Hypercementosis

introduction,varieties,etiology,clinical features,radiological features,histopathologic features,treatment and prognosis

1. Hypercementosis By Dr. Madhavi

2. INTRODUCTION : Cementum Hyperplasia Hypercementosis is a non-neoplastic condition in which excessive cementum is deposited in continuation with the normal radicular cementum. Hypercementosis may be regarded as a regressive change of teeth characterized by the deposition of excessive amounts of secondary cementum on root surfaces. This most commonly involves nearly the entire root area, although in some instances the cementum formation is focal, usually occurring only at the apex of a tooth.

3. hypercementosis of unknown etiology may occur either in a generalized form, involving all the teeth, or in a localized form, involving one tooth. Tooth function does not appear to favor the increased deposition of cementum on root surfaces. Actually, studies have indicated that the thickness of cementum is increased in nonfunctioning teeth, including embedded or impacted teeth. The stimulus in these instances is unknown.

4. ETIOLOGY: A variety of circumstances may favor the deposition of excessive amounts of cementum. These include: Accelerated elongation of a tooth Inflammation about a tooth local factors Tooth repair Osteitis deformans, or Paget’s disease of bone.---systemic factor Spike formation of cementum

5. ACCELERATED ELONGATION OF TOOTH: Acceleration in the elongation of a tooth owing to loss of an antagonist is accompanied by hyperplasia of the cementum, apparently as a result of the inherent tendency to maintain the normal width of the periodontal ligament. This hypercementosis is most prominent at the apex of the root , although deposition of secondary cementum usually involves the entire root, tapering off in thickness toward the cervical portion of the tooth.

6. INFLAMMATION AT THE TOOTH APEX: Inflammation at the apex of a tooth root, usually occurring as a result of pulpal infection, sometimes stimulates excessive deposition of cementum. This does not occur at the apex of the root directly adjacent to the area of inflammation , since the cementoblasts and their direct precursors in this area have been lost as a result of the inflammatory process. Instead, the cementum is laid down on the root surface at some distance above the apex, apparently being induced by the inflammatory reaction that, at some distance from its center, acts as a stimulus to cementoblasts . At the apex of the involved root itself it is not uncommon for actual resorption of cementum and dentin to occur.

7. TOOTH REPAIR: Tooth repair does not occasion the deposition of remarkable amounts of secondary cementum. Nevertheless, the cementum that is formed is often laid down with such rapidity that a mild form of hypercementosis is simulated. On occasion, occlusal trauma results in mild root resorption. Such resorption is repaired by secondary cementum. Root fracture is also repaired on occasion by deposition of cementum between the root fragments as well as on their periphery. Finally, cemental tears, detachment of strips of cementum from the root due to trauma, are repaired by cementum growing into and filling the defects and eventually uniting with the torn cementum.

8. PAGETS DISEASE: Osteitis deformans or Paget’s disease of bone is a generalized skeletal disease characterized by deposition of excessive amounts of secondary cementum on the roots of the teeth and by the apparent disappearance of the lamina dura of the teeth, as well as by other features related to the bone itself. Although the bone changes are the most prominent features of the disease, generalized hypercementosis should always suggest the possibility of the presence of osteitis deformans.

9. SPIKE FORMATION OF CEMENTUM: Spike formation of cementum is an uncommon condition characterized by the occurrence of small spikes or outgrowths of cementum on the root surface . These cemental spikes appear in some cases of excessive occlusal trauma, probably as a result of deposition of irregular cementum in focal groups of fibers of the periodontal ligament. The exact mechanism of spike formation is unknown, and its significance is obscure.

10. CLINICAL FEATURES: No clinical signs and symptom's No visible signs No remarked tooth sensitivity / tooth sensitivity on percussion When the tooth with hypercementosis is extracted, the root or roots appear larger in diameter than normal and present rounded apices.

11. Radiographic Features: On the periapical radiograph most cases of hypercementosis, at least of any significant degree, are distinguished by the thickening and apparent blunting of the roots . The roots lose their typical ‘sharpened’ or ‘spiked’ appearance and exhibit rounding of the apex.

12. Histologic Features: The microscopic appearance of hypercementosis is a characteristic one in which an excessive amount of secondary or cellular cementum is found deposited directly over the typically thin layer of primary acellular cementum. The area involved may be the entire root or only a portion, typically the apical region. The secondary cementum has been termed ‘ osteocementum ’ because of its cellular nature and its resemblance to bone . This cementum typically is arranged in concentric layers around the root and frequently shows numerous resting lines, indicated by deeply staining hematoxyphilic lines parallel to the root surface.

13. Treatment and Prognosis: No treatment is indicated for teeth exhibiting hypercementosis, since the condition in itself is innocuous. In those cases in which the overproduction of cementum is due to inflammation of pulpal origin, treatment of the primary condition is obviously necessary. The extraction of teeth because of hypercementosis is contraindicated, since the prognosis of such teeth is excellent in the absence of concomitant infection. CEMENTICLES

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