The Vital Illusion: Cone-Beam Computed Tomography (CBCT)-Tracked Evolution of Periapical Cemento-Osseous Dysplasia

Periapical cemento-osseous dysplasia (PCOD) is a benign fibro-osseous lesion that, in its early osteolytic stage, can mimic inflammatory periapical disease and prompt unnecessary endodontic treatment. This report documents its radiographic evolution in a 44-year-old woman referred for endodontic evaluation of the mandibular left canine and premolars. A previous panoramic radiograph obtained as a baseline was unremarkable. At initial presentation, panoramic and cone-beam computed tomography (CBCT) imaging revealed periapical radiolucencies around the apices of the canine, first, and second premolars, with a central radiopacity beneath the canine, consistent with transition to the mixed stage. All involved teeth were asymptomatic and responded normally to cold and electric pulp testing. No treatment was performed. At 13.5-month follow-up, the central radiopacity had enlarged while the teeth remained vital. Recognizing PCOD and confirming pulp vitality prevent misdiagnosis and overtreatment; periodic clinical and radiographic monitoring is the appropriate management.