Hypercementosis is an

idiopathic An idiopathic disease is any disease with an unknown cause or mechanism of apparent spontaneous origin. For some medical conditions, one or more causes are somewhat understood, but in a certain percentage of people with the condition, the cause ...

, non-

neoplastic A neoplasm () is a type of abnormal and excessive growth of tissue. The process that occurs to form or produce a neoplasm is called neoplasia. The growth of a neoplasm is uncoordinated with that of the normal surrounding tissue, and persists ...

condition characterized by the excessive buildup of normal

cementum Cementum is a specialized calcified substance covering the root of a tooth. The cementum is the part of the periodontium that attaches the teeth to the alveolar bone by anchoring the periodontal ligament. Structure The cells of cementum are ...

(calcified tissue) on the roots of one or more teeth. A thicker layer of cementum can give the tooth an enlarged appearance, mainly occurring at the

apex The apex is the highest point of something. The word may also refer to: Arts and media Fictional entities * Apex (comics) A-Bomb Abomination Absorbing Man Abraxas Abyss Abyss is the name of two characters appearing in Ameri ...

or apices of the tooth. The cellular cementum functions at the bottom half of the tooth roots which contain cementocytes that anchor the tooth into the jaw

socket Socket may refer to: Mechanics * Socket wrench, a type of wrench that uses separate, removable sockets to fit different sizes of nuts and bolts * Socket head screw, a screw (or bolt) with a cylindrical head containing a socket into which the hexag ...

, protect the tooth's pulp, and repair external

root resorption Resorption of the root of the tooth, or root resorption, is the progressive loss of dentin and cementum by the action of odontoclasts. Root resorption is a normal physiological process that occurs in the exfoliation of the primary dentition. How ...

Signs and symptoms

It is experienced as an uncomfortable sensation in the tooth, followed by an aching pain. Excess amounts of cementum may cause pressure on periodontal ligaments and adjacent teeth. The teeth affected may present as asymptomatic. It may be shown on radiographs as a

radiopaque Radiodensity (or radiopacity) is opacity to the radio wave and X-ray portion of the electromagnetic spectrum: that is, the relative inability of those kinds of electromagnetic radiation to pass through a particular material. Radiolucency or hypode ...

(or lighter) mass at each root apex to confirm the diagnosis.

Cause

Trauma and other developmental disorders such as Paget's disease may be more prone to develop hypercementosis in the maxillary region. Local factors: *

Occlusal trauma Occlusal trauma is the damage to teeth when an excessive force is acted upon them and they do not align properly.Bibb, CA: Occlusal Evaluation and Therapy in the Management of Periodontal Disease. In Newman, MG; Takei, HH; Carranza, FA; editors: ...

* Trauma * Non-functional tooth * Unopposed tooth (and impacted teeth, embedded teeth, teeth without antagonists) Systemic factors: * Idiopathic * Pituitary gigantism *

Paget's disease of bone Paget's disease of bone (commonly known as Paget's disease or, historically, osteitis deformans) is a condition involving Bone remodeling, cellular remodeling and deformity of one or more bones. The affected bones show signs of dysregulated bone ...

Acromegaly Acromegaly is a disorder that results in excess growth of certain parts of the human body. It is caused by excess growth hormone (GH) after the growth plates have closed. The initial symptom is typically enlargement of the hands and feet. There ...

Periapical granuloma Periapical granuloma, also sometimes referred to as a radicular granuloma or apical granuloma, is an inflammation at the tip of a dead (nonvital) tooth. It is a lesion or mass that typically starts out as an epithelial lined cyst, and undergoes a ...

* Arthritis * Calcinosis * Rheumatic fever It may be one of the complications of

in the form of generalized hypercementosis. It may also be a compensatory mechanism in response to attrition to increase occlusal tooth height.

Pathophysiology

Research has suggested that

mutation In biology, a mutation is an alteration in the nucleic acid sequence of the genome of an organism, virus, or extrachromosomal DNA. Viral genomes contain either DNA or RNA. Mutations result from errors during DNA or viral replication, ...

s in the ''

ENPP1 Ectonucleotide pyrophosphatase/phosphodiesterase family member 1 (PC-1, CD203a) is an enzyme that in humans is encoded by the ''ENPP1'' gene. Structure This gene is a member of the ecto-nucleotide pyrophosphatase/phosphodiesterase (ENPP) family. ...

'' and ''GACI'' genes may contribute to the development of hypercementosis. Loss of function in ''ENPP1'' caused generalized arterial calcification of infancy (''GACI)'' which was directly associated with individuals with hypercementosis. When ''ENPP1'' is inhibited, there is a deficiency in

pyrophosphate In chemistry, pyrophosphates are phosphorus oxyanions that contain two phosphorus atoms in a linkage. A number of pyrophosphate salts exist, such as disodium pyrophosphate () and tetrasodium pyrophosphate (), among others. Often pyrophosphates a ...

(''PPi'') that regulates the mineralization of bone by stopping

hydroxyapatite Hydroxyapatite (International Mineralogical Association, IMA name: hydroxylapatite) (Hap, HAp, or HA) is a naturally occurring mineral form of calcium apatite with the Chemical formula, formula , often written to denote that the Crystal struc ...

crystals from forming. ''PPi'' naturally inhibits crystal formation in inappropriate areas such as in the sub-gingival area. Loss of control in ''PPi'' may result in excessive cementum deposition in the lower third of the tooth.

Diagnosis

Periapical radiographs can locate radiopaque structures in proximity to the root which can appear as dense bone islands or

periapical Dental anatomy is a field of anatomy dedicated to the study of human tooth structures. The development, appearance, and classification of teeth fall within its purview. (The function of teeth as they contact one another falls elsewhere, under de ...

osseous dysplasia in cases of hypercementosis. The majority of affected teeth appear club-shaped due to cemental

hyperplasia Hyperplasia (from ancient Greek ὑπέρ ''huper'' 'over' + πλάσις ''plasis'' 'formation'), or hypergenesis, is an enlargement of an organ or tissue caused by an increase in the amount of Tissue (biology), organic tissue that results from ...

diffusing in a variety of severities. Most appear in the apical third of the root.

Complications

Such deposits form bulbous enlargements on the roots and may interfere with extractions, especially if adjacent teeth become fused (

concrescence Concrescence is an uncommon developmental condition of teeth where the cementum overlying the roots of at least two teeth fuse together without the involvement of dentin. Usually, two teeth are involved with the upper second and third molars bein ...

). It may also result in pulpal necrosis by blocking blood supply via the

apical foramen In dental anatomy, the apical foramen, literally translated "small opening of the apex," is the tooth's natural opening, found at the root's very tip—that is, the root apex — whereby an artery, vein, and nerve enter the tooth and commingle w ...

.Illustrated Dental Embryology, Histology, and Anatomy, Fehrenbach and Popowics, Elsevier, 2026, page 196-97 Teeth affected do not necessarily need treatment unless it causes complications to adjacent teeth and structures.

Epidemiology

Hypercementosis occurs more frequently in adults and increases with age. Teeth that are affected are primary

mandibular molars The molars or molar teeth are large, flat teeth at the back of the mouth. They are more developed in mammals. They are used primarily to grind food during chewing. The name ''molar'' derives from Latin, ''molaris dens'', meaning "millstone tooth ...

followed by secondary premolars in the

mandible In jawed vertebrates, the mandible (from the Latin ''mandibula'', 'for chewing'), lower jaw, or jawbone is a bone that makes up the lowerand typically more mobilecomponent of the mouth (the upper jaw being known as the maxilla). The jawbone i ...

and maxilla, however any teeth may be affected. While no one race is primarily affected, those with conditions that affect bone hormone levels such as Paget's disease and acromegaly are more likely to develop hypercementosis.

Treatment

While treatment is not necessary if teeth are asymptomatic, it is crucial to monitor the progression of hypercementosis to reduce the chances of surrounding teeth being affected. If pain is associated with teeth affected by hypercementosis, extractions or

endodontic treatment Root canal treatment (also known as endodontic therapy, endodontic treatment, or root canal therapy) is a treatment sequence for the infected Pulp (tooth), pulp of a tooth that is intended to result in the elimination of infection and the p ...

may be required. A risk assessment must be considered as excess cementum build-up may make determining the apical limit challenging during a root canal. The prognosis is the same as a regular tooth as long as the root canal is done properly.

Recent Research

A recent study has proposed a "teeth-as-tools" hypothesis that suggests early humans may have used

anterior teeth In dentistry, the term anterior teeth usually refers as a group to the incisors and canine teeth as distinguished from the posterior teeth, which are the premolars and molars. The distinction is one of anterior (front of the body) versus posterio ...

for non-dietary purposes. When excessive mechanical force is used in this way, it stimulates the production of cementum to improve the stability of the tooth. Research focuses on the types of occlusion and contamination that may give insight into how

Neanderthal Neanderthals ( ; ''Homo neanderthalensis'' or sometimes ''H. sapiens neanderthalensis'') are an extinction, extinct group of archaic humans who inhabited Europe and Western and Central Asia during the Middle Pleistocene, Middle to Late Plei ...

s adapted to diverse challenges in the world.

References

External links

{{Acquired tooth disease Periodontal disorders