A 48-year-old male visited a general dentist for an initial exam and prophy. Radiographic examination revealed an enlarged and bulbous root on tooth #13.
Joen Iannucci Haring, DDS, MS
The patient stated that he had previously been seen by a general dentist for regular dental examinations and extensive restorative treatment. The patient denied any pain or sensitivity in the involved area and reported no history of trauma.
The patient appeared to be in an overall good state of health at the time of the dental visit. A review of the medical history revealed hypertension diagnosed several years earlier and controlled by medication. At the time of the dental examination, only blood pressure medication was being taken by the patient.
The patient`s vital signs were all found to be within normal limits. A thorough examination of the head and neck regions revealed no abnormal findings. The intraoral examination revealed a dentition in good state of repair with no abnormalities present. In addition, examination of the oral soft tissues revealed no unusual findings.
The patient`s last dental radiographs were taken approximately two years earlier. Based on the findings of the oral examination and the patient`s previous caries and periodontal history, a complete series of radiographs were ordered and exposed. Examination of the periapical radiograph in the area of the left maxillary premolar region revealed an abnormally large and bulbous root on tooth #13 (see radiograph). Further examination of the remaining periapical radiographs revealed no other areas of involvement.
Based on the information presented, which of the following is the most likely diagnosis?
* condensing osteitis
* periapical cemental dysplasia
* sclerotic bone
The term hypercementosis refers to the excess deposition of cementum on root surfaces. This deposition is continuous with the normal radicular cementum.
A variety of local and systemic factors have been associated with hypercementosis and include the following: trauma, inflammation, supraeruption, pituitary gigantism, arthritis, calcinosis, Paget`s disease, rheumatic fever, and goiter. Although such numerous factors have been associated with hypercementosis, most cases are not linked to systemic disorders and have no obvious cause.
Hypercementosis occurs predominantly in adults and an increased frequency is seen with increasing age. If hypercementosis is identified in younger patients, a familial clustering often exists suggesting a possible hereditary influence.
No signs or symptoms are associated with hypercementosis, and most cases are discovered during routine radiographic examination. Hypercementosis may affect one tooth in a localized area or affect multiple teeth throughout the dental arches.
The premolar teeth are most often involved. Hypercemento-sis does not affect the vitality of teeth and therefore the involved teeth pulp test vital.
On a dental radiograph, the teeth affected by hypercementosis exhibit a thickening or blunting of the root surface. In addition, an excess amount of cementum is seen along all or part of the root surface. The apical regions are most often affected.
Tooth roots affected by hypercementosis appear enlarged and bulbous. In spite of the fact that abnormal amounts of cementum are present, the affected roots are separated from periapical bone by both a normal-appearing periodontal ligament space and intact lamina dura.
Diagnosis and Treatment
The diagnosis of hypercementosis is made based on the characteristic radiographic features described. Hypercementosis does not require treatment. In cases where extraction of an affected tooth is necessary, the tooth may be sectioned to facilitate removal.
Joen Iannucci Haring, DDS, MS, is an associate professor of clinical dentistry, Section of Primary Care, The Ohio State University College of Dentistry.