A cementoma refers to a group of benign conditions involving the cementum, a specialized calcified tissue covering the tooth root. These non-cancerous growths develop around tooth roots or within the jawbone. While characterized by abnormal cementum growth, they generally do not cause significant problems unless they affect surrounding structures.
Understanding Cementoma
Cementoma involves the abnormal proliferation of cementoblasts, the cells that form cementum. This process occurs at the apex, or tip, of a tooth root. Cementum is a calcified tissue that anchors the periodontal ligament to the tooth, providing stability within the jaw.
The development of cementoma occurs in stages. It begins with bone lysis (destruction) around the tooth root, followed by the formation of radiopaque, cementum-like material. The final stage involves the maturation and calcification of the lesion. This condition is benign and does not spread. While it can lead to thickening of the cementum, the growth is painless in its early stages.
Different Forms of Cementoma
The term “cementoma” encompasses several distinct conditions, categorized by their presentation and location.
Periapical Cemental Dysplasia (PCD)
PCD affects the anterior mandible, specifically around tooth root tips. It is a reactive process involving cementum-like tissue formation, common in middle-aged females, particularly those of African descent.
Florid Cemento-Osseous Dysplasia
This type presents as multifocal lesions in tooth-bearing or edentulous areas of both the maxilla and mandible, often with bilateral and symmetric involvement. It is also observed in individuals of African descent.
Focal Cemento-Osseous Dysplasia (FCOD)
FCOD involves a single site, commonly in the posterior mandible, and can occur in any tooth-bearing or edentulous area. While periapical and florid forms are more prevalent in specific ethnic groups, FCOD is more common among Caucasians.
Benign Cementoblastoma
Also known as true cementoma, this rare tumor originates from cementoblasts. It forms a mass of cementum or cementum-like tissue directly attached to a tooth root. Unlike the dysplasias, benign cementoblastoma is a true neoplasm. It is most frequently found in the mandibular molar region, often affecting the first mandibular molar.
Identifying Cementoma
Cementoma is often discovered incidentally during routine dental examinations, as it frequently presents without noticeable symptoms. Patients are unaware of its presence until a radiographic examination reveals the lesion. When symptoms occur, they can include dull pain, dentin hypersensitivity, or, in advanced cases, facial distortion or swelling, along with tooth displacement.
The diagnostic process begins with conventional radiography, such as periapical or panoramic X-rays. These provide a two-dimensional view and can show a well-defined radiopaque mass, appearing white due to its dense calcified nature, often associated with a tooth root. In early stages, the lesion might appear more radiolucent (dark) before calcifying. As it matures, it becomes more radiopaque and may be surrounded by a radiolucent rim or halo.
Cone Beam Computed Tomography (CBCT) offers a more detailed, three-dimensional view. It helps assess the tumor’s morphology, size, and exact location, and can reveal its relationship with surrounding bone and soft tissues. CBCT also identifies features like root resorption or cortical bone expansion and perforation, which can be associated with benign cementoblastoma.
Magnetic Resonance Imaging (MRI) may be used for detailed soft tissue contrast if CBCT results are inconclusive. While imaging provides strong indications, a definitive diagnosis relies on a combination of clinical evaluation, radiographic findings, and sometimes histopathological examination.
Managing Cementoma
Management of cementoma depends on the specific type and whether it causes symptoms. Given their benign nature, many forms, particularly cemento-osseous dysplasias, do not require active treatment. A strategy of “watchful waiting” or regular monitoring through dental check-ups and periodic radiographic evaluations is employed. This allows dental professionals to observe changes in size or characteristics over time.
However, specific scenarios may warrant intervention. Benign cementoblastoma, a true tumor, requires surgical removal of the mass, often with extraction of the affected tooth. This is because benign cementoblastomas can grow, leading to local destruction like cortical bone perforation or displacement of adjacent teeth. Complete excision of the tumor and associated tooth is considered curative, aiming to prevent recurrence.
In some instances, more conservative procedures like enucleation (surgical removal of the mass) with preservation of the affected tooth may be considered. This is an option if the lesion is small at diagnosis and endodontic therapy can be performed. Recurrence rates can be higher with incomplete excision. Regardless of the approach, regular follow-up appointments are important to monitor the site for recurrence or complications, ensuring long-term oral health.