from 2 to 70 years (mean 29.4 ± 16.9). Majority of the patients (55.5%; P = 0.23) were 10-29 years. There were 16 (35.6%) males and 29 (64.4%) females giving a male: female ratio of 1:1.8 (P = 0.01). The cross-sectional dimension of the tumors measured vertically and horizontally ranges from 1 cm2 to 420 cm2 (mean = 54.7 cm2 ± 82.9). There were 60% in the maxilla and 40% in the mandible (P = 0.014). Most of the lesions (68.9%; P = 0.01) showed patchy opacity and cotton wool appearances. Majority of the lesions were extirpated by enucleation alone (P = 0.01). CONCLUSION: The prevalence of OF among the fibro-osseous lesions was 51.0% while against other benign lesions, it was 16.0%. In conclusion, contrary to most other reports across the globe, this lesion in southeast Nigeria occurred more frequently in the maxilla than mandible.

Pattern of distribution of reactive localised hyperplasia of the oral cavity in patients at a tertiary health institution in Nigeria.

BACKGROUND: Reactive localized hyperplastic lesions of the oral cavity (RHLs) are relatively common peripheral lesions which present as a range of clinically similar lesions at dental centers. Diagnosis can be challenging if dentists are unfamiliar with their clinicopathological across various populations. OBJECTIVE: This study reviews the pattern of distribution of RHLs of the oral mucosa in a hospital- the Obafemi Awolowo University Teaching Hospital Complex (OAUTHC), Ile-Ife. MATERIALS AND METHODS: We reviewed 10 years data from the archives of the Department of Oral Maxillofacial Surgery and Oral Pathology, Obafemi Awolowo University, Nigeria. Information on RHLs were extracted and recorded on standardized data forms and analyzed using STATA. RESULTS: The most common lesions were pyogenic granuloma (43.7%) and focal fibrous hyperplasia (39.7%), respectively. RHLs were found to be more frequent in women (66.7%) than men (33.3%). The most common locations of involvement was the gingivae (84.6%), and lesions were more common in the 9-29 year age group and the mean age was 37.7 (±21.1) years. The relationship between age group and reactive lesions was however not statistically significant. CONCLUSION: The major benefit of this study is an improved knowledge of the frequency and distribution of oral reactive lesions in sub-Saharan Africa which may be highly beneficial when establishing a diagnosis and treatment plan in clinical practice.

[Child care management in maxillofacial humanitarian mission]. / Prise en charge de l'enfant en mission humanitaire maxillofaciale.

Our practice in a humanitarian (or crisis) context differs from what we experience in daily practice. There are several reasons for this. First, the diseases encountered are sometimes unfamiliar, such as sequelae of noma, or the presentation of familiar diseases may be unusual, such as facial malformations seen at a late stage. Secondly, these missions take place in developing countries, and consequently, evaluation and anticipation of possible malnutrition should be considered, especially because facial diseases themselves may be responsible for nutritional problems. Lastly, conditions are often difficult, occurring in an unusual environment, and we sometimes have to face communication and equipment problems. The goal of our work, based on a 15-year experience (in Bamako and Mopti with the Association "Santé et Développement", and in Ouagadougou with the organization "Les enfants du noma") and the analysis of literature, is to point out these features and maybe to be helpful to others.

The 5-year prevalence of maxillofacial fibro-osseous lesions in Uganda.

BACKGROUND: Fibro-osseous lesions of the jaws are a diagnostic challenge for the pathologist because histologically, they are not easily distinguishable. African data on the prevalence of these lesions are scarce. We present a 5-year report of benign fibro-osseous lesions at Mulago Hospital, Uganda, showing the frequency and distribution of these lesions. MATERIALS AND METHODS: Confirmed fibro-osseous lesions reports at the pathology department (2007-2012) were retrieved. Patients' clinical data including age, gender, anatomic location, and diagnosis were recorded. Descriptive statistics and simple proportion tests were carried out. RESULTS: We retrieved 155 confirmed benign fibro-osseous lesions over this period, 65% were females, 34% males, and the gender of one case was not specified. Fibrous dysplasia was the most prevalent lesion (n = 87, 56.1%) followed by ossifying fibroma (n = 50, 32.9%) and osseous dysplasia (n = 17, 10.9%). We neither found craniofacial nor polyostotic fibrous dysplasia. Fibrous dysplasia and ossifying fibroma peaked in the second decade at 40.2% and 40.0%, respectively. Florid osseous dysplasia was commonest in the fifth decade. CONCLUSION: In this study, all the florid osseous dysplasia were seen among females. We need to carry out prospective studies to establish as to why and what kind of women get afflicted by this lesion.

A retrospective analysis of reactive hyperplastic lesions of the oral cavity: study of 1149 cases diagnosed between 2000 and 2011, Chile / Análisis retrospectivo de lesiones reaccionales hiperplásicas en mucosa oral: estudio de 1149 casos diagnosticados entre el 2000–2011 en chile

El objetivo de este estudio fue determinar la frecuencia relativa y distribución de lesiones reaccionales hiperplásicas (LRH) de la mucosa oral, presentes en el registro de biopsias del Servicio de Anatomía Patológica de la Facultad de Odontología, Universidad de Chile. Este estudio de tipo retrospectivo consistió en 1149 biopsias con diagnóstico histopatológico de LRH, entre los años 2000-2011. Las LRH se clasificaron en 5 grupos: Hiperplasia fibrosa (HF), granuloma piogénico (GP), granuloma periférico de células gigantes (GPCG) y fibroma osificante periférico(FOP). Los datos de edad y sexo de los sujetos, y de localización y tipo de lesión, fueron obtenidos del registro de biopsias de cada caso. De las LRH, la lesión más frecuente fue HF (71,1 por ciento), seguido de GP (21,1 por ciento), GPCG (5 por ciento) y FOP (2,9 por ciento) respectivamente. Las biopsias de LRH fueron mas frecuentes en mujeres (70,7 por ciento). El rango etario más afectado fue el de 50 a 59 años (22 por ciento). La localización de mayor frecuencia de LRH fue el maxilar superior (24,7 por ciento), seguida de mejilla (20,6 por ciento), lengua (19,4 por ciento), mandíbula (18,5 por ciento), labio inferior (9,9 por ciento) y labio superior (6,7 por ciento). En este estudio, de las LRH el diagnóstico más prevalente fue FH. El sexo más afectado fue el femenino, el rango etario el de 50 a 59 años y la ubicación más frecuente, maxilar superior. Estos resultados en general son concordantes con lo descrito en otros países.

The aim of this study was to determine the relative frequency and distribution of reactive hyperplastic lesions (RHL) of the oral mucosa at the Oral Pathology Institute of the School of Dentistry at the University of Chile. This was a retrospective study of 1149 biopsies with histopathological diagnosis of RHL, performed between 2000 and 2011. The RHL were classified in 4 groups: fibrous hyperplasia (FH), pyogenic granuloma (PG), peripheral giant-cell granuloma (PGCG) and peripheral ossifying fibroma (POF). Results: the most frequent RHL was FH (71. 1%), followed by PG (21.1%), PGCG (5 %) and POF (2.9%). RHLs were more frequent in women (70.7%). The most highly affected age group was the 50- to 59-year-olds (22%). The most frequent location for RHL was maxilla (24.7%), followed by cheek (20.6%), tongue (19.4%) and jaw (18.5%). The most prevalent RHL diagnosis was FH. Themost frequently affected sex was female, the most frequent agerange was 50-59 years, and the most frequent location, maxilla.

A clinico-pathologic review of 56 cases of ossifying fibroma of the jaws with emphasis on the histomorphologic variations.

OBJECTIVE: This study aims at contributing to the definitive diagnosis of ossifying fibroma (OF) based on histomorphological features. The study also aims to determine some demographic features of OF, common sites of occurrence and to determine whether behavior correlates well with the histomorphological variations seen in the lesion. MATERIALS AND METHODS: A total of 80 patients who were diagnosed either as cementifying fibroma CF, OF and cemento-ossifying fibroma (COF) of the jaws from the files of the Oral Pathology Department of the University of the Witwatersrand Dental School were retrieved and the histology slides of each case were reviewed with the most recent diagnostic criteria for OF and the authors additional criteria. A total of 56 cases that met the set criteria were analyzed. RESULTS: The patients were clustered within the third and fourth decades of life ( n = 39, 69.6%). Majority of the patients were black (83.93%), whereas the rest were whites (12.50%) and Asians (3.57%). There were 17 males (30.4%) and 39 females (69.6%), giving a male to female ratio of 1:2.3. Most of the lesions (70.3%) occurred in the mandible, involving the premolar molar region (56.7%). Scanty fibrous tissues in highly cellular lesions were found in 36 (64.3%) of the cases. There were globular, dystrophic or granular calcifications mixed with irregularly shaped trabeculae of lamellar or cellular woven bone or osteoid were found, in 36 (64.3%) cases. CONCLUSION: Demographic data, clinicoradiologic features, combined with histopathology will continue to be relevant in the definitive diagnosis of OF and in predicting its behavior. Highly aggressive lesions with shorter duration in people below 15 years were called juvenile OF and treated as such, while OF applies to other conventional ones.

A Clinicopathologic Analysis of 207 Cases of Benign Fibro-Osseous Lesions of the Jaws.

Benign fibro-osseous lesion (BFOL) is a distinct group of jaw entities composed of fibrocellular tissue and mineralized materials. In this study, we examined the epidemiological, clinical, and pathological features of patients with BFOL. Records and microslides of 207 BFOLs submitted to pathology service were retrospectively reviewed. Overall, fibrous dysplasia (FD) was the most prevalent (36.7%), followed by ossifying fibroma (OF; 32.4%), osseous dysplasia (OD; 24.6%), and juvenile ossifying fibroma (JOF; 6.3%). Female predilection was noted. FD and JOF were common in maxilla, whereas most OF and OD affected the mandible. Most patients with FD and OF presented with painless swelling, while patients with OD were symptomless. The majority of FD specimens showed woven bone, while a mixture of woven bone and cementum-like materials was often noted in OF and OD. Our data show variations in the clinicopathologic features of BFOLs. A thorough examination of all aspects of BFOL patients is imperative for accurate diagnosis.

Benign fibro-osseous lesions of the jaws in children. A 12-year retrospective study.

INTRODUCTION: Fibro-osseous lesions, a diverse group of bone disorders including developmental, reactive or dysplastic diseases and neoplasms, share overlapping clinical, radiographic and histopathologic features and demonstrate a wide range of biological behaviour. AIM: To evaluate the characteristics, treatment and outcome of benign fibro-osseous lesions of the jaws in children. PATIENTS AND METHOD: All patients with fibro-osseous lesions of the jaws treated at the department of Oral and Maxillofacial Surgery of the «A & P Kyriakou¼ Children's Hospital of Athens from 2000 to 2011 were included in this study. Data were retrieved from patients' files and their present situation was registered. RESULTS: Sixteen males and 10 females (mean age 8.5 years) were treated. Fibrous dysplasia was most often encountered (26.9%), and the mandible was the most frequent location (76.9%). All cases were surgically treated and histopathologically confirmed. Marginal ostectomy was performed in 7 cases, partial ostectomy in 4, enucleation and curettage in 10 and trimming-remodelling in 5 cases. Mean follow-up was of 5.5 years with no recurrence, except in one case of fibrous dysplasia. CONCLUSIONS: Fibro-osseous lesions, although sharing similar microscopic features, exhibit a variety of clinical behaviour rendering their treatment highly individualized.

Benign fibro-osseous lesions: clinicopathologic features from 143 cases diagnosed in an oral diagnosis setting.

OBJECTIVE: The aim of this study was to report the clinicopathologic and radiologic features of 143 benign fibro-osseous lesions (BFOLs). STUDY DESIGN: Clinical and radiologic information were retrieved from the patients files, and histologic features were reviewed from hematoxylin and eosin-stained histologic slides. RESULTS: There were 22 ossifying fibromas (OFs), 21 fibrous dysplasias (FDs) and 100 osseous dysplasias (ODs; 65 florid, 18 focal, and 17 periapical). The mean age of the FD/OF patients was a decade lower than those with OD. The mandible was more affected than the maxilla, except in FDs. All FDs and OFs presented local swelling, whereas this was observed in <40% of the ODs. Radiologic images of the florid/periapical ODs and OFs were predominantly mixed, whereas FDs and focal ODs were predominantly radiopaque. CONCLUSIONS: Florid OD, OF, and FD were the most common diagnoses, and the clinicopathologic and radiologic features were somewhat distinct from the characteristics of other populations.

Osseous (cemento-osseous) dysplasia of the jaws: clinical and radiographic analysis.

OBJECTIVES: To explore the demographic characteristics and clinical features among patients with osseous (cemento-osseous) dysplasia (OD/COD) of the jaws and to determine the frequency of particular radiographic characteristics. METHODS: The charts and radiographic reports of 118 patients with OD/COD, obtained from the archives of the University of Toronto discipline of oral and maxillofacial radiology, were reviewed. Demographic and clinical data, radiographic findings and final diagnoses were collected and analyzed to determine typical characteristics. RESULTS: Of the 117 patients for whom age and sex were known, the majority (97 [82.9%]) were female; these female patients had a mean age (± standard deviation) of 44.3 ± 13.4 years. Eighty-three (72.2%) of the 115 patients for whom symptoms were known were clinically asymptomatic. Ninety-three patients (78.8%) had OD/COD at single sites (i.e., periapical OD/COD), and 25 (21.2%) had OD/COD at multiple sites (i.e., florid OD/COD). In addition, 15 (12.7%) of the cases were associated with one or more simple bone cysts, and 13 (11.0%) were associated with osteomyelitis. In most cases, the OD/COD was unilateral, with the lesion being located in the mandible, usually associated only with the posterior teeth. The lesions exhibited well-defined, sclerotic or corticated margins (108 patients [91.5%]) and were surrounded by a radiolucent border. Minimal effects on surrounding structures were observed. As well, 85 (72.0%) of the lesions were in the mixed radiolucent-radiopaque stage, with dense, cementum-like radiopacities. CONCLUSIONS: The majority of cases of OD/COD occurred in women in the fifth decade of life, and most cases were asymptomatic. OD/COD was more likely to present as solitary lesions but also occurred in association with simple bone cysts or osteomyelitis.

Fibroma ossificante periférico: um levantamento clínico e epidemiológico / Peripheral ossyfying fibroma: a clinical epidemiological survey

Este artigo aborda 18 casos de fibroma ossificante periférico (FOP) diagnosticados no Centro de Referência de Lesões Bucais da Universidade Estadual de Feira de Santana/Bahia, no período de 2002 a 2008. Para descrever a relação entre as variáveis sociodemográficas com o FOP, utilizou-se o Statistical Package for Social Science (SPSS), versão 10.0 for Windows (1998). Observou-se maior acometimento desta doença na quarta década de vida, sexo feminino e cor não branca. A gengiva superior anterior foi a região de maior prevalência. Faz-se importante que os cirurgiões-dentistas conheçam as características do FOP para o correto diagnóstico.

Relative frequency of localized reactive hyperplastic lesions of the gingiva: a retrospective study of 1675 cases from Israel.

BACKGROUND: The gingiva reacts to chronic irritation or trauma with localized reactive hyperplastic lesions (LRHL) that can be classified into four groups: focal fibrous hyperplasia (FFH), pyogenic granuloma (PG), peripheral ossifying fibroma (POF), and peripheral giant cell granuloma (PGCG). This study determined the frequency of LRHL in an oral pathology biopsy service and compared these data with reports from other countries. METHODS: The material included the biopsies of all consecutive LRHL of the gingiva stored in the departmental database (1989-2008). Lesions were analyzed according to their location and to the patients' age and gender. The findings were compared with those published in studies from other countries. RESULTS: There were 1675 LRHL that comprised 6.7% of the 25,106 accessed biopsies. FFH was the most common (31.8%), followed by PG (29.1%), POF (20.4%), and PGCG (18.7%). POF tended to affect younger patients than did FFH, PG, and PGCG. FFH, PG, and POF were more common in women, while PGCG showed no gender predilection. PG and POF were more common in the maxilla, PGCG more common in the mandible and FFH was distributed equally between the jaws. The anterior region of the maxilla was the most prevalent site for FFH, PG, and POF. CONCLUSION: The results of this study differ somewhat from those of other countries. There is a need for further investigation to answer the question whether the differences can be attributed to geographic or ethnic factors and/or to small sample sizes of the reported studies.

Pediatric localized reactive gingival lesions: a retrospective study from Israel.

PURPOSE: Chronic irritation of the gingiva causes localized reactive hyperplastic lesions (LRHLs), which are classified into: peripheral ossifying fibroma (POF); peripheral giant cell granuloma (PGCG); pyogenic granuloma (PG); and focal fibrous hyperplasia (FFH). The purpose of this study was to determine the frequency of localized reactive hyperplastic lesions in Israeli children and adolescents. METHODS: All consecutive archival LRHL biopsies of the gingiva between 1989 and 2008 were included. Lesions were analyzed according to location and patients' age and gender. Our findings were compared to pediatric and all-age data in publications from other countries. RESULTS: Of 233 gingival LRHL specimens, POFs were most common (33%), followed by PGs (25%), FFHs (23%) and PGCGs (20%). PGs and FFHs were more common in females, and PGCG were more common in males. POFs showed no gender predilection. PGCGs and FFHs were distributed almost equally between the maxilla and mandible, while POFs and PGs were more common in the maxilla. Comparing data to other countries was problematic because there were so few dedicated to the pediatric population and because of inconsistencies in data presentation. CONCLUSIONS: Pediatric dentists should be aware of gingival LRHLs, because they are not uncommon among children.