Endodontic implications of hypercementosis: A systematic review of anatomical challenges and therapeutic strategies

Hypercementosis, characterized by excessive cementum deposition that distorts apical root morphology, poses specific anatomical challenges in endodontics; this systematic review aimed to synthesize its endodontic implications and to propose tailored treatment strategies for affected teeth.

A systematic search was conducted across PubMed, Scopus, EBSCO-DOSS, and Google Scholar following PRISMA guidelines. The SPIDER tool was used to refine inclusion criteria, focusing on studies involving human teeth affected by hypercementosis and its impact on endodontic treatment.

Ten studies met the inclusion criteria: three experimental/descriptive and seven clinical studies. Hypercementosis was associated with anatomical challenges, complicating working length determination, canal negotiation, and obturation. Reported treatment approaches included orthograde treatment, surgical endodontics [including computer-aided-design-guided microsurgery], and the use of Cone Beam Computed Tomography for enhanced visualization of root morphology. Despite these interventions, treatment outcomes remained limited by persistent anatomical complexities.

Hypercementosis presents a significant challenge in endodontic treatment. A stepwise approach, ranging from clinical monitoring in asymptomatic cases to surgical interventions is recommended. The integration of advanced imaging technologies and individualized treatment planning is essential to improving therapeutic outcomes. Larger cohort studies with standardized diagnostic criteria are needed to better assess the prevalence of hypercementosis and its incidence on endodontic treatment.