Iatrogenic osteomyelitis in patients with florid cemento-osseous dysplasia: an illustrative case report

Introduction: Cemento-osseous dysplasia (COD) is a benign fibro-osseous lesion of the jaws, often asymptomatic but potentially complicated by secondary infection due to its hypovascular nature. Osteomyelitis may occur following minor trauma or dental procedures when the condition is unrecognized or improperly managed. Case report: A 52-yr-old woman of African descent developed osteomyelitis of the right mandible after multiple tooth extractions performed abroad. CBCT imaging revealed bilateral florid COD with mixed radiolucent–radiopaque lesions and bone sequestra. Conservative surgical debridement under local anesthesia, followed by prolonged antibiotic therapy, allowed symptom resolution, full mucosal healing, and bone remodeling. Discussion: This case illustrates the iatrogenic risk of invasive procedures in unrecognized COD. The hypovascular, sclerotic bone limits healing and antibiotic diffusion, predisposing to chronic infection. Previous reports similarly describe secondary osteomyelitis arising in florid COD and support conservative management combining limited debridement and prolonged antibiotic therapy. Early radiographic recognition and pulp vitality testing of teeth with unexplained periapical radiolucencies are key to preventing misdiagnosis. When infection occurs, conservative management, when possible, ensures optimal outcomes. Conclusion: Clinicians should suspect COD in middle-aged women of African descent presenting with mixed mandibular lesions. Early diagnosis and avoidance of unnecessary extractions can prevent osteomyelitis and reduce morbidity.