DEPARTMENT OF PERIODONTICS

Under the Guidance ofDr. Suraj Pandey

Submitted BySaurabh Verma BDS 3rd Yr.

CEMENTUM

CONTENT: Introduction Physical characteristic Chemical composition Classification Cementogenesis Cemento-dentinal junction Cemento-enamel junction Function Exposure of cementum Cemental anomalies

INTRODUCTION
o Also called as Substantia Ossea o Cementum is the mineralized dental tissue covering the anatomical root of teeth. o First demonstrated microscopically in Yr.1835 by two pupil of Purkinje. o It begins at the cervical portion of the tooth at the CEJ(cementoeamel junction) & continues to the apex. o Cementum is avascular & non-innervated. o It furnishes a medium for the attachment of collagen fibers, that binds the tooth to the surrounding tissue.

PHYSICAL CHARACTERISTICS
o Light yellow in colour. o Can be distinguish from enamel by its lack of luster and its darker hue. o Thickness:At CEJ = 20-50 um. At Apex = 150-200 um. o Hardness :- less than Dentin. o Least calcified o More permeable than Dentin.

CHEMICAL COMPOSITION

INORGANIC SUBSTANCE :o o o

45 50 % Mainly calcium & phosphate in form of hydroxyapatite. Cementum has highest fluoride content of all mineralized tissue.

ORGANIC SUBSTANCE :o o

50 55 % Mainly type I collagen polysaccharides(proteoglycan). Type III, V,VI,XII collagen are also seen.

&

protein

Non collagenous protein play important role in matrix deposition, initiation & controle of mineralization matrix remodelling. Cementum derived attachment proteinis an adhesion molecule unique to cementum, helps in the attachment of mesenchymal cells to the extracellular matrix.

CLASSIFICATION
SCHROEDER has classified cementum, as follows-

ACELLULAR AFIBRILLAR CEMENTUM(AAC) :o Contains neither cells nor extrinsic/intrinsic collagen fibers, apart from a mineralized ground substance. o Product of cementoblast. o Found as coronal cementum in human. o Thickness = 1-15 Am

ACELLULAR EXTRINSIC FIBER CEMENTUM(AEFC) :o o o o

Composed of densely packed bundles of Sharpeys fibers & lack cells. Product of fibroblast & cementoblast. Found in Cervical Third portion of root. Thickness = 30-230 Am

CELLULAR MIXED CEMENTUM(CMSC) :o

STRATIFIED

o o

Composed of Sharpeys fibers and intrinsic fibers & may contain cells. Co-product of fibroblast & cementoblast. Found primarily in the Apical Third portion of root & in furcation areas. Thickness = 100-1000 gym

CELLULAR INTRINSIC CEMENTUM(CIFC) :o Contains cells but no extrinsic fibers. o Product of cementoblast. o In humans, it fills resorption lacunae.

FIBER

INTERMEDIATE CEMENTUM

:-

o An ill-defined zone, near the CEJ. o Found in certain teeth that appears to contain cellular remnants of HERS(Hertwig Epithelial Root Sheath), embedded in calcified ground substance.

ACELLULAR & CELLULAR CEMENTUM ACELLULAR CEMENTUM:o o o o o o o First to be formed, so also called Primary Cementum. Cover cervical third of root. Formed before the tooth reaches the occlusal plane. Sharpeys fiber comprises most of part of it. These fiber are completely calcified. Also contains intrinsic collagen fibers. Thickness = 30-230 Am

CELLULAR CEMENTUM :o o o o o o o

Forms after acellular cementum. Secondary cementum Formed after tooth reaches the occlusal plane. More irregular & contains cells. Less calcified than acellular cementum. Sharpeys fiber occupies a smaller portion. Sharpeys fiber of cellular cementum, have a central, uncalcified core surrounded by a calcified border.

CEMENTOGENESIS
Define as the process of cementum formation.

CEMENTUM FORMATION :o Cementum formation in the developing tooth is proceded by the deposition of dentin along the inner aspect of Hertwigs epithelial root sheath. o For cementogenesis to begin, HERS must fragments. o Once HERS fragments, the dentin comes in contact with connective tissue of dental follicle. o Cells derived from this connective tissue are responsible for cementum formation, i.e. Cementoblast.

CEMENTOBLAST

:-

o Cementoblast synthesize collagen & protein polysaccharides, which makeup the organic matrix of cementum. o Have numerous mitochondria, a well-formed golgi apparatus, & large amounts of granular endoplasmic reticulum.

MINERALIZATION OF CEMENTUM

:-

o Highly organised event. o Gla proteins osteocalcin, osteonectin act as nucleator for mineralization. o Alkaline phosphate promote mineralization. o Osteopotin regulate growth of apatite crystals. o Uncalcified matrix is called Cementoid .

CEMENTO-DENTINAL JUNCTION
o Narrow interface zone between Cementum & dentin, can be detected with Electron Microscope. o Presence of proteoglycan is the major factor in this attachment. o Smooth in permanent teeth. o Scalloped in deciduous teeth. o Sometime, dentin is separated from Cementum by a zone, known as Intermediate Cementum Layer. Also known as HYALINE LAYER. o Hyaline layer is seen in Apical 2/3rd portion of root of Molar & Premolar.

CEMENTO-ENAMEL JUNCTION
o It is the junction of cementum & enamel at the cervical region of teeth. o In 60% of the teeth, cementum overlaps the cervical end of enamel for a short distance. o In 30% of all teeth, cementum meets the cervical end of enamel in a relatively sharp line. o In 10% of the teeth, enamel & cementum do not meet. o Recent observation showed a 4th type of CEJ, in which the enamel overlapping the cementum.

FUNCTION
o Cementum function is a single unit, but can be described under Anchorage Adaptation Repair

ANCHORAGE :o Primary function of cementum is to furnish a medium for the attachment of collagen fibers, that binds the tooth to the alveolar bone.

ADAPTATION :o

Cementum is the tissue, helps in the functional adaptation of teeth possible. As- Deposition of cementum in an apical area to compensate for loss of tooth surface from occlusal wear.

REPAIR :o o

Cementum is major tissue for repairing root surface. Any damage to root surface, such as fracture can be repaired by deposition of new cementum.

EXPOSURE OF CEMENTUM TO ORAL ENVIRONMENT

o

Cementum exposed to oral environment in case of

Gingival recession Loss of attachment in pocket formation

o Bacterial invasion of cementum occurs in periodontal disease. o Cementum become permeable to organic substance, inorganic ions & bacteria in above condition.

AGING OF CEMENTUM :o o o o Surfaces become rough. Cemental resorption. Permeability decreases. More cemental deposition lead to closure of apical foramen.

CEMENTAL ANOMALIES
HYPERCEMENTOSIS :o Abnormally prominent thickening of the cementum on the root surface. o Two type : Localized Cemental spikes Excementosis Generalized Pagets disease Chronic periapical infection

CEMENTAL HYPERPLASIA & HYPERTROPHY :o

Cementum overgrowth, where growth dose not help in increasing function of tooth. i.e. Cemental hyperplasia. If cemental overgrowth helps in increase functioning of tooth, i.e. Cemental hypertrophy.

CEMENTICLES :o Round lamellated cemental bodies, that lies free in PDL or attached to the root surface. o Mostly found in aging person or at site of trauma.

CEMENTAL RESORPTION & REPAIR :o o

Cementum undergoes resorption & repair according to change in environment faced by it. Causes : LOCAL Trauma Cyst & tumour Periapical pathology Excessive orthodontic force

alternatively

 SYSTEMIC Deficiency of calcium Deficiency of Vit. A & D Hypothyroidism

Resorption of cementum and dentin. A multinuclear osteoclast is seen at X. The direction of resorption is indicated by the arrow. Note the scalloped resorption front in the dentin (D). The cementum is the darkly stained band at the upper and lower right. P Periodontal ligament.

CLINICAL CONSIDERATIONS
o Cethan is bone, & it is for this reason that orthodontic tooth movement is made possible. o It is because bone is richly vascularized, whereas cementum is avascular. o Cementum resorption can occur after trauma or excessive occlusal forces. o Cementum is more resistant to resorption o In most cases of repair, there is a tendency to re-establish the former outline of the root surface by cementum. This is called anatomic repair. o However, if only a thin layer of cementum is deposited on the surface of a deep resorption, the root outline is not reconstructed, & a bay like recess remains. o In such areas the periodontal space is restored to its normal width by formation of a bony projection, so that a proper functional relationship will result. the outline of the alveolar bone in these cases follows that of the root surface. This is called functional repair.