Cementoblastoma is a rare benign lesion that represents less than 1% of all odontogenic tumours. It’s characterized by proliferation of cementum-like tissue and in almost all cases tends to be associated with an erupted permanent tooth, most often the first mo- lar. We present an unusual case of a large cemento-blastoma that affected the right mandibular body, extending from the first premolar to the second molar, of a 19-years-old male. In this case an initial surgery was attempted under local anaesthesia, resulting in incomplete tumor removal. A second surgical procedure was performed under general anaesthesia, ensuring the complete excision of the lesion. The patient was monitored for 1 year after surgery and did not show any signs of recurrence.
Cementoblastoma is currently ranked by the World Health Organization as an odontogenic mesenchyme or ectomesenchyme tumor, with or without involvement of the odontogenic epithelium [
A cementoblastoma lesion is usually found in the mandible, most commonly in the pre-molar and molar region [7,8]. Its prevalence is higher in young male adults who are under 30 years of age [
Radiographically, the lesion presents as a radiopaque mass that is attached to the root tooth, which is usually vital and is surrounded by a radiolucent halo [1,8-10,13, 16]. Histologically, cementoblastoma tissue is similar to cementum.
The clinical and radiological findings are of great importance for the differential diagnosis of odontogenic neoplasms [
The recommended treatment consists of the surgical removal of the tumor and associated teeth [
We present an unusual case of a residual cementoblastoma involving the right mandibular body of a 19- years-old male.
A 19-year-old, healthy Brazilian man, was referred to a maxillofacial surgeon due to the presence of a cementoblastoma in the right mandibular body. The patient reported that he was being treated at another clinic, and his initial complaint was related to a progressive facial asymmetry.
According to the patient, the surgeon who initially treated him requested a panoramic radiograph (
On clinical examination, the patient presented a painless hard swelling in the right lower posterior buccal and lingual gingiva, extending from the region of the
second premolar to the second molar on the right. These teeth were removed during the first surgery.
The initial panoramic radiograph revealed a well-defined, round, radiopaque lesion, that was delineated by a thin radiolucent halo, and was in contact with the roots of the second premolar, and the first and second right lower molars. The radiographic appearance was pathognomonic of cementoblastoma. Tomography showed the buccal and lingual extension of the lesion. The panoramic radiograph performed after the first surgery revealed that a large amount of the lesion was left in place, and a fracture in the apical portion of the mesial root of the third molar occurred intraoperatively (
Based on clinical and radiological findings, surgery under general anesthesia was planned to remove the remainder of the lesion. A subsequent reconstructive surgery was also planned to reconstruct the area with bone grafts and posteriorly osseointegrated implants.
Surgical removal of the residual tumor was performed at a hospital under general anesthesia. A buccolingual mucoperiosteal flap, extending from the lower right canine to the lower right third molar, was raised, and an osteotomy was performed to separate the remaining tumor from the subjacent bone with complete curettage of the cavity (
In the postoperative period, the patient presented inferior alveolar nerve paresthesia, which resolved spontaneously 20 days later. Panoramic radiography performed immediately after surgery revealed complete tumor removal. The patient was monitored for 1 year after surgery, and did not show any signs of recurrence (
Cementoblastoma is a rare odontogenic neoplasm, with an estimated occurrence, according to Baart et al. [
According to Brannon et al. [
Patients may be completely asymptomatic [1,2,8]; however, bone expansion and pain can occur [2,3,7-15]. Trismus [8,10], dental displacement, and increased mobility of adjacent teeth [
Radiographically, the lesion presents as a well-defined radiopaque mass, surrounded by a radiolucent halo associated with the root of the tooth or teeth [1,3,7-12,14,15, 17,18]. Depending on the developmental stage of the lesion, the radiological appearance and clinical interpretation can vary, leading to an erroneous diagnosis of osteoma or osteoblastoma [8,13,14]. Other features that can eventually be observed on radiographs include root resorption [1-3,10,14,17,18], obliteration of the periodontal ligament space [2,7], and invasion of the root canals [
Histologically, cementoblastoma is characterized by tissue layers that are similar to cement [3,13] and, consist of poorly mineralized cellular material with prominent basophilic reversal lines [1-3,15,17,18] organized in a fibrovascular stroma [1-3,9,12,13,18]. Prominent cementoblasts [
The most difficult challenge in the differential diagnosis of cementoblastoma is osteoblastoma. These two tumors may exhibit the same histomorphology [
In addition to osteoblastoma, the differential diagnosis of cementoblastoma must also include osteosarcoma [
The recommended treatment of cementoblastomas consists of the surgical removal of the lesion along with the tooth/teeth and/or structures that are affected, followed by complete curettage of the area or the peripheral osteotomy of the entire region [2,8,9,10,14]. When an early diagnosis is made, the treatment may involve the complete excision of the lesion with preservation of the involved tooth, thorough endodontic treatment [
Recurrences are rare if complete tumor enucleation is performed. Brannon et al. [
Cementoblastoma is a benign tumor with a low recurrence rate but unlimited growth potential. Appropriate treatment consists of the surgical removal, and early diagnosis favors a more conservative surgery with the possibility of preservation of the involved teeth. In cases in which the tumor is detected in advanced stages of development, the teeth should be removed along with the tumor to decrease the possibility of recurrence.