a 52-year - old korean female visited seoul veterans hospital with a complaint of acute pain and gingival swelling on the right mandibular molar region .
on palpation , bilateral buccal bony expansion was noted on the posterior mandible and maxilla ( fig .
1 ) . she had a complete denture , however her denture was out of use due to the gingival swelling and pain .
panoramic radiograph showed diffuse , lobular , and irregularly shaped radiopacities or cotton - wool appearance throughout the alveolar process of both quadrants of the maxilla and mandible .
multiple sclerotic masses with radiolucent borders were found in the maxilla and mandible , confined within the alveoli at the level corresponding to the roots of the teeth , above the inferior alveolar canal ( fig .
cone beam computed tomography ( cbct ) ( kavo 3d exam , kavo , biberach , germany ) images also revealed large radiopaque shadow extending into the mandible and maxilla .
the bucco - lingual aspects of the lesions could be visualized on the cbct images , which demonstrated the relationship of the bony lesions to the cortical plates in the bucco - lingual dimension .
some lesions appeared larger and connected with the buccal and lingual cortical plates . on the parasagittal reformatted images at this level ,
the radiographic appearance varied from radiolucent to mixed lesions or rather radiopaque masses . under local anesthesia , incision and surgical curettage was performed on the right mandibular posterior area . irregular bony defects and inflammatory fibrous tissue were seen in the operation field .
histological finding of this lesion showed the formations of dense sclerotic calcified cementum - like masses .
the lesion was composed of cementum - like substances characterized by islands of calcified deposits and areas of loose fibro - collagenous stroma , which showed the evidence of proliferation .
the patient of the present case has been followed up over the last 12 month and fcod has remained asymptomatic .
exuberant fibro - osseous lesions occurring in multi - quadrants of the jaws were designated as gigantiform cementomas or familial multiple cementomas in the first edition of the world health organization 's histological typing of odontogenic tumor , jaw cysts and allied lesions.11 however , the etiopathogenesis has not been clear .
our case was diagnosed with fcod based on the clinical , histologic , and radiographic features .
fcod should be differentiated from paget 's disease , chronic diffuse osteomyelitis , and gardner 's syndrome .
paget 's disease is polyostotic and shows the raised alkaline phosphatase level which is not a consistent feature of fcod .
it is a primary inflammatory condition of mandible with cyclic episodes of unilateral pain and swelling .
fcod is a reactive , non - neoplastic process confined to tooth - bearing areas of the jaws that is found most frequently in middle - aged and older black women .
melrose et al reported a study of 34 cases of such lesions , of which 32 were black women ( in a predominantly caucasian population ) with mean age of 42 years.12 the definite female gender predilection of the condition is unclear.2,3 in the present case , the patient was a 52-year - old korean female ; it was rare in regard to the race and gender .
fcod may be familial with an autosomal dominant inheritance pattern . however , there were only few examples in the literatures in which the familial pattern had been confirmed.10,13,14 in this case , the patient 's mother and twin daughters had similar lesions in the jaw , and they were diagnosed with familial gigantiform cementoma in other clinic , however the lesions were focal without pain and any other symptom .
conventional radiograph , which exhibit multi - quadrant diffuse radiopaque masses in the tooth - bearing areas of the jaws , plays an important role in the diagnosis for asymptomatic fcod patients .
the ct findings of the lesion have been previously reported.10 axial ct images clearly showed the location and extent of the lesion , especially in the maxilla .
the expansion of the cortical bone was clearly evaluated on the ct images even though it was slight .
extraction is not recommended due to the poor socket healing from the impaired blood circulation in the affected area of the bone .
extensive surgical resection and saucerization are proposed as treatment options when lesions become extensive and symptomatic.15,16 in this case , surgical resection and saucerization were performed due to the symptoms of the pain and gingival swelling on the edentulous area .
 cemento - osseous dysplasias are a group of disorders known to originate from periodontal ligament tissue and involve , essentially , the same pathological process . 
 they are usually classified into three main groups : periapical , florid , and focal cemental dysplasias depending on their extent and radiographic appearances . 
 radiographically , florid cementoosseous dysplasia ( fcod ) appears as dense , lobulated masses , often symmetrically located in various regions of the jaws . 
 the best management for the asymptomatic fcod patient consists of regular recall examinations with prophylaxis . 
 the management of the symptomatic patient is more difficult . a case of fcod occurring in a 52-year - old edentulous korean female 
 is reported which is rare with regard to race and sex . 
Case Report
Discussion