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Cemento-Osseous Dysplasia of the Jaw Bones

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Cemento-Osseous Dysplasia of the Jaw Bones Cemento-osseous dysplasia of the jaw bones: A radiographic analysis of 118 cases by Noura A. AlSufyani BDS A thesis submitted in conformity with the requirements for the degree of Master of Science Oral Radiology Graduate Department of Dentistry University of Toronto © Copyright by Noura A. AlSufyani BDS 2010 Cemento-osseous dysplasia of the jaw bones: A radiographic analysis of 118 cases Master of Science 2010 Noura A. AlSufyani BDS Graduate Department of Dentistry University of Toronto Abstract Objectives: This project explores the demographic and clinical presentation of cemento- osseous dysplasia (COD), and their pathognomonic radiographic features. Methods: Demographic and clinical data were collected from the charts of 118 subjects with COD from the Oral Radiology archives. Using a systematic objective survey instrument, 3 general dentists (GP) and 3 oral radiologists (RG) reviewed 50 image sets of COD and similarly-appearing entities. Participants were asked to identify radiographic features and to make a diagnosis based on the images provided. Results: The majority of cases occurred in clinically asymptomatic females in their fifth decade. RGs identified a well- defined border, radiolucent periphery, bilateral occurrence, mixed radiolucent/radiopaque internal structure, and association with anterior and posterior teeth as key features, correctly interpreting 79.3% of COD cases. The absence of root resorption and an association with anterior and posterior teeth were the only key features that guided GPs to correctly interpret 38.7% of COD cases. ii Acknowledgment I am heartily thankful to my supervisor, Dr. Ernest Lam, for his mentorship, encouragement, guidance and support. To my advisory committee members, Dr. Michael Pharoah, Dr. Grace Bradley and Dr. Robert (Bob) Wood, this project would not have been possible without your invaluable assistance and participation. My deepest gratitude goes to my family for their unconditional love and support throughout my life. I am forever indebted to my husband, Mohammed, for his endless care, love and motivation throughout this journey. To my dearest Sara, you are my greatest accomplishment. Thank you for being my inspiration. iii Table of Contents Abstract ......................................................................................................................... ii Acknowledgment ......................................................................................................... iii Table of contents .......................................................................................................... iv List of Tables ............................................................................................................... vi List of Figures ............................................................................................................. vii List of Appendices ..................................................................................................... viii Introduction ..................................................................................................................1 1.1.Literature review ..................................................................................................1 A. Definition and terminology ..............................................................................1 B. Demographic presentation ................................................................................6 C. Clinical presentation .........................................................................................7 D. Radiographic presentation ................................................................................7 E. Histopathology of cemento-osseous dysplasia ...............................................14 F. Association with simple bone cyst (SBC) ......................................................18 G. Secondary infection and osteomyelitis ...........................................................21 H. Misdiagnosis and mismanagement .................................................................24 I. Role of radiology ............................................................................................25 1.2. Aims ..................................................................................................................27 1.3. Objectives ..........................................................................................................28 1.4.Null hypotheses ..................................................................................................28 Materials and methods ..............................................................................................29 2.1. Research design .................................................................................................29 2.1.1. Part I: Chart review ..................................................................................29 2.1.2. Part II: Objective test ................................................................................30 2.2. Data collection ..................................................................................................32 2.3. Statistical analysis ............................................................................................32 Results .........................................................................................................................36 3.1. Part I: chart review ............................................................................................36 A. Demographics and clinical features................................................................36 B. Type of COD and associated pathoses ...........................................................36 C. Reported radiographic features of COD .........................................................39 D. Follow-up data ................................................................................................41 iv 3.2. Part II: objective test .........................................................................................43 A. Inter-examiner agreement ...............................................................................43 B. Radiographic features of COD .......................................................................50 C. Final interpretation of COD ............................................................................53 D. Key radiographic features for a correct interpretation of COD ......................55 E. Intra-examiner agreement ...............................................................................58 Discussion....................................................................................................................60 4.1. Part I: chart review ............................................................................................61 A. Demographics and clinical features................................................................61 B. Type of COD and associated pathoses ...........................................................62 C. Reported radiographic features of COD .........................................................65 4.2. Part II: objective test .........................................................................................67 A. Examiner agreement .......................................................................................67 B. Radiographic features of COD .......................................................................68 C. Final interpretation of COD ............................................................................71 D. Key radiographic features of COD .................................................................71 4.3. Limitations ........................................................................................................73 4.4. Conclusion .........................................................................................................75 References ...................................................................................................................77 v List of Tables Table 1. Variables collected for Part II of the study ....................................................34 Table 2. Most frequent reported radiographic features of COD .................................40 Table 3. Follow-up of subjects with COD ...................................................................42 Table 4. Radiographic survey and examiners’ interpretation of COD cases ...............44 Table 5. Landis and Koch interpretation of Kappa Cohen scores ...............................45 Table 6. Examiner agreement with the radiographic interpretation ............................46 Table 7. Inter-examiner agreement between general dentists ......................................48 Table 8. Inter-examiner agreement between oral radiologists .....................................49 Table 9. Frequent radiographic features of COD reported by each examiner group ...51 Table 10. Significant differences between examiner groups in reporting radiographic features of COD ............................................................................................52 Table 11. Examiners’ final interpretation of COD .....................................................54 Table 12. Multiple logistic regression analysis for general dentists ............................56 Table 13. Multiple logistic regression analysis for oral radiologists ...........................57 Table 14. Intra-examiner agreement on final radiographic interpretation ...................59
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