Hypercementosis is the process of excessive deposition of secondary cement, in which the root of the tooth thickens and deforms with the formation of characteristic protrusions. Most often, hypercementosis develops as a protective reaction during a chronic inflammatory process in the periodontium or during tooth overload. Pathology is asymptomatic and has no clinical manifestations, it is usually diagnosed accidentally during X-ray examination. The disease does not harm the health of the tooth, but in some cases it can interfere with its removal. There is no specific treatment, hypercementosis passes independently after the cause is eliminated.
Hypercementosis, or ossifying periodontitis, is a disease in which there is a limited or diffuse thickening of the tooth root due to the compensatory formation of secondary cement. This pathological process is diagnosed in 2% of cases of all dental diseases, most often it accompanies fibrous periodontitis or its other forms. In advanced dental diseases, when pulp tissues die, the deposition of cement leads to a narrowing of the apical opening of the root or its complete closure.
The process of excessive cementation can begin at the root of any tooth, but it is most likely to develop in the lower molars, first and second premolars. The lower teeth are affected 2 times more often than the upper ones. Ossifying periodontitis in the practice of a dental surgeon can complicate the operation to remove a tooth. Nevertheless, experts tend to consider the increased formation of cement as a positive factor – such a natural root seal tightly closes the canal and reliably protects the periodontal from infectious agents.
Secondary cement is formed as a compensatory reaction in chronic inflammatory periodontal diseases, as a consequence of tooth extrusion during dental operations or occlusive trauma (excessive mobility of teeth, periodontal fissure expansion, angular (vertical) defects in the alveolar bone). In some cases, the process of increased secondary cement formation is triggered in patients with Paget’s disease, diffuse toxic goiter, acromegaly and pituitary gigantism. Patients with these diseases have disorders in the hormonal regulation of calcium metabolism, and this can affect the condition of bones and teeth.
The disease occurs in a local, diffuse and generalized form. With local hypercementosis, the process affects the lateral or inter-root surface of the tooth, where rounded nodules or spikes are formed. When cementoblasts are displaced during extrusion, for example, during orthodontic treatment, the formation of cementicles in the epithelial remnants of Malasse begins. Cementicles are spherical bodies of cement 0.1–0.4 mm in diameter, fixed to the surface of the previously formed cement and gradually sinking into it. They tend to grow and merge at the origin. Specialists in the field of dentistry observe the phenomenon of local hypercementosis in patients with “enamel pearls” – spherical formations of dentine covered with enamel, from 1 to 4 mm in diameter. Excessive cement deposition is often found near the sites of the appearance of “enamel pearls”.
With a diffuse form, the process of hypercementosis affects the entire surface of the tooth root. Often this is preceded by a chronic periapical infectious process. In advanced cases, in the absence of the necessary dental treatment, cement synthesis is so intense that the root of the tooth and the wall of the bone alveoli are fused. In the generalized form, excessive formation is observed in all teeth. This is due to hormonal disorders, an active process of bone resorption, and intensive cement formation serves to repair and fix the tooth in the alveolus.
Diagnosis and treatment
With this disease, there are no clinical signs, and nothing bothers the patient. For diagnosis, the dentist uses dental x-ray, where there is an expansion of the root. It is surrounded by an area filled with periodontal ligament, and dentin covers an excess layer of cement.
Excessive cement formation does not play any destructive role, and, on the contrary, is a compensatory process. The need for treatment of hypercementosis occurs only when cement layers prevent tooth extraction. In this case, treatment of the initial disease is necessary, then ossifying periodontitis passes on its own. The prognosis of the disease is favorable.