A Cystic-like Lesion of Uncertain Origin—A Discussion on Cemento-Osseous Dysplasia and Traumatic Bone Cysts

Mandible cemento-osseous dysplasia (COD) can be found mostly associated with dental roots and tooth-bearing anatomical structures. A variety of odontogenic cysts and tumors might have similar appearances. A lesion in the jaw bone not associated with dental roots with a cyst-like appearance might suggest a non-odontogenic lesion, an empty bone cavity, an osseous, fibrous, or fibro-osseous lesion, or a traumatic bone cyst (TBC). A radiolucent irregular bone cavity without clear borders always requires improved diagnostics in cone-beam computed tomography (CBCT) as well as a revision and a biopsy in some cases. When there is some bone swelling and asymmetry on radiological evaluation, followed by extra-cortical spread, and the lesion has irregular borders with thickening or atypical calcifications, a biopsy should be performed. COD and TBCs can be found mostly associated with dental roots, but sometimes they are not associated with tooth-bearing jaw structures and might cause some diagnostic problems, especially if they resemble an empty radiolucent cystic-like lesion in an atypical location. Regardless of the type of lesion, a bone revision and a biopsy are important. When a sufficient amount of a sample is removed and evaluated, this can greatly improve the final diagnosis. The authors present an interesting case of a lesion accidentally found in a routine panoramic radiograph used for screening before scheduled orthodontic treatment.