Periapical cemento-osseous dysplasia is a condition that usually does not have symptoms and can be identified only through radiography. The condition usually occurs in the periapical area of the mandible, yet it also can affect multiple sites, including the root apex of several teeth, which can be visible only on a radiography scan.
During the first stage, a replacement of osseous tissue with fibrous one takes place, which causes lesions. Research shows that the average size of such lesions is 1.8 cm, but it can range from 0.2 to 11 cm. Nevertheless, despite the fact that the lesions emerge in close proximity to the apex of a tooth, the periodontal ligament continues to be visible in radiographs.
As periapical cemento-osseous dysplasia progresses, lesions assume a radiolucent-radiopaque mixed pattern in the radiograph because of an increased cementoblastic activity which causes cementum spicules depositions. Eventually, periapical cemento-osseous dysplasia becomes a fully opaque mass that occasionally may have a radiolucent halo.