Radiographic Prevalence and Association of Hypercementosis and Apical Root Resorption in Mandibular Molars Requiring Retreatment: A Cross-Sectional Study

Abstract

Background: This study aimed to investigate the prevalence of apical root resorption and hypercementosis in mandibular first molars requiring endodontic retreatment due to persistent periapical lesions and to evaluate the potential association between these 2 conditions.

Methods: A total of 487 digital panoramic radiographs were retrospectively analyzed, comprising 591 mandibular first molars with a periapical index score of ≥3. Apical root resorption was classified into 3 grades (0: none, 1: mild, 2: severe) based on the extent of root structure loss, and hypercementosis was categorized as diffuse, focal, or circular according to its morphological characteristics. Statistical analyses were conducted using chi-square and Fisher’s exact tests, with P < .05 considered statistically significant.

Results: Apical root resorption was observed in 43.5% of the teeth, and hypercementosis in 41.1%. Both conditions coexisted in 14.7% of cases. A statistically significant negative association was found between apical resorption and hypercementosis (P=.012), indicating that hypercementosis tends to decrease as the severity of resorption increases. Diffuse hypercementosis was the most common type, followed by focal and circular forms. Hypercementosis was significantly more prevalent in patients aged 50 years and older (58.2%) compared to those under 50 years (33.9%) (P=.032).

Conclusion: Apical root resorption and hypercementosis are frequently encountered in mandibular molars indicated for retreatment. Their co-occurrence may reflect a complex interplay between chronic inflammatory destruction and compensatory reparative responses. While hypercementosis might represent a protective adaptation, it can also pose clinical challenges during endodontic procedures and should be carefully evaluated during treatment planning.

Cite this article as: Tosun S, Kahraman EN, Yılmaz B. Radiographic prevalence and association of hypercementosis and apical root resorption in mandibular molars requiring retreatment: a cross-sectional study. Essent Dent. 2026, 5, 0072, doi:10.5152/
EssentDent.2026.25072.