|Year : 2022 | Volume
| Issue : 3 | Page : 202-204
Benign cementoblastoma of posterior mandible in growing patient
Santoshni Samal1, Diljith Rishi2
1 Department of Pedodontics and Preventive Dentistry, SCB Dental College and Hospital, Utkal University, Bhubaneswar, Odisha, India
2 Department of Dentistry, Padmavati Medical Foundation Hospital, Kollam, Kerala, India
|Date of Submission||27-Sep-2022|
|Date of Decision||22-Nov-2022|
|Date of Acceptance||28-Nov-2022|
|Date of Web Publication||31-Dec-2022|
Dr. Santoshni Samal
Department of Pedodontics and Preventive Dentistry, SCB Dental College and Hospital, Utkal University, Bhubaneswar, Odisha
Source of Support: None, Conflict of Interest: None
Cementoblastoma is a benign tumor of odontoblastic origin usually associated with pain and swelling and mainly occurs in the mandibular region. It is mainly associated with the roots of premolars and molars in the second and third decades of life. This case describes cementoblastoma in a growing affected person, where its diagnosis and intervention are explained in a 16-year-old male. Cementoblastoma is not so common in pediatric patient. This case reports describe a young growing patient where it is surgically treated keeping this in mind so that it will not affect future growth.
Keywords: Cementoblastoma, curettage, developing patient, odontogenic tumor, tooth root
|How to cite this article:|
Samal S, Rishi D. Benign cementoblastoma of posterior mandible in growing patient. Saudi J Oral Sci 2022;9:202-4
| Introduction|| |
The cementoblastoma as the name indicates is a benign tumor of mesenchymal origin and was first defined by Dewey in 1927 as an odontogenic tumor originating from the cementum of the tooth. Its far a real neoplasm of cementum. It accommodates 1% of the odontogenic tumor, on the whole, involved in the posterior mandible related to a permanent molar and on occasion deciduous teeth.
There is a predominance of cementoblastoma in young individuals three quarters (73%) of the individuals belonging to the age group below 30 with more male affliction when compared to females. The affliction of cementoblastoma is more toward the mandible than the maxilla and erupted tooth than the unerupted. The lesion can be asymptomatic and every now and then the affected person can also complain of pain and swelling. Diagnosis can be made through radiological examinations such as intraoral periapical (IOPA) radiograph, orthopantomogram (OPG), and radiovisiography. The final diagnosis must be made through histopathological examination after lesion removal. The tumor has limitless growth ability in developing patients. This case describes the management in growing patients keeping future aspects in mind. Consequently, enucleation at the side of the concerned tooth is the treatment of choice.
| Case Report|| |
A 16-year-old healthy person reported to the department with the complaint of pain and swelling within the right mandibular location for 4 months [Figure 1]a. The pain was slight and intermittent. The medical history became noncontributory. There has been no history of trauma associated with the region and there has been no history of dental treatment. Extraoral examination revealed moderate mandibular swelling, diffuse in nature, and tender on palpation. On intraoral examination, teeth were normal. There has been moderate obliteration with respect to 45 and 46 vicinities [Figure 2]a. Radiographs had been advised to the patient. OPG showed a well-described radiopaque lesion with a radiolucent border connected with 46 apical areas showing the calcification stage [Figure 1]b. Computed tomography (CT) examination showed expansion of both cortical bones within the axial plane [Figure 1]c. CT coronal view confirmed buccolingual cortex expansion related to 46, mixed density mass with a rounded appearance, and a relatively radiolucent rim. Loss of the periodontal ligament space along with loss of root outline is common [Figure 3]a and [Figure 3]b. Based on the clinical and radiological parameters, a provisional diagnosis of cementoblastoma was made keeping all other differential diagnosis in mind such as radicular cyst and dentigerous cyst. Surgical removal of the tooth along with lesion was planned since it was in the calcification stage [Figure 2]b and [Figure 2]c. Hematological assessments were done such as bleeding time, clotting time, and International normalized ratio (INR). Cementoblastoma was removed in conjunction with 46 in toto [Figure 2]d. Clinically the specimen was 1.9 cm × 2 cm tightly enclosing the 46 [Figure 2]d and [Figure 3]c. On microscopic examination in HEX50 the specimen confirmed, irregularly lamellated, hypocellular cemental mass attached to the tooth [Figure 3]d. A final diagnosis of cementoblastoma with respect to 46 was made. The patient was followed up after a year and the healing of the lesion was uneventful [Figure 4]. The patient consent was obtained to use de-identified data.
|Figure 1: (a) Preoperative clinical picture with right mandibular swelling, (b) OPG showing radiopacity with radiolucent border with respect to 46 roots (c) CT axial view showing cementoblastoma in 46 regions expanding the buccal and lingual cortex. OPG: Orthopantomagram, CT: Computed tomography|
Click here to view
|Figure 2: (a) Clinical intraoral picture showing vestibular obliteration with respect to 46 regions. (b) Intraoperative pictures. (c) Postoperative picture after cementoblastoma removal and curettage. (d) Cementoblastoma specimen in toto attached with 46|
Click here to view
|Figure 3: (a) CT coronal view (b) CT sagittal view (c) cementoblastoma specimen 1.9 cm × 2 cm (d) Ground section of cementoblastoma showing cemental lines. CT: Computed tomography|
Click here to view
| Discussion|| |
The usual clinical symptom associated with cementoblastoma is intermittent pain and swelling at the buccal and lingual/palatal aspect of the alveolar ridges, most customarily it is able to be asymptomatic. The concerned affected tooth stays intact and vital.[l] The usual findings are cortical enlargement and facial asymmetry. Paresthesia of the lip or pathologic fracture of the mandible is a unprecedented phenomenon. The radiographic like OPG can diagnose the lesion in the calcification stage and diagnosis depends on the degree of mineralization. It needs to be differentiated from hypercementosis, benign osteoblastoma, and odontomas and calcifying epithelial odontogenic tumors, cement-ossifying fibroma, and osteoma. OPG showing mixed lesions with radiolucent border of cementoblastoma, other differential features are extrusion of teeth due to cementum deposition, the presence of the periodontal membrane space around the hypercementosis, while no treatment is required for hypercementosis unlike cementoblastoma where complete excision is required and the handiest distinction is the absence of pain in hypercementosis. Radiographs play an crucial function to prevent any misdiagnosis. IOPA reveals specific tooth involved and OPG detects any other abnormality and associated lesion in the whole jaw, so OPG best describes the lesion along with any other associated tooth. CT detects the bony changes in the jaw in the initial stages. Since the lesion was involving the root with mixed density and loss of lamina dura with cortical expansion, surgical removal was planned. The tooth when vital, the diagnosis of radicular cyst can be eliminated. It was involving the root with erupted tooth; hence, the dentigerous cyst can also eliminated. Another differentiating feature of the dentigerous cyst from cementoblastoma is dentigerous cyst mainly involves third molar or unerupted teeth with follicular space >5 mm, whereas cementoblastoma involves premolars and molars and may be smaller than 5 mm. On microscopic examination, a cementoblastoma appears as a cementum-like tissue mass attached to the base of the teeth, bounded through cementoblast rows and basophilic reversal lines with free fibrovascular tissue with the presence of osteoblasts and osteoclasts indicative of a lesion's remodeling all through the developing phase. Within the outer edge, unmineralized tissue is present perpendicular to it. Stage one can be treated with endodontic treatment, but once it reaches the calcification stage, surgical removal of the lesion is the only choice. The treatment of choice is the surgical elimination of the lesion together with the affected tooth systems followed by entire curettage to save recurrence. In this situation, surgical removal with 46 together with curettage was done. There has been no reoccurrence with follow-up visits after 1 year. Prosthetic management should be done in young patients to achieve correct occlusion.
| Conclusion|| |
Cementoblastoma is a self-limiting benign lesion and sometimes it may become aggressive. Right clinical, radiographic, and histopathological examinations are obligatory to prevent any misdiagnosis. Enucleation is the treatment of choice in the last stage, i.e., the calcification stage. Postremoval curettage is obligatory to save from any reoccurrence. Surgical removal can be done and prosthetic management is mandatory in young patients to achieve correct occlusion.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Dewey KW. Osteoma of a Molar. Dent Cosmos 1927;69:1143-9.
Neville BW, Damm DD, Allen CM, Bouquot JE. Oral & Maxillofacial Pathology. 2nd
ed. Philadelphia, PA, USA: W.B. Saunders; 2002.
Ulmansky M, Hjørting-Hansen E, Praetorius F, Haque MF. Benign cementoblastoma. A review and five new cases. Oral Surg Oral Med Oral Pathol 1994;77:48-55.
Piattelli A, D'Addona A, Piattelli M. Benign cementoblastoma: Review of the literature and report of a case at an unusual location. Acta Stomatol Belg 1990;87:209-15.
Cundiff EJ 2nd
. Developing cementoblastoma: Case report and update of differential diagnosis. Quintessence Int 2000;31:191-5.
Sumer M, Gunduz K, Sumer AP, Gunhan O. Benign cementoblastoma: A case report. Med Oral Patol Oral Cir Bucal 2006;11:483-5.
Sharma N. Benign cementoblastoma: A rare case report with review of literature. Contemp Clin Dent 2014;5:92-4.
] [Full text]
Brannon RB, Fowler CB, Carpenter WM, Corio RL. Cementoblastoma: an innocuous neoplasm? A clinicopathologic study of 44 cases and review of the literature with special emphasis on recurrence. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002;93:311-20.
[Figure 1], [Figure 2], [Figure 3], [Figure 4]