Cementomas

Cementoma is a historic term used to describe a group of cemento-osseous lesions of the jaws that produce cementum-like material. In current practice, the term is largely replaced by more precise diagnoses, including cemento-osseous dysplasias (periapical, focal, florid) and cemento-ossifying fibroma. These lesions share a common pattern of abnormal bone remodeling with calcified deposits that resemble cementum.

Periapical cemento-osseous dysplasia (PCOD) is the most commonly cited cementoma-type lesion. It typically affects middle-aged women, especially of African descent, and occurs at the apices of mandibular anterior teeth. Teeth are usually vital. Early radiographs show radiolucent lesions that gradually become radiopaque as the process matures, often with a thin radiolucent border. The lesion generally causes no symptoms and shows little to no expansion; treatment is typically observation.

Focal cemento-osseous dysplasia presents as a single site lesion, most often in middle-aged women, commonly in the posterior mandible. Florid cemento-osseous dysplasia involves multiple quadrants and is more common in middle- to older-aged individuals. Radiographs reveal mixed radiolucent-radiopaque areas that may become more radiopaque with time. These lesions are usually asymptomatic and managed conservatively, with avoidance of unnecessary endodontic or aggressive surgical procedures.

Cemento-ossifying fibroma is a separate entity described as a true benign odontogenic tumor. It is usually a well-circumscribed radiolucent-to-radiopaque mass that may cause facial asymmetry or tooth displacement. Treatment typically involves surgical excision with a good prognosis and low recurrence when adequately removed.

Differential diagnoses include fibrous dysplasia and other mixed-density jaw lesions. Histology and clinical context guide accurate classification and management.

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