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Ossifying fibroma (OF) is a rare, benign, fibro-osseous lesion of the jawbone characterised by replacement of the normal bone with fibrous tissue. The fibrous tissue shows varying amount of calcified structures resembling bone and/or cementum. The central variant of OF is rare, and shows predilection for mandible among the jawbone. Although it is classified as fibro-osseous lesion, it clinically behaves as a benign tumour and can grow to large size, causing bony swelling and facial asymmetry. This paper reports a case of large central OF of mandible in a 40-year-old male patient. The lesion was treated by segmental resection of mandible. Reconstruction of the surgical defect was done using avascular fibula bone graft. Role of three-dimensional printing of jaw and its benefits in surgical planning and reconstruction are also highlighted.

Central ossifying fibroma is a rare, benign fibro osseous lesion that arises from the periodontal ligament. Odontoma is one of the most common odontogenic tumors containing enamel, dentin, cementum, and pulpal tissue. A 15-year-old boy came to our department with the chief complaint of missing teeth and malocclusion. On complete clinical and radiological investigations, we suspected a fibro osseous lesion and an odontoma occurring in the same site in the mandible, which was confirmed histopathologically to be complex odontoma and central ossifying fibroma. The patient was treated with en bloc resection and iliac crest graft. Such hybrid tumors where there is a synchronous occurrence of two tumors have been rarely reported in literature. There has been no established correlation in such cases but reporting more such cases may help in the establishment of a relationship.

Cemento-ossifying fibroma (COF) is a clinicopatological variant of ossifying fibroma which is benign fibro-osseous neoplasm affecting jaw or cranial skeletons. It is also called central ossifying fibroma. COF is a slow-growing tumor and occurs exclusively in the tooth bearing areas of the jaws. This tumor particularly affects adult female and rarely occurs in children. Here we show a rare case of COF involving the anterior mandible in an 8-year-old girl. She was referred to our department with painless and hard swelling of the mandibular symphysis. Computed tomography (CT) showed that well circumscribed and mainly radiodense lesion with radiolucent areas expanded the inferior border of the mandible. The size of this lesion is 35 × 30 × 24 mm. Pathological diagnosis was COF. She had underwent two times of surgery for tumor enucleation through an intraoral approach, and after that, we removed bilateral central incisors with residual tumor around the roots. There has been no sign of recurrence 1 years after the last surgery. We have continued follow-up observation.

A 34-year-old female patient attended a referral center for oral diagnosis presenting hardened increased volume in the posterior mandible. Panoramic radiography revealed a mixed unilocular lesion with clear and well-defined limits. The incisional biopsy showed proliferation of mesenchymal cells amid dense fibrous connective tissue. Mineralized material in different degrees of maturation was also observed. Regarding the histopathological aspects associated with the clinical, radiographic, and intraoperative data, the diagnosis of central ossifying fibroma (COF) was performed. COF has similar characteristics to other fibro-osseous lesions, and its diagnosis is a challenge for dental surgeons.

Ossifying fibroma is a rareentity among the other type of fibro-osseous lesions. It is a non-odontogenic, benign tumor of the jaw, which arises from the multipotential cells of the periodontal ligament. Previously in 1992, WHO classified this type of lesion into ossifying fibroma and cemento-ossifying fibroma. Now the term- “cemento-ossifying fibroma” is replaced with “ossifying fibroma” in recent WHO classification (2005). These tumors are slow growing, painless and occur more commonly in the mandible and in the third and fourth decades of life with slight female predilection. Hereby, in this article, an unusual case of central ossifying fibroma in an 80-year-old female patient with expansile swelling of the right side of mandible since 2 months is repotred. The diagnosis was further confirmed by Cone beam computed tomography (CBCT) and histopathological evaluation. The main objective of this article is to enlighten about the diagnostic dilemma of mandibular swellings and atypical clinical behavior of central ossifying fibroma.

Juvenile ossifying fibroma is a benign lesion similar to an ossifying fibroma, although more aggressive and of earlier onset. Clinically, it is a slowly growing asymptomatic swelling causing facial asymmetry, but the tumor can progress to a considerable size. Nonaggressive tumors can be managed conservatively, but aggressive lesions may require salvage procedures to prevent recurrence. We present a case of 3-year-old boy with slow growing, firm, nontender swelling of left lower jaw region. The nodular mass obliterated the buccal vestibular region and led to difficulty in mastication and speech. The tumor was treated by en bloc excision through intraoral mandibular vestibular approach.

Purpose Different lesions in the fibro-osseous group share microscopic features; thus, establishing a definitive diagnosis based on microscopic features alone can be a challenge. There is a need for additional microscopic tools to aid in differentiating these lesions. This study compared parameters related to vascularity among 3 lesions in the fibro-osseous group: fibrous dysplasia (FD), central ossifying fibroma (COF), and cemento-osseous dysplasia (COD). Materials and Methods This study was a cross-sectional analysis of biopsied lesions retrieved from 3 medical centers over a 14-year period. The primary predictor variables were the vascularity parameters (number, perimeter, and area). The outcome variables were diagnoses of FD, COF, and COD. Diagnosis was based on clinical, microscopic, and radiologic correlations. From each histopathologic slide, 5 representative fields were captured with a computerized digital camera. The number of blood vessels was counted, and the surface area and vascular perimeter were measured by tracing the perimeter of each vessel. Data were statistically analyzed using analysis of variance with logarithmic transformation and a Tukey adjustment. Results Sixty-six cases were included in the study (26 in FD group, 26 in COF group, and 14 in COD group). The mean number of vessels showed only a tendency to be larger in the FD group compared with the COF and COD groups (5.4 ± 2.6, 3.7 ± 2.3, and 3.6 ± 1.7, respectively), but the results did not reach the threshold for significance. The mean vascular perimeter was 1,385.8 ± 859.2 pixels in the FD group and 742.6 ± 661.8 in COF group after logarithmic transformation (P = .012). The perimeter in the COD group was smaller (941.1 ± 502) compared with that in the FD group, but the difference did not reach the threshold for significance. The mean area was 25,061 ± 24,875.6 in the FD group and 11,773.8 ± 21,734.4 in the COF group after logarithmic transformation (P = .004). The perimeter in the COD group was smaller (13,011.1 ± 8,338.3) compared with the FD group, but the difference did not reach the threshold for significance. Conclusion The vascular content of the FD group was markedly higher than of the COF group. These vascular changes can aid in differentiating these lesions microscopically.

Radiographic examinations complement the anamnesis and physical exam with the purpose of reaching diagnosis, prognosis and treatment planning. In this case report, a 48 year-old male Caucasian patient was referred to an oral and maxillofacial surgeon by a general practitioner after a panoramic radiography for treatment planning; the implant surgery follow-up portrayed a multilocular radiolucent image at the left posterior mandible. Based solely on the panoramic radiography, the diagnostic hypothesis was ameloblastoma. The surgeon decided to perform an incisional biopsy. However, during the procedure, the professional noted that the lesion was easily detached from the adjacent bone and opted for the total removal of the lesion, thus altering its diagnostic hypothesis to central ossifying fibroma (COF). The histopathological result confirmed the diagnostic hypothesis provided by the surgeon, i.e. COF. Although multilocular presentation is not common, COF should be considered in the scope of multilocular radiolucent lesions of the jaws. In addition, computerized tomography imaging exam complemented by surgical and histopathological aspects should be considered for establishing the final diagnosis and conducting the therapeutic approach.

O fibroma ossificante central é um tumor fibro-ósseo de crescimento lento bem circunscrito, raro, benigno e agressivo. Tal lesão também é conhecida por aumentar de forma expansiva e é caracterizada pela substituição de osso por um tecido celular fibroso contendo focos de mineralização. Essa lesão geralmente ocorre no terceiro ou quarta décadas de vida com uma predileção feminina. Afeta a mandíbula em 70% a 80% dos casos. O tratamento compreende enucleação e curetagem ou ressecção cirúrgica para lesões maiores. Assim, o objetivo deste artigo é apresentar e avaliar as características de um caso clínico de um paciente com Fibroma Ossificante Central em maxila. Foi descrito um caso de uma paciente do sexo feminino, 34 anos de idade, HIV positivo, cuja queixa era de aumento de volume indolor em rosto há meses após exodontia do dente 12, resultando em dificuldades de se alimentar durante a mastigação. O exame físico evidenciou-se uma edema difuso intra e extra-oral em região anterior de maxila direita, endurecido à palpação, que foi submetida a enucleação mais curetagem cirúrgica. Foi feita uma biópsia incisional e levado material para análise no laboratório de anatomia histopatológica de uma universidade, no qual se obteve o resultado de lesão óssea benigna, sugestiva de fibroma ossificante central. O paciente segue com 2 anos de pós-operatório, não apresentando sinais de recidiva.

Considered as an aggressive counterpart of central ossifying fibroma (OF), juvenile ossifying fibroma (JOF) is a benign fibro-osseous neoplasm characterized by an unpredictable destructive behavior, elevated morbidity, mutilating treatment and high potential for local recurrences. The aim of this study is to compare the analysis for cell proliferation and vascular markers between JOF and OF. Cell proliferation index was measured by Ki-67 and Mcm-2 expression and microvessel density (MVD) was obtained by the immunoexpression of CD34/CD105. We observed a reduced expression of vascular markers, where MVD for CD34 was significantly higher in JOF than in OF (p = 0.009), but no statistical difference was found for CD105. JOF and OF showed low expression for Ki-67 and Mcm-2 and no difference was noted between both, suggesting that other mechanisms such as anti-apoptotic and/or pro-autophagic pathways or even increased expression of matrix metalloproteinases may be responsible for the aggressiveness of JOF.

Ossifying fibroma (OF) is classified as, and behaves like, a benign bone neoplasm. It is often considered to be a type of fibro-osseous lesion (FOL). It can affect both mandible and the maxilla, particularly the mandible. This bone tumour consists of highly cellular, fibrous tissue that contains varied amounts of bone or cementum resembling calcified tissue. Present case is an unusual report of central ossifying fibroma involving the left side of mandible in an 18 year old female patient, who presented to the department with a painless hard swelling. The lesion was treated by surgical resection and reconstruction.

Central ossifying fibroma is a lesion in which diagnosis has proved intriguing and unclear for presenting clinical, radiographic, and even histopathological similarities to other types of lesions such as the fibrous dysplasia of bone and cement-bone dysplasia. It is a benign neoplasm of uncertain etiology and slow development in which the mandible is affected more frequently than the maxilla. We described a case of central cemento-ossifying fibroma involving the right mandible of a thirty-five-female patient by presenting its clinical, radiographic, and histological characteristic sand discussing some differential diagnoses.

Ossifying fibroma (OF) is a benign, non-odontogenic tumor of the jaw, a type of fibro-osseous lesion. Traditionally, this type of lesion was subclassified histologically into ossifying fibroma and cementifying fibroma according to the hard tissues formed, but both types are now known by the unified term, ossifying fibroma. It is generally accepted that the histological subclassification of these two lesions is of academic interest only since differential diagnosis is often arbitrary and their biological behaviour seems to be identical. The present article discusses the case of central ossifying fibroma in a 35-year-old female patient who presented with a swelling in premolar-molar region of left mandible which was symptom-free and present since last 6 months. The diagnosis was confirmed by histopathology.

Central ossifying fibroma is a benign slow-growing tumor of mesenchymal origin and it tends to occur in the second and third decades of life, with predilection for women and for the mandibular premolar and molar areas. Clinically, it is a large asymptomatic tumor of aggressive appearance, with possible tooth displacement. Occasionally treated by curettage enucleation, this conservative surgical excision is showing a recurrence rate extremely low. The following article reports a case of a 13-year-old male patient, who presented with a very large ossifying fibroma in the maxilla, which was successfully treated by surgical intervention. A brief literature review of this lesion, focusing on the histology, clinical behavior, and management of these uncommon lesions is also conducted

The differential diagnosis of exophytic gingival lesions include peripheral odontogenic fibroma, peripheral giant cell granuloma, pyogenic granuloma, and peripheral ossifying fibroma (POF). The peripheral odontogenic broma, the peripheral counterpart of the central dontogenic fibroma, is neoplastic, whereas the othrs are generally regarded reactive in nature. The roliferative activity of the reactive lesions are conidered to be initiated by local irritants occurring in he gingival crevice or associated with adjacent teeth. hese irritants stimulate the gingival fibers of the eriodontal ligament, a specialized periosteal tissue, r the periosteum itself. Depending on the tissue timulated, these fibrous growths may contain bone nd/or cementum. The POF has been described by many names, includng ossifying fibroid epulis, peripheral fibroma with alcification, calcifying fibroplastic granuloma, and eripheral odontogenic fibroma. Gardner convincingly argued that the term peripheral odontogenic fibroma be reserved for those lesions that are neoplastic and have characteristic odontogenic epithelium. This diagnosis would include only those lesions that meet the World Health Organization criteria. He also reinforced the concept that the POF is not the peripheral variant of the central ossifying fibroma, a true neoplasm, but a distinct non-neoplastic inflammatory proliferation. POF occurs more frequently in female than in male individuals, is more common in the maxilla, and generally presents as a painless mass smaller than 2 cm. Occasionally larger lesions have been reported in the literature. The generally ac

Objective The aim of this multicenter study was to perform a histomorphometric analysis of peritrabecular clefting in fibrous dysplasia (FD) in an attempt to obtain data that could be useful for distinguishing between FD and ossifying fibroma (OF). Study Design A clinicopathologic analysis was performed in 68 patients diagnosed with FD and 37 patients diagnosed with OF. Histologic sections were scanned using an Aperio ScanScope CS. A histomorphometric analysis was performed with the aid of an image analyzer (UTHSCSA Image Tool 3.0 version) on 37 randomly selected samples of FD, and the results were compared with the 37 OF specimens. Results The presence of peritrabecular clefting was observed in 32 (86.5%) cases of FD, whereas no case of OF presented peritrabecular clefting. Conclusions Peritrabecular clefting may be a hallmark of the lesions in patients with FD, and it may be a valuable microscopic feature for distinguishing it from OF.

Gingival tissues are highly susceptible to developmental changes in the form of various reactive and neoplastic lesions. Peripheral ossifying fibroma is an inflammatory growth of the gums developing in response to plaque and other associated local factors favoring plaque accumulation and originating from the cells of the gingival corium, periosteum and periodontal ligament. Clinical picture of this lesion mimics a variety of other such reactive lesions and hence histological analysis is an important diagnostic tool. A case of peripheral ossifying fibroma in a 23 yr old female has been presented with its detailed clinical, radiographic and histo-pathological findings, the diagnostic challenges associated with such lesions and the management approaches for the same. Establishing an early diagnosis becomes imperative to rule out potential for malignant transformation.

Cemento-ossifying fibroma (COF) is considered a benign osseous tumor. Herewith, we present a case of multiple central ossifying fibroma in a 35-yeaold woman. Intraorally, there was swelling in the left upper posterior teeth region and another diffused swelling in the fourth quadrant. Radiographs revealed the presence of well-defined mixed radiolucent-radiopaque area having thin radiolucent rim followed by thick sclerotic margin. No genetic correlation could be established. As bilateral COF is a rare entity, we present such a case with different radiographic appearance, using various radiographic techniques.

Fibro osseous lesions are benign mesenchymal skeletal tumours in which mineralized tissue, blood vessels and giant cells, in varied proportions replace normal bone. Included in this group are fibrous dysplasia (FD), cherubism, ossifying fibroma and osteoblastoma. Although fibro osseous lesions have similar histologic and radiographic features, they may exhibit a wide range of biological behaviours. Because the histologic appearance does not predict the rate of growth or prognosis, treatment is based on the clinical and biologic behaviour of the tumour. The term “Juvenile active ossifying fibroma”(JAOF) has been given to a less common, more aggressive variant of the central ossifying fibroma which occurs primarily in children and young adults. This lesion has been described in literature under variety of terms like “aggressive psammomatoid ossifying fibroma” or “juvenile ossifying fibroma”. We are presenting a case of Juvenile aggressive ossifying fibroma in a 17 years old girl who reported to our institute.

Peripheral ossifying fibroma (POF) is a focal, reactive, non-neoplastic tumor-like growth of the soft tissue occurring frequently in the maxillary anterior region, mainly affects females, predominating in the second decade of life. POF typically presented as a solitary, slow growing nodular mass that is either pedunculated or sessile. POF is commonly associated with poor oral hygiene, trauma, microorganisms etc and majority of cases showing no marked underlying bone involvement radiographically. The definitive diagnosis is based on histology, with identification of cellular connective tissue and focal presence of osseous component or other calcifications. Surgery is the treatment of choice, though it has a recurrence rate of 8-20%. We report an unusual case of a large POF in the posterior mandible region of a male child patient with histopathological correlations and also highlights the differential diagnosis and management.

Central ossifying fibroma is a benign, non-odontogenic tumor of the jaw, a type of fibro-osseous lesion characterized by slow growth and proliferation of fibrous cellular tissue, bone, cement, or a combination. This lesion tends to occur in the second to fourth decades of life, with predilection for women and for the mandibular premolar and molar areas. The following article reports a case of a 49-year-old female patient, who presented with large ossifying fibroma in the mandible and brief literature review of these uncommon lesions is also conducted.

Adenomatoid odontogenic tumor (AOT) is a relatively rare neoplasm. This tumor most commonly occurs in the maxilla, in the age range of 3–82 years and has a female predilection. Most AOTs occur intraosseously, while few occur within gingival structures. AOT located intraosseously may/may not be associated with an unerupted tooth (extrafollicular variant). This article highlights the unusual presentation of AOT seen in an 11-year-old female patient with a history of trauma 4 years back and a noticeable swelling in the same region 2 years later. The clinical findings were suggestive of traumatic bone cyst, fibroma, central ossifying fibroma, central giant cell granuloma (CGCG), and odontogenic tumor. Based on the radiological features, a differential diagnosis of central ossifying fibroma, CGCG, fibrous dysplasia, and extrafollicular variant of AOT/odontogenic tumor was given. Eventually, radiographic and histopathologic investigations confirmed the case as an extrafollicular variant of AOT.

Osteomas are relatively rare benign osteogenic neoplasms, characterized by the proliferation of compact and/or cancellous bone. Osteomas can develop as peripheral (periosteal) masses attached to the cortical plates or as central lesions arising from endosteal bone surfaces. Although multiple osteomas of the jaws are a hallmark of Gardner syndrome (familial adenomatous polyposis), nonsyndromic cases are typically solitary. A search of the literature identified 91 well documented cases of solitary osteoma of the jaws published since 1955: 93.4% were peripheral and only 6.6% central, a ratio of 14:1 in favor of peripheral osteomas. Solitary central osteomas of the jaws seem to be very rare, with only 6 such cases reported since 1955. Adding the 4 new cases described here brings the total to 10 central osteomas, 30% occurring in the maxilla and 70% in the mandible. Whereas peripheral osteomas are fairly easy to diagnose, central osteomas pose a more challenging diagnostic problem and need to be differentiated from other similar lesions of the jaws, such as central ossifying fibroma, condensing osteitis, idiopathic osteosclerosis, osteoblastoma, cementoblastoma, and complex odontoma. With such a low number of cases of central osteoma reported, the objectives of the present report are to describe 4 new cases, analyze the clinical and radiographic characteristics, and discuss the features which distinguish these lesions from other similar lesions of the jaws.

Objective: To analyze radiographic and histopathologic findings of a series of cases of central ossifying fibroma (COF) and fibrous dysplasia (FD) of the jaw...

Background/Purpose Central ossifying fibroma (COF) is the most common benign fibro-osseous lesion of the jaw. This retrospective study evaluated the clinical and histopathologic features of 28 COFs in Taiwanese patients. Methods Twenty-eight consecutive cases of COF were collected from 1988 to 2006. The clinical data and microscopic features of these cases were reviewed and analyzed. Results The mean age of patients at the time of diagnosis was 34 years. There were six male and 22 female patients. Twenty-six (93%) cases were found in the mandible and two (7%) in the maxilla. The most common sites for COFs were the molar region (17 cases, 61%), followed by the premolar (8 cases, 28%), and incisor/canine (3 cases, 11%) regions. Bone swelling or expansion (96%, 26/27) was the most frequent clinical presentation. Six (21%) COFs presented as a radiolucent lesion, 17 (61%) as a mixed lesion, and five (18%) as a radio-opaque lesion. No recurrence of the lesion was found after surgical excision in this series. Microscopically, COFs showed trabeculae of woven bone (25 cases) and/or lamellar bone (5 cases) and/or spherules of cementoid (19 cases) in a cellular fibrous connective tissue stroma. The stromal component was highly cellular in 21 cases, moderately cellular in seven cases, prominently vascular in 11, and collagenous in six. Conclusion COFs occur more frequently in female patients and in those in the second to fourth decades of life. The most commonly affected site is the mandible, especially the molar region. The majority of COF lesions present as a well-defined, mixed lesion radiographically. Most COFs can be treated by conservative surgical excision without subsequent recurrence.

Central ossifying fibroma (COF) is a rare benign fibro-osseous neoplasm which has a predilection for mandible and is encountered in middle aged women. It arises from mesenchymal blast cells of the periodontal ligament, and with a potential to form fibrous tissue, cementum and bone. It is a well circumscribed lesion mainly comprising of fibrous tissue with varying amounts of bone or cementum or osteo-cementum like tissue. We present an uncommon case of COF of the maxilla in a 35-year-old male who presented with a pus discharging sinus in the maxilla. Due to the bizarre size of the lesion we have termed as ‘giant’ COF. There is extensive facial asymmetry on the right side with obliteration of the maxillary antrum, deviation of the nose and upward displacement of the orbit.