Recurrent benign cementoblastoma: A case report and literature review
A 16-year-old male visited the Department of Oral and Maxillofacial Surgery of Kyungpook National University Dental Hospital with pain in the right mandible while chewing. The patient sensed pain on palpation of the gingiva near the mandibular right first molar. All the teeth in the affected area were caries-free. The overlying mucosa appeared normal, with no clinical signs of inflammation. The patient reported that the symptoms had begun several months ago. The patient had no significant family or medical history contributing to pain.\nAn initial panoramic radiograph (Orthopantomograph OP 200 D, Instrumentarium Imaging, Tuusula, Finland) showed a round radiopaque mass with mixed radiodensity surrounded by a radiolucent rim. The lesion was attached to the root of the right first molar and caused displacement of the inferior alveolar canal (). The lesion extended to the periapical area of the mandibular right second molar. Cone-beam computed tomography (CBCT) images (PaX-Flex 3D apparatus, Vatech, Kyungi, Korea) demonstrated a well-circumscribed mass involving the roots of the mandibular right first molar, causing perforation of lingual cortical bone with sclerosing osteitis around the lesion (). We established a differential diagnosis of benign cementoblastoma with secondary infection based on the clinical and radiographic findings. Under general anesthesia, the patient underwent surgical excision of the lesion with extraction of the mandibular right first and second molars (). During surgery, the mass and the involved tooth were well separated. The defect was immediately filled with bone graft material () and the specimen was submitted for a histopathological examination. Macroscopically, the surgical specimen consisted of a round hard tissue mass in conjunction with the first molar roots. Hematoxylin and eosinstained sections showed that the lesion included sheets of cementum-like tissue with basophilic reversal lines surrounded by well-vascularized cellular connective tissue, with large and abundant cementoblasts and irregular lacunae (). The final diagnosis of benign cementoblastoma was established based on the histopathologic examination. Postoperative healing was uneventful.\nRoutine post-surgical follow-up examinations revealed a new lesion at the age of 20 years on the previous operation site. The clinical symptoms included intermittent pain in the right mandible during physical activity. Three years after the initial surgery, a panoramic radiograph showed masses with heterogeneous radiopacity surrounded by radiolucent rims with sclerotic borders at the previous operation site, suggesting recurrence of the lesion (). CBCT showed perforation and expansion of the buccolingual cortical bone (). The patient underwent a reoperation on the mandibular right posterior region. Under general anesthesia, the patient underwent surgical curettage of the lesion, mandibular right second premolar extraction, and grafting with the left iliac bone. The gross specimen included multiple cemental masses near the operation site (). Areas of cementum-like calcified trabecular tissue with benign cementoblastoma and multinucleated giant cells were present along the loosely arranged vascular connective tissue stroma (). Histopathological examination confirmed the diagnosis of recurrent benign cementoblastoma. Six months after the second surgery, there was no further sign of recurrence at a regular follow-up visit ().