Excessive cementum formation, referred to as hypercementosis (HC), is an uncommon nonneoplastic process that principally occurs with permanent teeth. Widespread tooth involvement has been confined mostly to Paget disease of bone. Only a limited number of reports of HC coincident with periodontitis has appeared in the literature. The aim of this article is to present the clinical, radiographic, and histopathologic findings of a 44-year-old female with moderate to severe periodontitis synchronous with 22 HC-affected teeth. A list of other etiologies associated with HC is provided. Keywords: etiology, florid, hypercementosis, periodontitis