Periapical cemental dysplasia (PCD) often occurs in middle-aged women. At the initial stage, PCD is characterized by the radiolucent shadows at the apices of multiple mandibular anterior teeth. Depending on the different stages of the lesion, sometimes radiopaque images around the root tips will be observed. Clinically, patient has no symptoms, and usually no need of treatment. PCD is similar with apical periodontitis in the early stage; differential diagnosis should be done to avoid misdiagnosis and unnecessary treatment. (J. Family Dent. 6(4): 45-48, 2012)