A Differential Diagnosis of the Periapical Radiolucency: The Ossifying Fibroma

Most of the cases of a periapical radiolucency are caused by a periapical granuloma or a radicular cyst. However, differential diagnoses exist, which require a modified approach. The following case presentation demonstrates a rare differential diagnosis of a periapical radiolucency. Per incidental finding, multiple apical osteolysis were detected on the panoramic radiograph taken by a 65-year-old female patient. Until the very first clinical examination, there were no complaints of the affected teeth present. The vitality test taken showed all teeth being positive. Following the CT Scan osteolysis around the teeth 33, 35, 36 and 41 and a vestibular distension on 36 were found, which were clinically manifest as well. The histologic examination of the samples taken from the regions 36 and 41 revealed an ossifying fibroma. Following root canal treatment of the affected teeth 33, 35, 36 and 41, a surgical resection of the fibroma based on a microscope-based surgery and a neurolysis of the mental and alveolar inferior nerve were carried out. An apecectomy was performed on several teeth. The defects were drilled out and the soft and fibrous tissues were removed completely. Collagen was placed in the bony defects. The one-year postoperative clinical and radiologic examination revealed no recurrence of the ossifying fibroma. The treatment of the ossifying fibroma consists of the exstirpation and curettage in toto. All structures affected from the lesion should be removed as well. Following a total resection of the tumoral tissues, it can be claimed to have a good prognosis. Even asymptomatic incidental findings should be examined using further diagnostic investigations such as a CT-Scan, and where applicable, samples should be taken for a histologic clarification, so that a reliable diagnosis can be evaluated. Keywords: Ossifying Fibroma, Periapical Radiolucency