Oral Pathology Case Study #9

Anna Rusnak, Michele Andrus and Scott Sonnier

November 4th, 2017

The case study we were given as group 9, involves a 22-year-old male patient who was

at a regular dental check-up when a concerning lesion was found. The following is an

explanation of the correct diagnosis from the options we were given for this patient.

The first diagnosis option is a complex odontoma. A complex odontoma is a specific type

of mixed odontogenic tumor that can be associated with impacted or un-erupted teeth. It is the

most common type of odontogenic tumor. The tumor mass is made up of all the components

of normal tooth structure including, enamel, dentin, cementum and pulp, but the arrangement

within the mass does not resemble normal tooth structure. The posterior region of the

mandible is the most common site for a complex odontoma, and the most common clinical sign

is the failure of a permanent tooth eruption. Odontomas are usually small lesions, but large

odontomas can cause some major clinical signs and problems for the patient, such as blocking

the eruption of permanent teeth, swelling, and can even shift teeth out of alignment and

displace them. The radiographic features of complex odontomas include, a radiopaque mass

that is surrounded by a thin radiolucent halo, the mass does not resemble teeth. There will

usually be un-erupted permanent teeth on the radiograph, and the complex odontoma will be

obstructing their eruption.

The lesion in this case study could not be a complex odontoma because there are no un-

erupted permanent teeth being blocked by the lesion. The lesion does appear radiographically
similar to a complex odontoma with a large radiopaque mass surrounded by a radiolucent halo,

but the other clinical signs do not suggest complex odontoma.

The second diagnosis option is periapical cemental dysplasia, a type of benign fibro-

osseous lesion. This is an asymptomatic lesion of the jaw that usually occurs in middle age

African American females. Early lesions of periapical cemental dysplasia present as a well-

defined radiolucency at the apex of the roots of the mandibular anterior teeth. The teeth

involved with this lesion are usually free from caries or restorations.

The lesion in this case study could not be periapical cemental dysplasia because the

lesion in the case study is radiopaque. Also, periapical cemental dysplasia most commonly

occurs at the apex of the roots of mandibular anterior teeth of African American women, and

the lesion in the case study involves a mandibular posterior molar of a male patient. Lastly,

periapical cemental dysplasia involves teeth with no restorations or caries history, and the

tooth in the case study has an occlusal restoration.

The third diagnosis option is osteoblastoma. Osteoblastoma is a benign, symptomatic

condition that occurs most commonly in the axial skeleton, but can occur in the mandible. This

lesion can affect any age, but is most commonly found in male patients’ younger than 30. The

lesion appears as well defined with irregular spaces of radiopacity due to mineralization. This

lesion can be very aggressive and grow 4-6cm in size while causing destruction of the cortical

bone.
 The lesion in this case study could not be osteoblastoma because the lesion appears as a

well-defined radiopaque lesion with no irregular spaces of radiopacity involved. There was also

no huge destruction of cortical bone in the case study lesion, and cortical bone destruction is a

clinical sign of osteoblastoma.

The fourth diagnosis option is cementoblastoma, a specific type of mesenchymal

odontogenic tumor. Cementoblastoma is a benign tumor that is usually found fused to the

roots of a vital tooth. The tumor produces cementum, which obliterates the apex of the root

involved. The lesions of cementoblastoma are usually found attached to the apical third of one

root of a mandibular molar. These lesions are mostly found in patients under age 30.

Radiographic characteristics include a well-defined, unilocular, radiopaque lesion with a

radiolucent halo. The radiolucent halo is said to be the PDL. This lesion can sometimes cause

pain and a slight expansion of the bone in the area.

Cementoblastoma is the correct diagnosis for this case study. There were no unusual

historical findings that led to this diagnosis. The patient had no history of previous tumors in

the area and denied any pain. The history of the area included a restoration on the tooth in

question and the tooth is still vital. The clinical exam showed a slight bony enlargement near

the area. Cementoblastoma can cause bone expansion. The radiograph taken showed a well-

defined radiopaque lesion with a radiolucent halo, that had obliterated one root of a lower
molar. This description fits perfectly with the usual radiographic findings with

cementoblastoma. The patient is under the age of 30, which also fits with cementoblastoma.

The fifth diagnosis option is focal sclerosing osteomyelitis. This is a specific type of

inflammatory periapical lesion that is caused by a low-grade infection which causes a change in

the bone near the apex of a tooth. This lesion is usually seen near a lower first or second molar

that is non-vital with a large carious lesion or large previous restoration. The radiographic

appearance of focal sclerosing osteomyelitis is a well-defined radiopaque lesion near the apex

of the tooth, but it does not seem to be continuous with the cementum of the root affected.

The lesion in this case study could not be focal sclerosing osteomyelitis because the

lesion in this case study is continuous with the cementum of the apex and that is not a

characteristic of this lesion. Also, the tooth involved in this case study only has a small occlusal

filling and no large carious lesion. Focal sclerosing osteomyelitis is usually found on a non-vital

tooth with a large filling or carious lesion.

This case study was very difficult to determine from the information provided. In many

of the textbooks we used for this paper three of the diagnosis options were very similar and are

actually all a differential diagnosis for each other. The three options that are extremely similar

and, in some cases, can only be differentiated after a biopsy and histologic lab testing is

completed are osteoblastoma, cementoblastoma, and focal sclerosing osteomyelitis.

 Works Cited

Sapp, J. Philip. (2004) Contemporary Oral and Maxillofacial Pathology, 2nd Edition. C.V. Mosby,
Vital Source

Newland, J. Robert. (2012) Oral Hard Tissue Diseases, 3rd Edition: Hudson, Ohio: Lexicomp

Ibsen, A.C. Olga & Phelan, A. Joan. (2017) Oral Pathology for the Dental Hygienist, 7th Edition:
St. Louis, Missouri: Elsevier