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

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