Introduction
Cementoblastoma or true cementoma is a benign odontogenic tumor of mesenchymal origin that arises from cementoblasts, comprising 1–6.2% of all odontogenic tumors 1,2. It was first described by Dewey in 1927. This tumor occurs more often in males, with an overall male to female ratio of 2.1 : 1, with a mean age of 20.7 years 2,3. The mandible premolar–molar region is the most common site 4. The most common symptoms are pain and swelling, but it may be asymptomatic and discovered during routine investigation 4,5. It has a characteristic radiographic presentation, appearing as a radiopaque mass that has a well-developed radiolucent rim or halo and is closely associated with the roots of teeth 4,6. The tumor has unlimited growth potential 4,7. Histologically, the tumor presents sheets of cementum-like tissue, which may contain a large number of reversal lines with active cementoblasts. The outermost aspect of the lesion is frequently composed of a band of fibrous connective tissue that resembles a capsule 2,6,8. It may obliterate PDL, produce root resorption, and fuse with the root of the tooth 4,5. The recommended treatment is complete enucleation of the tumor mass with the extraction of the involved tooth 1,4. The recurrence rate is 37.1% because of incomplete removal of the tumor 1,3,9.
Case report
A 16-year-old male patient presented to the department of oral and maxillofacial surgery with the chief complaint of pain and swelling of the left side of the face since 6 months. The patient was apparently asymptomatic before 6 months, after which he noticed pain and swelling in relation to the lower left second permanent molar. The swelling increased in size slowly, causing expansion of buccal and lingual cortical plates. There was no history of trauma and his medical history was insignificant. On clinical examination, there was a well-defined swelling 3×5 cm in size present at the left body of the mandible with bony hard consistency. There was no fluctuancy and no discharge. Overlying skin was normal. Tenderness was present. Intraorally, the swelling extended from the lower left first molar to distal of the second permanent molar, with expansion of buccal and lingual cortical plates. Superoinferiorly, the swelling extended from the alveolar ridge to vestibular depth. Pain on percussion was not present in adjacent teeth. Overlying mucosa was normal. Tenderness was not present. X-ray OPG indicated a well-defined mixed radiopaque radiolucent lesion 1.5 cm diameter in size surrounded by a radiolucent rim associated with roots of the second permanent molar. The right lateral oblique showed a well-defined radiopaque mass 2 cm diameter in size surrounded by a radiolucent rim present in the left body of the mandible, extending from distal of the first molar to mesial of the third molar with expansion of the lower border of the mandible and displacement of the inferior alveolar canal inferiorly. Occlusal radiograph showed expansion of both lingual and buccal cortical plates. A provisional diagnosis of benign cementoblastoma was made. The patient was operated under general anesthesia and enucleation of the tumor along with extraction of the second and third molar was done. Histologically decalcified section showed cementum-like tissue covered by soft tissue that showed vascular to cellular elements. Fibrous connective tissue was also observed at the periphery. The diagnosis of benign cementoblastoma was confirmed.
Discussion
The cementoblastoma was described by the WHO as a benign odontogenic tumor composed of cementum-like tissue attached to the tooth roots and appearing as a circumscribed radiopaque mass surrounded by a thin radiolucent line 4. In the above-reported case, the patient was a 16-year-old male, is similar to the cases reported in the literature 1,2,4. Benign cementoblastoma is common in young adults, with a male to female ratio of 2.1 : 1 1.
Pain and swelling are the most common complaints for which a patient seeks treatment and similar findings were reported in our case 1–5. The mandibular first molar is the most common tooth found associated with the tumor as reported in the literature 4,6,10. In our case, the tumor was associated with the lower second molar.
Radiographically, our case presented with well-defined radiopacity surrounded by a radiolucent border attached to the roots of the second mandibular molar, which is similar to the cases reported in the literature 5–7,10.
During surgery, the lesions are enucleated easily and are well capsulated 4. Histologically, the tumor has sheets of cementum-like tissue, which may contain a large number of reversal lines with active cementoblasts 2. Similar findings were present in our case. Our case presented with typical clinical, radiological, and histological features as reported in the literature 1–3,6,10 (Figs 1–6).
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Fig. 1: Preoperative X-ray OPG.
Fig. 2: Intraoperative view of the empty bony cavity.
Fig. 3: Postoperative X-ray OPG.
Fig. 4: Resected specimen.
Fig. 5: Histopathologic view.
Fig. 6: Follow-up after 6 months.
Conclusion
A case of benign cementoblastoma in a 16-year-old male patient is reviewed. The lesion was typical and associated with the mandibular left second molar. The tumor has unlimited growth potential; therefore, prompt surgical treatment is necessary. The recurrence rate is 37.1%; therefore, follow-up should be performed.
Acknowledgements
Conflicts of interest
There are no conflicts of interest.
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