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Periodontal ligament Root canal Alveolar bone Apical foramen Alveolar vessels & nerves
TEETH IN-SITU
Cementum
The other bone It is a hard avascular connective tissue that covers the roots of teeth
Role of Cementum
1) It covers and protects the root dentin (covers the opening of dentinal tubules) 2) It provides attachment of the periodontal fibers 3) It reverses tooth resorption
Varies in thickness: thickest in the apex and In the inter-radicular areas of multirooted teeth, and thinnest in the cervical area 10 to 15 m in the cervical areas to 50 to 200 m (can exceed > 600 m) apically
Development of Cementum
Cementum formation occurs along the entire tooth Hertwigs epithelial root sheath (HERS) Extension of the inner and outer dental epithelium HERS sends inductive signal to ectomesenchymal pulp cells to secrete predentin by differentiating into odontoblasts HERS becomes interrupted Ectomesenchymal cells from the inner portion of the dental follicle come in with predentin by differentiating into cementoblasts Cementoblasts lay down cementum
Cementoblasts
Derive from dental follicle Transformation of epithelial cells
Adhesion molecules
Bone sialoprotein Osteopontin
Other
Alkaline phosphatase
Properties of Cementum
Physical: Cementum is pale yellow with a dull surface Cementum is more permeable than other dental tissues Relative softness and the thinness at the cervical portion means that cementum is readily removed by the abrasion when gingival recession exposes the root surface to the oral environment
Collagenous component
TYPE I
TYPE III TYPE XII
TYPE V TYPE XIV
Classification of Cementum
Presence or absence of cells
Origin of collagenous fibers of the matrix Prefunctional and functional
A: Acellular cementum B: Hyaline layer of Hopwell-Smith C: Granular layer of Tomes D: Root dentin
Cellular: Has cells Acellular: No cells and has no structure Cellular cementum usually overlies acellular cementum
Acellular
Cellular
CEMENTUM
Canaliculus GT Lacuna of cementocyte
Dentin
Acellular cementum Cellular cementum Hyaline layer (of Hopewell Smith) Granular layer of tomes Dentin with tubules
Cementoblast and cementocyte Cementocytes in lacunae and the channels that their processes extend are called the canaliculi Cementoid: Young matrix that becomes secondarily mineralized Cementum is deposited in increments similar to bone and dentin
Are acellular and cellular cementum formed from two different sources? One theory is that the structural differences between acellular and cellular cementum is related to the faster rate of matrix formation for cellular cementum. Cementoblasts gets incorporated and embedded in the tissue as cementocytes. Different rates of cementum formation also reflected in more widely spaced incremental lines in cellular cementum
Classification Based on the Nature and Origin of Collagen Fibers Organic matrix derived form 2 sources: 1. Periodontal ligament (Sharpeys fibers) 2. Cementoblasts Extrinsic fibers if derived from PDL. These are in the same direction of the PDL principal fibers i.e. perpendicular or oblique to the root surface Intrinsic fibers if derived from cementoblasts. Run parallel to the root surface and at right angles to the extrinsic fibers The area where both extrinsic and intrinsic fibers is called mixed fiber cementum
Combined classification
Acellular Extrinsic Fiber Cementum (AEFC-Primary Cementum) Located in cervical half of the root and constitutes the bulk of cementum
The collagen fibers derived from Sharpeys fibers and ground substance from cementoblasts
Covers 2/3rds of root corresponding with the distribution of primary acellular cementum Principal tissue of attachment Function in anchoring of tooth Fibers are well mineralized
CE junction
Cementum overlaps enamel Cementum just meets enamel Small gap between cementum and enamel 60% 30% 10%
Aging of Cementum
1. Smooth surface becomes irregular due to calcification of ligament fiber bundles where they are attached to cementum Continues deposition of cementum occurs with age in the apical area. [Good: maintains tooth length; bad: obstructs the foramen Cementum resorption. Active for a period of time and then stops for cementum deposition creating reversal lines Resorption of root dentin occurs with aging which is covered by cemental repair
2.
3.
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Cementicles
Calcified ovoid or round nodule found in the PDL Single or multiple near the cemental surface Free in ligament; attached or embedded in cementum Aging and at sites of trauma Origin: Nidus of epithelial cell that are composed of calcium phosphate and collagen to the same amount as cementum (45% to 50% inorganic and 50% to 55% organic)
Cemental Repair
Protective function of cementoblasts after resorption of root dentin or cementum Resorption of dentin and cementum due to trauma (traumatic occlusion, tooth movement, hypereruption) Loss of cementum accompanied by loss of attachment Following reparative cementum deposition attachment is restored
Clinical Correlation
Cellular cementum is similar to bone but has no nerves. Therefore it is non-sensitive to pain. Scaling produces no pain, but if cementum is removed, dentin is exposed causes sensitivity
Cementum is resistant to resorption especially in younger Patients. Thus, orthodontic tooth movement causes alveolar bone resorption and not tooth root loss
ALVEOLAR PROCESS
Bone of the jaw containing sockets for teeth. Consist of cortical plate, spongiosa and alveolar bone. Cortical plate and alveolar bone meet at alveolar crest.(1.5-2mm below the CEJ)
ALVEOLAR PROCESS
Alveolar bone is perforated by foramina and referred as lamina dura radiographically because of increased radiopacity. Bundle bone is the bone lining the socket (inner aspect of alveolar bone). PDL fibers are embedded in this bone.
PERIODONTAL LIGAMENT
Soft specialize connective tissue b/w cementum & alveolar bone. 0.15 0.35 cm in width. Thinnest around middle third of root. Decrease with age.
FUNCTIONS
Supports teeth in their sockets. Withstand force of mastication. Act as sensory receptor.
DEVELOPMENT
Dental follicle Initially ligament space consist of unorganized connective tissue with short fiber bundles extending into it from the bone and cemental surfaces. Ligament mesencymal cells secret collagen type I which assemble as bundle extending from bone and cemental surfaces.
Several uncollagenous protein are also secreted that help in maintainence of PDL spaces. Eruptive tooth movement & the establishment of occlusion modify this initial attachment. Obliquely (apical direction) horizontally oblique (coronal direction)
CELLS
FIBROBLAST: Principle cells. High rate of turn over of protein. Well developed cytokeratin. EPITHELIAL CELLS: cells rest of Melassez. UNDIFFERENTIATED MESENCHYMAL CELLS. BONE &CEMENTUM CELLS.
FIBERS
Collagen type I, III, XII Arrange in bundles known as principle fiber bundle of PDL. Alveolar crest group: below CEJ running downwards and outwards. Horizontal group: apical to alveolar crest running horizontally. Oblique group : most numerous, oblique direction and insert in bone coronally.
Apical group: around the apex of the root forming base of socket. Inter- radicular group: between two roots.
GINGIVAL LIGAMENT
Fiber found in lamina propria of the gingiva Collagen fibers associated with maintaining the functional integrity of the periodontium Dentogingival group: from cervical cementum to lamina propria of free and attached gingiva. Alveologingival group: from bone of the alveolar crest to lamina propria of free and attached gingiva.
Circular group: 1. Forms a band around the neck of the tooth. 2. Interlacing with other group of fibers in the free gingiva. 3. Bind free gingiva to the tooth.
Dentoperiosteal group: Runs apically from cementum over the periosteum of the outer cortical plates of the alveolar process. Transeptal fiber system: 1. Runs interdentally from cementum just apical to the base of junctional epithelium of one tooth over the alveolar crest and inserted into a cementum of other tooth 2. Interdental ligament
ELASTIC FIBERS
Oxytalan in PDL. Elaunin in gingival ligament. From cementum to root apex forming a branching meshwork that surrounds the roots.
GROUND SUBSTANCE
70% Water. Glycosaminoglycans.
BLOOD SUPPLY
Superior and inferior alveolar arteries. Enter PDL called perforating arteries. > In posterior teeth. > Mandibular teeth. Arteriovenous anastomoses. Lymphatics follows the venous drainage.
NERVE SUPPLY
Run from apical region towards the gingival margin Join by fibers entering laterally through the foramina of the socket wall > in apical region Nociceptors and mechanoreceptor