Cementoblastomas

Cementoblastoma is a rare, benign odontogenic neoplasm characterized by the formation of cementum-like tissue that is intimately fused to a tooth root. It represents a true neoplasm of cementoblasts and most often arises in the jaw, particularly the mandible.

Epidemiology and presentation: Cementoblastomas typically affect young patients, often under 30, with a slight male predominance reported in some series. The mandible, especially the molar–premolar region, is most commonly involved. Patients commonly present with dull pain, swelling, facial asymmetry, and sometimes tooth displacement or eruption disturbance. Sensitivity may be preserved, depending on involvement of adjacent structures.

Radiographic features: The lesion appears as a radiopaque mass that is fused to the root of a tooth, usually surrounded by a thin radiolucent rim. It often causes partial or complete root resorption and is surrounded by a surrounding sclerotic border. The associated tooth is typically nonvital. These features help distinguish it from other radiopaque jaw lesions.

Histology: Microscopically, the mass consists of dense cementum-like material with reversal lines and active cementoblasts at the periphery. The lesion is embedded in a fibrous stroma and shows a zonal arrangement of mineralized tissue.

Differential diagnosis: Osteoblastoma, osteosarcoma, and other cemento-osseous dysplasias can mimic cementoblastoma. A key diagnostic criterion is the fusion of the radiopaque mass to the tooth root.

Management and prognosis: Standard treatment is surgical excision en bloc with removal of the involved tooth or complete removal of the lesion with adequate margins. Recurrence is uncommon when fully excised. The prognosis after removal is favorable.