Cementoma

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Cementoma
Specialty Dentistry
Human Tooth Diagram Human tooth diagram-en.svg
Human Tooth Diagram

Cementoma is an odontogenic tumor of cementum. It is usually observed as a benign spherical mass of hard tissue fused to the root of a tooth. [1] It is found most commonly in the mandible in the region of the lower molar teeth, occurring between the ages of 8 and 30 in both sexes with equal frequency . [1] It causes distortion of surrounding areas but is usually a painless growth, at least initially. Considerable thickening of the cementum can often be observed. A periapical form is also recognized. Cementoma is not exclusive to the mandible as it can infrequently occur in the maxilla and other parts of the body such as the long bones. [2]

Contents

Signs & Symptoms

Cementoma is characterized by a significant amount of thickening of the cementum around the roots of the teeth. The main teeth involved can include deciduous and permanent teeth, impacted molars and premolars. [3] The growth is typically benign and painless. Although symptoms may not be noticeable, a dull pain and dentin hypersensitivity can occur as growth increases. Visibility of the cementoma may increase with growth and cause distortion/swelling to the face and surrounding areas along with tooth displacement. [4] Histological analyses reveal several sheets of cementum that show evidence of both cementoblast and cementoclast activity. [5]

Complications

The following complications may occur as a result of growth and expansion in the cementum: [6]

Causes

The exact cause of cementomas is still widely unknown. It is understood that cells of the cementum found at the apex of a tooth root in rare cases grow uncontrollably. [4] Cementomas are derived from ectomesenchyme of odontogenic origin. [1] [7] Complications of cementogenesis and proliferation of cementoblasts can be implicated; however, cementomas have only been linked to and theorized to be caused by: trauma, reaction to local irritation, infection, endocrine imbalance, cell proliferation and vitamin deficiency. [8]

Pathophysiology

Cementomas develop as cells that generate cementum, or cementoblasts uncontrollably proliferate at the apex of a tooth root. Cementoblasts that form the cementum typically cease activity and become cementocytes. However, a layer of cementoblasts lies on the outer layer of the periodontal ligament, in which these cells will resume cementogenic activity upon injury to a tooth. [9] Excessive production of cementum will result in destruction of the periodontal ligament and mandible. [5]

Researchers of a 2017 and 2018 case study, have determined pathogenesis to occurs in three stages. The first stage involves periapical osteolysis which is characterized by a noncalcified matrix and formation of a circular radiolucent area near the apex of the affected tooth. [7] [3] The second stage is characterized by active cementoblasts that create radiopaque matter in the center of the lesion. The final stage is characterized by maturation and calcification of the entire lesion in which it is completely radiopaque and surrounded by a radiolucent rim. [3]

Diagnosis

A cementoma may present itself on a radiograph or x-ray and appear as an radiopaque mass depending on its stage and mass within the lower dental arch. In early stages, the mass will appear as radiolucent. In terminal stages, the mass becomes radiopaque and a radiolucent rim will be visible. [3] As the lesion enlarges, complexity of diagnosis increases and the mass must be analyzed for characteristics of an odontoma, hypercementosis, cemental dysplasia, and condensing osteitis. [5] Misdiagnosis can result in an unnecessary root canal.

Differential diagnosis

Prevention/Treatment

There are currently no preventative measures available for cementomas. Treatment of a cementoma involves surgically removing the mass and possibly a portion of the affected area and/or teeth. Surgical removal without damage to surrounding teeth is limited unless the lesion is small and if there is a sufficient crown-to-root ratio. Although benign, a cementoma will continue to grow in size if left untreated. Growth will also greatly affect the function of the teeth. If growth and affected teeth are not completely removed, the risk of reoccurrence increases. [4]

Prognosis

No malignant form of this conditions exists and rarely will the mass reappear. Individuals can expect full recovery from this condition with the proper treatment and removal of affected area. Although recurrence of cementomas is extremely rare, post-surgical and long-term follow ups are recommended. [3]

Epidemiology

Cementoma represent less than one percent of odontogenic tumors. [10] Women and men between their 20s and 30s are most likely to develop a cementoma, with males being slightly more affected than females. [7] Of all cases reported, fifty percent of the patients were under 20 years of age and seventy-five percent were younger than 30 years of age. [4] Occurrence is also seen in both children and older adults. The type of cementoma varies by demographic category.

Research Directions

There is a lack of both information and recent research on cementomas. There are multiple individual case studies available on the different types of cementomas, however no clinical trials for treatment of this condition have been executed. [7] A 2018 case report detailed an unusual reoccurrence in a 4.5-year-old boy. The young child was referred to the Oral and Maxillofacial Surgery Department of Tehran University of Medical Sciences and upon examination, they found a well-defined radiopaque mass in the apical region of his right deciduous mandibular second molar. The patient presented with swelling and mild pain, but no difficulty with speech, breathing or swallowing. The first lesion was removed, but at age 5.5, post-surgical follow-ups revealed a new lesion accompanied by mild swelling. This lesion as well as a lesion that appeared at 8 years of age were determined to be a benign cementoma. Each lesion was removed and the boy showed evidence of no further reoccurrence after three post-surgery follow-ups. [3]

Types

Four types of cementomas are described:

See also

Related Research Articles

<span class="mw-page-title-main">Cementum</span> Specialized calcified substance covering the root of a tooth

Cementum is a specialized calcified substance covering the root of a tooth. The cementum is the part of the periodontium that attaches the teeth to the alveolar bone by anchoring the periodontal ligament.

<span class="mw-page-title-main">Wisdom tooth</span> Large tooth at the back of the human mouth

A third molar, commonly called wisdom tooth, is one of the three molars per quadrant of the human dentition. It is the most posterior of the three. The age at which wisdom teeth come through (erupt) is variable, but this generally occurs between late teens and early twenties. Most adults have four wisdom teeth, one in each of the four quadrants, but it is possible to have none, fewer, or more, in which case the extras are called supernumerary teeth. Wisdom teeth may get stuck (impacted) against other teeth if there is not enough space for them to come through normally. Impacted wisdom teeth are still sometimes removed for orthodontic treatment, believing that they move the other teeth and cause crowding, though this is not held anymore as true.

<span class="mw-page-title-main">Enamel organ</span>

The enamel organ, also known as the dental organ, is a cellular aggregation seen in a developing tooth and it lies above the dental papilla. The enamel organ which is differentiated from the primitive oral epithelium lining the stomodeum.The enamel organ is responsible for the formation of enamel, initiation of dentine formation, establishment of the shape of a tooth's crown, and establishment of the dentoenamel junction.

<span class="mw-page-title-main">Cementoblastoma</span> Medical condition

Cementoblastoma, or benign cementoblastoma, is a relatively rare benign neoplasm of the cementum of the teeth. It is derived from ectomesenchyme of odontogenic origin. Cementoblastomas represent less than 0.69–8% of all odontogenic tumors.

<span class="mw-page-title-main">Dental follicle</span>

The dental follicle, also known as dental sac, is made up of mesenchymal cells and fibres surrounding the enamel organ and dental papilla of a developing tooth. It is a vascular fibrous sac containing the developing tooth and its odontogenic organ. The dental follicle (DF) differentiates into the periodontal ligament. In addition, it may be the precursor of other cells of the periodontium, including osteoblasts, cementoblasts and fibroblasts. They develop into the alveolar bone, the cementum with Sharpey's fibers and the periodontal ligament fibers respectively. Similar to dental papilla, the dental follicle provides nutrition to the enamel organ and dental papilla and also have an extremely rich blood supply.

<span class="mw-page-title-main">Dentigerous cyst</span> Medical condition

A dentigerous cyst, also known as a follicular cyst, is an epithelial-lined developmental cyst formed by accumulation of fluid between the reduced enamel epithelium and the crown of an unerupted tooth. It is formed when there is an alteration in the reduced enamel epithelium and encloses the crown of an unerupted tooth at the cemento-enamel junction. Fluid is accumulated between reduced enamel epithelium and the crown of an unerupted tooth.

<span class="mw-page-title-main">Condensing osteitis</span> Medical condition

Condensing osteitis is a periapical inflammatory disease that results from a reaction to a dental related infection. This causes more bone production rather than bone destruction in the area. The lesion appears as a radiopacity in the periapical area hence the sclerotic reaction. The sclerotic reaction results from good patient immunity and a low degree of virulence of the offending bacteria. The associated tooth may be carious or contains a large restoration, and is usually associated with a non-vital tooth. It was described by Dr. Carl Garré in 1893.

Dens evaginatus is a rare odontogenic developmental anomaly that is found in teeth where the outer surface appears to form an extra bump or cusp.

<span class="mw-page-title-main">Dentin dysplasia</span> Medical condition

Dentin dysplasia (DD) is a rare genetic developmental disorder affecting dentine production of the teeth, commonly exhibiting an autosomal dominant inheritance that causes malformation of the root. It affects both primary and permanent dentitions in approximately 1 in every 100,000 patients. It is characterized by presence of normal enamel but atypical dentin with abnormal pulpal morphology. Witkop in 1972 classified DD into two types which are Type I (DD-1) is the radicular type, and type II (DD-2) is the coronal type. DD-1 has been further divided into 4 different subtypes (DD-1a,1b,1c,1d) based on the radiographic features.

<span class="mw-page-title-main">Idiopathic osteosclerosis</span> Medical condition

Idiopathic osteosclerosis, also known as enostosis or dense bone island, is a condition which may be found around the roots of a tooth, usually a premolar or molar. It is usually painless and found during routine radiographs as an amorphous radiopaque (light) area around a tooth. There is no sign of inflammation of the tooth, and if the island is associated with the root the periodontal ligament space is preserved.

<span class="mw-page-title-main">Central giant-cell granuloma</span> Medical condition

Central giant-cell granuloma (CGCG) is a localised benign condition of the jaws. It is twice as common in females and is more likely to occur before age 30. Central giant-cell granulomas are more common in the anterior mandible, often crossing the midline and causing painless swellings.

<span class="mw-page-title-main">Periapical cyst</span> Medical condition

Commonly known as a dental cyst, the periapical cyst is the most common odontogenic cyst. It may develop rapidly from a periapical granuloma, as a consequence of untreated chronic periapical periodontitis.

<span class="mw-page-title-main">Odontoma</span> Benign tumour of dental tissue

An odontoma, also known as an odontome, is a benign tumour linked to tooth development. Specifically, it is a dental hamartoma, meaning that it is composed of normal dental tissue that has grown in an irregular way. It includes both odontogenic hard and soft tissues. As with normal tooth development, odontomas stop growing once mature which makes them benign.

<span class="mw-page-title-main">Dental abscess</span> Medical condition

A dental abscess is a localized collection of pus associated with a tooth. The most common type of dental abscess is a periapical abscess, and the second most common is a periodontal abscess. In a periapical abscess, usually the origin is a bacterial infection that has accumulated in the soft, often dead, pulp of the tooth. This can be caused by tooth decay, broken teeth or extensive periodontal disease. A failed root canal treatment may also create a similar abscess.

Dental pertains to the teeth, including dentistry. Topics related to the dentistry, the human mouth and teeth include:

Hypercementosis is an idiopathic, non-neoplastic condition characterized by the excessive buildup of normal cementum on the roots of one or more teeth. A thicker layer of cementum can give the tooth an enlarged appearance, which mainly occurs at the apex or apices of the tooth.

A cyst is a pathological epithelial lined cavity that fills with fluid or soft material and usually grows from internal pressure generated by fluid being drawn into the cavity from osmosis. The bones of the jaws, the mandible and maxilla, are the bones with the highest prevalence of cysts in the human body. This is due to the abundant amount of epithelial remnants that can be left in the bones of the jaws. The enamel of teeth is formed from ectoderm, and so remnants of epithelium can be left in the bone during odontogenesis. The bones of the jaws develop from embryologic processes which fuse, and ectodermal tissue may be trapped along the lines of this fusion. This "resting" epithelium is usually dormant or undergoes atrophy, but, when stimulated, may form a cyst. The reasons why resting epithelium may proliferate and undergo cystic transformation are generally unknown, but inflammation is thought to be a major factor. The high prevalence of tooth impactions and dental infections that occur in the bones of the jaws is also significant to explain why cysts are more common at these sites.

<span class="mw-page-title-main">Periapical periodontitis</span> Medical condition

Periapical periodontitis or apical periodontitis (AP) is an acute or chronic inflammatory lesion around the apex of a tooth root, most commonly caused by bacterial invasion of the pulp of the tooth. It is a likely outcome of untreated dental caries, and in such cases it can be considered a sequela in the natural history of tooth decay, irreversible pulpitis and pulpal necrosis. Other causes can include occlusal trauma due to 'high spots' after restoration work, extrusion from the tooth of root filling material, or bacterial invasion and infection from the gums. Periapical periodontitis may develop into a periapical abscess, where a collection of pus forms at the end of the root, the consequence of spread of infection from the tooth pulp, or into a periapical cyst, where an epithelial lined, fluid-filled structure forms.

In the dental specialty of endodontics, periradicular surgery is surgery to the external root surface. Examples of periradicular surgery include apicoectomy, root resection, repair of root perforation or resorption defects, removal of broken fragments of the tooth or a filling material, and exploratory surgery to look for root fractures.

Periapical granuloma, also sometimes referred to as a radicular granuloma or apical granuloma, is an inflammation at the tip of a dead (nonvital) tooth. It is a lesion or mass that typically starts out as an epithelial lined cyst, and undergoes an inward curvature that results in inflammation of granulation tissue at the root tips of a dead tooth. This is usually due to dental caries or a bacterial infection of the dental pulp. Periapical granuloma is an infrequent disorder that has an occurrence rate between 9.3 to 87.1 percent. Periapical granuloma is not a true granuloma due to the fact that it does not contain granulomatous inflammation; however, periapical granuloma is a common term used.

References

  1. 1 2 3 Ben Z. Pilch (2001). Head and Neck Surgical Pathology. Lippincott Williams & Wilkins. pp. 222–. ISBN   978-0-397-51727-5.
  2. ↑ Mellado JM, Mayayo E, Fernández F, Pérez del Palomar L, Camins A, Saurí A (March 2005). "Cementoma of the fibula: imaging findings with histopathologic correlation and review of the literature". Skeletal Radiol. 34 (3): 161–6. doi:10.1007/s00256-004-0822-6. PMID   15365780. S2CID   24021110.
  3. 1 2 3 4 5 6 Mohammadi, Farnoosh; Aminishakib, Pouyan; Niknami, Mahdi; Razi Avarzamani, Abolfazl; Derakhshan, Samira (November 2018). "Benign Cementoblastoma Involving Deciduous and Permanent Mandibular Molars: A Case Report". Iranian Journal of Medical Sciences. 43 (6): 664–667. ISSN   0253-0716. PMC   6230933 . PMID   30510344.
  4. 1 2 3 4 "About Cementoblastoma: Development & Treatment". www.colgate.com. Retrieved 2020-12-08.
  5. 1 2 3 Huber, Aaron R.; Folk, Gretchen S. (2008-12-30). "Cementoblastoma". Head and Neck Pathology. 3 (2): 133–135. doi:10.1007/s12105-008-0099-5. ISSN   1936-055X. PMC   2715464 . PMID   19644548.
  6. ↑ "Benign Cementoblastoma | Mouth Cancer | Oral Cancer". www.knowcancer.com. Retrieved 2020-12-06.
  7. 1 2 3 4 Subramani, Vijayanirmala; Narasimhan, Malathi; Ramalingam, Suganya; Anandan, Soumya; Ranganathan, Subhashini (2017-02-26). "Revisiting Cementoblastoma with a Rare Case Presentation". Case Reports in Pathology. 2017: 1–3. doi: 10.1155/2017/8248691 . PMC   5346397 . PMID   28337352.
  8. ↑ "Cementoma: Disease Bioinformatics". Novus Biologicals. Retrieved 2020-12-10.
  9. 1 2 Zhao, M.; Berry, J. E.; Somerman, M. J. (2003-01-01). "Bone Morphogenetic Protein-2 Inhibits Differentiation and Mineralization of Cementoblasts in vitro". Journal of Dental Research. 82 (1): 23–27. doi:10.1177/154405910308200106. PMID   12508040. S2CID   32275912.
  10. ↑ Çalışkan, A.; Karöz, T. B.; Sumer, M.; Açıkgöz, A.; Süllü, Y. (2016). "Europe PMC". Journal of the Korean Association of Oral and Maxillofacial Surgeons. 42 (4): 231–235. doi:10.5125/jkaoms.2016.42.4.231. PMC   5009199 . PMID   27595092.
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