Cementoblastoma — ORE Part 1 MCQ

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HardOral PathologyCementoblastomaORE Part 1

A patient presents with a painless radiopaque mass at the apex of a vital lower first molar. The mass has a radiolucent rim. On the periapical radiograph, the mass appears to be attached to the root and has caused root resorption. What is the most likely diagnosis?

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Correct answer: D — Cementoblastoma

Cementoblastoma is the diagnosis. The pathognomonic triad of (1) well-defined radiopaque mass, (2) surrounding radiolucent rim, and (3) intimate attachment to the tooth root occurs in >90% of cases. Vitality is preserved in 78% of cementoblastomas, and root resorption occurs in 60%, distinguishing it from idiopathic osteosclerosis (radiopacity only, no resorption or rim) and hypercementosis (generalized root deposition without discrete mass or rim). Periapical cemental dysplasia produces mixed radiolucent/radiopaque lesions but NOT discrete masses fused to roots with radiolucent halos. Complex odontomas do not fuse to the root or cause resorption. The location (mandibular first molar) and typical young-adult age group further support cementoblastoma, which requires surgical enucleation.

Reference: Gómez RS, et al. Cementoblastoma: An updated analysis of 258 cases reported in the literature. Journal of Oral Pathology & Medicine. 2017. https://pubmed.ncbi.nlm.nih.gov/28869132/