Bone regeneration and dental implant surgeries in florid cemento-osseous dysplasia: A case report

Cemento-osseous dysplasia (COD) is a benign fibro-osseous pathology in which fibrous connective tissues, osteoid and cementum-like materials, replace bone. Concerning the hypovascularization and increased mineralization of bone that occurs in these patients, the clinician may face two types of problems: infectious complications such as osteomyelitis and increased implant failure. The present study aims to report the successful and innovative management of a COD patient complicated by mandibular osteomyelitis and the implant rehabilitation of this area. We report the management of a 54-year-old patient presenting with florid cemento-osseous dysplasia (FCOD) complicated by mandibular osteomyelitis, which required antibiotic administration and two surgeries to resolve. This area was then reconstructed with guided bone regeneration before three implants were placed using guided surgery, including one implant in a dysplastic area and one in the graft site. Osseointegration of the implants allowed rehabilitation with a supra-implant bridge. An optimal functional rehabilitation and complete integration of implants were observed 13 months after the surgery. Eight cases of implant placement in COD patients have been reported before in the literature (n=35 implants). The success rate of dental implants in non-dysplastic areas is comparable to the general population, but it decreases when implants are placed in dysplastic areas. Guided implant surgery is an interesting tool for placing implants outside dysplastic regions.