Focal cemento-osseous dysplasia involving a mandibular lateral incisor.

AIM: To report a case of focal cemento-osseous dysplasia (FCOD) affecting a single tooth misdiagnosed as an inflammatory periapical lesion.

SUMMARY: The patient, a black 47-year-old woman complained of pain affecting the right side of the mandible. Routine X-ray examination discovered a periapical radiolucency on the mandibular left lateral incisor (tooth 32), which was otherwise normal and not carious. As the response of this tooth to a vitality test was doubtful, the lesion was diagnosed as a periapical granuloma or cyst secondary to pulpal necrosis. Endodontic treatment and curettage of the periapical lesion were performed, and histological examination of the curettage material revealed a localized osseous dysplasia.

KEY LEARNING POINTS: FCOD may rarely affect only one tooth, resembling a periapical granuloma or cyst. Careful diagnosis is of paramount importance in cases of questionable periapical lesions affecting normal-looking teeth, before beginning treatment. FCOD generally requires no treatment. Biopsy is warranted in case of doubt.