Clinical, Radiographic and Histopathological Analysis of Cemento-Ossifying Fibromas and Fibro-Osseous Lesions of the Oral and Maxillofacial Region: A 53-Year Retrospective Study and Update of Current Concepts.

Background: Fibro-osseous lesions (FOL) of the jawbones and cemento-ossifying fibroma (COF) represent a heterogeneous group of lesions with overlapping histopathological features and variability in biological behavior. Thus, this study aimed to evaluate the clinical, radiographic, and histopathological characteristics of FOLs (cemento-osseous dysplasia-COD, fibrous dysplasia-FD, ossifying fibroma-OF) as well as COF, diagnosed at a reference center in oral pathology over 53 years.

Methods: Sex, age, symptoms, clinical diagnosis, time of evolution, anatomical site, size of the lesion, and radiographic characteristics were collected from all cases of lesions previously diagnosed as FOLs.

Results: Among 19 600 cases of oral and maxillofacial lesions diagnosed at our center, 156 (0.8%) had a histological diagnosis of FOL, with COD being the most common (37.2%). Radiographically, most cases presented as unilocular lesions (64.3%) (p = 0.034) with mixed radiolucency (53.8%). COD and COF frequently exhibited well-defined borders. Additionally, 50% of COD cases displayed a cotton-wool appearance, while half of FDs appeared as ground-glass opacifications. Histopathologically, a significantly high frequency of lamellar bone was observed in all types of FOL (p = 0.0001). In contrast, peritrabecular clefting was significantly found in FDs, and cementum-like tissue in CODs and COFs (p < 0.05). Lesional bone fusing with the normal adjacent bone was more significantly observed in COD and FD (p = 0.001).

Conclusion: A definitive and accurate diagnosis of FOL is achievable when cases are individually investigated, and all clinical, radiographic, and histopathologic features are analyzed.