Periapical cemental dysplasia. Case report.
A white, 40-year-old female patient came to the clinic after a colleague's appointment for endodontic treatment of teeth with "periapical lesions in all lower anterior teeth". No symptoms were reported and on clinical examination, normal appearance of the teeth and adjacent tissues cited. On clinical examination, negative percussion and palpation tests and thermal tests with normal response. Radiographic examination revealed periapical radiolucent images in all lower incisors and also in the region of 34 and 35.
In the family history survey, the woman reported black ancestry by grandparents, which reinforced the diagnosis hypothesis of periapical cemental dysplasia. The patient was oriented for clinical and radiographic follow-up, with no need for endodontic intervention.
Case conducted by student Marcus Thurler from class 9 of the endodontics specialization course at HPG Brasília.
Cemental dysplasia in: Bittencourt et al. Periapical Cemental Dysplasia. Relato de Caso. Rev Inst Ciênc Health
2007; 25(3):319-21
Introduction and Literature Review
Periapical cemental dysplasia (PCD) is a benign odontogenic tumor of mesenchymal origin derived from the periodontal ligament.
.
PCD is self-limiting, i.e., the bone cortex is not expanded and progressive growth is rare. There are no clinical manifestations and are therefore asymptomatic except when located near the mental foramen, due to nerve compression that can lead to pain and paresthesia . For these reasons, this lesion is usually discovered in routine radiographic examinations.
There is a marked predilection for women (14:1) and approximately 70% of cases affect blacks. The diagnosis is never made before 20 years of age. In imaging exams they are most frequently seen in areas corresponding to the roots of the lower incisors. Multiple foci are more usual, but when single, they do not exceed 1 cm in diameter. It can also be seen that the lesion is contiguous to the periodontal ligament and the lamina dura remains intact.
This pathology has a natural evolution, going through three phases of development: osteolytic; cementoblastic and maturation. The 1st phase is characterized by the replacement of bone tissue by fibrous tissue, which determines a periapical radiolucency. In the 2nd phase, there is deposition of cementum spicules, due to increased cementoblastic activity, causing
areas of opaque focal condensation with areas of rarefaction. In the final, maturing phase, there is complete calcification of the region providing a radiopaque image, often surrounded by a narrow radiolucent halo. PCD can take months or even years to reach the maturation phase.
Treatment is unnecessary since the lesion stabilizes without causing complications, requiring only periodic observation. Knowing the characteristics of PCD, its great similarity with other pathologies is noted, such as those of endodontic origin (cysts and granuloma), which are more commonly found conditions that resemble the 1st or osteolytic phase.
Therefore, it is essential to perform the pulp vitality test since in cases of PCD the pulp is sensitive to the test, not justifying endodontic treatment.
Periapical cemental dysplasia
