Hypercementosis

Hypercementosis is a nonneoplastic deposition of excessive secondary cementum on the root surface.

Clinical and Radiographic features

Radiographically, affected teeth demonstrate a thickening or blunting of the root, but the exact amount of increased cementum often is difficult to ascertain because cementum and dentin demonstrate similar radiodensities (figure 1-1). It may occur on any part of the root, but the apical two-thirds are most commonly affected. The enlarged root is surrounded by the radiolucent periodontal ligament space and the adjacent intact lamina dura. Hypercementosis may be isolated, may involve multiple teeth, or may appear as a generalized process. Premolar teeth are involved most frequently (figure 1-2). In some cases on the x-rays there are similarities between atypical hypercementosis and cementoblastoma. Cementoblastoma must be included in the differential diagnosis.

Figure 1.1  Premolar and Molar with
Hypercementosis in a patient with arthritis.

Hypercementosis occurs predominantly in adulthood, and the frequency increases with age. Its occurrence has been reported in younger patients, and many of these cases demonstrate a familial clustering, suggesting hereditary influence. Apart from the idiopathic nature of hypercementosis, this condition is associated with local and systemic factors (Box 1-1).

Of these factors, Paget’s disease of bone has received the most attention. Numerous authors have reported significant hypercementosis in patients with Paget’s disease, and this disorder should be considered whenever generalized hypercementosis is discovered in a patient of the appropriate age.

In spite of the association with a number of disorders, most localized cases of hypercementosis are not related to any systemic disturbance.

Figure 1.2 Hypercementosis. Maxillary second premolars exhibiting
 thickening and blunting of the roots.

Histopathologic Features

The periphery of the root exhibits deposition of an excessive amount of cementum over the original layer of primary cementum. The excessive cementum may be hypocellular or exhibit areas of cellular cementum that resemble bone (osteocementum). Often the material is arranged in concentric layers and may be applied over the entire root or be limited to the apical portion. On routine light microscopy, the distinction between dentin and cementum often is difficult, but the use of polarized light clearly separates the two different layers.

Treatment and Prognosis

Patients with hypercementosis  require no treatment. Because of a thickened root, occasional problems have been reported during the extraction of an affected tooth. Sectioning of the tooth or surgically removing significant amounts of the surrounding bone may be necessary in certain cases to aid in removal.

Box 1-1 Factors associated with Hypercementosis.

Local factors

Abnormal occlusal trauma

Periapical inflammatory processes

Unopposed teeth (e.g., impacted, embedded, without antagonist) ( figure 1-3)

Systemic factors

Acromegaly and pituitary gigantism

Arthritis

Calcinosis

Paget’s disease of bone

Rheumatic fever

Thyroid goiter

Vitamin A deficiency

Figure 1.3 Hypercementosis. Mandibular canines showing
thickening and blunting of the roots in a complete upper
edentulous patient.

By:  Noslen De Lapuente, DDS