Unusual imaging appearance of cemental tear in the maxillary first molar on cone-beam computed tomography: A case report.

A cemental tear (CeT) is a definitive clinical entity and its radiographic appearance is well known in single-rooted teeth. However, the imaging features of CeT in multi-rooted teeth have not been clarified. We report a case of CeT which arose in the maxillary first molar and exhibited an unusual appearance in cone-beam computed tomography images. The torn structure was verified as cementum by micro-computed tomography and histological analysis. The hypercementosis, most likely induced by occlusal force, might have been torn from the root by a stronger occlusal force caused by the mandibular implant. An unusual bridging structure was created between the two buccal roots. These features may occur in multi-rooted teeth with long-standing deep pockets and abscesses that are resistant to treatment.

The prevalence of equine odontoclastic tooth resorption and hypercementosis and the role of interincisal angulation in disease severity in a representative cohort of horses in Switzerland.

INTRODUCTION: Equine odontoclastic tooth resorption and hypercementosis (EOTRH) is an increasingly diagnosed degenerative dental disease in aged horses. The primary aim of this retrospective study was to determine the prevalence of EOTRH in horses admitted to the Equine Hospital, University of Zurich, for dental procedures from 2004 to 2017. A secondary goal was to measure and compare interincisal angles on two-dimensional radiographs of horses with EOTRH to determine whether the interincisal angle is associated with age and severity of the disease. Radiographs were assessed for the presence of lysis and/or hypercementosis, and the number and position of the teeth affected were determined. Each tooth was also evaluated using the modified classification system introduced by Rehrl et al. (2018), in which stage 0 indicates no radiographic abnormalities and stage 3 denotes severe abnormalities. The overall stage was defined by the tooth with the most severe lesions. The interincisal angle was determined in horses that had suitable radiographs. The medical records of 838 horses admitted for dental procedures were evaluated, and 85 (10,1 %) had clinical evidence of EOTRH. The mean interincisal angle was 136,06 ° in horses with mild to moderate EOTRH and 135,10 ° (SD = 11,90 °) in severely affected patients. In conclusion, the angle measurements on lateral radiographs were highly reproducible. However, the interincisal angle was not associated with age or the severity of EOTRH. The interincisal angle and the disease pattern were not correlated.

INTRODUCTION: La résorption et l'hypercémentose odontoclastique des dents chez le cheval (EOTRH) est une maladie dentaire dégénérative de plus en plus diagnostiquée chez les animaux âgés. L'objectif principal de cette étude rétrospective était de déterminer la prévalence de l'EOTRH chez les chevaux admis à l'Hôpital équin de l'Université de Zurich pour des interventions dentaires entre 2014 et 2017. Un objectif secondaire était de mesurer et de comparer les angles inter-incisifs sur des radiographies bidimensionnelles de chevaux atteints d'EOTRH afin de déterminer si cet angle est associé à l'âge et à la gravité de la maladie. Les radiographies ont été évaluées pour la présence de lyse et/ou d'hypercémentose, et le nombre et la position des dents affectées ont été déterminés. Chaque dent a également été évaluée à l'aide du système de classification modifié introduit par Rehrl et al. (2018), dans lequel le stade 0 indique l'absence d'anomalies radiographiques et le stade 3 indique des anomalies graves. Le stade global a été défini par la dent présentant les lésions les plus sévères. L'angle inter-incisif a été déterminé chez les chevaux qui avaient des radiographies appropriées. Les dossiers médicaux de 838 chevaux admis pour des interventions dentaires ont été évalués et 85 (10,1 %) présentaient des signes cliniques d'EOTRH. L'angle inter-incisif moyen était de 136,06° chez les chevaux présentant une EOTRH légère à modérée et de 135,10° (écart-type = 11,90°) chez les patients gravement atteints. En conclusion, les mesures d'angle sur les radiographies latérales étaient très reproductibles. Cependant, l'angle inter-incisif n'était pas associé à l'âge ou à la sévérité de l'EOTRH. L'angle inter-incisif et le profil de la maladie n'étaient pas corrélés.

The True History of Cementoblastoma.

REVIEW OF THE LITERATURE: Cementoblastoma (CB) is unique among odontogenic tumors because its gross pathological anatomy is pathognomonic in most cases, i.e., a rounded calcified growth that is fused to the root of a tooth and completely encapsulated by fibrous tissue. The resulting radiographic appearance is a well-defined, globular mixed radiopaque/lucent or completely radiopaque mass obliterating some details of the root, with a thin radiolucent zone surrounding the central opacity. Although hundreds of publications have covered the clinicopathologic features of CB, almost nothing is known about its true history. Also it seems there is little understanding about how the term "CB" was originally introduced as a pathologic entity. This report covers some overlooked papers on CB dating back to the 19th century, including the first complete description in 1888 and the first radiographic presentation in 1906.

Equine odontoclastic tooth resorption and hypercementosis: Investigating individual incisor disease patterns using radiological classification.

BACKGROUND: Equine odontoclastic tooth resorption and hypercementosis (EOTRH) is a destructive, painful and underdiagnosed dental disorder. Radiography is necessary to fully assess the disease as early stages occur on clinically normal teeth. OBJECTIVES: To investigate the distribution pattern of appearance of EOTRH within the incisor arcade. In particular, we aimed to determine the influence of tooth position and horse age on the severity of EOTRH as well as on the frequency of the individual severity stages. STUDY DESIGN: Retrospective cross-sectional radiographic case study. METHODS: Digital radiographs of 142 horses (10 years and older) presented for routine dental examination at our Equine Hospital were obtained and evaluated for changes related to EOTRH. Radiological findings were classified in terms of EOTRH severity, and each tooth was evaluated individually (tooth stage). RESULTS: The tooth stages of EOTRH showed a bilateral symmetrical distribution pattern over the entire incisor arcade. There was a significant positive correlation between age and tooth stages (p < 0.001, rho = 0.48, 95% CI 0.43-0.51), and the frequency of higher tooth stages increased from central incisors to middle and corner incisors. MAIN LIMITATIONS: Individual head anatomy in some male horses lead to superimposition of the lower jaw corner incisors and canine teeth. The radiographic technique proved difficult in smaller and uncooperative horses. Differentiating between mild pathological signs of EOTRH and age-related radiological changes was not possible in all cases. CONCLUSION: These results reconfirm an age-correlated progression of EOTRH. EOTRH affects the incisor arcade in a bilaterally symmetrical pattern with the corner incisors being the most severely affected.

[Patterns of hypercementosis and their relationship with possible local etiological factors in radiographs of individuals from a mexican population]. / Patrones de hipercementosis y su relación con posibles factores etiológicos locales en radiografías de individuos de una población mexicana.

Objective: Hypercementosis (HPC) is an asymptomatic pathology that, according to the existing literature, has a low prevalence, there is a lack of information and research on it, within these studies, few are made by ethnic groups. To determine the prevalence and radiographic patterns of this condition, as well as the analysis of the relationship of the pathology with some of what are considered possible local triggering factors (FDL) in Mexican individuals. Methodology: 1193 orthopantomographies (OPG) were analyzed, randomly selected from patients of both sexes, with a chronological age range between 18 and 90 years, identifying the prevalence of HPC, as well as its relationship between age groups, its morphological patterns (focal, diffuse and sleeve-shaped), its distribution by anatomical region and dental organs (ODs) and the association of its presence with possible local triggering factors. Results: 348 DO with HPC were found in a total of 194 patients (16.30%), with no relevant differences between genders (P> 0.05). There was a significant increase with respect to the presence of HPC in relation to the increase in the age of the patients (P= 0.001), finding it present in 10% of the age group <40 years, in 20.30% in the group of 40 to 60 years and > 60 in 30.20%. It was found more frequently in a diffuse form (75.28%), followed by the focal pattern (19.54%) and finding the sleeve-shaped morphology less common (5.17%). The mandible presented the greatest number of ODs with the presence of HPC, 136 (39.08%), with the left side being the most affected with 86 OD. The dental group with the greatest involvement was that of molars and premolars. Conclusions: The prevalence of hypercementosis was 16.30% in the Mexican individuals evaluated. Its presence increases as the age of the patients advances. Its main location is the mandibular region with a predilection for premolars and molars. Even though the idiopathic origin is the most frequent, it was observed that dental impaction is a possible local triggering factor.

Application of Two-Dimensional Entropy Measures to Detect the Radiographic Signs of Tooth Resorption and Hypercementosis in an Equine Model.

Dental disorders are a serious health problem in equine medicine, their early recognition benefits the long-term general health of the horse. Most of the initial signs of Equine Odontoclastic Tooth Resorption and Hypercementosis (EOTRH) syndrome concern the alveolar aspect of the teeth, thus, the need for early recognition radiographic imaging. This study is aimed to evaluate the applicability of entropy measures to quantify the radiological signs of tooth resorption and hypercementosis as well as to enhance radiographic image quality in order to facilitate the identification of the signs of EOTRH syndrome. A detailed examination of the oral cavity was performed in eighty horses. Each evaluated incisor tooth was assigned to one of four grade-related EOTRH groups (0-3). Radiographs of the incisor teeth were taken and digitally processed. For each radiograph, two-dimensional sample (SampEn2D), fuzzy (FuzzEn2D), permutation (PermEn2D), dispersion (DispEn2D), and distribution (DistEn2D) entropies were measured after image filtering was performed using Normalize, Median, and LaplacianSharpening filters. Moreover, the similarities between entropy measures and selected Gray-Level Co-occurrence Matrix (GLCM) texture features were investigated. Among the 15 returned measures, DistEn2D was EOTRH grade-related. Moreover, DistEn2D extracted after Normalize filtering was the most informative. The EOTRH grade-related similarity between DistEn2D and Difference Entropy (GLCM) confirms the higher irregularity and complexity of incisor teeth radiographs in advanced EOTRH syndrome, demonstrating the greatest sensitivity (0.50) and specificity (0.95) of EOTRH 3 group detection. An application of DistEn2D to Normalize filtered incisor teeth radiographs enables the identification of the radiological signs of advanced EOTRH with higher accuracy than the previously used entropy-related GLCM texture features.

Equine Odontoclastic Tooth Resorption and Hypercementosis.

Equine odontoclastic tooth resorption and hypercementosis (EOTRH) is a recently described painful and progressive condition of unknown etiology that occurs in middle-aged and geriatric equines. It predominantly affects the permanent incisor and canine teeth and, less commonly, the premolar and molar dentition. EOTRH was first reported in peer-reviewed literature in 2008, with subsequent publications of case reports, histological studies and retrospective case series. There have been few significant research developments related to this disease. The existing studies have primarily involved single case studies or small sample sizes, without control groups. This review aimed to report current information about EOTRH in terms of clinical, histopathological, diagnostic, radiological, and therapeutic aspects, by searching the available peer-reviewed scientific literature.

Clinical, Diagnostic and Histological Findings Involving Cheek Teeth Hypercementosis in Nine Horses.

Hypercementosis is infrequently reported to affect the cheek teeth of horses and presents as mineral deposits either attached (peripheral) or solitary ovoid (nodular) structures in the tooth bearing region. There is overlap between radiological and histological appearance of hypercementosis, cementoma, and equine odontoclastic tooth resorption and hypercementosis (EOTRH). The clinical presentation, imaging features, surgical management, and histological findings of nine horses that presented for dental lesions and associated hypercementosis of cheek teeth are reported. Horses were 4-15 years old and presented for either nasal discharge or facial swelling. Peripheral and nodular mineral structures were identified using radiographs or computed tomography in six and three horses, respectively. Eight of nine cases involved maxillary cheek teeth. Of six cases with peripheral hypercementosis, three had enlargement of the apical cross-sectional area that was greater than the coronal cross-sectional area thus preventing extraction along the normal eruption pathway and necessitating sectioning (two cases) and repulsion. Nodular hypercementosis lesions were extracted in three of the four cases. Post-extraction complications occurred in five cases; four cases required additional procedures. All horses returned to their intended use, ie riding or pasture. Histology of extracted dental and proliferative mineral material revealed hypercementosis characterized by large sheets of eosinophilic matrix with lacunae (usually empty; presumed artifact) and frequent, irregular, basophilic cement lines. All cases had evidence of chronic inflammation, such as caries, chronic fractures and/or pulpitis. The findings of this case series share many features with previous published descriptions of cementoma and with histological findings of hypercementosis lesions of EOTRH. Further investigation into differentiation of these entities is warranted.

Selection of Filtering and Image Texture Analysis in the Radiographic Images Processing of Horses' Incisor Teeth Affected by the EOTRH Syndrome.

Equine odontoclastic tooth resorption and hypercementosis (EOTRH) is one of the horses' dental diseases, mainly affecting the incisor teeth. An increase in the incidence of aged horses and a painful progressive course of the disease create the need for improved early diagnosis. Besides clinical findings, EOTRH recognition is based on the typical radiographic findings, including levels of dental resorption and hypercementosis. This study aimed to introduce digital processing methods to equine dental radiographic images and identify texture features changing with disease progression. The radiographs of maxillary incisor teeth from 80 horses were obtained. Each incisor was annotated by separate masks and clinically classified as 0, 1, 2, or 3 EOTRH degrees. Images were filtered by Mean, Median, Normalize, Bilateral, Binomial, CurvatureFlow, LaplacianSharpening, DiscreteGaussian, and SmoothingRecursiveGaussian filters independently, and 93 features of image texture were extracted using First Order Statistics (FOS), Gray Level Co-occurrence Matrix (GLCM), Neighbouring Gray Tone Difference Matrix (NGTDM), Gray Level Dependence Matrix (GLDM), Gray Level Run Length Matrix (GLRLM), and Gray Level Size Zone Matrix (GLSZM) approaches. The most informative processing was selected. GLCM and GLRLM return the most favorable features for the quantitative evaluation of radiographic signs of the EOTRH syndrome, which may be supported by filtering by filters improving the edge delimitation.

Multiple assessment of molars with hypercementosis lost due to periodontitis using X-ray micro-computed tomography, electron microprobe analysis, and histological sections.

This article aimed to achieve a better understanding of cementum hyperplasia in the maxillary second molars lost due to periodontitis. Six maxillary second molars with hypercementosis were measured for the mineral concentration using micro-computed tomography and calcium element distributions using electron microprobe analysis. Calcium was distributed throughout the cementum, although the mineral concentration differed based on the cementum depth. The hyperplastic cementum was of the extrinsic fiber-rich cellular mixed stratified type. These results have implications for future studies aiming to diagnose hypercementosis. Further studies are needed to investigate the composition of the cementum matrix.

Application of Hyperbaric Oxygen Therapy (HBOT) as a Healing Aid after Extraction of Incisors in the Equine Odontoclastic Tooth Resorption and Hypercementosis Syndrome.

Hyperbaric Oxygen Therapy (HBOT) is a stress-free, relatively safe method supporting the treatment of many different diseases. Although it is widely used in human medicine (including dentistry), in veterinary medicine, especially in the treatment of horses, there are not many scientifically described and documented cases of its use. Equine Odontoclastic Tooth Resorption and Hypercementosis syndrome is a disease that affects older horses and significantly reduces their quality of life. The only effective treatment for this condition is extraction of the incisors. The described case compares the recovery process of the alveolar area after extraction of incisors during the course of EOTRH syndrome without and with the use of a chamber, in horses with the same clinical picture of the disease, of the same age, and living in the same conditions. According to the authors' knowledge, the presented case describes the use of a chamber in equine dentistry for the first time.

EOTRH Syndrome in Polish Half-Bred Horses - Two Clinical Cases.

The aim of this paper is to thoroughly describe the etiology, diagnostic processes and recommended treatment of equine odontoclastic tooth resorption and hypercementosis (EOTRH). It is a relatively recently described disease. Most recent reports show that it is a common problem involving older equine patients. The most common and significant symptom of EOTRH is oral pain. The main clinical signs include periodontitis and gingivitis with a gingival recession, alveolar bone protrusion, periodontic fistulas and soreness of the incisors. When establishing the final diagnosis, it is necessary to compare the results of the clinical and radiological examination, because in the early stage, the disease may not show any symptoms. Authors used two clinical cases of Polish Half-Bred horses to present some aspects of diagnostic and surgical techniques. The knowledge presented in the paper may be valuable for equine practitioners working in the field to achieve more beneficial outcomes and provide a higher level of welfare for their equine patients. Nevertheless, further research and observations are necessary, since the etiology of the disease remains unclear.

Prevalence of hypercementosis and frequency of possible etiological factors in a Turkish subpopulation.

OBJECTIVE: The aim of this study was to investigate the prevalence and types of hypercementosis and the frequency of possible etiological factors in a large sample of Turkish central Anatolian population. SUBJECTS AND METHODS: A cross-sectional study was performed using panoramic radiographs of 1176 randomly selected adult patients with an age range of 18-96 years, who presented to the Department of Oral and Maxillofacial Radiology of the Faculty of Dentistry, Cumhuriyet University (Sivas, Turkey) for dental care. Patients were questioned about the presence of systemic diseases. Panoramic radiographs of the patients were examined for the presence and types of hypercementosis (diffuse, focal and shirt sleeve cuff) and the frequency of local factors that may be associated with hypercementosis. Chi-square and t-tests were used for statistical analysis. RESULTS: Hypercementosis was detected in 128 of 1176 patients. In total, 85.6% of the teeth with hypercementosis had a diffuse, 7.5% had a focal, and 6.8% had a shirt sleeve cuff type. Hypercementosis was observed most frequently in the mandibular (P < 0.05) and the premolar region. Gender-related differences were nonsignificant (P > 0.05). Atherosclerosis, osteoporosis, and multiple diseases were reported more frequently in individuals with hypercementosed teeth (P < 0.05). While idiopathic origin (39.3%), bruxism (30%), and inflammation (24.37%) were the most prevalent local etiological factors, impacted teeth (1.25%) and history of trauma (0.62%) were less common. CONCLUSION: The prevalence of hypercementosis was 10.8% in the study population. The lesions were more common in the mandibule. Idiopathic origin was the most common factor associated with hypercementosis.

Incidence of hypercementosis in mandibular third molars determined using cone beam computed tomography.

PURPOSE: This study was conducted to investigate the incidence and predictors of hypercementosis in mandibular third molars using cone beam computed tomography. METHODS: Using a retrospective approach, 1,160 cone beam computed tomography image sets were analyzed. Two oral radiologists independently evaluated the image sets based on four severity grades: 0, no hypercementosis around the root; 1, hypercementosis surrounding less than half of the root surface; 2, hypercementosis surrounding more than half of the root surface; and 3, hypercementosis surrounding the entire root surface. Hypercementosis was identified as a dark or light layer. Statistical analyses of relationships between hypercementosis incidence and possible predictors (e.g. age, sex, impaction, and occlusion) were performed using chi-square test or Fisher's exact test; logistic regression was used for multivariate analysis. RESULTS: The severity of hypercementosis increased with age, and the incidences were as follows: ≤19 years, 0%; 20-24 years, 14.1%; 25-29 years, 57.7%; 30-39 years, 83.0%; 40-49 years, 92.7%; 50-59 years, 93.4%; and ≥60 years, 96.8%. CONCLUSION: The observed incidences of hypercementosis were relatively higher than in previous studies, and the incidence was significantly lower for occluded teeth than for non-occluded teeth.

Orthodontic treatment of open bite involved in diffuse hypercementosis: A case report.

BACKGROUND: Open bite is considered one of the most complicated malocclusions in orthodontic treatment. In this study, the authors successfully treated total open bite involved in hypercementosis using orthodontic miniscrews. CASE DESCRIPTION: A woman aged 25 years 8 months had total open bite. Her occlusal contact at the maximum intercuspation was present at the right second molars. A panoramic radiograph showed diffuse hypercementosis. The titanium miniscrews were interradicullay implanted between the first and second molars, and intrusion force was applied for 14 months. After active treatment, the patient's maxillary first molars showed about 1.6-millimeters of intrusion, resulting in counterclockwise mandibular rotation. Her acceptable occlusion was maintained after 1.0-year retention. PRACTICAL IMPLICATIONS: Miniscrews might be useful tool to improve malocclusion involved in diffuse hypercementosis though they are considered to be difficult to move and brought on ankylosis.

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.

Update on Equine Odontoclastic Tooth Resorption and Hypercementosis.

Equine odontoclastic tooth resorption and hypercementosis (EOTRH) is a progressive, painful disease, affecting incisors, canines, and cheek teeth. Examination findings include gingival inflammation, gingival recession and/or hyperplasia, subgingival swelling, bulbous enlargement of teeth, associated periodontal disease, pathologic tooth fracture, and/or tooth mobility and loss. Current hypotheses include biomechanical stresses and secondary bacterial involvement. Early recognition allows case management, but it is a progressive disease. Owner education is crucial; horses with complete or multiple extractions have a favorable prognosis. Human oral and dental health may be affected by bisphosophonate use; long-term effects of these drugs are currently unknown in horses.

Radiographic evaluation and determination of hypercementosis patterns in Al-Madinah Al-Munawwarah, Saudi Arabia: A retrospective cross-sectional study.

OBJECTIVES: Hypercementosis (HC) is an asymptomatic excessive cementum deposition at the dental root apex. There is a lack of research that determines the pattern and associated factors of HC in Saudi Arabia. MATERIALS AND METHODS: A retrospective cross-sectional study was conducted on a random sample of 815 Orthopantomograms (OPGs) that was obtained from a total of 14003 female patients archived OPGs. The OPGs were retrieved from the Kodak Carestream-R4 database for the period between 2015 and 2017 at Taibah University Dental College and Hospital (TUDCH), Al-Madinah Al-Munawwarah, Saudi Arabia. Width and radiodensity of HC were measured and the distribution was calculated. Association between HC and factors including age and nationality were explored. Descriptive and inferential analyses were performed. RESULTS: The mean/SD age of HC affected patients (9.8%) was 30.16 ± 13.1 years, of whom 55% were Saudis. The mean/SD width and radiodensity of the hypercementosed roots were 4.14 ± 1.2 mm and 119.86 ± 29.83, respectively. The mandibular teeth were more frequently associated with hypercementosis (65%) specifically first molars (47.5%), while the majority (64%) had a single unilateral distribution pattern. There was a non-significant association between nationality, age, and HC (P = 0.921, P = 0.633, respectively). CONCLUSION: Hypercementosis observed in 9.8% of female patients attending TUDCH which was primarily unilateral and prominently confined to the mandibular teeth roots. The complication of teeth extraction among female patients in Almadinah region should be anticipated.

Florid hypercementosis synchronous with periodontitis: a case report.

Excessive cementum formation, referred to as hypercementosis (HC), is an uncommon nonneoplastic process that principally occurs with permanent teeth. Widespread tooth involvement has been confined mostly to Paget disease of bone. Only a limited number of reports of HC coincident with periodontitis has appeared in the literature. The aim of this article is to present the clinical, radiographic, and histopathologic findings of a 44-year-old female with moderate to severe periodontitis synchronous with 22 HC-affected teeth. A list of other etiologies associated with HC is provided.