Radiopacity attached to root of mandibular molar, the teeth vital and non carious.. Periapical Cemental dysplasia

Radiopacity attached to root of mandibular molar, the teeth vital and non carious?
A- Ossifying fibroma
B- Hypercementosis
C- Periapical Cemental dysplasia***

Periapical cementum dysplasia (DCOP), a fibrous bone lesion, is characterized by the gradual replacement of healthy bone tissue with fibrous tissue - this is an idiopathic condition.
DCOP originates from the periodontal ligament, and thus can affect both maxilla and mandible, either alone or in a group of dental elements.
In general, as fibro bone lesions progressively cause bone tissue replacement, radiographically these pathologies will present different characteristics according to their maturation, that is, with their age. It means that more recent lesions have a predominantly radiolucent / hypodense imaging aspect; lesions in an intermediate stage will appear mixed density (radiopaque and radilucent / hyperdense and hypodense); and finally, old lesions are predominantly radiopaque / hyperdense.
DCOP is self-limiting, that is, this type of lesion, when it reaches its final stage of maturation will not cause an expressive increase in cortical bone volume.
The teeth associated with DCOP respond positively to the pulp vitality test.
Authors classify DCOP into three phases:

- Phase 1 - Osteolytic:
 At first, there is bone lysis. Its radiographic characteristic is predominantly radiolucent. It is radiographically identical to a periapical bone thinning arising from an inflammatory process. What clinically differs COPD from periapical bone thinning is that in the latter, the affected dental element has no pulp vitality.

- Phase 2 - Cementoblastic:
 Intermediate stage represented by mixed density. It shows that bone tissue at the time of radiographic / tomographic acquisition is being continually replaced by fibrous tissue.

- Phase 3 - Maturation:
 Final stage, which represents the apex of the apposition of fibrous tissue in the periapical region. We see predominantly radiopaque (hyperdense) imaging, surrounded by radiolucent halo (hypodense) - all root extension can be observed.
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