[1] COD occurs when fibrous tissue containing osteoid and cementoid replace bone, and may be due to pathogenic mutations in various signaling pathways.

[3] Studies have demonstrated that these patients tend to be in the fourth decade of life, and approximately 70% of COD cases are located near teeth apices.

Incorrect diagnosis could lead to unnecessary root canal treatments, or biopsy or surgical intervention which can be invasive and increase the risk of infection.

[7] Cone-beam computed tomography (CBCT) has proven useful in distinguishing between COD and periapical cysts, when examined with quantitative texture analysis using specialized software.

[8] Symptomatic patients may receive treatment options that include surgical curettage with bleeding stimulation or pulp vitality testing in areas showing periapical inflammation.