|Year : 2015 | Volume
| Issue : 3 | Page : 178-180
Generalized hypercementosis with multiple missing teeth in a young female: A rare case report
Santosh R Patil1, Nidhi Yadav2
1 Department of Oral Medicine and Radiology, College of Dentistry, College of Dentistry, Al Jouf University, Sakaka, Al Jouf, Saudi Arabia
2 Department of Oral Medicine and Radiology,Jodhpur Dental College and Hospital, Jodhpur National University, Jodhpur, Rajasthan, India
|Date of Web Publication||16-Jul-2015|
Santosh R Patil
Department of Oral Medicine and Radiology, College of Dentistry, Al Jouf University, Sakaka, Al Jouf
Source of Support: None, Conflict of Interest: None
Hypercementosis is a nonneoplastic thickening of the cementum. It may be restrained to the apex of the root, on one side of it, or involve it entirely. Hypercementosis is coupled with a number of etiological factors, which may be local or systemic in nature. It is decisive that the general dental practitioner is aware of these factors and is able to distinguish presentation due to a local cause from that of a systemic disease process. We report a first case of generalized hypercementosis with multiple missing teeth in a young Saudi female.
Keywords: Cemental hyperplasia, etiology, hypercementosis
|How to cite this article:|
Patil SR, Yadav N. Generalized hypercementosis with multiple missing teeth in a young female: A rare case report. Int J Health Allied Sci 2015;4:178-80
|How to cite this URL:|
Patil SR, Yadav N. Generalized hypercementosis with multiple missing teeth in a young female: A rare case report. Int J Health Allied Sci [serial online] 2015 [cited 2019 Nov 12];4:178-80. Available from: http://www.ijhas.in/text.asp?2015/4/3/178/160895
| Introduction|| |
Hypercementosis is also termed as cementum hyperplasia, characterized by thickening of the cementum. It may be localized at the apex of the root, on any of the root surface or integrated with complete root involvement. This condition may be isolated comprehending single tooth, may involve multiple teeth, or may show up as a generalized process. Premolar teeth are proclaimed to involve most frequently.  The cementum is deposited beyond the physiologic confinement of the tooth. This disproportionate deposition of cementum leads to an anomalous thickening of the apex that metamorphose into round shaped. It has been noticed not only on erupted teeth but also on a tooth that is not erupted.  The apportioning of hypercementosis by race or population group has not yet been entrenched until. On the foot of macroscopic appearance, hypercementosis is classified as (a) club-shaped (b) focal and (c) circular cemental hyperplasia.  The provenance of hypercementosis is attributed to local or systemic factors. Local factors encompass functional stress due to occlusion forces, periapical pathosis, and continuous dental eruption. Systemic factors comprise Paget's disease of bone, atherosclerosis, rheumatic fever, acromegaly, deforming arthritis, calcinosis, hypertrophic arthritis, thyroid diseases and possibly Vitamin A deficiency. In spite of the confederacy with a number of disorders, most localized cases of hypercementosis are not analogous to any systemic disturbance. A hereditary ingredient is usually suspected when hypercementosis is seen affecting younger patients. In a substantial majority of cases, hypercementosis is proclaimed to be affecting vital teeth.  A case of young Saudi female patient with a generalized hypercementosis and multiple missing teeth is described here.
| Case report|| |
A 20-year-old female patient reported to us with a chief complaint of spacing between the anterior teeth since childhood. Her past medical history was noncontributory, and family history revealed that she was born to nonconsanguineous marriage with normal delivery and no one in his family has similar complaints. The patient revealed no history of trauma or extractions. Extraoral examination revealed a normal facial profile and normal skeletal dental base relations. Intraoral examination revealed interdental spacing in anterior teeth and missing permanent mandibular left lateral incisor, second premolar and right mandibular canine. Over-retained 72, 75, 83 were noted. Orthopantomograph revealed generalized hypercementosis, which was more pronounced in mandibular arch, absence of tooth buds of mandibular left lateral incisor and second premolar and right mandibular canine [Figure 1]. Routine physical examinations with laboratory investigations were carried out. All the laboratory values including serum calcium, phosphorus, and alkaline phosphatase were within normal limits. Considering the history, clinical, radiographic and laboratory findings, a diagnosis of generalized hypercementosis with multiple missing teeth of idiopathic origin was arrived. The patient was referred to an orthodontist for further management.
|Figure 1: Orthopantomograph showing generalized hypercementosis and multiple missing teeth|
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| Discussion|| |
Hypercementosis is contemplated to be a nonneoplastic condition in which exorbitant deposition of cementum is seen in continuance with the orderly radicular cementum. It is varyingly divulged as an age-related process. It is also considered as an abnormal thickening of cementum that may be generalized or localized. Localized hypercementosis is customarily characterized by nodular augmentation localized to the apical third of the root.  Generalized hypercementosis is conspicuous as increased thickness of cementum embroiling the thorough radicular surfaces of all teeth and is an innate feature of Paget's disease. Hypercementosis is regarded essentially in adults, and the frequency perceived to be increasing with maturing age. Its exigency has also been divulged in younger patients, and many of these cases authenticate a positive family history that advocate a hereditary influence. 
Radiographically, no amendment of the biologic width between the root surface, the periodontal ligament, and the alveolar bone can be ascertained. It is not possible to estimate the magnitude of extra cementum present in the affected root radiographically because dentin and cementum have the same radiodensity. Hypercementosis is evident on a radiograph as an expanded deposition of cementum localized to a part or unabridged of the tooth and the effected teeth authenticate a thickening or blunting of the root. Normal radiolucent periodontal membrane space and an unblemished lamina dura can be appreciated surrounding this bulbous enlargement. Radiographically, hypercementosis is an occasional finding. From a diagnostic standpoint, periapical cemental dysplasia, condensing osteitis, and focal periapical osteopetrosis, may be differentiated from hypercementosis by the fact that all of these entities lie alfresco the shadow of the periodontal ligament and lamina dura.  Radiographically, the explicit amount of cementum thickness increase is difficult to notice, as the dentin and cementum have analogous radiodensity. Similar radiological features are seen amidst atypical hypercementosis and cementoblastoma. In the differential diagnosis, we must consider cementoma, infective hyperplasia of the bone (condensing osteitis) and thermal hyperplasia of the bone. Histopathologically, the fringe of the affected root exhibits deposition of an exorbitant amount of cementum over the primary layer of cementum. The excessive cementum may be hypocellular or cellular cementum that resembling osteocementum. Often this excessive deposited cementum material is systemized in concentric layers and may be applied over the entire root or limited to the root apex.  It is burdensome to distinguish between dentin and cementum using light microscopy, but the two different layers can be differentiated using polarized light.  Patients with hypercementosis stand in no need of any treatment. Root thickening may cause occasional botheration during the extraction of such tooth sectioning of the tooth or surgically relegate significant amounts of the surrounding bone may be necessary in such footing.  Clinically, hypercementosis may also directly leverage on root canal treatment, and the clinician should appraise the necessity of adapting the usual endodontic therapy approach to assure all endodontics principles and reach treatment success.  Etiologically, hypercementosis may be divided into those cases affiliate with local factors, those with systemic disorders, and a group of idiopathic origin and in the present case it is very likely that the cause is idiopathic. The excessive cementum formation, apart from the limit required to fulfill its orderly functions, resulting in abnormal thickening and macroscopic change in the root or in hypercementosis. Very few case reports of generalized hypercementosis are procurable in the literature and comprehensive review of the literature indicates that this is the first case report of generalized hypercementosis with multiple missing teeth.
| Conclusion|| |
Hypercementosis is conjoined with a number of etiological factors, which may be local or systemic in nature. This condition epitomize an adaptive change of the periodontal ligament, portrayed by excessive cementum thickness on the root surface, besides the limit required to fulfill its unexceptional functions, resulting in thickening and alteration in the macroscopic shape of the root. The incidence of hypercementosis by race or population group has not yet been entrenched. It is decisive that the general dental practitioner is cognizant of these factors and is able to diagnosticate presentation due to a local instigation from that of a systemic disease process.
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