Periapical Cemental Dysplasia: Case Report

Ricardo GARIBA-SILVA2,3
Manoel D. SOUSA-NETO1
Jacy Ribeiro CARVALHO Jr.1
Paulo C. SAQUY1,3
Jesus D. PÉCORA3

1Disciplina de Endodontia, Curso de Odontologia, Universidade de Ribeirão Preto, Ribeirão Preto, SP, Brasil
2Disciplina de Endodontia, Curso de Odontologia, Universidade Paulista, Ribeirão Preto, SP, Brasil
3Disciplina de Endodontia, Faculdade de Odontologia de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil


Braz Dent J (1999) 10(1): 1-60 ISSN 0103-6440

| Introduction | Material and Methods | Results | Discussion | Acknowledgment | References |


The authors present a case of periapical cemental dysplasia affecting the mandibular left canine, with vital pulp, in a 43-year-old black female patient, an occurrence that follows the classical cases found in the literature. The need of a careful history, clinical and radiographic exams and vitality tests are emphasized in order to reach the correct diagnosis of this disease.


Key Words:   periapical cemental dysplasia, cementoma, endodontic treatment.


Introduction

    Literature uses many terms to refer to periapical cemental dysplasia, the most common being: cementoma, fibrocementoma, periapical osteofibroma and cementoblastoma (Manganaro and Millett, 1997), as well as periapical osteofibrosis, cementifying fibroma, and local osteofibroma (Shafer, 1987).
    The classical description of this pathology is of a relatively common occurrence, although its nature and etiology are unknown. It is sometimes associated with slight chronic trauma (Shafer, 1987). Although not common, familiar incidence may occur (Thakkar et al., 1993).
    Clinically, this condition affects females more frequently, and more specifically black women in their forties. Occurrence before the twenties is rare. The mandibular anterior teeth are more frequently affected than the maxillary teeth, generally occurring in two or more teeth. The florid osseous dysplasia seems to be an exuberant case of periapical cemental dysplasia (Stafane and Gibilisco, 1982; Shafer, 1987; Ackermann and Altini, 1992; Miyauchi, 1995).


Case report

    A 43-year-old black female patient presented for treatment at the Dental School of the University of Ribeirão Preto for root canal treatment of tooth 41. On radiographic examination, the presence of radiolucent images near the apex of teeth 43, 42, 41, 31, 32 and 33 were found. Using vitality tests, it was found that tooth 41 had pulp necrosis, while the others were vital. Thus, endodontic treatment was conducted on tooth 41 and periapical cemental dysplasia was detected on the other teeth involved (Figure 1).


Discussion

    Periapical cemental dysplasia has a natural history of definite pattern, which is why it can present a variable radiographic aspect, depending on the phase where it is discovered. The first phase is called osteolithic, when there is loss of bone and substitution by connective tissue, with a radiographic appearance of localized bone destruction (radiolucence), similar to periapical lesions, such as cysts or granulomas resulting from pulp necrosis. The second phase, cementoblastic, is the beginning of the calcification in the radiolucent area of the fibrosis. In the third stage, maturation, an excessive amount of calcified material is found in the focal area.
    Thus, in the first phase some confusion regarding diagnosis and treatment of the disease can occur. In despite of periapical cemental dysplasia being a well-defined condition, some patients are submitted to conventional endodontic treatment due to incorrect diagnosis of periapical cyst or granuloma. This can be avoided with the aid of vitality tests (Valdron, 1993).
    It is understood that this disease does not require endodontic or any kind of treatment. If the correct diagnosis is made, the only treatment needed is observation
(Stafane and Gibilisco, 1982; Shafer 1987; Ackermann and Altini, 1992; Summerlin and Tonich, 1994; Miyauchi, 1995; Smith et al., 1998).
    There is a great probability of incorrect diagnosis of periapical cemental dysplasia, leading to an incorrect indication for endodontic treatment. Endodontic symptomology is of vital importance for the correct treatment of this disease, which is simple observation.
    Correct procedures for diagnosis of the disease must be observed (Cohen and Burns, 1997), avoiding incorrect procedures that could only injure the patient, who would be submitted to endodontic treatment when there is no need or indication.


References

Ackerman GL, Altini M: The cementomas - a clinicopathological reappraisal. J Dent Ass South Africa 47: 187-194, 1992

Cohen S, Burns RC: Pathways of the Pulp. 8th ed. Mosby, St. Louis 2-24, 1997

Manganaro AM, Millett GV: Displasia periapical cementaria. J Endod Practice 3: 70-74, 1997

Miyauchi Y: Florid cemento-osseous dysplasia with concomitant simple bone cysts: a case in a Japonese woman. J Oral Pathol Med 24: 285-287, 1995

Shafer WG: Tratado de Patologia. 4th ed. Guanabara Koogan, Rio de Janeiro 275-276, 1987

Smith S, Patel K, Hoskinson AE: Periapical cemental dysplasia: a case of misdiagnosis. Br Dent J 185: 122-123, 1998

Stafane EC, Gibilisco JA: Diagnóstico Radiográfico Bucal. 4th ed. Interamericana, Rio de Janeiro, 168-172, 1982

Summerlin DJ, Tomich CE: Focal cemento-osseous dyplasia: a clinicopathologic study of 221 cases. Oral Surg 75: 611-620, 1994

Thakkar NS, Horner K, Sloan P: Familial occurrence of periapical cemental dysplasia. Virchows Archiv A Pathol Anat 423: 233-236, 1993

Waldron CA: Fibro-osseous lesions of the jaw. J Oral Maxillofac Surg 51: 828-835, 1993


Correspondence: Manoel D. Sousa Neto, Vicente de Carbalho, 546, 14020-040 Ribeirão Preto, SP, Brasil. E-mail: sousanet@odin.unaerp.br


Accepted December 14, 1998
Electronic publication: September, 1999


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