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{{SI}}                                                                 
{{SI}}                                                                 
{{CMG}} {{AE}} {{MV}}
{{CMG}}; {{AE}} {{MV}} {{ADG}}
{{SK}} Synonym 1; Synonym 2; Synonym 3
   
   
{{SK}} Cementoblastomata; True cementoma; Benign cementoblastoma
==Overview==
==Overview==
 
'''Cementoblastoma''' is a relatively rare [[benign]] [[neoplasm]] of the [[cementum]] of the [[teeth]]. Cementoblastoma is derived from [[ectomesenchyme]] of [[odontogenic]] origin. According to the World Health Organization, cementoblastoma is classified as a true cemental neoplasm. True cemental neoplasms may be classified into 4 categories: benign cementoblastoma, cementifying fibroma, periapical cemental [[dysplasia]], and [[gigantiform cementoma]]. Cementoblastomas are uncommon neoplasms and account for approximately 0.69%–8% of all odontogenic tumors. Common complications of cementoblastoma include [[bleeding]], [[nerve injury]], and [[malocclusion]]. X ray is the imaging modality of choice for cementoblastoma. On x ray, characteristic findings of cementoblastoma include well defined, markedly radiopaque mass, radiolucent peripheral "line" which overlies and obliterates the tooth root, apparent [[External resorption|external]] [[root resorption]], and severe hypercementosis. Surgical tooth extraction in conjunction with post-surgery biopsy is the most common approach to the treatment of cementoblastoma.<ref name="pmid19644548">{{cite journal |vauthors=Huber AR, Folk GS |title=Cementoblastoma |journal=Head Neck Pathol |volume=3 |issue=2 |pages=133–5 |year=2009 |pmid=19644548 |pmc=2715464 |doi=10.1007/s12105-008-0099-5 |url=}}</ref><ref>Leena S Sankari and K Ramakrishnan,  Benign cementoblastoma, ''Journal of Oral and Maxillofacial Pathology, ''2011 Sep-Dec; 15(3): 358–360 at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3227271/</ref>
'''Cementoblastoma''' (also known as benign cementoblastoma) is a relatively rare [[benign]] [[neoplasm]] of the [[cementum]] of the [[teeth]]. Cementoblastoma is derived from ectomesenchyme of odontogenic origin.<ref>Leena S Sankari and K Ramakrishnan,  Benign cementoblastoma, ''Journal of Oral and Maxillofacial Pathology, ''2011 Sep-Dec; 15(3): 358–360 at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3227271/</ref>


==Historical Perspective==
==Historical Perspective==
*Cementoblastoma was first discovered by Norberg in 1930.  
*Cementoblastoma was first discovered by Norberg in 1930.<ref name="pmid19644548">{{cite journal |vauthors=Huber AR, Folk GS |title=Cementoblastoma |journal=Head Neck Pathol |volume=3 |issue=2 |pages=133–5 |year=2009 |pmid=19644548 |pmc=2715464 |doi=10.1007/s12105-008-0099-5 |url=}}</ref>


==Classification==
==Classification==
*According to the World Health Organization, cementoblastoma is classified as a true cemental neoplasm. 
*True cemental neoplasms may be classified according to histological types into 4 categories:<ref name="pmid19644548">{{cite journal |vauthors=Huber AR, Folk GS |title=Cementoblastoma |journal=Head Neck Pathol |volume=3 |issue=2 |pages=133–5 |year=2009 |pmid=19644548 |pmc=2715464 |doi=10.1007/s12105-008-0099-5 |url=}}</ref><ref name="AtlasFaceTumor"> Prein J. Atlas of tumors of the facial skeleton, odontogenic and nonodontogenic tumors. Not Avail; 1986. https://books.google.com/books?id=7XhyBgAAQBAJ&pg=PA34&lpg=PA34&dq=o+norberg+germany+1930+cementoblastoma&source=bl&ots=OtxdFwBhPf&sig=CMlOt07lv1M1XMSwRfFu5CvWLK8&hl=en&sa=X&ved=0ahUKEwij__nOwKrOAhWGVh4KHXnHDbAQ6AEIHDAA#v=onepage&q=o%20norberg%20germany%201930%20cementoblastoma&f=false Accessed on August 5, 2016 </ref>
:*Benign cementoblastoma
:*Cementyfing fibroma
:*Periapical cemental dysplasia
:*[[Gigantiform cementoma]]


*According to the World Health Organization, cementoblastoma is classified as a true cemental neoplasm. 
==Pathophysiology==
==Pathophysiology==
*The pathogenesis of cementoblastoma is characterized by originating from the root and slowly enlarging (it therefore obliterates the periodontal ligament space).  
*The pathogenesis of cementoblastoma is characterized by origination at the root and slowly enlarges until it obliterates the [[periodontal ligament]] space.
*Cementoblastoma is commonly located in the mandibular molar area.  
*Cementoblastoma arises from [[cementoblast]]s, which are normally involved in the formation of [[cementum]].  
*Cementoblastoma is commonly located in the [[mandibular]] [[molar (tooth)|molar area]].  
*There are no genetic mutations associated with the development of cementoblastoma.
*There are no genetic mutations associated with the development of cementoblastoma.
*On gross pathology, characteristic findings of cementoblastoma, include:
*On gross pathology, characteristic findings of cementoblastoma include:<ref name="pmid19644548">{{cite journal |vauthors=Huber AR, Folk GS |title=Cementoblastoma |journal=Head Neck Pathol |volume=3 |issue=2 |pages=133–5 |year=2009 |pmid=19644548 |pmc=2715464 |doi=10.1007/s12105-008-0099-5 |url=}}</ref>
:*Dense homogenous, irregular, and spherical mass
:*Dense [[homogenous]], irregular, and spherical mass
:*Tooth root
:*[[Tooth|Tooth root]]
*On microscopic histopathological analysis, characteristic findings of cementoblastoma, include:  
*On microscopic histopathological analysis, characteristic findings of cementoblastoma include:<ref name="pmid19644548">{{cite journal |vauthors=Huber AR, Folk GS |title=Cementoblastoma |journal=Head Neck Pathol |volume=3 |issue=2 |pages=133–5 |year=2009 |pmid=19644548 |pmc=2715464 |doi=10.1007/s12105-008-0099-5 |url=}}</ref>
:*Large globules fused to form a mass
:*Large globules fused to form a mass
:*Composed of proliferative fibrovascular stroma
:*Composed of proliferative fibrovascular [[stroma]]
:*Trabeculae lined by plump osteoblasts
:*[[Trabeculae]] lined by plump [[osteoblast]]s


==Causes==
==Causes==
* Common causes of cementoblastoma, include:
*There are no established causes of cementoblastoma.<ref name="pmid19644548">{{cite journal |vauthors=Huber AR, Folk GS |title=Cementoblastoma |journal=Head Neck Pathol |volume=3 |issue=2 |pages=133–5 |year=2009 |pmid=19644548 |pmc=2715464 |doi=10.1007/s12105-008-0099-5 |url=}}</ref>


==Differentiating Cementoblastoma from Other Diseases==
==Differentiating Cementoblastoma from Other Diseases==
*Cementoblastoma must be differentiated from other diseases that cause tooth pain, or swelling, such as:
*Cementoblastoma must be differentiated from other diseases that cause tooth pain or swelling, such as:<ref name="pmid19644548">{{cite journal |vauthors=Huber AR, Folk GS |title=Cementoblastoma |journal=Head Neck Pathol |volume=3 |issue=2 |pages=133–5 |year=2009 |pmid=19644548 |pmc=2715464 |doi=10.1007/s12105-008-0099-5 |url=}}</ref>
:*Sclerosing osteomyelitis  
:*Sclerosing [[osteomyelitis]]
:*Osteoblastoma   
:*[[Osteoblastoma]]  
:*Periapical cemental dysplasia
:*Periapical cemental [[dysplasia]]
:*Osteitis  
:*[[Osteitis]]
:*Hypercementosis
:*Hypercementosis


==Epidemiology and Demographics==
==Epidemiology and Demographics==
* Cementoblastoma is uncommon.
*Cementoblastoma accounts for approximately 0.69%–8% of all odontogenic tumors.
* Cementoblastoma accounts less than 0.69%–8% of all odontogenic tumors.  
 
===Age===
===Age===
*Cementoblastoma is more commonly observed among patients aged 20 to 25 years old.
*Cementoblastoma is more commonly observed among patients aged 20 to 25 years old.
*Cementoblastoma is more commonly observed among young adults.  
*Cementoblastoma is more commonly observed among young adults.  
===Gender===
===Gender===
*Cementoblastoma affects men and women equally.
*Males are more commonly affected with cementoblastoma than females.  
 
===Race===
===Race===
*There is no racial predilection for cementoblastoma.
*There is no racial predilection for cementoblastoma.


==Risk Factors==
==Risk Factors==
*Common risk factors in the development of cementoblastoma, include:
*There are no known risk factors in the development of cementoblastoma.
:*
 
:*
==Natural History, Complications, and Prognosis==
== Natural History, Complications and Prognosis==
*The majority of patients with cementoblastoma are initially asymptomatic.  
*The majority of patients with cementoblastoma are initially asymptomatic.  
*Early clinical features include tooth pain, swelling, and 
*Early clinical features may include tooth pain or swelling.
*If left untreated, patients with cementoblastoma may progress to develop
*Common complications of cementoblastoma include:<ref name="pmid19644548">{{cite journal |vauthors=Huber AR, Folk GS |title=Cementoblastoma |journal=Head Neck Pathol |volume=3 |issue=2 |pages=133–5 |year=2009 |pmid=19644548 |pmc=2715464 |doi=10.1007/s12105-008-0099-5 |url=}}</ref>
*Common complications of cementoblastoma, include:
:*[[Bleeding]]
*Prognosis is generally good, and the recurrence rate of patients with cementoblastoma is approximately  
:*[[Nerve injury]]
:*[[Malocclusion]]
*Prognosis is generally good, and the recurrence rate of patients with cementoblastoma is approximately 37.1%.<ref name="pmid19644548">{{cite journal |vauthors=Huber AR, Folk GS |title=Cementoblastoma |journal=Head Neck Pathol |volume=3 |issue=2 |pages=133–5 |year=2009 |pmid=19644548 |pmc=2715464 |doi=10.1007/s12105-008-0099-5 |url=}}</ref>
 
== Diagnosis ==
== Diagnosis ==
=== Symptoms ===
=== Symptoms ===
*Cementoblastoma is usually asymptomatic.
*Cementoblastoma is usually asymptomatic.
*Symptoms of cementoblastoma may include the following:
*Symptoms of cementoblastoma may include:<ref name="pmid22144847">{{cite journal |vauthors=Sankari LS, Ramakrishnan K |title=Benign cementoblastoma |journal=J Oral Maxillofac Pathol |volume=15 |issue=3 |pages=358–60 |year=2011 |pmid=22144847 |pmc=3227271 |doi=10.4103/0973-029X.86725 |url=}}</ref>
:*Tooth pain  
:*Tooth pain  
:*Dentin hypersensitivity  
:*[[Dentin]] hypersensitivity


=== Physical Examination ===
=== Physical Examination ===
*Patients with cementoblastoma usually are well-appearing.
*Patients with cementoblastoma usually are well-appearing.
*Oral examination may be remarkable for:
*Oral examination may be remarkable for:<ref name="pmid22144847">{{cite journal |vauthors=Sankari LS, Ramakrishnan K |title=Benign cementoblastoma |journal=J Oral Maxillofac Pathol |volume=15 |issue=3 |pages=358–60 |year=2011 |pmid=22144847 |pmc=3227271 |doi=10.4103/0973-029X.86725 |url=}}</ref>
:*Swelling  
:*[[Swelling]]
:*Malocclusion
:*[[Malocclusion]]
:*Gingival recession
:*[[Gingival recession]]
:*Gingivitis
:*[[Gingivitis]]


=== Laboratory Findings ===
=== Laboratory Findings ===
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===Imaging Findings===
===Imaging Findings===
*Conventional radiograph is the imaging modality of choice for cementoblastoma.
*X ray is the imaging modality of choice for cementoblastoma.
*On conventional radiograph, characteristic findings of cementoblastoma, include:
*On x ray, characteristic findings of cementoblastoma include:<ref name="pmid22144847">{{cite journal |vauthors=Sankari LS, Ramakrishnan K |title=Benign cementoblastoma |journal=J Oral Maxillofac Pathol |volume=15 |issue=3 |pages=358–60 |year=2011 |pmid=22144847 |pmc=3227271 |doi=10.4103/0973-029X.86725 |url=}}</ref>
:*Well defined, markedly radiopaque mass
:*Well defined, markedly radiopaque mass
:*Radiolucent peripheral "line", which overlies and obliterates the tooth root.
:*Radiolucent peripheral "line", which overlies and obliterates the tooth root
:*There is usually apparent external resorption of the root where the tumor and the root join.
*There is usually an apparent [[External resorption|external]] [[root resorption]] where the tumor and the root join.
:*Severe hypercementosis may be present  
*Severe hypercementosis may be present
====Gallery====


== Treatment ==
== Treatment ==
=== Medical Therapy ===
=== Medical Therapy ===
*There is no treatment for cementoblastoma; the mainstay of therapy is surgery.  
*There is no medical treatment for cementoblastoma; the mainstay of therapy is surgery.  


=== Surgery ===
=== Surgery ===
*Surgery is the mainstay of therapy for cementoblastoma.
*Surgery is the mainstay of therapy for cementoblastoma.<ref name="pmid22144847">{{cite journal |vauthors=Sankari LS, Ramakrishnan K |title=Benign cementoblastoma |journal=J Oral Maxillofac Pathol |volume=15 |issue=3 |pages=358–60 |year=2011 |pmid=22144847 |pmc=3227271 |doi=10.4103/0973-029X.86725 |url=}}</ref>
*Surgical tooth extraction in conjunction with post-surgery biopsy is the most common approach to the treatment of cementoblastoma.
*Surgical tooth extraction in conjunction with post-surgery [[biopsy]] is the most common approach to the treatment of cementoblastoma.


=== Prevention ===
=== Prevention ===
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{{Reflist|2}}
{{Reflist|2}}
   
   
[[Category: Oncology]]
[[Category:Oncology]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Otolaryngology]]

Latest revision as of 00:51, 6 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2] Aditya Ganti M.B.B.S. [3]

Synonyms and keywords: Cementoblastomata; True cementoma; Benign cementoblastoma

Overview

Cementoblastoma is a relatively rare benign neoplasm of the cementum of the teeth. Cementoblastoma is derived from ectomesenchyme of odontogenic origin. According to the World Health Organization, cementoblastoma is classified as a true cemental neoplasm. True cemental neoplasms may be classified into 4 categories: benign cementoblastoma, cementifying fibroma, periapical cemental dysplasia, and gigantiform cementoma. Cementoblastomas are uncommon neoplasms and account for approximately 0.69%–8% of all odontogenic tumors. Common complications of cementoblastoma include bleeding, nerve injury, and malocclusion. X ray is the imaging modality of choice for cementoblastoma. On x ray, characteristic findings of cementoblastoma include well defined, markedly radiopaque mass, radiolucent peripheral "line" which overlies and obliterates the tooth root, apparent external root resorption, and severe hypercementosis. Surgical tooth extraction in conjunction with post-surgery biopsy is the most common approach to the treatment of cementoblastoma.[1][2]

Historical Perspective

  • Cementoblastoma was first discovered by Norberg in 1930.[1]

Classification

  • According to the World Health Organization, cementoblastoma is classified as a true cemental neoplasm.
  • True cemental neoplasms may be classified according to histological types into 4 categories:[1][3]

Pathophysiology

  • The pathogenesis of cementoblastoma is characterized by origination at the root and slowly enlarges until it obliterates the periodontal ligament space.
  • Cementoblastoma arises from cementoblasts, which are normally involved in the formation of cementum.
  • Cementoblastoma is commonly located in the mandibular molar area.
  • There are no genetic mutations associated with the development of cementoblastoma.
  • On gross pathology, characteristic findings of cementoblastoma include:[1]
  • On microscopic histopathological analysis, characteristic findings of cementoblastoma include:[1]

Causes

  • There are no established causes of cementoblastoma.[1]

Differentiating Cementoblastoma from Other Diseases

  • Cementoblastoma must be differentiated from other diseases that cause tooth pain or swelling, such as:[1]

Epidemiology and Demographics

  • Cementoblastoma accounts for approximately 0.69%–8% of all odontogenic tumors.

Age

  • Cementoblastoma is more commonly observed among patients aged 20 to 25 years old.
  • Cementoblastoma is more commonly observed among young adults.

Gender

  • Males are more commonly affected with cementoblastoma than females.

Race

  • There is no racial predilection for cementoblastoma.

Risk Factors

  • There are no known risk factors in the development of cementoblastoma.

Natural History, Complications, and Prognosis

  • The majority of patients with cementoblastoma are initially asymptomatic.
  • Early clinical features may include tooth pain or swelling.
  • Common complications of cementoblastoma include:[1]
  • Prognosis is generally good, and the recurrence rate of patients with cementoblastoma is approximately 37.1%.[1]

Diagnosis

Symptoms

  • Cementoblastoma is usually asymptomatic.
  • Symptoms of cementoblastoma may include:[4]
  • Tooth pain
  • Dentin hypersensitivity

Physical Examination

  • Patients with cementoblastoma usually are well-appearing.
  • Oral examination may be remarkable for:[4]

Laboratory Findings

  • There are no specific laboratory findings associated with cementoblastoma.

Imaging Findings

  • X ray is the imaging modality of choice for cementoblastoma.
  • On x ray, characteristic findings of cementoblastoma include:[4]
  • Well defined, markedly radiopaque mass
  • Radiolucent peripheral "line", which overlies and obliterates the tooth root
  • There is usually an apparent external root resorption where the tumor and the root join.
  • Severe hypercementosis may be present

Treatment

Medical Therapy

  • There is no medical treatment for cementoblastoma; the mainstay of therapy is surgery.

Surgery

  • Surgery is the mainstay of therapy for cementoblastoma.[4]
  • Surgical tooth extraction in conjunction with post-surgery biopsy is the most common approach to the treatment of cementoblastoma.

Prevention

  • There are no primary preventive measures available for cementoblastoma.

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 Huber AR, Folk GS (2009). "Cementoblastoma". Head Neck Pathol. 3 (2): 133–5. doi:10.1007/s12105-008-0099-5. PMC 2715464. PMID 19644548.
  2. ↑ Leena S Sankari and K Ramakrishnan, Benign cementoblastoma, Journal of Oral and Maxillofacial Pathology, 2011 Sep-Dec; 15(3): 358–360 at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3227271/
  3. ↑ Prein J. Atlas of tumors of the facial skeleton, odontogenic and nonodontogenic tumors. Not Avail; 1986. https://books.google.com/books?id=7XhyBgAAQBAJ&pg=PA34&lpg=PA34&dq=o+norberg+germany+1930+cementoblastoma&source=bl&ots=OtxdFwBhPf&sig=CMlOt07lv1M1XMSwRfFu5CvWLK8&hl=en&sa=X&ved=0ahUKEwij__nOwKrOAhWGVh4KHXnHDbAQ6AEIHDAA#v=onepage&q=o%20norberg%20germany%201930%20cementoblastoma&f=false Accessed on August 5, 2016
  4. ↑ 4.0 4.1 4.2 4.3 Sankari LS, Ramakrishnan K (2011). "Benign cementoblastoma". J Oral Maxillofac Pathol. 15 (3): 358–60. doi:10.4103/0973-029X.86725. PMC 3227271. PMID 22144847.
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