Definition
Cementoma is a benign odontogenic lesion characterized by the formation of excessive cementum-like hard tissue associated with the tooth root. It is classified within the spectrum of cemento‑osseous dysplasias and can present as a focal (localized) lesion, a periapical form, or a florid (multifocal) condition. In some classifications, the term “cementoblastoma” is used for the true neoplastic variant that arises from cementoblasts attached to a tooth root.
Classification
| Type | Typical Location | Clinical Behavior |
|---|---|---|
| Focal cemento‑osseous dysplasia (Cementoma) | Posterior mandible, usually a single tooth area | Asymptomatic, self‑limiting |
| Periapical cemento‑osseous dysplasia | Anterior mandible, periapical region of vital teeth | Often asymptomatic, may progress to radiolucent stage |
| Florid cemento‑osseous dysplasia | Multiple quadrants of the jaws | May cause expansion, secondary infection |
| Cementoblastoma (true cementoma) | Root of permanent mandibular molars | Painful, causes root expansion, may require surgical removal |
Epidemiology
- Occurs predominantly in adults, most commonly between ages 30 and 50.
- Female predilection is noted, especially for the florid form.
- Higher prevalence in individuals of African descent for florid cemento‑osseous dysplasia.
Etiology and Pathogenesis
The precise cause is unknown. The lesion is thought to arise from dysregulated activity of cementoblasts, the cells responsible for cementum formation. Hormonal, genetic, or metabolic factors have been postulated but lack definitive supporting evidence.
Clinical Presentation
- Most lesions are discovered incidentally on radiographs.
- When symptomatic, patients may report dull, localized jaw pain, swelling, or tooth mobility.
- Cementoblastoma often presents with tenderness and noticeable expansion of the involved root.
Radiographic Features
- Early stage: radiolucent area around the tooth apex.
- Maturation: mixed radiolucent‑radiopaque appearance with a well‑defined border; a radiopaque mass may appear contiguous with the root.
- Florid lesions display multiple radiopaque foci throughout the jaws, often with a “cotton‑wool” appearance.
Histopathology
- Presence of cementum‑like calcified material with trabecular or lamellar organization.
- Fibrous connective tissue stroma containing cementoblasts.
- In cementoblastoma, a peripheral zone of active cementoblasts is evident.
Diagnosis
Diagnosis integrates clinical examination, radiographic imaging (panoramic radiograph, cone‑beam CT), and, when required, histopathologic biopsy. Vitality testing of adjacent teeth helps differentiate cementoma from periapical inflammatory lesions.
Management
- Asymptomatic focal or periapical forms: Observation with periodic radiographic monitoring; intervention is unnecessary unless lesion progresses.
- Florid form: Management is conservative; surgery is reserved for complications such as infection or significant swelling.
- Cementoblastoma: Surgical excision of the lesion with removal of the involved tooth (enucleation) is the treatment of choice. Root‑preserving procedures are attempted only when feasible.
Prognosis
- Non‑neoplastic cemento‑osseous dysplasias have an excellent prognosis with low recurrence.
- Cementoblastoma carries a recurrence rate of approximately 10–20% if incomplete removal occurs; thorough excision yields favorable outcomes.
History
The term “cementoma” was introduced in the early 20th century to describe cementum‑producing lesions of the jaw. Over time, classification systems have evolved, distinguishing between dysplastic (non‑neoplastic) and neoplastic (cementoblastoma) entities, leading to the current nomenclature of “cemento‑osseous dysplasia” for most lesions previously labeled cementoma.
References
- Neville, B. W., Damm, D. D., Allen, C. M., & Chi, A. C. (2020). Oral and Maxillofacial Pathology (4th ed.). Elsevier.
- WHO Classification of Head and Neck Tumours (2022). Odontogenic and Maxillofacial Bone Tumors. International Agency for Research on Cancer.
This entry reflects the current understanding of cementoma as described in peer‑reviewed dental pathology literature.
