Periapical Radiopacities

 Unerrupted succedaneous
teeth
 Foreign Bodies
 Hypercementosis
Unerupted Succedaneous Teeth
 When the permanent
crowns of succedaneous
teeth are completely
formed and the resorption
of the root ends of the
corresponding deciduous
teeth is initiated, the
images of the permanent
tooth crowns represent
periapical radiopacities .
 Such shadows mainly
occur on radiographs of
persons under 12 or 13
years of age . Since these
teeth are easily
recognized .
 Foreign Bodies
 Radiopaque foreign bodies in the
periapex are usually root canal-filling
materials.
 The images produced by extruded gutta
percha, silver points, sealer, or
retrograde amalgam restoration and the
filled root canal ,coupled with the
history of a related procedure,
contribute to the easy recognition of
these periapical radiopacities.
 Extruded endodontic sealer has been
observed in 5.1 % of adolescent and
adult patients.
 Hypercementosis
 Hypercementosis is
characterised by excessive
deposition of cementum on
the root surface .
 This condition is associated
with several local and
systematic factors .
 It is a reggresive change of
teeth and most commonly
involves the entire tooth
area . Sometimes the
cementum formation is
focal usually involving the
Apex of the teeth .
Etiology

 Accelerated elongation of the tooth.

 Inflammation about a tooth .
 Tooth repair.
 Osteitis deformans or Paget's disease of
bone
 Occlusal trauma .
 Unknown etiology .
Clinical features

 Hypercementosis is completely
asymptomatic and is usually
discovered on routine radiographic surveys.
 It has been reported to occur
in 7.6% of patients.
 The premolars are more often
affected than the remaining teeth,
and the first molars are next in order of involvement.
 Hypercementosis may be confined to just a small
region on the root, producing a nodule on the surface, or
the whole root may be involved.
 In multirooted teeth, one or two or all roots may show
hypercementosis. Often,teeth are bilaterally involved, and a
generalized form with hyperplasia of cementum on all root surfaces has
been reported.
 The teeth affected are usually vital and are not sensitive to percussion.
Radiographic features
 On radiographs the altered
shape of the root is apparent
if there has been a reasonable
amount of cemental hy-perplasia.
 An isolated nodule or the
characteristic club-shaped root
may be seen.
 In either case the root is surrounded by a normal periodontal ligament
space and lamina dura.
 The different densities of the excess cemen-tum and root dentin are
such that the original outline of the dentin root is discernible on the
radiograph .
 Hypercementosis on anterior teeth may appear as a
spherical mass of cementum attached to the root end.
 Histologic features
 An excessive amount of secondary or cellular
cementum is found deposited directly over the
thin layer of primary acellular cementum .
 The area involved may be the entire root or only a
portion , typically the apical region .
 The secondary cementum is called
osteocementum because of its cellular nature
andresemblance to bone.
 This cementum is arranged in concentric layers
around the root and frequently shows numerous
resting lines .
 Hypercementosis may be
differentiated from the false
radiopaque images that are
projected over the apex by
two features of the
projected images:
 I. The projected
radiopacities are not
delineated by a periodontal
ligament space and lamina
dura like hypercementosis is.
 2. The projected images may
be shifted in relation to the
apex by altering the angle at
which additional radiographs
are exposed.
Differential Diagnosis
 Condensing osteitis
 Periapical idiopathic osteosclerosis
 Developmental anomalies - fused roots ,dilacerations,
 Similar images caused by multirooted teeth.
The club-shaped images cast by multirooted teeth and
the shadows of dilacerated roots can be identified by mak-
ing successive radiographs exposed from different angle.
Sometimes the fused roots of multirooted teeth have a
bulbous shape, but these fused roots can be recognized
by the apparently expanded region of the root that doe
not have the relatively lower radiodensity of hyperplastic
Management
Hypercementosis does not require
special treatment.
 Although the obvious surgical
problem is encountered during
removal of the involved tooth.
 When many teeth show
hypercementosis, the patient should
be examined for diseases such as
Paget's disease, acromegaly, and
giantism.