1. Cementicles, Cemental Spurs & Concrescence
By Paige Zambito
D218

2. What are cementicles? Small globular masses of cementum
Found in approximately 35% of human roots
Three types: Attached to cementum surface, free in the periodontal ligament or embedded in the cementum
More common in apical and middle third of the root

3. Free cementicles in PDL

4. Attached cementicles on surface of cementum

5. Etiology
They form from the apposition of cementum around cellular debris in the periodontal ligament.
Appear to arise through calcification of thrombosed capillaries in periodontal ligament.

6. How do cementicles impact the patient dentally?
Most patients don’t know whether or not they have cementicles. They are only visible on radiographs
May interfere with periodontal treatment

7. What are cemental spurs?
Symmetrical spheres of cementum attached to the cemental root surface, similar to enamel pearls
Found at or near the CEJ

8. Etiology
Result from irregular deposition of cementum on the root

9. How can cemental spurs affect the patient dentally?
The patient may not know that they have cemental spurs, however the dental hygienist would know through radiographs
They can present some clinic problems in differentiation from calculus
Not easily removed since they are hard dental tissue
May interfere with periodontal treatment

10. What is concrescence?
The union of the root structure of two or more teeth through cementum only
Mainly occurs with permanent maxillary molars

11. Concrescence
(Radiographs)

12. Etiology
Teeth involved are originally separate but join because of the excessive cementum deposition on one or more teeth after eruption
Traumatic injury or crowding of the teeth in the area during apposition and maturation stage of the tooth development may be the cause

13. How can concrescence affect the patient dentally?
May present problems during extraction and endodontic treatment
Preoperative radiographs are important in the detection of this developmental disturbance

14. At what point in the developmental process does this occur?
Cementicles
A result of microtrauma to Sharpery’s fibers
Sharpey’s fibers are a part of the collagen fibers from the periodontal ligament that are each partially inserted into the outer part of cementum at 90 degrees

15. At what point in the developmental process does this occur?
Cemental Spurs
A result of irregular deposition of cementum on the root surface

16. At what point in the developmental process does this occur?
Concrescence
Traumatic injury or crowding of the teeth in the area during he apposition and maturation stage of tooth development is believed to be the cause

17. Role of the Dental Hygienist
The role of the dental hygienist is to ensure the patient that these problems occur during development and are not harmful to the patient’s overall health
Since cementicles, cemental spurs and concrescence do not effect the patient on a day to day basis, they will not know of these underlying conditions
If a problem should occur with the teeth effected, then the dental hygienist would let the patient know what it is they have and show the patient through radiographs (if available) so that they have a better understanding