International Journal of Clinical Case Reports 2015, Vol.5, No. 37, 1-3
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Figure 1 Intraoral photograph showing temporary restoration in
left mandibular first molar
Figure 2 Panoramic radiograph showing well defined radiopaque
lesion attaching the distal root of left mandibular first molar
The provisional diagnosis of benign cementoblastoma
was made, and the patient was scheduled for surgical
removal of the tumor and extraction of the associated
tooth under local anesthesia. The surgical plan was
revised and the tooth was luxated with extraction
forceps and delivered buccally. The associated tumor
mass was also removed along with the tooth. The
periphery of the bony cavity was curetted and the
wound was closed primarily. Post-operative period
was uneventful. The excised tumor specimen was hard
tissue, it was decalcified and then processing was
done. The microscopic study showed presence of
sheets and trabeculae of cementum like material and
few bony trabeculae surrounded by a cellular fibro
vascular stroma, adjacent to the apical portion of the
root. At places few osteoclastic multinucleated giant
cells were seen (Figure 3). The diagnosis of BC was
achieved. The patient was followed up for one year
and no evidence of recurrence was noted.
Discussion
BC is a relatively rare slow growing odontogenic
neoplasm of the jaws arising from cementoblasts. It
was first described by Dewey in 1927. BC generally
occurs in young persons, most frequently tends to be
Figure 3 Photomicrograph showing sheets and trabeculae of
cementum like material surrounded by a cellular fibro vascular
stroma
associated with an erupted permanent tooth, most
often the first molar or second premolar in the lower
jaw. Most patients initially present with mild pain and
bony swelling in the area of the lesion. At least 50%
of the reported cases occurred in patients under the
age of 20 years and 75% under the age of 30 years
(Regezi et al., 1978). These clinical features were well
correlated in the present case with respect to age and
site of tumor. Radiographically it appears as a
well-defined solitary circular radio-opacity with a
radiolucent halo (Matteson, 2000). The radiographic
features also be well correlated with the present case
which showed a radio-opaque mass attached to the
distal root of mandibular first molar. The clinical and
radiographic findings led to the diagnosis of BC.
Differential diagnosis of BC includes periapical
radio-opacities like osteoblastoma, odontome, periapical
cemental dysplasia, condensing osteitis and hyper-
cementosis (Slootweg, 1992).
The BC and osteoblastoma are closely related lesions
that are histologically very similar. The cementoblastoma
is distinguished from the osteoblastoma by its location
in intimate association with a tooth root. The
osteoblastoma arises in the medullary cavity of many
bones, including the long bones, vertebrae and jaws.
The odontome is usually not fused to the adjacent
tooth and appears as a more heterogeneous radio-opacity,
reflecting the presence of multiple dental hard tissues.
Periapical cemental dysplasia usually produces a
smaller lesion than BC and shows a progressive
change in radiographic appearance over time, from
radiolucent to mixed to radio-opaque. Condensing
osteitis lacks a peripheral radiolucent halo. The
radiopaque lesion of hypercementosis is usually small,
and there is no associated pain or swelling. Condensing
