Dx: Cementoblastoma

KEY FACTS

Terminology Synonyms Benign cementoblastoma True cementoblastoma Definition: Benign odontogenic neoplasm of cementoblasts and cementum Imaging Well-defined radiopacity or mixed radiodensity lesion attached to and surrounding tooth root May have amorphous or wheel-spoke pattern Has well-defined radiolucent rim External root resorption seen in most cases Outline of roots often obscured Most commonly form on permanent premolar or 1st molar Rarely seen in primary dentition Mandible > maxilla Large lesions may be expansile Usually no larger than 1-2 cm in diameter Top Differential Diagnoses
Periapical cemental dysplasia Periapical sclerosing osteitis Idiopathic osteosclerosis (enostosis) Hypercementosis

Pathology Closely resembles osteoblastoma microscopically Clinical Issues Pain and swelling in some cases Associated tooth is vital Treatment: Excision and extraction of associated tooth or tumor amputation with endodontic treatment of associated tooth
TERMINOLOGY

Synonyms Benign cementoblastoma True cementoblastoma Definitions Benign odontogenic neoplasm of cementoblasts and cementum
IMAGING

General Features Best diagnostic clue: Bulbous mixed radiodensity lesion attached to and surrounding tooth root Location Most common in mandible Most common on permanent premolar or 1st molar

Rare in primary dentition Size: Usually no larger than 1-2 cm in diameter Imaging Recommendations Best imaging tool Periapical or panoramic images Occlusal and CBCT will best show any expansion Radiographic Findings Well-defined radiopacity or mixed radiopaque-radiolucent mass May have amorphous or wheel spoke pattern Well-defined radiolucent rim surrounding mass External root resorption seen in most cases Outline of roots often obscured Large lesions may expand mandible, but cortex remains intact
DIFFERENTIAL DIAGNOSIS

Periapical Cemental Dysplasia Well-defined periapical radiopacity with radiolucent periphery or rim (mature stage)

Occasionally radiolucent periphery is not discernible Lesion does not attach directly to root May be round or have irregular shape Most common in mandibular anterior area but may be seen anywhere in dentition Affected teeth are vital and asymptomatic
Periapical Sclerosing Osteitis

Thick, dense trabeculae at periphery of rarefying periapical inflammation Surrounds apex or apices of tooth with pulpal necrosis but may also extend coronally along root surface Blends with surrounding trabecular pattern
Does not have radiolucent rim or periphery Idiopathic Osteosclerosis (Enostosis)

Most common in mandibular premolar-molar region Well-defined radiopacity that often blends with trabecular pattern May be in periapical area but may be seen in other areas of jaws
Does not have radiolucent rim or periphery Hypercementosis

Excessive cementum seen as irregular enlargement of tooth root Extra cementum is directly attached to tooth root without separating radiolucent periphery Lamina dura and periodontal ligament space encompass enlargement Osteoblastoma Rare in jaws; if seen, slight predilection for mandible Pain that is unrelieved by aspirin Well-defined or ill-defined radiolucency with patchy areas of radiopacity; usually > 2 cm
Osteoid Osteoma

Very rare in jaws Nocturnal pain relieved by aspirin Mixed density lesion with central nidus of radiolucency, surrounded by zone of reactive sclerosis; usually < 1 cm
PATHOLOGY

Microscopic Features Thick trabeculae of mineralized material with irregularly placed lacunae and prominent basophilic reversal lines Trabeculae lined by prominent cementoblasts Cellular fibroblastic tissue present between mineralized material Periphery is uncalcified matrix Multinucleated giant cells often present Closely resembles osteoblastoma
CLINICAL ISSUES

Presentation Most common signs/symptoms Pain and swelling in some cases Associated tooth is vital Demographics Age: Ranges from 12-65 years, but predominantly seen in young adults Gender: More common in males than females Treatment Excision and extraction of associated tooth Tumor amputation with endodontic treatment of associated tooth