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Cementoma
Last reviewed: 07.07.2025
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In the International Histological Classification, cementoma is classified as a tumor whose occurrence is associated with the connective tissue of the odontogenic organ.
There are four histological types of cementoma: benign cementoblastoma (true cementoma), cementoforming fibroma, periapical cemental dysilasia (periapical fibrous dysplasia), and gigantoform cementoma (hereditary multiple cementoma).
As noted in the classification, this is a complex group of tumors with poorly delineated characteristics. However, the WHO explanatory notes indicate that from a clinical and radiological standpoint, this entire group is characterized by an almost obligatory connection of the tumor with teeth, gradual enlargement, and clear delineation of the lesions from the surrounding tissue.
True cementoma is a benign tumor found in the body of the mandible. It is characterized by slow growth, originating from the root, with the formation of cement-like tissue of varying degrees of mineralization.
Less frequently observed are cementomas of the upper jaw, which can grow to the base of the skull. During clinical examination of the upper jaw, deformation in the area of the base and body of dense consistency, painless, rounded, with clear boundaries is determined. Deformation of the face, exophthalmos, profuse bleeding from the nasal passages, difficulty in nasal breathing are observed. After radical operations such as resection, relapses may occur after several years.
In the initial stages of development, radiologically it is possible to establish a connection between the tumor and the roots. In these cases, the periodontal gap is absent. The roots of one or several teeth are underdeveloped, intimately connected with the tumor. The latter may have a rather bizarre configuration, but its outline is clearly traced. In the first periods of growth, its shadow has a uniform structure.
Periapical cemental dysplasia
Refers to tumor-like lesions. When affected, cement formation is disrupted. The lesion is localized in the area of the tooth roots, capturing the jaw bone tissue.
The clinical course of the lesion is asymptomatic and can be detected accidentally during an X-ray examination, including during dental treatment or extraction, especially when a root fracture occurs.
Radiographically, in the area of the root or roots of the teeth, the lesion is characterized by destructive changes at the apex of the tooth or teeth. A distinctive feature is the absence of a periodontal gap. In areas of periradicular bone destruction, dense tissue areas without clear boundaries are visible.
Diagnostics is based on X-ray images. The most reliable information is provided by digital X-ray with the ability to magnify the jaw segment or segments by 4-5 times.
The microscopic picture is represented by a cement tissue of white or yellow color with different mineralization, which determines its density or softer consistency.
Differential diagnosis is not difficult due to the fairly typical radiological picture.
Treatment consists of dynamic observation; surgical intervention is not indicated.
The prognosis is favorable.
Cement-forming fibroma
Refers to benign formations.
The clinical picture is characterized by an asymptomatic course. In cases of large neoplasms, jaw deformation occurs. Growth is determined by bone mineralization, which may be delayed at the end of this restructuring or stop altogether.
The radiographic picture is characterized by the presence of a bone rarefaction site with clear boundaries.
Diagnosis and differential diagnosis are similar to those for cementoma. The final diagnosis is determined by the morphology of the removed material.
Histologically, cementoma with a low degree of mineralization has a predominantly fibroblastic structure; in the late stages of mineralization, the tissue becomes cement-like.
Treatment: observation is recommended. Surgery is performed in case of significant jaw deformation. If intervention is performed, it should be radical. However, surgery can lead to major aesthetic disorders. Therefore, dynamic observation is more often performed.
The prognosis is favorable.
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Gigantoform cementoma
Familial multiple cementoma is a genetic disorder that occurs in several family members.
The clinical picture is asymptomatic. It can be detected accidentally during dental treatment and X-ray examination. The X-ray shows shadows with a dense structure of spongy bone, often located symmetrically in the jaws. The diagnosis is established based on the X-ray picture.
Differential diagnosis is carried out with other cementomas, bone dysplasias. The main ones are the study of various targeted and panoramic images, digital radiography with magnification and CT.
Treatment: dynamic observation is indicated.
The prognosis is favorable.
If the question of surgical intervention is being decided (true cementoma, periapical cementodysplasia, etc.), it is necessary to take into account the constant connection of histological types of cements with the roots of 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.