involve single tooth, several teeth or generalizedFigure 4.3 Hypercementosis; extracted tooth with hypercementosis at the tip of the roots(source: by kind permission of Professor Charles Dunlap, Kansas City, USA).
Isolated hypercementosis involves mandibular molars, followed by maxillary and mandibular second premolars, and mandibular first premolars
An extracted tooth shows blunt root tips (Figure 4.3)
4.3.5 Radiographical features
Detected on routine radiography
Widening of roots
Apical third shows a blunt root tip surrounded by radiolucent periodontal ligament space
Occasionally, fusion of the roots of the adjacent roots caused by hypercementosis (concrescence) is seen
4.3.6 Microscopic Features
Deposition of excessive cementum (mostly acellular) over the original layer of primary cementum
Concentric layers of cementum deposition are seen
May include the entire root or limited to the root tip
4.3.7 Differential Diagnosis
Cemento‐osseous dysplasia
Cementoblastoma
4.3.8 Management
No treatment required
Problems with extraction
Systemic conditions associated with hypercementosis should be treated by specialists
4.4 Cracked Tooth Syndrome
4.4.1 Definition/Description
An incomplete fracture of a vital posterior tooth that involves the dentine and occasionally extends into the pulp
4.4.2 Frequency
Common
Incidence rate of 34–74%
4.4.3 Aetiology/Risk factors
Teeth grinding (bruxism/habitual clenching)
Large restorations
Chewing or biting hard food
Trauma: blows to the teeth (violence or accident related)
4.4.4 Clinical Features
Majority of patients are 30–50 years of age
Men and women are equally affected
Most affected teeth are the mandibular second molars, followed by mandibular first molars, and maxillary premolars
Deep cracks may involve pulp (Figure 4.4)
Patient complains of pain on biting that ceases after the masticatory pressure has been withdrawn
Pain on tooth grinding and with cold drinks or food
Difficulty in identifying offending tooth (by the patient)
Vitality test is usually positive
Tenderness can be elicited when pressure is applied to an individual cusp
Pain/tenderness increases as the occlusal force increases, and relief occurs once the pressure is withdrawnFigure 4.4 Cracked tooth syndrome; fractured premolar tooth (black arrows) viewed in the mouth (left) and after extraction (right). (Source: Coronation Dental Specialty Group Canada; Wikipediahttps://en.wikipedia.org › wiki. Creative Commons Attribution‐Share Alike 3.0 Unported license
4.4.5 Differential Diagnosis
Acute periodontal diseases
Reversible pulpitis
Dentinal hypersensitivity
Galvanic pain associated with silver amalgam restorations
Sensitivity following microleakage from recently placed composite resin restorations
Areas of hyperocclusion from dental restorations
Occlusal trauma from parafunctional habits
Orofacial pain arising from conditions such as trigeminal neuralgia and atypical facial pain
4.4.6 Diagnosis
Detailed history:Recent dental restorations, occlusal adjustmentsParafunctional habits (bruxism)Pain history: character, intensity, relation to chewing, etc.
Clinical examination:Periodontal probing
Bite tests:Patient is asked to bite on various items such as a toothpick, cotton roll, rubber abrasive wheels, or wooden stickPain/tenderness increases as the occlusal force increases, and relief occurs once the pressure is withdrawn (diagnostic)
Dye test:Special stains such as methylene blue or gentian violet are frequently used to highlight the cracks
Vitality tests for individual tooth are usually positive
Radiographs are not reliable (since cracks usually occur in a mesiodistal direction)
Transillumination is an important aid in diagnosing the cracks
4.4.7 Management
Depends on the site, direction, size, or the degree of the crack
Minor cracks: restored with a filling or a crown
Deep cracks with pulp involvement: root canal treatment and a crown
Pain management by analgesics
Crack extending into the root of the tooth beneath the bone: extraction of the tooth
4.4.8 Prognosis
Prognosis is good for most cases with endodontic treatment and crown
Where vertical cracks occur or where the crack extends through the pulpal floor or below the level of the alveolar bone, the prognosis is not favourable, and extraction is the treatment of choice.
Recommended Reading
1 Odell, E.W. (2017). Tooth wear, tooth resorption, hypercementosis and osseointegration. In: Cawson's Essentials of Oral Pathology and Oral Medicine, 9e, 85–91. Edinburgh: Elsevier.
2 Imfeld, T. (1996). Dental erosion: definition, classification, and links. European Journal of Oral Sciences 104: 151–154.
3 Neville, B.W., Damm, D.D., Allen,