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33: Cementum

33: Cementum

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Published by NYUCD17
5/1/14
5/1/14

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Transcribed by Joseph Schwimmer Craniofacial Biology - Lecture #33
 –
 Cementum 5/1/14
(lecture given 5/2/13)
 
Slide 1
 –
 Introduction
Dr. Ronald Craig
– 
 (begins mid-
sentence) …
the periodontal connective tissue attachment apparatus, right, so
that’s cementum, periodontal ligament, alveolar bone. We’ve also talked ab
out formation of the dental gin
gival junction, or otherwise called the gingival connective tissue attachment briefly. That’s cementum into
which fibers attach to go out into the gingiva, so
that’s coronal to the periodontal connective tissue attachment, and then there’s this epithelium that’s attached to the two surface junctional epithelium, and that’s called epithelial attachment. So you got three different attachments to the teeth. So let’s begin a
discussion of each one of the component of periodontal
tissue, so we’ll spend about 40
-45 minutes on
cementum and then the big one is periodontal ligament because it has a lot of stuff in there. Then we’ll talk a
little bit about alveolar bone,
my understanding is that you’ve got a lot of bone biology so you probably don’t need much more, only that which is associated with alveolar bone. And then we’ll have two hours on gingiva,
gingival connective tissue and epithelium, because if you understand
the biology there’s a lot of neat things you can do for your patients, gingivally, gingival surgery and stuff like that. So let’s talk a little bit about
cementum. So I think of cementum as being the last frontier of the human
body. There’s not a lot of it, so it’s really har to study, and we rally don’t have a good cell culture system, we haven’t been able to coulture cementoblasts in plate. We really don’t have any proteins or genes that are characteristic of cementum, there’s a couple on the horizon, but they’re not really great. So because of lacking a cell model system, not
having a lot of the extracellular matrix to begin with, and not have any markers for cementum
, we really don’t
understand cementum very much. Of course, you have to have cementum to ha during evolution of our
species, so all that’s kind of combined together to sort of make cementum sort of an unknown field.
But an
important one, because if you’re gonna get a periodontal connective tissue attachment apparatus on teeth or
on biomateria
ls, and that’s where everybody is kind of looking now, can I get a periodontal connective tissue attachment apparatus on the implants. Now implants are good, but they can’t move, they don’t do the things
teeth do, can I get a periodontal connective tissue attachment apparatus on dental implants then I can do all
the things with dental implants that I can do with teeth, so people are kind of focused on this and we’ll talk a
little bit about that next week. Slide 2 - Cementum
So right now let’s talk about cementum as a tissue, I think I’ve got some summary slides here.
 Slide 3
 –
 Components We know a bout the functions of the periodontium. We know all these things are just to recapitulate. So
here’s the gingival epithelium up here, so right in here this area is not attached to the tooth surface, cause that’s called sulcus,
if it’s not inflamed it’s called a sulcus, if it’s inflamed it’s called a pocket.
We haven’t
talked about pathology yet, so all this is sulcus, so sulcular epithelium and then junctional epithelium is attached to the tooth surface, so all this is junctional epithelium, and classically, the junctional epithelium should terminate at the cementoenamel junction, and this cartoon has kind of missed that here. But you can kind of see it in the actual section. So in health, junctional epithelium terminates at the cementoenamel  junction which is right here. So this is the epithelial attachment, epithelial cells are attaching to the enamel surface. Down here you have
 
cementum and you have these fibers that are going down to the gingiva, so
that’s the gingival connective tissue attachment, and here’s
 the alveolar crest, this is kind of unusual, usually the alveolar crest is lower down. So fibers that go down from cementum through the periodontal ligament to
 
the alveolar crest are called periodontal connective tissue attachment apparatus. So there’s 3
different ways
of attaching tissue to a natural tooth, and we’ll compare this
with dental implants, as implants are getting more and more kind of important. Slide 4
 –
 Components And we already talked about some of the components. Slide 5
 –
 Classification
So, cementum, there’s nomenclature that has to go, has to be presented, and it’s kind of confusing, so I’
m gonna try to give you an easier way of sorting kinds of cementum in your mind. So some people classify
cementum by time of formation, why? I don’t
 know. But primary cementum is that which is formed before the tooth erupts into the oral cavity. And secondary cementum isi that this forms after the tooth erupts into the
oral cavity. Biochemically, cell biology, clinically, it doesn’t have any real relevance. So I’m just giving that to you for your background. Location, some people classify cementum by where it’s found on the tooth. So, you
can have radicular cementum which is on the tooth root, or sometimes you can get some cementum on the enamel surface. So what we think is that the reduced enamel epithelium
 –
 in humans
 –
 may break down, allowing cells of the dental follicle to attach, or to contact that enamel surface, and that induces cementum formation. So those of you who have little children, as their six year molars erupt, if you kind of pry their little
mouths open and take a look, sometimes you’ll see this chalky
-whitish flaky material on the apical 1/3 of their
crowns, and that’s little flecks of cementum formation where the reduced enamel epith
elium broke down. Some species like cown horses and ungulate, they exploit the differences in density between enamel, dentin and cementum to make an ecer-renewing surface to grind grasses with. So if you look at a cow molar nad all of you should as dentists know about every tooth in the entire animal kingdom, there are these sort of elongated
 –
 they look like a washboard, and if you look at the surface of the cow molar, it has like a layer, or zone of enamel, then a layer or a zone of dentin, then a layer or a zone of cementum. And as the cow grinds grains and stuff, the cementum wears faster than the dentin and the dentin wears faster than the enamel, so you always have like a sharp surface to grind against, which is kind of neat. So those are ungulates. S
o that’s called coronal cementum. So if the cementum is found on the crown of the tooth, that’s called coronal cementum. That really doesn’t have much interest for us. For some reason, in our profession we’ve really gotten into this idea of acellular ceme
ntum versus cellular
cementum. And I’ve already kind of told you that there’s some suspicion that a
cellular cementum may be distinct
from cellular cementum. So acellular cementum is the first cementum that’s laid
down during tooth formation. And over that acellular cementum surface, you can get cementum that has incorporated into it,
cementocytes, so it’s called
cellular cementum. (inaudible student question) No. so this is why is throw out
that kind of idea, and you’ll see why in a second. And cellular cem
entum tends to form on the apical 1/3 of the root surface, but it can form in other places. So what I tend to like, and most people in the profession tend to like is the following classification system. Slide 6
 –
 Classification So all cementums can either have no cells in it, or it can have cells, and all cementums can either have fibers
attaching into it from the periodontal ligament or from the gingiva, that’s called the extrinsic fibers of dental cementum. They’re cemented into the cementum matrix and
they either go out into the gingiva or into the
periodontal ligament. Or if there’s no periodontal ligament, say if it’s coronal cementum, there’s nothing to attach to, so there are no fibers, it’s afibrillar.
Ad so you can mix and match those two guys together and you
can kind of accurately describe what kind of cementum you’re dealing with. So the first cementum that’
s laid
down as the tooth root forms doesn’t have any cells, so it’s acellular, but it has fibers in it. So it’s acellular
 
fibrillar cemen
tum. On top of that may form a cementum that has cells incorporated in it so it’s cellular, but it still has the fibers associating into it, so it’s cellular fibrillar cementum. We get back to our friend the cow, the cementum that’s on the tooth surface in
 
the cow’s mouth, what kind of cementum would it be? Would it have cells or no cells? No cells, can’t live out there, can’t live in the barnyard. Would it have fibers or no fibers?
Nothing to attach to, so
it has no fibers. So it’s acellular afibrillar cem
entum. Now to get back to your question,
we’ll see that it’s actually possible to regenerate down cementum.
So the people who came up with that
previous classification system of primary and secondary, they didn’t know that you can regenerate, they came
up
with that terminology before we understood how to actually regenerate lost tissue. So it doesn’t really make much sense. So that’s why we kind of go with cells and fibers together.
Slide 7
 –
 Dental development
And we’ve already kind of talked about all this, right?
Slide 8
 –
 
Hertwig’s
 
And we’ve talked about Hertwig’s epithelial root sheath.
Slide 9
 –
 HERS
But what we didn’t talk about was this intermediate cementum layer. So the inner cell layer of Hertwig’s
 epithelial root sheath is biosynthetic and then it makes this wonderful matrix called intermediate cementum, and after it makes that matrix it pulls away, or it appears to pull away, it loses contact with this
 –
 probably a better term
 –
 loses contact with that intermediate cementum layer, and some of the cells fenestrate and in come these cells from the dental follicle and attach at the intermediate cementum layer. And they differentiate in the cementoblasts. So since the first step in development and if you want to regenerate lost periodontal connective tissue attachment apparatus is the development of cementum, or the deposition of
cementum, people all over the world really kind of focused in on what’s the induction factor for cementum
formation. So there
was a person, Harold Slavkin, was past dean of USC dental school, general dentist. He’s also the past director of the national association of Dental Research, and Harold’s a general dentist, and Harold’s golden fleece, if you will, is to create a tooth, a
 
whole tooth, and put it back into people, because he’s tired of doing fillings, he’d rather just regenerate a lost tooth. And Harold is a very charismatic man. I remember once USC was playing UCLA and you know how in halftime they’ll have like faculty mem
bers being
interviewed, and so there I am and I’m having an adult beverage, and I’m watching the game on New Years Day, and all of a sudden, there’s Harold Slavkin, and he has this long hair, so he sort of looks like the MGM lion in a way, and he’s talking
 
about, “what we’re gonna do is clone these cells and combine them together and we’re gonna put them back in people’s mouths”, and I’m like wow.
Along his pathway to bioengineering a tooth, he had to clone genes that are associated with enamel formation. So he was trying to clone the amelogenin
gene. So the amelogenin gene is like the devil’s own protein. So it’s like 72kD protei
n and you can isolate it from forming tooth buds and you can see it on your polyacrylamide gel, and you cut out the 72kD protein,
and you can send it for amino acid analysis, and they tell you oh you didn’t give me a 72, you gave me a ladder of peptides, so the protein itself is autoproteolytic, so it dissolves itself. So Harold felt, if I can’t sequence it that way so what I’ll do is I’ll make monoclonal antibodies against all the little peptide fragments and I’ll pull out the CNDA clones with my monoclonal antibodies. So as the story goes, he had this enormous
room filled with post docs looking at microscope sections of developing teeth, making sure that the monoclonal antibodies that he was generating against amelogenin actually lit up the forming crown of the
tooth. So in walks my friend, he’s not my friend he’s kind of like my mentor, Lars
Hammerstrom from Sweden, everything comes form Sweden, and Lars worked at that time at the Karalinska Institute, those are the people who give out the Nobel prizes, so Lars is very interested in cementum formation, so he takes a sabbatical at USC and he sees all these guys looking at these micros
copes and he’s not interested in the crowns, he’s

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