a 42-year - old female patient was admitted to the department of dentomaxillofacial radiology , faculty of dentistry , ankara university with a complaint of bleeding on the gums .
the patient 's medical history included having undergone treatment for pernicious anemia and a gastric ulcer two years earlier .
on intraoral examination , the patient was asymptomatic except for a few restored and missing teeth .
a lesion was found incidentally on routine periapical radiographs taken for the restored teeth and edentulous areas ( fig .
radiopaque masses were coincidentally observed in the periapical radiographs but the exact boundaries of the masses could not be seen . for further and more detailed examination , cone - beam computed tomography
the panoramic radiograph and cbct revealed maxillary bilateral and symmetrical , well - defined , round , radiopaque masses in contact with the root of the maxillary right second molar and left first molar teeth .
lobular , irregularly shaped radiopacities with clear radiolucent demarcation were also present in the right edentulous mandibular molar area ( figs . 2 and 3 ) .
the bucco - lingual aspects of the lesions were best visualized on the axial cbct image ( fig .
cbct added valuable radiographic information regarding the relationships of the lesions with significant anatomical structures , cortical plates , and tooth roots .
dirty yellow , bone - hard tissues of 1 cm1 cm0.6 cm dimensions were analyzed in this examination .
on the basis of the histopathologic findings , the tumor was diagnosed as fod ( fig .
the patient was advised to have routine follow - up examinations at six - month intervals .
the case has been followed up over the last 14 months and has remained asymptomatic .
osseous dysplasias ( periapical , focal , florid osseous dysplasias , and familial gigantiform cementoma ) are a group of disorders that involve the same pathological processes.10 the clinical and radiological features of osseous dysplasia help to distinguish these lesions from others .
pod is mostly confined to the anterior mandible , within the space between the canines.8 fod is a widespread form of pod and is a single lesion.1,5 the differential diagnosis of fod includes paget 's disease , chronic osteomyelitis , and gardner 's syndrome.1,10 paget 's disease is often polyostotic and shows changes in the level of serum calcium , phosphorous , and alkaline phosphatase.1,2,10 gardner 's syndrome may involve jaw bone changes similar to those with fod , but fod does not show any of the other skeletal changes that are seen in gardner 's syndrome.10 chronic osteomyelitis is a primary infection of the mandible presenting with unilateral pain , soft tissue swelling , fever , and lymphadenopathy.8,10 the secondarily infected lesion of fod has a wider radiolucent border than chronic osteomyelitis.1 steven et al reported a case that was diagnosed as chronic osteomyelitis with underlying infected fod.8 macdonald - jankowski published a systematic review on fod in 20036 that reviewed 158 cases , the mean age of which was 49 years .
half of these cases had pain , swelling , and pus discharge / fistula with the frequencies of 52% , 31% , and 18% , respectively .
fods can affect several areas of the jaws : posterior mandible area ( 99% ) , posterior maxilla ( 73% ) , anterior mandible ( 64% ) , and anterior maxilla ( 36% ) .
the fod features observed in the present case report were in accordance with the results of that study .
ong and siar provided their patient with surgical treatment to reduce the mass of the swellings.2 in rare cases , fod can be a hereditary condition with an autosomal dominant familial heredity.4 in our case , no familial aspect was observed .
gndz et al7 reported a case of fod in which the lesion was seen throughout the alveolar processes of all quadrants of the maxilla and the mandible .
the lesion was identified in three quadrants of the jaws in our case . while some reports have described diagnosing fod by clinical and radiological evaluation,5,7,10,13 others performed a biopsy.4,8,12 in the present case ,
a biopsy was also taken to confirm the diagnosis . in line with the various other reported cases ,
our patient was asymptomatic and the lesion was noticed incidentally on periapical radiographs taken for other purposes.4,5,7,10,13 up to now , two cases diagnosed by ct have been reported in the literature7,13 cbct images are useful diagnostic tools for identifying the location and extent of the lesion .
cbct can be utilized to discriminate fod from lesions that display a similar sclerotic appearance on panoramic and periapical radiography.7 unlike the previous reports , in the diagnosis of the present case , not only clinical and radiological methods but also histological methods were used .
clinicians should know the properties of such lesions and should be aware of their radiographic appearance .
periapical radiographs may be insufficient to determine multifocal localization and the limits of the lesion .
therefore , panoramic radiographs and ct images are preferable for a broader and more detailed examination .
however , when infection of the lesion , resulting from trauma occurs , it requires surgical debridement and enucleation since antibiotics may not be effective due to the avascular nature of the lesion .
 florid osseous dysplasia ( fod ) is an uncommon , benign , cemento - osseous lesion of the jaws . 
 the etiology of fod is still unknown . 
 it is often asymptomatic and may be identified on routine dental radiographs . 
 the classic radiographic appearance of fod is amorphous , lobulated , mixed radiolucent / radiopaque masses of cotton - wool appearance with a sclerotic border in the jaws . in our case the lesion was found incidentally on routine periapical radiographs taken for restored teeth and edentulous areas . for further and detailed examination , a panoramic radiograph and cone - beam computed tomograph ( cbct ) were taken . 
 the panoramic radiograph and cbct revealed maxillary bilateral and symmetrical , non - expansile , well - defined , round , radiopaque masses in contact with the root of the maxillary right second molar and left first molar teeth . 
 our aim in presenting this case report was to highlight the importance of imaging in diagnosis of fod . 
Case Report
Discussion