Radiology · patient case question
What is the radiographic diagnosis for the root findings?
Patient case: Bulbous root form on a recall radiograph
Patient: Male, 61 years old
Chief complaint: “Nothing hurts — I'm here for my cleaning.”
History: Hearing aid fitted last year. Reports his hat size has increased. Takes no regular medications.
Findings: Periapical radiographs show generalised bulbous, club-shaped root enlargement with the periodontal ligament space and lamina dura following the enlarged outline. The bone shows a patchy, cotton-wool trabecular pattern. Teeth are vital.
Show answer and explanation
Correct answer: D. Hypercementosis
- A. Cementoblastoma is a single, well-circumscribed radiopaque mass fused to one root with a radiolucent rim, usually the mandibular first molar, and it is usually PAINFUL and expansile. This is generalised and asymptomatic.
- B. Ankylosis is fusion of root to bone, so the defining sign is the OPPOSITE: LOSS of the PDL space and lamina dura, with the root blending into the trabecular pattern. That the PDL is preserved here rules it out.
- C. Condensing osteitis is sclerosis of the BONE around the apex of a non-vital or chronically inflamed tooth. The root itself is normal in shape and the tooth is typically non-vital.
- D. CORRECT. Hypercementosis is excessive deposition of cementum producing a bulbous, club-shaped root. The decisive radiographic sign is that the PERIODONTAL LIGAMENT SPACE AND LAMINA DURA REMAIN INTACT and follow the enlarged contour — the thin radiolucent line around the swollen root tells you this is cementum belonging to the tooth, not bone fused to it.
Note: Causes worth knowing: Paget disease of bone, acromegaly, chronic low-grade periapical inflammation, occlusal trauma or hyperfunction, and supra-eruption of an unopposed tooth. It also occurs idiopathically with age.