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Case Report

Cementoblastoma: A report of three new cases

Ravi Prakash a,*, Sankalp Verma b, Neha Agarwal c, Udita Singh c,

Kuber Tyagi d
a
Professor and Head of the Department, Oral Medicine and Radiology, Kothiwal Dental College and Research Centre,
Moradabad, UP, India
b
Senior Lecturer, Oral Medicine and Radiology, Kothiwal Dental College and Research Centre, Moradabad, UP, India
c
Post Graduate Student, Oral Medicine and Radiology, Kothiwal Dental College and Research Centre, Moradabad,
UP, India
d
Senior Lecturer, Oral Medicine and Radiology, Teerthankar mahavir Dental College and Research Centre,
Moradabad, UP, India

article info abstract

Article history: Cementoblastoma is relatively a rare tumor of odontogenic ectomesenchyme origin

Received 7 January 2013 characterized by proliferating cementum like tissue, manifested as a bulbous growth
Accepted 8 July 2013 around and attached to the apex of the tooth root. This tumor accounts for 0.8%e2.6% of all
odontogenic tumors. We report three new cases of cementoblastoma in mandibular per-
Keywords: manent first molar.
Cementoblastoma ª 2013 Indian Journal of Dentistry. All rights reserved.
Mandible
Sunray appearance

1. Introduction interpretation in forming a diagnosis is highlighted. This

report also serves as a reminder that rare odontogenic tumors
Cementoblastoma, also called as “true cementoma” or may present initially in primary care and it is essential that all
“attached cementoma” was first described by Dewey in 1927.1,2 practitioners are aware of them.5
It is relatively a rare tumor of odontogenic ectomesenchyme
origin characterized by proliferating cementum like tissue
occurring in juxtaposition to tooth roots.1 This tumor accounts
2. Case report
for 0.8%e2.6% of all odontogenic tumors.1 It manifests as a
bulbous growth around and attached to the apex of the tooth
2.1. Case 1
root. The tumor most often develops with permanent teeth but
in rare cases, can occur with primary teeth.3,4
A 19-year-old male complained of mild pain on chewing in the
We present three cases of cementoblastoma involving
left lower molar region since 6 months. The patient was in
permanent mandibular first molar. The importance of
good general health. An intraoral examination revealed a
adequate radiographic investigation and appropriate
swelling in the left mandibular first molar region. The swelling

* Corresponding author. C/o Dr. R. P. Singh (MS), Dhanwantri Nursing Home, Sarai Khalsa, Behind Head Post Office, Moradabad 244001,
UP, India. Tel.: þ91 (0) 9997119919.
E-mail addresses: sasan_ravi@rediffmail.com, ushabillu@yahoo.com (R. Prakash).
0975-962X/$ e see front matter ª 2013 Indian Journal of Dentistry. All rights reserved.
http://dx.doi.org/10.1016/j.ijd.2013.07.006

Please cite this article in press as: Prakash R, et al., Cementoblastoma: A report of three new cases, Indian Journal of Dentistry
(2013), http://dx.doi.org/10.1016/j.ijd.2013.07.006
2 i n d i a n j o u r n a l o f d e n t i s t r y x x x ( 2 0 1 3 ) 1 e4

Fig. 1 e (a) Radiopacity involving the roots of left mandibular first molar. (b) Panoramic radiograph demonstrating a well
defined radiopacity involving the roots of left mandibular first molar surrounded by a radiolucent halo. The radiopacity is
obscuring the root outlines. (c) Mandibular lateral cross-sectional occlusal radiograph showing radiating spicules of
cementoid material emanating from the central area and radiating towards the periphery giving a sunray appearance. (d)
Excised tumor mass along with extracted left mandibular second premolar and first molar.

was bony hard and mildly tender. The left mandibular first
molar elicited a dull sound on percussion. A delayed response
on pulp sensibility testing was noted.
Intraoral periapical radiograph and panoramic radiograph
demonstrated a well defined radiopacity involving the roots of
left mandibular first molar surrounded by a radiolucent halo.
The radiopacity obscured the root outlines (Fig. 1a and b).
Mandibular lateral cross-sectional occlusal radiograph
showed radiating spicules of cementoid material emanating
from the central area and radiating towards the periphery
giving a sunray appearance. The cemental spicules were more
mineralized towards the centre, with individual spicules
appearing less radiopaque towards the periphery. Buccal and
lingual cortical plates were expanded and reduced to paper
thin margins (Fig. 1c). The tumor was excised along with the
extraction of left mandibular second premolar and first molar
(Fig. 1d). Histopathology of decalcified section revealed a
tumor composed of cementum like tissue, with irregular
lacunae and numerous reversal lines confirming the clinical
diagnosis of cementoblastoma (Fig. 2a). Ground section pre-
pared from extracted left mandibular first molar, showed
numerous cementocytes surrounding the root (Fig. 2b).

Fig. 2 e (a) Histopathology of decalcified section revealing a tumor composed of cementum like tissue with irregular lacunae
and numerous reversal lines. (b) Ground section of the extracted tooth showing numerous cementocytes surrounding the
root apex.

Please cite this article in press as: Prakash R, et al., Cementoblastoma: A report of three new cases, Indian Journal of Dentistry
(2013), http://dx.doi.org/10.1016/j.ijd.2013.07.006
 i n d i a n j o u r n a l o f d e n t i s t r y x x x ( 2 0 1 3 ) 1 e4
Fig. 3 e (a) Intraoral radiograph showing an ovoid mixed radiolucent-radiopaque mass attached to the root of the lower left
first molar with a radiolucent peripheral halo. (b) Excised tumor mass along with the extracted molar tooth.
2.2. Case 2
A 25-year-old male complained of mild pain on chewing in left
lower molar region since 3 months. His medical history was
non-contributory. The clinical examination revealed minimal
buccal and lingual cortical expansion in relation to permanent
left first and second mandibular molars. Teeth responded
normally with electric pulp testing. On intraoral periapical
radiograph, an ovoid mixed radiolucent-radiopaque mass was
seen attached to the root of the lower left first molar with a
radiolucent peripheral halo (Fig. 3a). However, characteristic
sunray appearance was not evident in the occlusal radio-
graphs. Enucleation of the calcified mass along with the
extraction of the involved tooth was then performed (Fig. 3b).
The histopathological findings confirmed the diagnosis of
cementoblastoma.
2.3. Case 3
A 30-year-old female presented with swelling and dull pain in
lower left molar region since 3 months. Her medical history
Fig. 4 e Cropped panoramic radiograph showing round
mixed radiolucent-radiopaque mass was seen attached to
the root of the lower left first molar with a radiolucent rim
at the periphery.
Please cite this article in press as: Prakash R, et al., Cementoblastoma: A report of three new cases, Indian Journal of Dentistry
(2013), http://dx.doi.org/10.1016/j.ijd.2013.07.006
3
was unremarkable. Clinical examination revealed a swelling
in buccal vestibule with normal overlying mucosa extending
from premolar to molar region .The teeth in the region were
vital. On panoramic radiograph, a round mixed radiolucent-
radiopaque mass was seen attached to the roots of the lower
left first molar with a radiolucent rim at the periphery (Fig. 4).
Occlusal radiograph revealed expansion of buccal cortical
plates without any radiating spicules. Enucleation of the
calcified mass with the extraction of the involved tooth was
performed. Histopathological findings were consistent with a
diagnosis of cementoblastoma.
3. Discussion
Cementoblastoma is a slow growing, benign odontogenic
tumor arising from cementoblasts.6 In W.H.O classification of
odontogenic tumors, cementoblastoma has been classified as
one of the cementoma lesions which also includes giganti-
form cementoma, peripheral florid dysplasia and cementify-
ing fibroma.4 In 1974, Cherrick and his colleagues established
definitive criteria for this lesion that included a bulbous
growth of cementum on the root of the tooth, tendency to
expand the bony plates of the jaws and active histologic
appearance. All three of our cases fulfilled these criterias.7
The tumor is most commonly found in the second and
third decades of life. All three of our cases were in the second
decade. Male predominance has also been reported. Two of
our patients were male while one was female. Virtually all
cementoblastoma occur in premolar-molar region, more
commonly in the mandible than maxilla.1,2,7e9 All three of our
cases involved the permanent mandibular first molars.
The radiological features of this tumor are characteristic. It
probably develops in three distinct stages. The first stage is
uncalcified matrix stage which is characterized by develop-
ment of a circular radiolucent area at the apex of the vital
tooth where in most cases half of the root length may get
resorbed by radiolucent mass. The second stage is called as
cementoblastic stage which begins with appearance of radi-
odense material in the centre of the lesion with a radiolucent
band surrounding the lesion.7 The third stage is the mature
stage where the lesion is completely radiopaque.
4 i n d i a n j o u r n a l o f d e n t i s t r y x x x ( 2 0 1 3 ) 1 e4
The mass should also be examined from occlusal aspect.
This view shows expansion of both buccal and lingual cortical
plates. A characteristic finding observed is the presence of
radiating spicules of cementoid material towards the periph-
ery giving a sunray or spoke wheel appearance. The spicules
are more mineralized towards the centre.7e9 This appearance
was observed in our first case.
Cementoblastoma is histopathologically characterized by
formation of sheets of cementum like tissue containing many
reversal lines, irregular lacunae and cellular fibrovascular
stomata.2
Treatment of choice is complete removal of the lesion with
extraction of the associated tooth, root amputation with
tumor removal or curettage of the lesion without extraction of
tooth. The prognosis is excellent.10,11
Conflicts of interest
All authors have none to declare.
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Please cite this article in press as: Prakash R, et al., Cementoblastoma: A report of three new cases, Indian Journal of Dentistry
(2013), http://dx.doi.org/10.1016/j.ijd.2013.07.006
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