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Excessive Cementation in Teeth – Hypercementosis

Enamel covers the portion of the tooth above the gumline. Cementum covers the portion below the gumline (the root surface). Hypercementosis is the thickening or increased deposit of cementum on the root surface. It may involve the entire root surface, but more commonly it appears as a bulbous mass involving the root end (called the apex).

No pain or other signs or symptoms of hypercementosis are usually present; typically it is discovered during routine dental x-rays. The characteristic x-ray appearance when Hypercementosis is present includes a thickening of the cementum layer as well as blunting or rounding of the root tip.
Apposition of excessive amounts of cementum is not uncommon and due to several possible causes.

Causes of Hypercementosis

• Ageing
• Periapical periodontitis. A common cause but minor in amount. Close to the apex there is usually a little resorption, but coronally, cementum is laid down, forming a shoulder
• Functionless and unerupted teeth. Hypercementosis and resorption may alternate
• Paget’s disease. Alternating, irregular apposition and resorption, with apposition predominating, produce an irregular mass of cementum on the root with a histological ‘mosaic’ pattern
• Cementoblastoma

Increased thickness of cementum is not itself a disease, and no treatment is necessary. If hypercementosis is gross, as in Paget’s disease, extractions become difficult.

Hypercementosis in Paget’s disease. An irregular craggy mass of bone-like cementum has been formed over thickened regular and acellular cementum.

Concrescence

Rarely hypercementosis causes fusion of the roots of adjacent teeth. It is rarely noticed until an attempt is made to extract one of the teeth. The two teeth are then found to move in unison, and surgical intervention becomes necessary.

Concrescence. Two upper molars fused together by cementum.

Concrescence. Histological section of fused teeth reveals that the teeth are joined by cementum and not dentine.

Diseases Related to Hypercementosis

Tooth Ankylosis

Solid fixation of a tooth resulting from fusion of the cementum and alveolar bone, with obliteration of the periodontal ligament. It is uncommon in the deciduous dentition and very rare in permanent teeth.

Gingival Overgrowth

Excessive growth of the gingiva either by an increase in the size of the constituent cells (Gingivial hypertrophy) or by an increase in their number (Gingivial hyperplasia).

Salivary Gland Calculi (Sialolithiasis)

Calculi occurring in a salivary gland. Most salivary gland calculi occur in the submandibular gland, but can also occur in the parotid gland and in the sublingual and minor salivary glands.

Salivary Duct Calculi (Salivary Duct Calculus)

Presence of small calculi in the terminal salivary ducts (salivary sand), or stones (larger calculi) found in the larger ducts.

Necrosis

The pathological process occurring in cells that are dying from irreparable injuries. It is caused by the progressive, uncontrolled action of degradative enzymes, leading to mitochondrial swelling, nuclear flocculation, and cell lysis. This should be distinguished it from apoptosis which is a normal, regulated cellular process.

Treatment

Usually, no treatment of hypercementosis is necessary, but it is important to diagnose the condition in order to rule out some of the other treatable conditions listed above. The other significant reason to diagnose Hypercementosis occurs when we need to extract a tooth with this condition. Frequently, these teeth require surgical extraction in order not to fracture the supporting bone or disturb the healthy adjacent tooth.

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