Exuberant hypercementosis mimicking cementoblastoma / Hipercementose exuberante simulando cementoblastoma

RESUMEN La hipercementosis se clasifica como una proliferación no neoplásica que implica un depósito excesivo de cemento a lo largo del cemento radicular normal. Presentamos el caso de un paciente masculino de 77 años que acude al dentista por una lesión supurativa en la encía que evoluciona desde hace varios meses. El examen radiográfico mostró una gran área radiopaca involucrando la raíz del diente 46, que estaba completamente rodeada por un área radiolúcida, sugiriendo un cementoblastoma asociado con el proceso infeccioso. El examen histopatológico del diente afectado reveló hipercementosis extensa asociada con inflamación supurativa crónica, además de osteomielitis crónica localizada. Esta presentación es infrecuente y, debido a los hallazgos clínico-patológicos, se propone el término "hipercementitis crónica". Los dentistas, especialmente los patólogos orales y endodoncistas, deben estar tener conocimiento de esta inusual presentación para establecer el diagnóstico correcto.

Hipercementosis, una alteración de la estructura dentaria: recopilación bibliográfica / Hypercementosis, an alteration of the dental structure: bibliographic compilation

La hipercementosis se presenta como depósitos de cemento en la raíz de uno o más dientes. Siendo más frecuente en dientes que están sometidos a fuerzas de oclusión, particularmente en pacientes con enfermedad de Paget. El aumento de cemento se depositará en una banda que se encuentra situada alrededor del tercio apical de la raíz, es de ayuda útil realizar una evaluación radiográfi ca antes de una extracción dental (AU)

Hypercementosis occurs as cement deposits in the root of one or more teeth. Being more frequent in teeth that are subjected to occlusion forces or in patients with Paget's disease. The cement increase can be deposited in a band that can be found near the apical third of the root, it is a dental aid that a radiographic evaluation is made before a dental extraction (AU)

Prevalence of hypercementosis in a saudi arabian population: a cone beam computed tomography study

Objective: to determine the prevalence of hypercementosis in a Saudi Arabian population. material and methods: a total of 642 CBCT scans from patients comprising 4471 teeth were incorporated in the study sample. all teeth were analyzed for the presence of hypercementosis in sagittal, axial and coronal plains by two qualified and experienced observers. the characteristics of the involved tooth in terms of gender, jaw and location were recorded from the CBCT scans. the obtained data were statistically analyzed using SPSS 21.0. the reliability of measurements was evaluated by kappa statistics. results: out of total 642 subjects hypercementosis was observed in 31 patients (4.82 percent) and 43 teeth (0.96 percent). Eight (2.68 percent) maxillary 1st molars, 6 (1.88 percent) mandibular 1st molars, 5 (1.46 percent) maxillary second molars, 7 (1.95 percent) mandibular 2nd molars, 9 (4.76 percent) maxillary 3rd molars and 8 (3.58 percent) mandibular 3rd molars were observed to have hypercementosis. among males, 4.76 percent were affected with hypercementosis as compared to 4.86 percent of females (p=0.97). likewise, no significant difference in the occurrence of hypercementosis was observed between maxillary and mandibular arches or between sides (p>0.05). conclusion: the prevalence of hypercementosis in a Saudi population was found to be 4.82 percent with respect to patients and 0.96 percent with respect to teeth. No significant propensity for gender, jaw and arch side was noted.

Intentional partial odontectomy—a long-term follow-up study / 대한악안면성형재건외과학회지

BACKGROUND: The surgical extraction of the third molar is the most frequently encountered procedure in oral and maxillofacial surgery and is related with a variety of complications. This study examined the efficacy of intentional partial odontectomy (IPO) in the third molars which have no periapical lesions and are located near important anatomical structures such as inferior alveolar nerve. METHODS: Seven patients (four males, three females, 39.1 ± 11.6 years), who received IPO to reduce the risk of inferior alveolar nerve injury (IANI), were followed long-term. The treated teeth were horizontally impacted third molars in the mandibular left (n = 5) or mandibular right (n = 4) areas and were all ankylosed with the surrounding alveolar bone. During the IPO, the bone around the crown was removed to expose the crown, and then the tooth was resected at cement-enamel junction (CEJ). Any secondary trauma to the healthy root was minimized and remained intact after primary suture. RESULTS: The mean follow-up time was 63.2 ± 29.8 months, and all sites showed good bone healing after the crown removal. Also, sensory abnormality was not found in any patients after IPO. In one patient, the bone fragments erupted 4 months after IPO. In other patient, an implant placed on second molar site adjacent to the third molar that received IPO was explanted about 2 years after the patient’s persistent discomfort. CONCLUSIONS: In case where high risk of IANI exists, IPO may be chosen alternatively to surgical extraction to reduce the risk of nerve damage. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s40902-017-0127-z) contains supplementary material, which is available to authorized users.

Acromegaly: Oral Diagnostician’s Role in Diagnosis: A Case Report.

Acromegaly is an acquired disorder related to overproduction of growth hormone (GH). The condition, though described more than 120 years ago, was only later found to be due to pituitary over secretion and adenomas. It is a rare condition with a tendency toward overgrowth of the mandible, maxillary widening, tooth separation, and skeletal malocclusion which makes its diagnosis important for us dentists. The majority of the cases in the past have been diagnosed by physicians and endocrinologists. Here, we present a case of a 38-year-old male patient who presented with the complaint of increase in the size of lips and forward movement of the jaws since 1 year. Clinical features, radiographic features, and arrival at the diagnosis of Acromegaly with the subsequent referral and treatment are discussed.

Raíces dentales humanas normales y con perlas de cemento: comparación histológica de estructuras / Normal human dental roots and withcementum pearls: structural histological comparison

Durante la vida del diente en boca se deposita cemento celular en el ápice a fin de compensar el desgaste oclusal considerado normal. Al extraer un diente, en raras ocasiones es posible visualizar excesos de cemento con forma de perlas bien delimitados y duros al tacto, ubicados en otro sector radicular diferente al ápice. Nuestro objetivo fue comparar estructuras en ambos tipos de cemento a fin de hallar diferencias histológicas. Se utilizaron 20 dientes permanentes con perlas (G1) y 20 con raíces normales (G2). Las raíces de G1 se cortaron con disco metálico de grano fino a baja velocidad en sentido transversal, a la altura de la parte más prominente de la protuberancia, las raíces de G2 se marcaron en tercios y se cortaron en sentido transversal aproximadamente a la altura de la mitad del tercio apical y de ambos grupos se obtuvieron un segmento que fue reservado y otro que fue preparado con técnica por desgaste para visualización con MO a menor y mayor aumentos. Los resultados se compararon con prueba t de student, las variables categóricas se compararon con pruebas de Fisher significación 5 por ciento. Se obtuvieron 40 dientes de pacientes adultos, 42,5 por ciento masculinos y 57,5 por ciento femeninos, edad promedio 61+/-16 en G1 y 55+/-18 en G2 (p=0,289). El contorno exterior de las perlas fue liso, conservando su perímetro, la zona granular de Tomes fue visible al igual que las lagunas, que fueron menos abundantes, de mayor tamaño y con distribución desordenada llegando en menor proporción al borde del tejido comparado con cemento normal.

During tooth life in mouth cellular cement settles in the apex in order to compensate the occlusal wear considered normal. After a tooth extraction, on rare occasions it is possible to visualize cement excesses with pearls form well delimited and hard to tact, located in another radicular sector different of the apex. Our aim was to compare structures in both types of cement in order to find histological differences. Consequently, 20 permanent teeth with pearls (G1) and 20 with normal roots (G2) were used. G1 roots were cut by a thin grain metallic disc at low speed in transverse sense, at the height of the protuberance most prominent part; G2 roots were marked in thirds and cut in transverse sense at the half of the third apical. From both groups a segment was obtained to be reserved and other one that was prepared by erosion technology to be visualized by MO at minor and major increases. Results were compared with student t test, categorical variables with Fisher's tests significance 5 percent. Forty adult patients teeth were obtained, male 42.5 percent and female 57.5 percent, age average in G1 61+/-16 and 55+/-18 in G2 (p=0.289). Pearls exterior face was smooth, with a preserved perimeter, Tomes granular zone was visible as were lagoons, which were less abundant, greater in size and with uneven distribution arriving at tissue border in a lesser proportion compared with normal cement.

Hipercementose e aumento da espessura do cemento com a idade: implicações clínicas e significados / Hypercementosis and cementum thickness increasing over age: clinical implications and its meanings

Uma alteração muito comum, que suscita muitas dúvidas sobre sua etiopatogenia e significado, é a hipercementose. A literatura pertinente é reduzida e o cemento representa o tecido dentário menos estudado, ignorando-se até qual o seu grau de reatividade frente a estímulos e agressões. A espessura e a estrutura do cemento mudam com a idade. Deve-se fazer uma diferença precisa entre o aumento da espessura do cemento e a hipercementose. Na hipercementose se tem uma formação excessiva do cemento, além do limite necessário para cumprir suas funções normais, com alteração da forma macroscópica da raiz, especialmente em seu diâmetro. Cada forma de hipercementose tem significados diferentes: como interpretá-los no planejamento e/ou no acompanhamento do tratamento? Deve-se tomar algum cuidado especial, do ponto de vista biológico, ao se colocar um implante vizinho a um dente com hipercementose? Para colaborar com as respostas a esses questionamentos — e ao mesmo tempo colaborar para diagnósticos mais seguros da hipercementose, valorizando-se o seu significado clínico e biológico —, nos propusemos a reanalisar a literatura e uma amostra estudada ao longo dos anos em trabalhos, dissertações e teses.

A very common alteration that raises many questions about its etiopathogenesis and meaning is the hypercementosis. The pertinent literature is reduced and cementum represents the less studied dental tissue, and even its reactivity level under stimulation and aggression is ignored. Cementum thickness and structure change overtime. One should make an accurate differentiation between cementum thickness increase and hypercementosis. In hypercementosis there is an excessive formation of cementum beyond the limit necessary to allow its regular functions, with macroscopic root shape alteration, specially regarding to its diameter. Each hypercementosis type has different meanings: How to understand them when planning and/or on treatment follow-up? One must take special care, from a biological point of view, while setting an implant in the neighborhood of a tooth with hypercementosis? To help answering these questions and at once collaborate to more secure hypercementosis diagnoses, appreciating its clinical and biological meaning, we have set ourselves out to reanalyze the literature and a sample studied over the years in papers, dissertations and thesis.

Cementum, apical morphology and hypercementosis: a probable adaptive response of the periodontal support tissues and potential orthodontic implications

Information about orthodontic movement of teeth with hypercementosis is scarce. As cementum deposition continues to occur, cementum is expected to change the shape of the root and apex over time, but this has not yet been demonstrated. Nor has it ever been established whether it increases or decreases the prevalence of root resorption during orthodontic treatment. The unique biological function of the interconnected network of cementocytes may play a role in orthodontic movement and its associated root resorptions, but no research has ever been conducted on the topic. Unlike cementum thickness and hypercementosis, root and apex shape has not yet been related to patient age. A study of the precise difference between increased cementum thickness and hypercementosis is warranted. Hypercementosis refers to excessive cementum formation above and beyond the extent necessary to fulfill its normal functions, resulting in abnormal thickening with macroscopic changes in the tooth root, which may require the delivery of forces that are different from conventional mechanics in their intensity, direction and distribution. What are the unique features and specificities involved in moving teeth that present with hypercementosis? Bodily movements would be expected to occur, since inclination might prove difficult to achieve, but would the root resorption index be higher or lower?.

Hipercementosis apicales y no apicales en raíces dentarias humanas / Apical and non-apical hypercementosis in human dental root

El cemento secundario del ápice radicular se deposita en forma lenta y continua durante toda la vida útil del diente, siendo su función compensar el desgaste producido por la masticación. En raras ocasiones podemos hallar en la raíz dental, a posteriori de una extracción dentaria, excesos de cementos redondeados u ovalados, bien delimitados y duros al tacto, ubicados en un sector radicular diferente al ápice. Nuestro objetivo fue comparar las características físicas y radiológicas de raíces dentales normales con aquéllas que presentan este tipo de formaciones que alteran la anatomía radicular. Fueron incluidos 20 dientes adultos con raíces normales y 20 con raíces donde se visualizaron estos depósitos. Las variables investigadas fueron edad, sexo, patologías generales y periodontales previas, tipo de diente extraído, ubicación en el arco dental, motivo de extracción, características de consistencia, color, aspecto y textura de todas las raíces. La imagen radiológica fue crucial para la inclusión de dientes con exceso de cemento. Se recolectó un total de 40 dientes adultos, cuya edad promedio fue de 61 años (16-79), 42.5 por ciento masculinos y 57.5 por ciento femeninos. Patología general presentó el 37.5 por ciento y periodontal el 55 por ciento, los dientes mas extraídos fueron premolares superiores del lado derecho 15 por ciento. La caries fue causa principal de extracción 72.5 por ciento. En ambos grupos las raíces fueron de consistencia dura y textura lisa. El aspecto nacarado fue de 70 por ciento y 60 por ciento, los colores claros 45 por ciento y 75 por ciento, respectivamente. En las radiografías se observó que el cemento no se diferenció de la dentina en el 40 por ciento y 85 por ciento de cada grupo (p=0.004). Los adultos pueden desarrollar anomalías de cemento ubicadas en otro sector del ápice si bien las características físicas de la raíz se consideran dentro de parámetros normales.

Secondary cementum is deposited in a root apical third throughout the lifespan of a tooth to compensate occlusal erosion, keeping dental pieces in occlusion contact. Pearls are more difficult to spot, found by X-rays or after extraction. Their ovoid or spherical aspect is well outlined, hard to touch, and located in different thirds of the root. Our objective was to compare physical and radiological dental normal roots characteristics with those presenting this type of formations that alter radicular anatomy. We used 20 normal roots and 20 pearl shapes. Variables compared: age, sex, previous general pathologies and periodontals; extracted tooth type, dental arch location, extraction cause, consistency characteristics, color, aspect and texture of all roots and pearls. Radiological image was crucial for incorporation of teeth with cementum excess. Proportions between normal pieces and pearls were calculated with Fisher's Exact Test, with 5 percent significance level. Average age was 61years (16-79), and male proportion was 42.5 percent and 57.5 percent female. General pathology presented 37.5 percent and periodontal 55 percent, more extracted teeth were right side upper premolars 15 percent. Caries were extraction chief motive 72.5 percent. Roots were of hard consistency and smooth texture in both groups; nacreous aspect was 65 percent, clear colors 75 percent. Pearl consistency was hard in all of them; white color 60 percent and root similar color 40 percent; nacreous aspect 75 percent and smooth texture 90 percent. In radiographs was observed that cementum did not differ from dentine in 85 percent of pearls and in 60 percent of normal roots (p=0.004). Adults can develop cementum anomalies located in another apex sector although the root physical characteristics are considered inside normal parameters.

Hypercementosis: a challenge for endodontic therapy

Introduction and objective: The purpose of this study was to describe through literature review, the morphological characteristics of teeth with hypercementosis that are relevant to endodontic practice. Literature review: The pathologic deposition of cement increases proportionally as the patient's age increases. Genetic factors seem to be related to hypercementosis occurrence in young patients. Based on literature, it is possible to notice a lack of scientific studies which guide the endodontist for treating teeth with hypercementosis, since the cement deposition lead to the length increase of the cementum canal, and consequently, to the increase of the distance from CDC junction to apical root end. Conclusion: Thus, it is clinically relevant to correlate the morphology of teeth with hypercementosis with the specific aspects of endodontic therapy, aiming to establish the limits of root canal treatment in cases of hypercementosis.

A scanning electron microscopic study of hypercementosis

The purpose of this study was to evaluate morphological characteristics of teeth with hypercementosis that are relevant to endodontic practice. Twenty-eight extracted teeth with hypercementosis had their root apexes analyzed by scanning electron microscopy (SEM). The teeth were divided according to tooth groups and type of hypercementosis. The following aspects were examined under SEM: the contour and regularity of the root surface; presence of resorption; presence and number of apical foramina, and the diameter of the main foramen. The progression of club shape hypercementosis was directly associated with the presence of foramina and apical foramen obstruction. Cases of focal hypercementosis presented foramina on the surface, even when sidelong located in the root. Circular cementum hyperplasia form was present in 2 out of 3 residual roots, which was the highest proportion among the tooth types. The detection of a large number of foramina in the apical third of teeth with hypercementosis or even the possible existence of apical foramen obliteration contributes to understand the difficulties faced during endodontic treatment of these cases.