Generalized hypercementosis

Cemento-Osseous Dysplasia of the Jaw: Demographic and Clinical Analysis of 191 New Cases

Cemento-osseous dysplasia (COD) is a form of benign fibro-osseous lesion of the jaw. We sought to evaluate the demographic and clinical presentations of COD by collecting and analyzing the demographic, clinical, radiographic, and pathologic data of COD diagnosed in our institution from 2017 to 2022. Over this six-year period, the records of 191 patients with COD were reviewed. Most patients were African American and female. Eighty-five patients were diagnosed with florid COD (FLCOD), 63 with periapical COD (PCOD), and 43 with focal COD (FCOD). Twenty-eight (14.7%) patients presented symptoms. The most common symptom was pain. All the symptomatic cases of COD that were histopathologically diagnosed were osteomyelitis in the setting of COD. Symptomatic patients were older (mean of 61.3 years) than the asymptomatic patients (mean of 51.2 years). Due to the radiographic appearance of a radiolucency or a mixture of radiolucency and radiopacity, forty-five asymptomatic patients were biopsied. Most of the asymptomatic patients biopsied were patients with FCOD (n = 19, 54.3%), followed by PCOD (n = 16, 25.8%), and FLCOD (n = 10, 15.2%). FLCOD is the most common form of COD to present with symptoms. Due to the significant overlap in clinical and radiographic presentation with other entities, FCOD and PCOD remain a diagnostic challenge to dentists. In conclusion, we analyzed the demographic and clinical features of 191 new cases of COD, which reaffirms that cemento-osseous dysplasia is a condition that primarily affects middle-aged females of African descent and occurs more frequently in the mandible.

Insights into the aetiologies of hypercementosis: A systematic review and a scoring system

OBJECTIVES

This paper aims to better define hypercementosis, investigate its described potential aetiologies, and determine whether there are different patterns of cementum apposition and if they are a function of their supposed aetiology.

DESIGN

A literature review was undertaken using the Medline, DOSS, Scopus and Cochrane Library electronic databases. Two co-authors selected the published works independently, extracted the data in accordance with the PRISMA statement.

RESULTS

Among 546 articles, 75 articles were finally selected. Eight different supposed aetiologies were identified: (1) intensive masticatory effort, (2) systemic disease, (3) carious lesion and apical periodontitis, (4) impaction, (5) periodontal disease, (6) concrescence, (7) super-eruption, and (8) drugs. Some of these aetiologies can be combined in the same tooth. Hypercementosis manifestations are various in nature and extent with different patterns that may be aetiology-specific. To improve the description and associated consistency in the characterisation of hypercementosis, in this review but also in future studies, we propose a new qualitative scoring system to quickly characterise hypercementosis and determine its most relevant aetiology.

CONCLUSIONS

This systematic review demonstrates that hypercementosis is a complex and not yet well-defined condition. Some forms of apposition are specific to a given aetiology. The hypercementosis characterisation may contribute to document the oral condition and/or the individuals masticatory activity.

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.

Physiological Responses and Perceived Comfort to High Flow Nasal Cannula Therapy in Awake Adults: Effects of Flow Magnitude and Temperature

Clinical use of heated, high flow nasal cannula (HFNC) for non-invasive respiratory support is increasing and may have a therapeutic role in stabilizing the upper airway in obstructive sleep apnea (OSA). However, physiological mechanisms by which HFNC therapy may improve upper-airway function and effects of different temperature modes are unclear. Accordingly, this study aimed to determine effects of incremental flows and temperature modes (heated and non-heated) of HFNC on upper airway muscle activity (genioglossus), pharyngeal airway pressure, breathing parameters and perceived comfort. Six participants (2 females, aged 35±14 years) were studied during wakefulness in supine position and received HFNC at variable flows (0-60 L/min) during heated (37ºC) and non-heated (21ºC) modes. Breathing parameters via calibrated Respitrace inductance bands (chest and abdomen), upper-airway pressures via airway transducers, and genioglossus muscle activity via intra-muscular bipolar fine wire electrodes were measured. Comfort levels during HFNC were quantified using a visual analogue scale. Increasing HFNC flows did not increase genioglossus muscle activation despite increased negative epiglottic pressure swings (p=0.009). HFNC provided ~7cmH₂O positive airway pressure at 60 L/min in non-heated and heated modes. In addition, increasing the magnitude of HFNC flow reduced breathing frequency (p=0.045), increased expiratory time (p=0.040), increased peak inspiratory flow (p=0.002), and increased discomfort (p=0.004). Greater discomfort occurred at higher flows in non-heated versus heated mode (p=0.034). These findings provide novel insight into key physiological changes that occur with HFNC for respiratory support and indicate the primary mechanism for improved upper-airway stability is positive airway pressure, not increased pharyngeal muscle activity.

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.

Hypercementosis: a rare finding in a patient with systemic lupus erythematosus

Hypercementosis is excessive deposition of non-neoplastic cementum over normal root cementum, which alters root morphology. This cementum may be either hypocellular or cellular in nature. The aetiopathogenesis of hypercementosis is ambiguous. Although most of the cases are idiopathic, several local and systemic factors are also linked to this condition, such as Paget's disease, acromegaly, vitamin A deficiency, etc. We report two rare cases of hypercementosis associated with systemic lupus erythematosus, not previously described in the literature, and also discuss the possible aetiopathogenesis.

Generalized Hypercementosis in Geriatric Horses

Hypercementosis has been described in the horse associated with painful tooth root resorption and infection in and around the roots of incisor teeth, or as painful swellings in the oral cavity in elderly horses. A screening radiological examination of 16 clinically normal horses older than 15-years showed varying amounts of hypercementosis, especially around the reserve crown and apices of the incisor teeth in 9 cases. The amount of cementum formation varied from several mm to 2-cm especially associated with the roots of the maxillary and mandibular third incisor teeth. The periodontal ligament of the incisor teeth was always seen radiographically as a homogeneous and distinct radiolucent line surrounding the roots. Computed tomographic evaluation indicated that the hypercementosis was more pronounced on the labial aspect. The distinction between the enamel and cementum was more clearly delineated on computed tomographic imaging. Teeth in horses with acute angles between the maxillary and mandibular incisor teeth had greater hypercementosis than incisor teeth with more vertical angulation supporting the theory that stress on incisor teeth may be an etiological factor. Hypercementosis was also noted in the interradicular area of worn cheek teeth but not exceeding the original outer shape of the roots. Histological examination of hypercementosis affected teeth showed no evidence of tumor or infection regardless of the location of the tooth. As in humans, hypercementosis does not require specific treatment unless secondary complications occur.

Irregular periapical radiopacity in mandibular premolars and molars

Increased deposition of cementum is observed in a wide number of both benign and malignant conditions. Many cases are often diagnosed during routine examination as an incidental finding. Diagnosing correctly without confusing it with other similarly appearing lesions, thus avoiding subjecting the patient to unnecessary investigations and stress, is of prime importance. We report one such case, where the patient presented with the routine complaint of a painful tooth, during the investigation of which he was also diagnosed with hypercementosis affecting the mandibular second premolars and molars bilaterally. The literature review reveals that not many cases of hypercementosis are frequently reported.

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.

Localized Attachment Loss in Pendred Syndrome: Incidental?

BACKGROUND

Pendred syndrome is a rare, inherited, autosomal recessive disorder with an iodine organification defect of thyroxin produced by the thyroid gland. Its clinical features include sensorineural hearing loss, classically congenital and prelingual, and goiter.

METHODS

This is the first case report of Pendred syndrome in the dental literature with oral findings that include localized extensive attachment loss involving mandibular incisor teeth and idiopathic hypercementosis involving multiple teeth in addition to other oral manifestations, suggesting hypothyroidism-like macroglossia and macrocheilia. Furthermore, serum alkaline phosphatase along with inorganic calcium and phosphate levels were also elevated. Peripheral neutrophil function test suggested a defective function of neutrophils.

RESULTS

Management of the case included augmenting thyroxin supplementation, in consultation with an endocrinologist, and extraction of hopeless mandibular central incisors followed by placement of immediate transitional dentures.

CONCLUSION

A comprehensive medical history and systemic and laboratory evaluations should be considered a prerequisite to identify, manage, and report such rare conditions in routine clinical practice.

Atypical hypercementosis versus cementoblastoma

Hypercementosis is a non-neoplastic condition in which excessive cementum is deposited in continuation with the normal radicular cementum. Apart from the idiopathic nature of hypercementosis, this condition is associated with several local and systemic factors. Cementoblastoma is an odontogenic tumour characterized by the proliferation of functional cementoblasts that form a large mass of cementum or cementum-like tissue on the tooth root. Although hypercementosis and cementoblastoma are typical conditions with distinct clinical evolution, atypical cases may challenge their diagnosis. Because cementoblastoma is a neoplasm with unlimited growth potential, the usual treatment is complete surgical resection, whilst conservative treatment is recommended for hypercementosis. An atypical case of hypercementosis with similarities to cementoblastoma is reported and its differential diagnosis is discussed.