735 49 2305 4 10 20220429 PDF
735 49 2305 4 10 20220429 PDF
http://jurnal.pdgi.or.id/index.php/jrdi/index
Ichda Nabiela Amiria Asykarie1*, Fahri Reza Ramadhan1, Ria Noerianingsih Firman2
ABSTRACT
Objectives: This case report is aimed to describe form of thickening of the cementum at the apex of
radiographic features of multiple hypercementosis the remaining teeth. The teeth were in vital
in an incidental case. condition and there were no clinical signs.
Case Report: A 38-year-old man came to the Dental Conclusion: Based on the examination results, it
Hospital of Padjadjaran University with a complaint was concluded that the panoramic radiograph
that he had lost some of his teeth and wanted to showed excessive cementum thickening and root
make dentures because he found it difficult to chew enlargement on the remaining teeth. This case
food. Then the patient was referred for a leads to a radiological diagnosis suspect of multiple
radiographic examination, the results of a hypercementosis or cementum hyperplasia.
panoramic radiograph found abnormalities in the
This work is licensed under a
Creative Commons Attribution 4.0
which permits use, distribution and reproduction,
provided that the original work is properly cited,
the use is non-commercial and no modifications or Keywords: Hypercementosis, cemental hyperplasia, multiple hypercementosis, panoramic radiograph
adaptations are made.
Cite this article: Asykarie INA, Ramadhan FR, Firman RN. Multiple hypercementosis– a case report of an incidental find-
ing on panoramic radiograph. Jurnal Radiologi Dentomaksilofasial Indonesia 2022;6(1)17-20. https://doi.org/10.32793/
jrdi.v6i1.735
INTRODUCTION
Hypercementosis was first described by mandibular teeth was higher than that of the
Gardrner and Goldstein in 1931 as an overgrowth maxilla.5In another similar case report, it was also
of cementum on the teeth. Radiographically, this mentioned that hypercementosis was more often
condition is seen as radicular cementum deposition found in premolars and mostly unilateral or only
which may involve one or several one or two teeth were affected, although there
teeth.1Hypercementosis is a rare dental disorder were some cases where hypercementosis occurred
that is often found incidentally. It is characterized bilaterally or multiple, this is very rare. However,
by excessive deposition of cementum at the tooth some literature states that this disorder does not
apex and is mostly idiopathic.2 This disorder does require special treatment.6,7
not cause any clinical symptoms or is The main etiologic factor in hypercementosis
asymptomatic. Hypercementosis also does not cases is idiopathic, but in most cases this disorder is
cause any changes in the periodontal ligament and associated with age, besides other local factors
1
Dentomaxillofacial Radiology Residen- lamina dura. The features of multiple such as trauma, inflammation and changes in
cy Program, Faculty of Dentistry, hypercementosis are rarely mentioned in the masticatory function or excessive occlusal pressure
Universitas Padjadjaran, Bandung, literature. Usually this is caused by hereditary are suspected to be factors that cause
Indonesia 40132
2
factors or systemic factors. Radiographically, hypercementosis. Multiple hypercementosis is not
Department of Dentomaxillofacial
Radiology, Faculty of Dentistry, Univer-
hypercementosis shows radiopacity in the roots of a common disorder, so it is often associated with
sitas Padjadjaran, Bandung, Indonesia the teeth which makes the roots appear larger and systemic conditions or hereditary factors. In
40132 more rounded.1,3 previous studies it has been mentioned that there
Cementum is a calcified avascular mesenchymal is a relationship between hypercementosis and
tissue that forms the outermost part of the tooth Paget's disease, hyperthyroidism, rheumatoid
*
Correspondence to: root. Abnormalities in cementum thickness are arthritis, acromegaly, calcinosis and vitamin A
Ichda Nabiela Amiria Asykarie
✉ [email protected]
divided into two, namely cemental aplasia or deficiency.8
hypoplasia (absence or lack of cellular cementum) The aim of this article is to report a rare case of
and cementum hyperplasia or hypercementosis hypercementosis occurring in number and location
Received on: November 2021 (excessive deposition of cementum).4 In a previous in the maxilla and lower. This case report provides
Revised on: December 2021 study conducted by Warrier and Vinayachandran, it an explanation of the radiographic appearance of a
Accepted on: January 2022
was found that cases of hypercementosis were case of multiple hypercementosis which was found
detected in 1.7% of cases and were more common incidentally on a panoramic radiograph.
in premolars than molars, and the incidence of
Figure 1. Pre-treatment
intra-oral photographs
and vitamin A deficiency. Most cases of disappear, and there is expansion of the cortical
hypercementosis occur in vital teeth.15 bone (Figure 2).22,23
Radiographically, hypercementosis is seen as an Based on the morphology, the appearance of
enlarged root that is rounded on some or all of the hypercementosis can be classified into four, namely
root surface and is surrounded by the periodontal normal root appearance, diffuse, focal or localized
ligament and an intact lamina dura. The and “shirt sleeve cuff” appearance. Based on this
periodontal ligament and lamina dura are clearly classification, the case that we report belongs to
visible on the outer margin of the hypercementotic the diffuse type (Figure 3). In healthy teeth,
tooth root, surrounding the entire root surface as patients with hypercementosis do not require any
seen in normal tooth roots.16,17Radiographically, treatment. However, in the case of treatments such
hypercementois did not change the biological width as endodontics and extractions it will be more
between the root surface, the periodontal ligament difficult to process, thus dentists who find these
and the alveolar bone. Although hypercementosis abnormalities incidentally on radiographic
can be identified radiographically, it is not possible examination should be more alert before
to estimate the amount of excess cementum performing these treatments.24
present in the root because dentin and cementum In another case report that reported a case of
have similar radiodensities.18,19 hypercementosis that occurred in molar without
Accurate diagnosis and differential diagnosis antagonistic teeth, it was stated that almost all
with other radiopaque lesions are very important teeth with hypercementosis did not have
because there may be other radiopaque lesions antagonist teeth, usually hypercementosis was
such as cementoblastoma. Radiographically, the seen in one third of the root with nodular
appearance of cementoblastoma is similar to that thickening and occurred in an effort to maintain the
of hypercementosis. Cementoblastoma is a slow- width of the periodontal ligament due to excessive
growing and benign odontogenic tumor occlusal pressure.10
characterized by the formation of cementum-like Hypercementosis can be said to be an adaptive
tissue attached to the tip of the tooth root. This response to the increase in periodontal tissue due
benign tumor is derived from odontogenic to functional stress, this occurs due to an increase
ectomesenchyme. The characteristic feature of this in the amount of cementum matrix attached to the
tumor is the development of cementum-like tissue. surface of the periodontal fibers. Cementoblasts on
These lesions are also more common in the the surface result in the deposition of cementum
mandible and in the premolar and molar regions.20 organic matrix. These cells line the root surface
Cementoblastoma radiographically appears as a between the periodontal fibers, which are also
round radiopaque lesion at the root tip, well- known as “sharpey fibers” which fuse or adhere to
defined and surrounded by a radiolucent halo. One the collagen cementum. Collagen in cementum
of the hallmarks of this lesion is the presence of a forms a fibrillar network that is sometimes parallel
radial pattern on its internal structure that to the tooth root surface or is irregularly
resembles the image of a wheel. 21Radiographically, distributed. Excessive pressure on the tooth surface
hypercementosis and cementoblastoma both give a will form a thickening of cementum.25
picture of the root of the tooth that looks enlarged Multiple hypercementosis is a rare disorder. In
and rounded, so that cementoblastoma is a addition to panoramic radiographs, patients are
differential diagnosis of hypercementosis. The also advised to do blood tests to help diagnose
difference between the two is in hypercementosis, whether the etiology of this disorder is caused by
the appearance of a rounded root surrounded by a local factors or systemic factors. Serum calcium,
lamina dura and an intact periodontal ligament phosphorus, alkaline phosphatase levels and
without root resorption. In cementoblastoma, the thyroid function are among criteria that should be
radiopaque appearance of the root is surrounded tested. In addition, if teeth with hypercementosis
by a radiolucent image (radiolucent halo), there is require extraction or endodontic treatment,
root resorption, the ligament and lamina dura modifications in the treatment process are