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Cementoma
Last reviewed: 23.04.2024
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In the International Histological Classification, cementoma is assigned to tumors originating from the connective tissue of the odontogenic organ.
There are four histological types of cement: benign cementoblastoma (true cementoma), cement-forming fibroma, periapical cement disilia (periapical fibrotic dysplasia) and gigantiform cementoma (hereditary multiple cementoma).
As noted in the classification, it is a complex group of tumors with poorly delineated characteristics. However, in the explanatory notes of the WHO it is stated that from the clinical and radiologic positions for the whole group there is an almost obligatory connection of the tumor with the teeth, a gradual increase, a clear delineation of the lesions from the surrounding tissue.
True cementoma - a benign tumor, is found in the area of the body of the lower jaw. It differs by slow growth, coming from the root, with the formation of cement-like tissue of different degrees of mineralization.
Less commonly observed cementomata of the upper jaw, which can sprout to the base of the skull. In clinical studies on the upper jaw, deformation is determined in the base and body area of a dense consistency, painless, rounded, with clear boundaries. Observe deformation of the face, exophthalmos, profuse bleeding from the nasal passages, difficulty in nasal breathing. After radical operations such as resection, relapses may occur after several years.
In the initial stages of development, a tumor can be identified radiographically with the roots. In these cases, the periodontal gap is absent. The roots of one or more of the teeth are underdeveloped, intimately associated with the tumor. The latter can have a rather bizarre configuration, but its contour is well traced. In the first periods of growth, its shadow has a uniform structure.
Periapical cement dysplasia
Refers to tumor-like lesions. When the lesion occurs, a violation of the formation of cement. The lesion is localized in the area of the roots of the teeth, capturing the bone tissue of the jaw.
The clinical course of the lesion is asymptomatic and can be detected accidentally during X-ray examination, including when treating the teeth or when they are removed, especially when a root fracture occurs.
X-ray in the root or root area of the lesion is characterized by destructive changes in the tip of the tooth or teeth. A distinctive feature is the absence of a periodontal gap. In areas of root bone destruction, dense tissue regions without clear boundaries are visible.
Diagnosis is based on an x-ray picture. The most reliable information is provided by digital radiography with the possibility of increasing the jaw segment or segments by 4-5 times.
The microscopic picture is represented by a cement cloth of white or yellow color with different mineralization, which determines its density or softer consistency.
Differential diagnosis is not difficult due to a fairly typical X-ray picture.
Treatment consists in dynamic observation, surgical intervention is not shown.
The forecast is favorable.
Cement-forming fibroids
Refers to benign formations.
The clinical picture is asymptomatic. In cases of large neoplasm, deformation of the jaw arises. Growth is determined by the mineralization of the bone, which can be delayed at the end of this adjustment or completely stops.
Radiological picture is characterized by the presence of a focus of rarefied bone with clear boundaries.
Diagnostics and differential diagnostics are similar to those for cement. The final diagnosis determines the morphology of the deleted material.
Histologically, cementoma with a low degree of mineralization has a predominantly fibroblastic structure; in the late stages of mineralization, the fabric becomes cement-like.
Treatment: observation is recommended. The operation is performed in case of significant deformation of the jaw. If an intervention is made, it must be radical. At the same time, the operation can lead to great aesthetic disturbances. Therefore, more often conduct a dynamic observation.
The forecast is favorable.
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Giant-form cement
Family multiple cementoma refers to genetic defects and occurs in several family members.
The clinical picture is asymptomatic. It can be found by chance in the treatment of teeth and X-rays. On the roentgenogram, shadows with a dense spongy bone structure, often located symmetrically in the jaws, are found. The diagnosis is established on the basis of an x-ray picture.
Differential diagnosis is carried out with other cementomas, bone dysplasia. The main are the study of different sighting and panoramic shots, digital radiography with magnification and CT.
Treatment: Dynamic observation is shown.
The forecast is favorable.
If the question of surgical intervention is solved (true cementoma, periapical calcification, etc.), it is necessary to take into account the constant connection of histological types of cements with the roots of the teeth: the plan of any operation should include the removal of the alveolar process block with teeth and tumor. Preservation of teeth in the tumor zone, as a rule, leads to relapses.