S. R. Prabhu - Handbook of Oral Pathology and Oral Medicine

Isolated (single or a group of teeth) hypercementosis:Most cases are idiopathic and age relatedSome cases show periapical pathosis, parafunctional occlusal trauma, and lack of functional opposition

Diffuse or generalized (involving all teeth) hypercementosis:May be associated with various syndromes and systemic diseases, such as Paget's disease of bone, acromegaly, thyroid goitre, calcinosis, arthritis, and rheumatic fever

Asymptomatic in the majority of cases

May involve single tooth, several teeth or generalized Figure 4.3Hypercementosis; extracted tooth with hypercementosis at the tip of the roots(source: by kind permission of Professor Charles Dunlap, Kansas City, USA).

Isolated hypercementosis involves mandibular molars, followed by maxillary and mandibular second premolars, and mandibular first premolars

An extracted tooth shows blunt root tips ( Figure 4.3)

Detected on routine radiography

Widening of roots

Apical third shows a blunt root tip surrounded by radiolucent periodontal ligament space

Occasionally, fusion of the roots of the adjacent roots caused by hypercementosis (concrescence) is seen

Deposition of excessive cementum (mostly acellular) over the original layer of primary cementum

Concentric layers of cementum deposition are seen

May include the entire root or limited to the root tip

Cemento‐osseous dysplasia

Cementoblastoma

No treatment required

Problems with extraction

Systemic conditions associated with hypercementosis should be treated by specialists

An incomplete fracture of a vital posterior tooth that involves the dentine and occasionally extends into the pulp

Common

Incidence rate of 34–74%

Teeth grinding (bruxism/habitual clenching)

Large restorations

Chewing or biting hard food

Trauma: blows to the teeth (violence or accident related)

Majority of patients are 30–50 years of age

Men and women are equally affected

Most affected teeth are the mandibular second molars, followed by mandibular first molars, and maxillary premolars

Deep cracks may involve pulp ( Figure 4.4)

Patient complains of pain on biting that ceases after the masticatory pressure has been withdrawn

Pain on tooth grinding and with cold drinks or food

Difficulty in identifying offending tooth (by the patient)

Vitality test is usually positive

Tenderness can be elicited when pressure is applied to an individual cusp

Pain/tenderness increases as the occlusal force increases, and relief occurs once the pressure is withdrawn Figure 4.4Cracked tooth syndrome; fractured premolar tooth (black arrows) viewed in the mouth (left) and after extraction (right). (Source: Coronation Dental Specialty Group Canada; Wikipediahttps://en.wikipedia.org › wiki. Creative Commons Attribution‐Share Alike 3.0 Unported license

Acute periodontal diseases

Reversible pulpitis

Dentinal hypersensitivity

Galvanic pain associated with silver amalgam restorations

Sensitivity following microleakage from recently placed composite resin restorations

Areas of hyperocclusion from dental restorations

Occlusal trauma from parafunctional habits

Orofacial pain arising from conditions such as trigeminal neuralgia and atypical facial pain

Detailed history:Recent dental restorations, occlusal adjustmentsParafunctional habits (bruxism)Pain history: character, intensity, relation to chewing, etc.

Clinical examination:Periodontal probing

Bite tests:Patient is asked to bite on various items such as a toothpick, cotton roll, rubber abrasive wheels, or wooden stickPain/tenderness increases as the occlusal force increases, and relief occurs once the pressure is withdrawn (diagnostic)

Dye test:Special stains such as methylene blue or gentian violet are frequently used to highlight the cracks

Vitality tests for individual tooth are usually positive

Radiographs are not reliable (since cracks usually occur in a mesiodistal direction)

Transillumination is an important aid in diagnosing the cracks

Depends on the site, direction, size, or the degree of the crack

Minor cracks: restored with a filling or a crown

Deep cracks with pulp involvement: root canal treatment and a crown

Pain management by analgesics

Crack extending into the root of the tooth beneath the bone: extraction of the tooth

Prognosis is good for most cases with endodontic treatment and crown

Where vertical cracks occur or where the crack extends through the pulpal floor or below the level of the alveolar bone, the prognosis is not favourable, and extraction is the treatment of choice.

1 Odell, E.W. (2017). Tooth wear, tooth resorption, hypercementosis and osseointegration. In: Cawson's Essentials of Oral Pathology and Oral Medicine, 9e, 85–91. Edinburgh: Elsevier.

2 Imfeld, T. (1996). Dental erosion: definition, classification, and links. European Journal of Oral Sciences 104: 151–154.

3 Neville, B.W., Damm, D.D., Allen, C.M., and Chi, C.A. (2016). Abnormalities of teeth. In: Oral and Maxillofacial Pathology, 4e, 49–66. St Louis, MO: Elsevier.

4 Schlueter, N., Amaechi, B.T., Bartlett, D. et al. (2020). Terminology of erosive tooth wear: consensus report of a workshop organized by the ORCA and the cariology research group of the IADR. Caries Research 54: 2–6.

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