Hypercementosis

Hypercementosis
Specialty	Dentistry

Hypercementosis is an idiopathic, non-neoplastic condition characterized by the excessive buildup of normal cementum (calcified tissue) on the roots of one or more teeth. A thicker layer of cementum can give the tooth an enlarged appearance, which mainly occurs at the apex or apices of the tooth.

Signs and symptoms

Location of where excess cementum may appear

It is experienced as an uncomfortable sensation in the tooth, followed by an aching pain. Excess amount of cementum may cause pressure onto periodontal ligaments and adjacent teeth. Teeth affected made present as asymptomatic. It may be shown on radiographs as a radiopaque (or lighter) mass at each root apex to confirm diagnosis.

Cause

Trauma and other developmental disorders such as Paget's disease may be more prone to develop hypercementosis in the maxillary region. Further research is required to determine exact cause.

Local factors:

• Occlusal trauma
• Trauma
• Non-functional tooth
• Unopposed tooth (and impacted teeth, embedded teeth, teeth without antagonists)

Systemic factors:

• Idiopathic
• Pituitary gigantism
• Paget's disease of bone
• Acromegaly
• Periapical granuloma
• Arthritis
• Calcinosis
• Rheumatic fever

It may be one of the complications of Paget's disease of bone in the form of generalized hypercementosis.

It may also be a compensatory mechanism in response to attrition to increase occlusal tooth height.

Pathophysiology

Research has suggested that mutations in the ENPP1 and GACI genes may contribute to the development of hypercementosis. Loss of function in ENPP1 caused generalized arterial calcification of infancy (GACI) which was directly associated with individuals with hypercementosis.

Diagnosis

Periapical radiographs can locate radiopaque structures in proximity to the root which can appear as dense bone island or periapical osseous dysplasia in cases of hypercementosis. Majority of affected teeth appear as club-shaped due to cemental hyperplasia diffusing in a variety of severities. Most appear in the apical third of the root.

Complications

Such deposits form bulbous enlargements on the roots and may interfere with extractions, especially if adjacent teeth become fused (concrescence). It may also result in pulpal necrosis by blocking blood supply via the apical foramen.Teeth affected do not necessarily need treatment unless it causes complications to adjacent teeth and structures.