Benign Cementoblastoma Radiology: Dental Notes

Benign Cementoblastoma Radiology: Dental Notes for BDS, MDS, NBDE Exams.

Synonyms

• Cementoblastoma
• True cementoma

Disease Mechanism

• Slow-growing mesenchymal neoplasm composed of cementum-like tissue.
• Manifests as a bulbous growth around and attached to the apex of a tooth root.
• Histologic characteristics are identical to osteoblastomas.
• Some authors classify cementoblastomas as bone tumors due to these similarities.
• Typically develops with permanent teeth; rare cases involve primary teeth.

Clinical Features

• Uncommon lesion but may be more prevalent than reported.
• More common in males than females.
• Age range: 12–65 years; most patients are relatively young.
• No racial predilection.
• Usually a solitary, slow-growing lesion that may eventually displace teeth.
• The involved tooth is vital and often painful.
• Pain varies among patients; can be relieved by anti-inflammatory drugs.

Imaging Features

Location

• Predominantly occurs in the mandible (78%).
• Commonly forms on the roots of a premolar or first molar (90%).

Periphery

• Appears as a well-defined radiopacity with a cortical border.
• Surrounded by a well-defined radiolucent band just inside the cortical border.

Internal Structure

• Mixed radiolucent-radiopaque lesion; predominantly radiopaque internally.
• May display an amorphous pattern or a wheel-spoke pattern.
• Cemental mass density often obscures the root outline.
• Central radiopaque mass surrounded by a radiolucent band, indicating maturation from center to periphery.

Effects on Surrounding Structures

• External root resorption may be visible if the root outline is apparent.
• Large tumors can cause mandibular expansion.
• Possible perforation through the outer cortical plate without periosteal reaction.

Differential Diagnosis

Periapical Osseous Dysplasia

• Radiolucent band is usually less defined and uniform compared to cementoblastoma.
• Has a more irregular, undulating outline.

Periapical Sclerosing Osteitis

• Lacks a soft tissue capsule present in cementoblastomas.

Dense Bone Island (DBI)

• Also lacks a soft tissue capsule.

Hypercementosis

• Surrounded by a periodontal membrane space, which is thinner than the cementoblastoma’s capsule.
• Does not cause root resorption or jaw expansion.

Treatment

• Self-limiting; rarely recurs after enucleation.
• Simple excision and extraction of the associated tooth are usually sufficient.
• The gold-standard treatment: total curettage and surgical excision of the lesion followed by extraction of affected tooth structures. (Ref)
• Tumor may be amputated from the tooth in some cases, followed by endodontic treatment.

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Benign Cementoblastoma Radiology Reference:

• Oral radiology Principles and Interpretation; White & Pharoah
• Essentials of Oral and Maxillofacial Radiology; F. Karjodkar
• Concise Oral Radiology; HR Umarji