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CEMENTU

DR. PRIYAANCA SAXENA

2008
JAIPUR DENTAL COLLEGE
6/27/2008
Cementum
CEMENTUM
CEMENTUM is calcified avascular mesenchymal tissue that forms the outer
covering of anatomic root. Its provides anchorage mainly
to principal fibres of periodontal ligament. Two surfaces of
collagen fibres can be found in the cementum:

1 Sharpey’s fibres which are formed by the fibro blast .

2 Fibres belonging to the cementum matrix per se


[intrinsic] produced by cementoblasts.

Two types of cementum were described earlier:

1 Acellular cementum / primary cementum

2 Cellular cementum/ secoundary cement

Acellular Cementum Cellular Cementum

1 Forms during Root formation 1 Forms after eruption of tooth & in


response to functional demands

2 Doesn,t contains any cell 2 Contains cementocytes

3 Seen at the coronal portion of the 3 Seen more apically


root

4 Formation is slow 4 Deposition is more rapid

5 Arrangement of collagen fibres is 5 Collagen fibres are irregularly


more organized arranged

CL ASSFICATION
Depending on location , morphology and histolological appearance ,shroeder and
page have classified cementum as:

a. Acellular afibrillar cementum (AAC): It contains only the mineralized ground


substance. It does not contain collagen fibers nor does it exhibit entrapped
cementocytes. It is a product of cementoblasts and is found almost exclusively on
the enamel near the cementoenamel junction with a thickness of 1 to 15 m.

b. Acellular extrinsic fiber cementum (AEFC): By definition it is composed primarily


of Sharpey’s fibers of periodontal ligament but does not contain cementocytes.
Developmentally they come to occupy the coronal one half of the root surface. Its
thickness is between 30 and 230 m.

c. Cellular mixed stratified cementum (CMSC): It harbours both intrinsic


(cementoblasts derived) and extrinsic (fibroblast derived) fibers and may contain
cells. In humans it is seen in the apical third of the roots, apices and furcation areas.
Its thickness varies from 100 to 1000 p.m.

d. Cellular intrinsic fiber cementum (CIFC): It contains only intrinsic fibers secreted
by cementoblasts and not by the periodontal ligament fibroblasts. In humans it fills
the resorption iacunae.

e. Intermediate cementum (or) the hualine layer of Hope Well Smith: It is an ill-
defined zone extending from pre-cemenfoenamel junction to the apical 1/3rd of the
root. It appears to contain cellular remnants of Heriwigs Sheath embedded in
calcified ground substance. The significance of this layer is that. it contains enamel
like proteins, which helps in attachment of cementum to dentin. It has been
observed by many that, when this layer is removed during root planing procedure,
the resultant reparative cementum that is formed will not be attached firmly on the
dentin.

DEVELOPMENT OF CEMENTUM
To understand the development of cementum one has to understand the root
formation. Development of cementum and root of the teeth starts once the
formation of enamel is completed.
Early development of cement

The outer and inner epithelial together form the epithelial root sheath of Hertwig
,which is responsible for determing the shape of the root .

The outer and inner epithelial layers become continuous in area of the cej and form
a two layered sheath ,which grows in underlying mesenchyme.

The root sheath bends horizontally at level of future cement enamel junction
forming the epithelial diaphragam ,following which the cervical opening becomes
smaller.

Once the crown formation is complete the cells of the inner enamel epithelium
loose their ability to form enamel epithelium ,but retain the ability to induce
perimesenchymal cells differtiante into odontoblasts and to proceed with the
formation of predentin and dentin .

The root sheath at this stage becomes discontinuous

After the dentin formation is completed ,certain changes occur in root sheath , the
epithelial cells of root sheath produce a layer of on root dentin ,has hyaline layer of
“ HOPE WELL SMITH or INTERMEDIATE CEMENTUM” .

The root sheath at this stage becomes discontinuous and enable the surrounding
follicular mesenchyme to come in contact with the amelogein
These follicular cells then differentiate into cementoblast and deposit the organic
matrix of cementum on the root surface.

LATER DEVELOPMENT OF CEMENTUM


C ementoblast are cuboidal cells that are
arranged on the outer surface of the hyaline
layer . These cells are responsible for the
organic matrix .

These cells are responsible for the


deposition of the organic matrix of
cementum which consists of cementum
which consists of proteoglycan ground
substance ,intrinsic collagen fibres and is
followed by subsequent mineralization of
organic matrix .

Mineralization starts with the formation of a


thin layer called cementoid . Mineral salts
are derived from the tissue fluid containing
calcium and phosphate ions and are deposited as hydroxiapatite crystals .

The disintegrated hertwigs root sheath slowly moves away from the root surface
and remain in the periodontal ligament forms from the dental follicle soon after
root formation begins

As the cementum continues to increase in thicknes more fibres become


incorporated into the cementum a nd eventually called as “SHARPEY”S FIBRES “
,when periodontal ligament become established .

Aleveolar bone forms around the periodontal ligament. Thus space of periodontal
ligament become narrower.

Functions
a. Primary function of
cementum is to provide
anchorage to the tooth in its
alveolus. This is achieved
through the collagen fiber
bundles of the periodontal
ligament, whose ends are
embedded in cementum.
b. Cementum also plays an important role in maintaining occlusai ielationsps.
whenever the incisal and occlusal surfaces are abraded due to attrition, the tooth
supra erupts in order to compensate for the loss and deposition of new cementum
occurs at the apical root area.

COMPOSITION

The cementum is composed of both inorganic (46%) and organic matter. The
organic matrix is chiefly composed of 90 percent Type I collagen. 5 percent Type III
collagen and non-collagenous proteins like enamel proteins, adhesion molecules
like tenacin and fibronectin, glycosaminoglycans like chondroitin sulfate, dermatans
sulfate & heparan sulfate which constitute the remaining organic matrix.

Thickness of Cementum
Formation of cementum is a continuous process, the formative rate of which varies
throughout life. It is most rapid at the apical regions. At the coronal half the
thickness varies from 16 to 60 p.m (almost the thickness of hair) and at the apical
third it varies from 150 to 200 p.m. it is thicker in the distal surfaces as compared to
the mesial surfaces and this can be explained by functioral stimulation following
mesial migration.

Hypercementosis or cemental hyperplasia is a rominent thickening of the


cementum. It can be localized or generalizd. It may ppçggpzed thic1cenjpgf the
cemen±unj.ith nodular eniargemnt a pgor as spike like projections (cemental
spikes). The etiology of hypercementosis is not very well understood.TI1spike like
projections could be as a result of excessive tension from orthodontic appliancçor
occlusal forces. The generalized type may be associated with a variety of situations
like, teeth without antagonists, in teeth with chronic pulpal and periapical infections.
J7Yypercementosis of the entire dentition may be seen in patients with Paget’s
disease.

Cementoenamel Junction
At the cementoenamel junction three types of relationships may exist. In about 6o
-65 percent of cases the cementum overlaps the enamel, in about 30 percert of
cases end-to-end_relationship of enamel and cementum is seen and to 10 percent
the cementum and enamel fail to meet.

Cemental Resorption and Repair

Cemental resorption may be caused by local, systemic idiopathic factors. Local


conditions that contribute to cemental resorption are, trauma from occlusion,
orthodontic tooth movement, pressure from erupting teeth, cysts and tumors, teeth
without functional antagonist, per apical disease and periodontal disease,systemic
conditions that may predispose to cemental resportion are calcium deficieny,
hypothyroidism and pagets disease.

Remodellin g of cementum requires the presence of viable connective tissue and


occur even in non-vital teeth.

Cernentum is not exposed to the oral environment because it is covered by alveolar


bone and gingival . In cases of gingival recession and as a consequence of loss of
attachment in pocket formation, cementum can become exposed to the oral
environment. Once exposed organic substances, inorganic ions and bacteria
pentrate the sufficiently permeable cementum. Caries of the cementum may also
develop.

PATHOLOGIES ASSOSIATED WITH CEMENTUM


1. HYPERCEMENTOSIS
2. BENIGN CEMENTOBLASTOMA
3. PERIAPICAL CEMENTAL DYSPLASIA
4. HYPOCEMENTOPHOSPHATASIA
5. PAGET’S DISEASE

SUMMARY
1. Cementum is a calcified avascular mesenchymal tissue that forms the outer
covering of the anatomic root
2. Acellular cementum forms during root formation and is seen at the coronal
portion of the root, whereas cellular) cementum forms after eruption of the tooth
and is seen apically on the root.
3. The cementum consists of 46 percent inorganic matter and the rest 90
percent omanic being Type I collagen and the remaining consists of non-
collagenous proteins.
4. Three types of relationships of cementum may exist at the cementoenamel
junction. In 60 to 65 percent of cases cementum overlaps the enamel, in 30 percent
edge-to- edge butt joint exists and in 5 to 10 percent the cementum and enamel do
not meet.

BIBILIOGRAPHY
1. A.R. TENCATE
2. JAN LINDE
3. S.N.ORBAN’S
4. NEWMAN, TAKEI, FERMIN, A. CARRANZA