ABSTRACT
Hypercementosis is a non-neoplastic proliferation involving excessive cementum deposition along the normal root cementum. Here, we report an unusual case of exuberant hypercementosis associated with chronic suppurative inflammation. A 77-year-old man sought dental care presenting a gingival suppurative lesion with several months of evolution. The radiographic examination showed a large radiopaque area involving the root of the tooth #46 surrounded entirely by a radiolucent area, suggesting cementoblastoma associated with infectious process. The histopathological examination of the involved tooth revealed an extensive hypercementosis associated with chronic suppurative inflammation and localized chronic osteomyelitis. This is an unusual presentation and due to the clinicopathological findings, the term “chronic hypercementitis” is proposed. Dentists, especially oral pathologists and endodontists, should be aware of this unusual presentation in order to establishing the correct diagnosis.
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A) facial surface; B) mesial surface; C) distal surface; D) macroscopic view of the cut surface, showing hard lesional tissue adhered to root and gutta percha filling the root canal; E) microscopic whole view of the lesional tissue adhered to root (HE stain, ×2.5).HE: hematoxylin and eosin.
A) interface showing the intimate contact between the dental root and cementum hyperplasia (×5); B) hypercementosis exhibiting irregular cavities, some of them empty (×5); C) peripheral area of the lesional tissue showing numerous bacteria, inflammatory cells and liquefactive necrosis (×20); D) Grocott-Gomori stain evidencing the presence of numerous filamentous bacteria in close contact with lesional hard tissue (×10); E) periodic acid-Schiff stain showing bacterial colonies surrounding the lesional hard tissue (×10); F) Grocott-Gomori; G) periodic acid-Schiff stains showing cementum-like mass sequestration surrounded by filamentous bacteria (×40).HE: hematoxylin and eosin.