Florid cemento-osseous dysplasia (FCOD) is a benign fibro-osseous lesion that predominantly affects middle-aged women and may occasionally be associated with simple bone cysts (SBC), posing a diagnostic challenge. A 49-year-old female presented with a three-month history of dull pain in the lower right posterior region, radiating to the head, neck, and right shoulder. Clinical examination revealed mild cortical expansion, left submandibular lymphadenitis, and tenderness over the maxillary sinuses and cervical muscles. Radiographic evaluation demonstrated multiple radiolucent areas in the mandible associated with hypercementosis and sclerotic changes. Biochemical investigations, including serum calcium, phosphorus, alkaline phosphatase, and parathyroid hormone levels, were within normal limits. Histopathological examination confirmed the diagnosis of florid cemento-osseous dysplasia associated with a simple bone cyst. The coexistence of these lesions can result in atypical clinical and radiographic features, making accurate diagnosis challenging. This case highlights the importance of integrating clinical findings with radiographic, biochemical, and histopathological investigations for the diagnosis of complex fibro-osseous lesions of the jaws. A comprehensive and multidisciplinary diagnostic approach is essential for distinguishing FCOD associated with SBC from other mixed or radiolucent jaw lesions and for guiding appropriate patient management.

Background: Large cyst-like periapical lesions are often managed initially with conventional nonsurgical root canal treatment. However, persistent clinical signs despite adequate disinfection and obturation may necessitate endodontic microsurgery. Careful case selection, advanced imaging, and modern microsurgical techniques are essential for predictable healing. Case Presentation: A 35-year-old male presented with pain, swelling, and a draining sinus tract in the maxillary right anterior region for one month, with a history of dental trauma ten years earlier. Clinical examination revealed tenderness to percussion, purulent discharge, and negative pulp sensibility responses in teeth 11 and 12, while tooth 13 exhibited an exaggerated lingering response suggestive of symptomatic irreversible pulpitis. Cone-beam computed tomography (CBCT) demonstrated a large cyst-like periapical lesion measuring 20.1 × 12.7 × 18.5 mm with buccal and palatal cortical plate perforation, extension to the nasal floor, and involvement of the nasopalatine canal. Conventional root canal treatment was performed for teeth 11, 12, and 13. Teeth 11 and 12 underwent sequential intracanal medication using calcium hydroxide and double antibiotic paste alternatively for 5 visits. Following successful canal drying and obturation, the persistent sinus tract and extensive osseous destruction warranted endodontic microsurgery. Apicoectomy and ultrasonic root-end preparation were performed under a dental operating microscope, followed by retrograde filling with Biodentine. The osseous defect was managed using sticky bone prepared with Osseograft® and injectable platelet-rich fibrin (i-PRF), covered with a platelet-rich fibrin (PRF) membrane. At six-month follow-up, the patient was asymptomatic, with resolution of the sinus tract and radiographic evidence of progressive periapical healing. Conclusion: This case demonstrates that endodontic microsurgery is a predictable treatment option for persistent large cyst-like periapical lesions following appropriate nonsurgical root canal treatment. Integration of CBCT-based diagnosis, microsurgical techniques, bioceramic root-end filling, and regenerative adjuncts may contribute to favorable clinical and radiographic outcomes in extensive periapical defects.

Background: Immature permanent teeth with pulpal necrosis and open apices are difficult to manage because of incomplete root development and the absence of an apical constriction. Case Presentation: A 29-year-old male with a history of trauma 20 years earlier presented with discolored, fractured maxillary central incisors. Clinical and radiographic findings confirmed pulpal necrosis with chronic apical abscess and open apices. Treatment comprised chemomechanical preparation, calcium hydroxide intracanal medication, MTA apexification, thermoplasticized gutta-percha obturation, internal bleaching, and porcelain laminate veneer rehabilitation. Conclusion: A multidisciplinary approach successfully restored periapical health, function, and esthetics with satisfactory one-year follow-up.