Denosumab usage in atypical cemento-osseous dysplasia involving the entire mandible: a case report

BackgroundCemento-osseous dysplasia (COD) is the most common apical radiopaque lesion that develops in the tooth-bearing area. However, large, destructive lesions are rare. Herein, we report a case in which COD extended to bilateral condyles, affecting the entire mandible, and was managed with denosumab rather than surgical resection.Case PresentationA 45-year-old woman presented to our hospital with progressive, large, destructive COD involving the entire mandible, including bilateral condyles, and associated bony expansion, which led to facial deformity and malocclusion. The patient declined total mandible resection and opted for off-label denosumab use instead. Although rapid ossification of the osteolytic lesion was observed after 9 months of treatment, the lesion volume remained unchanged. Single-photon emission computed tomography performed at follow-up revealed stable disease without progression.ConclusionDenosumab may help prevent the progression of severe, destructive COD in patients averse to surgical intervention.