Types of hypercementosis based on panoramic radiographic observation

Background and aim: Hypercementosis is a dental anatomical anomaly marked by excessive non-neoplastic cementum
deposition, which can be effectively identified using panoramic radiography. Its morphological variants—diffuse, focal,
and shirt sleeve cuff—carry notable clinical relevance, particularly in orthodontic, endodontic, and oral surgery
procedures. Purpose: This study aims to review and synthesise the types of hypercementosis documented through
panoramic radiographic assessments. Methods: A literature search was conducted using Google Scholar, PubMed, and
Scopus with the keywords hypercementosis, diffuse, focal, localized, shirt sleeve cuff, and panoramic. Eligible articles
included full-text, open-access, Scopus-indexed studies (Q1–Q4) employing panoramic radiographs and original study
designs. Excluded materials consisted of animal studies, review papers, case reports lacking type classification, and
studies not utilizing panoramic imaging. Seven studies met the criteria and were analysed according to study design,
diagnostic methods, and reported hypercementosis types. Result: The diffuse variant emerged as the most commonly
reported form across population-based studies and case reports. In contrast, focal and shirt sleeve cuff types were less
frequently observed but displayed distinct radiographic characteristics. Panoramic radiography proved to be a reliable
modality for recognizing cementum thickening patterns, root morphology alterations, and potential local etiological
contributors such as eruption disturbances, impactions, or occlusal trauma. Conclusion: Diffuse hypercementosis is the
most prevalent morphological type reported in panoramic assessments. Panoramic radiography plays a crucial initial
diagnostic role in identifying and classifying hypercementosis to guide appropriate clinical management.