Cementoblastoma
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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]
Synonyms and keywords: Cementoblastomata; True cementoma; Benign cementoblastoma
Overview
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.[1] According to the World Health Organization, cementoblastoma is classified as a true cemental neoplasm. True cemental neoplasms may be classified into 3 categories: cementyfing fibroma, periapical cemental dysplasia, and gigantiform cementoma. Cementoblastomas are a uncommon neoplasms and account less than 0.69%–8% of all odontogenic tumors. Common complications of cementoblastoma, include: bleeding, nerve injury, and malocclusion. Conventional radiograph is the imaging modality of choice for cementoblastoma. On conventional radiograph, characteristic findings of cementoblastoma, include: well defined, markedly radiopaque mass, radiolucent peripheral "line", which overlies and obliterates the tooth root, apparent external resorption of the root, and severe hypercementosis may be present. Surgical tooth extraction in conjunction with post-surgery biopsy is the most common approach to the treatment of cementoblastoma.[2]
Historical Perspective
- Cementoblastoma was first discovered by Norberg in 1930.[2]
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 3 categories:[2]
- Cementyfing fibroma
- Periapical cemental dysplasia
- Gigantiform cementoma
Pathophysiology
- The pathogenesis of cementoblastoma is characterized by originating from the root and slowly enlarging (it therefore obliterates the periodontal ligament space).
- cementoblastoma arises from cementoblasts, which are normally involved the formation of cementum (calcified substance covering the root of a tooth).
- 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:[2]
- Dense homogenous, irregular, and spherical mass
- Tooth root
- On microscopic histopathological analysis, characteristic findings of cementoblastoma, include:[2]
- Large globules fused to form a mass
- Composed of proliferative fibrovascular stroma
- Trabeculae lined by plump osteoblasts
Causes
- There are no established causes of cementoblastoma.[2]
Differentiating Cementoblastoma from Other Diseases
- Cementoblastoma must be differentiated from other diseases that cause tooth pain, or swelling, such as:[2]
- Sclerosing osteomyelitis
- Osteoblastoma
- Periapical cemental dysplasia
- Osteitis
- Hypercementosis
Epidemiology and Demographics
- Cementoblastoma is uncommon.
- Cementoblastoma accounts less than 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
- Cementoblastoma affects men and women equally.
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:[2]
- Prognosis is generally good, and the recurrence rate of patients with cementoblastoma is approximately 37.1%.[2]
Diagnosis
Symptoms
- Cementoblastoma is usually asymptomatic.
- Symptoms of cementoblastoma may include the following:[3]
- Tooth pain
- Dentin hypersensitivity
Physical Examination
- Patients with cementoblastoma usually are well-appearing.
- Oral examination may be remarkable for:[3]
- Swelling
- Malocclusion
- Gingival recession
- Gingivitis
Laboratory Findings
- There are no specific laboratory findings associated with cementoblastoma.
Imaging Findings
- Conventional radiograph is the imaging modality of choice for cementoblastoma.
- On conventional radiograph, characteristic findings of cementoblastoma, include:[3]
- Well defined, markedly radiopaque mass
- 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.
- Severe hypercementosis may be present
Treatment
Medical Therapy
- There is no treatment for cementoblastoma; the mainstay of therapy is surgery.
Surgery
- Surgery is the mainstay of therapy for cementoblastoma.[3]
- 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
- ↑ 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/
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 Huber AR, Folk GS (2009). "Cementoblastoma". Head Neck Pathol. 3 (2): 133–5. doi:10.1007/s12105-008-0099-5. PMC 2715464. PMID 19644548.
- ↑ 3.0 3.1 3.2 3.3 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.