Hypercementosis Radiology: Dental Notes for BDS, MDS, NBDE Exams.
Disease Mechanism
Hypercementosis is the excessive deposition of cementum on tooth roots. (ref)
Causes:
- Often unknown.
- Supraeruption of a tooth after the loss of an opposing tooth.
- Inflammation from rarefying or sclerosing osteitis.
- Cementum is deposited on the root surface adjacent to the apex.
- Associated with teeth in hyperocclusion or that have been fractured.
Occurs in patients with:
- Paget’s disease of bone.
- Hyperpituitarism (e.g., gigantism and acromegaly).
Clinical Features
- Asymptomatic: Does not cause any clinical signs or symptoms.
Imaging Features
- Appears as an excessive buildup of cementum around all or part of the root.
Outline:
- Usually smooth.
- May appear as an irregular or bulbous enlargement of the root.
- Most evident at the apical end as a mildly irregular accumulation of cementum.
- Cementum is slightly more radiolucent than dentin.
- Lamina dura and periodontal ligament (PDL) space encompass the extra cementum.
- In Paget’s disease: Hypercementosis is very exuberant and irregular in outline.
Differential Diagnosis
- Dense Bone Island (DBI)
- Mature Periapical Osseous Dysplasia
- Small Cementoblastoma
- Severely Dilacerated Root
Differentiating Characteristics:
- Presence of the periodontal membrane space around the hypercementosis.
- Radiopaque structures in the vicinity of the root but with different features.
Management
- No treatment required for hypercementosis itself.
- If associated with a periapical inflammatory lesion, treatment may be necessary.
- Clinical Significance:
- May cause difficulty during tooth extraction due to altered root configuration.
Hypercementosis Radiology Reference:
- Oral radiology Principles and Interpretation; White & Pharoah
- Essentials of Oral and Maxillofacial Radiology; F. Karjodkar
- Concise Oral Radiology; HR Umarji
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