Tsementoma – the formation of an odontogenny origin developing from connecting fabric. The disease proceeds asymptomatically. At achievement of the big sizes of a tsementom causes deformation of a jaw. Owing to thinning of a kortikalny plate unsharp morbidity appears. Diagnostics of a tsementoma includes collecting complaints, fizikalny inspection, a X-ray analysis, EOD. Confirmation of the diagnosis manages to be received after carrying out a histologic research. Treatment of a true tsementoma and the cementing fibroma surgical. At a periapikalny dysplasia and a gigantoformny tsementoma dynamic observation is shown.
Tsementoma (periradikulyarny osteofibrosis) – an odontogenny malformation of connecting fabric. At adult age of a tsementoma meet at women more often. The tumor is in most cases localized in a part of the body and a corner of the lower jaw. At the same time roots of big and small molars are involved in pathological process. At children of a tsementoma are not connected with roots and are inclined to unlimited growth. At children's age the maxillary bone is surprised more often. Cases of germination of a good-quality new growth in a cavity of a gaymorovy sine and the basis of a skull are recorded. At achievement of the big sizes of a tsementom can lead to a jaw fracture. One of kinds of a tsementoma – a periapikalny cement dysplasia is revealed mainly at women of negroid race aged from 30 up to 50 years. The teeth associated with defeats are permanently vital and seldom have restorations. Prevalence makes from 1 to 5,9%.
The pathogenesis cement remains to unknown. Scientists assume that jet or displastichesky process takes place. The Gigantoformny tsementoma is genetically determined disease at which the multiple centers of defeat reveal at several family members. At the pathoanatomical level at a tsementoma there is a progressing resorption of a normal alveolar bone to replacement with its fibrous fabric consisting of fibroblast, collagen and various quantity of bone or cement-like kaltsifikat.
The initial stage of development of a tsementoma is characterized by proliferation of fibroblast and collagenic fibers in apikalny area of a periodontal sheaf therefore there is a resorption of the brain substance surrounding an apex. At this stage on the roentgenogram the zones of depression of a bone tissue having strong likeness with the periapikalny centers of an infectious transdental origin are visible. Further during the second stage of development of a tsementoma there is a differentiation of tsementoblast. It, in turn, promotes emergence of sites of the raised mineralization. At the third stage the ossifikation of fibrous fabric is observed. Defeat looks as the kaltsifikation of limited density surrounded with a narrow radiotransparent rim.
Classification by cement
In stomatology allocate 4 main types with cement:
1. True tsementoma. The tumor develops without the expressed clinic. More often the new growth is diagnosed incidentally during a X-ray analysis of the tooth tied with tsementomy or the next teeth. At a histologic research of a tsementoma reveal coarse-fibered connecting fabric with different degree of a kaltsifikation. The tumor is surrounded with the cover delimiting pathologically changed fabrics from a healthy bone. Microscopically the new growth has similarity since osteoides - osteomine, Pedzhet's disease.
2. The cemented fibroma. The disease proceeds with the erased symptomatology. At growth of a tsementom thins a kortikalny layer of a bone, from pressure upon a periosteum there is an unsharp morbidity. Histologically the cementing fibroma represents the good-quality new growth consisting of the cages intertwining among themselves and fibers of connecting fabric with the expressed mineralization zones. The cementing fibroma, as well as a true tsementoma, has the external capsule.
3. Periapikalny cement dysplasia. It is more often localized in frontal department of a body of the lower jaw. It is characterized by emergence of the multiple pathological centers which do not exceed 1 cm in the diameter and do not extend to a kortikalny plate. The tumor passes 3 stages in the development: osteolytic, kaltsifitsiruyushchy and mature. On the roentgenogram along with destruction of a bone tissue reveal sites of the raised mineralization.
4. Gigantoformny tsementoma. It is characterized by intensive transformation of connecting fabric in cement. On the roentgenogram find the site of a rounded or oval shape which is densely soldered to a fang. Degree of density of a gigantoformny tsementoma has strong likeness with structure of solid tissues of tooth. The periodontal crack is not traced, cellular elements are practically absent.
The asymptomatic current is characteristic of a tsementoma. Opening of a mouth at patients free, is carried out in full. Color of integuments is not changed. Mucous in a projection of a tsementoma of a light pink shade, without visible pathological changes. At achievement of the big sizes of a tumor thickness of a kortikalny plate therefore the tsementoma puts pressure upon a periosteum decreases. It causes emergence of unsharp morbidity at a conversation, during meal.
During the palpatorny research it is possible to reveal a local thickening of a bone in a zone, the corresponding localization of a tsementoma. The tumor can sprout in mucous that leads to formation of a punched opening which serves as entrance gate for penetration of an infection and development of inflammatory process. If the tsementoma is localized on the top jaw, the good-quality new growth can grow into a cavity of a gaymorovy sine, causing characteristic symptomatology of antritis.
Diagnostics of a tsementoma
Diagnosis of a tsementom is based on data of the anamnesis of a disease, complaints of the patient, results of clinical, radiological and histologic researches. At the considerable sizes of a tumor during vneshnerotovy fizikalny survey the dentist reveals asymmetry of the person. Integuments are in color not changed, opening of a mouth free. Mucous light pink. At a palpation slaboboleznenny deformation of an affected area of a bone is observed. Can result from germination of a tumor in a mucous membrane at the corresponding localization of a tsementoma to a soustya. If the tsementoma of the small sizes, specific clinical symptoms of a disease are absent.
The only possible way of diagnostics is the radiological research. Two types of changes are characteristic of a tsementoma. In the first case radiographic determine the correct rounded shape plus fabric, by density the reminding tooth tissue which is closely connected with its root part. On the periphery of a tsementoma the thin strip of an enlightenment corresponding to a zone of depression of a bone is localized. The periodontal crack on a circle of a root is absent. In the second case on X-ray diagnose minus fabric. At the same time against the background of depression of a bone reveal zones of the raised mineralization.
For the purpose of performing differential diagnosis of a periapikalny cement dysplasia with inflammatory periapikalny changes use EOD. Unlike periodontitis at a tsementoma viability of a pulp is kept that is confirmed by data of EOD in the range of values from 2 to 6 mk. Results of a histologic research are solving at diagnosis of a tsementom. Identification of cement-like fabric without signs of an atipiya confirms development of a tsementoma. The disease is differentiated with chronic periodontitis, benign and malignant odontogenny tumors. The patient is examined by the maxillofacial surgeon.
Treatment of a tsementoma
At identification of a true tsementoma and the cementing fibroma carry out removal of a tumor of an oral cavity with a resection of a part of the affected bone. The tooth involved in pathological process is also subject to removal. Treatment of a periapikalny cement dysplasia has the features. As the tendency to active tumoral growth is not observed, this type cement does not demand removal. Also do not apply an operational method of treatment when diagnosing a gigantoformny tsementoma. To the patient appoint regular surveys for the purpose of observation of the nature of changes in dynamics for timely identification of complications. Due to the raised ossifikation of fabric it is broken a traffic that leads further to emergence of necrotic changes.
At a periapikalny cement dysplasia avoid removal of teeth. Rejection of sclerous cement-like masses happens during a long interval of time and leads to recovery. Formation of deepening of a saucer-shaped form in the site of the affected bone can accelerate recovery processes. As viability of a pulp is kept, endotreatment is not carried out. Forecast of a cement and bone dysplasia good. Late identification of a true tsementoma and the cementing fibroma leads to development of complications: to violation of integrity of a bone, spread of a tumor on a maxillary sine, to emergence of punched openings on a mucous oral cavity.