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 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 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.[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 4 categories:[2][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:[2]
  • On microscopic histopathological analysis, characteristic findings of cementoblastoma include:[2]

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]

Epidemiology and Demographics

  • Cementoblastoma is uncommon.[4]
  • Cementoblastoma accounts for approximately 0.69%–8% of all odontogenic tumors.[4]

Age

  • Cementoblastoma is more commonly observed among patients aged 20 to 25 years old.[4]
  • 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:[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:[5]
  • Tooth pain
  • Dentin hypersensitivity

Physical Examination

  • Patients with cementoblastoma usually are well-appearing.
  • Oral examination may be remarkable for:[5]

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:[5]
  • 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.[5]
  • 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. 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. 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. PMC 2715464Freely accessible. PMID 19644548. doi:10.1007/s12105-008-0099-5. 
  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 Cementoblastoma. Wikipedia. https://en.wikipedia.org/wiki/Cementoblastoma Accessed on April 26, 2016
  5. 5.0 5.1 5.2 5.3 Sankari LS, Ramakrishnan K (2011). "Benign cementoblastoma". J Oral Maxillofac Pathol. 15 (3): 358–60. PMC 3227271Freely accessible. PMID 22144847. doi:10.4103/0973-029X.86725. 

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