cementoblastoma is a relatively uncommon benign odontogenic neoplasm of the jaws and was first described by dewey in 1927 .
the benign cementoblastoma is recognized in the world health organization 's ( who 's ) classification ( 1971 ) of periapical odontogenic tumors as one of the four types of cementum - producing disorders .
the other three are periapical cemental dysplasia , cementifying fibroma , and gigantiform familial cementoma.[57 ] the who defines benign cementoblastoma as  a neoplasm characterized by the formation of sheets of cementum- like tissue containing a large number of reversal lines and a lack of mineralization at the periphery of the mass or in the more active growth area . 
the who has classified benign cementoblastoma and cementifying fibroma as the only true cemental neoplasm .
the most commonly affected tooth is mandibular first molar.[61113 ] however , other teeth involved have included mandibular second and third molars , mandibular bicuspids and maxillary bicuspids , and first , second and third molars .
true cementoblastoma can be associated with deciduous molars , although this is an uncommon occurrence .
lesions generally are discovered in patients younger than 30 years of age , often on a routine radiograph although the range has been 1072 years .
symptoms may be totally absent or when they do occur , they tend to be minor .
radiographically , cementoblastoma typically consists of well - defined radiopacity with a cortical border and then a well - defined radiolucent band just inside the cortical border .
the outline of the affected root is generally obliterated because of the resorption of the root and fusion of the mass to the tooth .
most teeth affected by the cementoblastoma respond normally to the vitality tests during early stages of the lesion , but necrotic pulp can occur with this entity , usually in later stages .
a 55-year - old female reported to the department of oral and maxillofacial surgery , with complaints of swelling in the right mandibular angle since 1 year and pus discharge in the same region since 2 months .
history revealed that the patient had mild swelling with respect to the right mandibular angle since 6 years which underwent a sudden increase in size since a year .
no history of fever , paresthesia , and numbness of the lower lip was reported .
an extraoral examination revealed facial asymmetry due to the presence of diffuse swelling and draining sinus with respect to the inferior border of the right mandibular angle .
a hard mass was palpable beneath the buccal mucosa and also on the lingual mucosa with respect to the mandibular angle .
provisional diagnosis of cementoblastoma , cement - ossifying fibroma , and complex odontoma was made .
a panoramic radiograph revealed a dense radiopaque mass surrounded by a well - defined radiolucent band with respect to the mandibular angle .
the outline of the roots of the third molar was obliterated and the radiopaque mass seemed to be attached to the roots of third molar [ figures 15 ] .
axial view of lesion on ct scan three dimensional view of lesion on ct scan a ct examination of the mandible revealed a large expansile radiopaque mass measuring 22 cm in size .
the patient was treated for the copd first by the physician and simultaneously the patient was put on antibiotics to eradicate the infection from the lesion .
after the patient was medically fit , the lesion was surgically excised along with the tooth and the sinus lining was excised .
histopathologically , the tumor consisted of a calcified mass fused with the roots of third molar with a resultant obliteration of the periodontal ligament .
the tumor comprised sheets of calcified tissue with multiple reversal lines and prominent cementoblasts and multinucleated cementoclasts .
the peripheral columns showed characteristic radiating columns of the cementum perpendicular to the surface of the lesion .
the cementoblastoma or true cementoma is a slow - growing , benign odontogenic tumor arising from ectomesenchyme .
although statistical data suggest that benign cementoblastomas are uncommon , many believe that they occur more often than published account indicates .
cementoblastomas have an unlimited growth potential and endodontic therapy does not eliminate or arrest them .
. lesions commonly occur in the younger age group with people less than 30 years of age .
more than 50% of the lesions occur under 20 years of age and the lesion is located in the mandible in more than 70% of cases ( with a predominant location at the first molar and second premolar ) .
the expansion of the cortical plates of the bone is the typical feature of cementoblastoma .
the internal structure of the mass may possess a mixed radiolucent  radiopaque quality with a radiating pattern .
a radiolucent band around the benign cementoblastoma is usually better defined and more uniform than with cemental dysplasia .
periapical cemental dysplasia is small in size and shows a progressive change in radiographs from radiolucent to mixed to radiopaque over time .
the cementoblastoma is distinguished from the osteoblastoma by its location in an intimate association with the tooth root .
the odontome is usually not fused with the tooth root and appears as a more heterogenous radiopacity .
hypercementosis is a small lesion and does not associate with pain or jaw swelling . due to benign but a locally aggressive nature of the lesion , the treatment of choice is a complete removal of the lesion along with the associated tooth .
a more conservative approach to retain the associated tooth and removal of the lesion using a surgical endodontic technique has been reported .
it can be used for small lesions in strategic teeth in which the lesion can be excised without injuring adjacent teeth and if a sufficient crown - to - root ratio remains after apicoectomy .
recurrence after the excision is rare ; if it recurs , it is because of an inadequate excision of the lesion .
 cementoblastoma is a relatively uncommon , benign odontogenic neoplasm of jaws . 
 mandible is affected more than the maxilla . 
 the lesions are generally diagnosed on a routine radiograph . 
 the localized expansion of cortical plates is observed . 
 radiographically , it consists of well - defined radiopacity with a radiolucent band . here is a case report of a female aged 55 years having swelling in the right mandibular angle with an extraoral draining sinus . 
 a panoramic radiograph shows a dense radiopaque mass along the roots of the third molar surrounded by a radiolucent band . 
 surgical excision was carried out and a histopathological examination was carried out which was suggestive of cementoblastoma . 
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