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Periapical cementoblastoma
ORAL ROENTGENOLOGY American Arthur
H.
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Academy of Oral Roentgenology Wuehrmann,
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PERIAPICAL Report
Editor
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*
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CEMENTOBLASTOMA
of a Case*
(A3orge A. .Ilorgnn, D.D.S., F.LC.D., P.C.D., N.D.D., Toronto, On.tnrio
and cr’my Il. Poyton,
P
roent~genolueencies often present great diagnostics. problems. The) ma.y represent cementoblastomas, benign neoplasms made up of connective tissue generally of limited growth. They may Fe spoken of as cemcntifying fihromas. The lesions originate in the periapical region of the normal pcrmanent dentition as a result of proliferation of cells of the periodontal membrane. In some instances the result is fibrous connective tissue containing foci of osteoid, while in others cementum is produced. Stafnr, in a large series of cases (10,000 consecutive adult patients), found twenty-four cases of p&apical roentgenolncencies involving a total of fifty-two teeth. Prior to his examination, however, some of these patients may have had teeth associated with such areas removed on the assumption that they were grurulornas or early radicular cysts. One can assume, therefore, that the iticaidenc::is at least two per 1,000 persons. The ages of the patients varied from ~‘0 to 62 pears. Seventy of the patients were women. Complete general physical examinations did not reveal any specific systemic disturbance that would accaount for resorption of bone. There were no patients with hyperthyroidism. There are many instances in which the lesion remains very small and the rcentgenopacity varies so little from the surrounding bony process that roentgcnographic diagnosis is uncertain. Differential dia.gnosis depends largely upon t’he stage of the development at which t,hc periapical condition is observed and upon the clinical appearance of the involved teeth in association with pertinent history. The initial stage F,RIAPlCAl,
From
*First
the Departrncnt of Kadiodontics. of a series of reports of unusual
Faculty cases.
of Ikntistry,
Irniversity
of Toronto.
Volume
PERIAPICAL
12
NumberII
CEMENTOBLASTOMA
1345
is the one which causes most confusion in diagnosis and the one at which most misinterpretations are made. Depending upon the size of the area, the periapical roentgenolucencies are invariably diagnosed as periapical infection or radicular cysts. The presence of roentgenolucent areas around the apex of a tooth which has normal color, positive vitalit,y, and no history of trauma, pain, or pulpitis should suggest this growth to be a cementoblastoma. This is partkularly true if the tooth involved is a mandibular incisor. CASE
REI‘ORT
The case illustrated in Fig. 1 is that of a 43-year-old white woman with no pain symp There are no systemic complaints. The teeth are normal as to color and vitality. The case is illustrative of either multiple periapical cementoblastomas or cementomas, since considerable roentgenopaque tissue has been deposited (Fig. 1) about the apices of both maxillary anterior and mandibular an’erior and posterior teeth. It is only very cecasionally that this condition is s:en about the apices of both the maxillary and mandibular teeth in the same mouth. t0111s.
Fig. SUMMARY
AND
1
CONCLUSIONS
The occurrence of periapical roentgenolucencies in man is not as uncommon as formerly supposed. The significance of the lesion lies in the fact that it should be included in the differential diagnosis of apical pathology. In later development, roentgenopaque tissue is deposited while the growth usually remains relatively small and the teeth affected invariably remain vital. These roentgenopaque areas may attain large size, as in the case presented. Removal is rarely justifiable; this is particularly true if such removal involves the devitalization or loss of vital, healthy teeth.
H.
.
Academy of Oral Roentgenology Wuehrmann,
.
l
PERIAPICAL Report
Editor
l
l
l
l
l
.
l
l
.
.
l
l
.
.
l
*
.
CEMENTOBLASTOMA
of a Case*
(A3orge A. .Ilorgnn, D.D.S., F.LC.D., P.C.D., N.D.D., Toronto, On.tnrio
and cr’my Il. Poyton,
P
roent~genolueencies often present great diagnostics. problems. The) ma.y represent cementoblastomas, benign neoplasms made up of connective tissue generally of limited growth. They may Fe spoken of as cemcntifying fihromas. The lesions originate in the periapical region of the normal pcrmanent dentition as a result of proliferation of cells of the periodontal membrane. In some instances the result is fibrous connective tissue containing foci of osteoid, while in others cementum is produced. Stafnr, in a large series of cases (10,000 consecutive adult patients), found twenty-four cases of p&apical roentgenolncencies involving a total of fifty-two teeth. Prior to his examination, however, some of these patients may have had teeth associated with such areas removed on the assumption that they were grurulornas or early radicular cysts. One can assume, therefore, that the iticaidenc::is at least two per 1,000 persons. The ages of the patients varied from ~‘0 to 62 pears. Seventy of the patients were women. Complete general physical examinations did not reveal any specific systemic disturbance that would accaount for resorption of bone. There were no patients with hyperthyroidism. There are many instances in which the lesion remains very small and the rcentgenopacity varies so little from the surrounding bony process that roentgcnographic diagnosis is uncertain. Differential dia.gnosis depends largely upon t’he stage of the development at which t,hc periapical condition is observed and upon the clinical appearance of the involved teeth in association with pertinent history. The initial stage F,RIAPlCAl,
From
*First
the Departrncnt of Kadiodontics. of a series of reports of unusual
Faculty cases.
of Ikntistry,
Irniversity
of Toronto.
Volume
PERIAPICAL
12
NumberII
CEMENTOBLASTOMA
1345
is the one which causes most confusion in diagnosis and the one at which most misinterpretations are made. Depending upon the size of the area, the periapical roentgenolucencies are invariably diagnosed as periapical infection or radicular cysts. The presence of roentgenolucent areas around the apex of a tooth which has normal color, positive vitalit,y, and no history of trauma, pain, or pulpitis should suggest this growth to be a cementoblastoma. This is partkularly true if the tooth involved is a mandibular incisor. CASE
REI‘ORT
The case illustrated in Fig. 1 is that of a 43-year-old white woman with no pain symp There are no systemic complaints. The teeth are normal as to color and vitality. The case is illustrative of either multiple periapical cementoblastomas or cementomas, since considerable roentgenopaque tissue has been deposited (Fig. 1) about the apices of both maxillary anterior and mandibular an’erior and posterior teeth. It is only very cecasionally that this condition is s:en about the apices of both the maxillary and mandibular teeth in the same mouth. t0111s.
Fig. SUMMARY
AND
1
CONCLUSIONS
The occurrence of periapical roentgenolucencies in man is not as uncommon as formerly supposed. The significance of the lesion lies in the fact that it should be included in the differential diagnosis of apical pathology. In later development, roentgenopaque tissue is deposited while the growth usually remains relatively small and the teeth affected invariably remain vital. These roentgenopaque areas may attain large size, as in the case presented. Removal is rarely justifiable; this is particularly true if such removal involves the devitalization or loss of vital, healthy teeth.