CEMENTUM

 Cementum is the mineralized dental tissue covering the anatomic roots of human teeth.
 It begins at the cervical portion of the tooth at the CE junction and continues to the apex.
 Human Cementum is avascular and non-innervated.
 Cementum is thinnest at the CE junction (20–50 µm) and thickest toward the apex (150–200
µm).
 The apical foramen is surrounded by Cementum.
 Cementum can form throughout the life of a tooth.
 Cementum is light yellow in color and can be distinguished from enamel by its lack of luster and
its darker hue.

FUNCTION

 Cementum furnishes a medium for the attachment of collagen fibers that bind the tooth to
surrounding structures.
 It is a specialized connective tissue that shares some physical, chemical, and structural
characteristics with compact bone.

CHEMICAL COMPOSITION

 Contains about 45%–50% inorganic substances and 50%–55% organic material and water.
 The inorganic portion consists mainly of calcium and phosphate in the form of hydroxyapatite.
 Cementum has the highest fluoride content of all the mineralized tissues.
 The organic portion of Cementum consists primarily of type I collagen and protein
polysaccharides (proteoglycans). The other types of collagen seen are types III, V, VI, and XII.
 The non-collagenous proteins play important roles in matrix deposition, initiation, and control of
mineralization and matrix remodeling.
 Bone sialoprotein (BSP) and osteopontin are two such major proteins that fill up the large
interfibrillar spaces.
 Osteopontin, which is present in Cementum in lesser amounts than in bone, regulates
mineralization.
 Cementum-derived attachment protein (CAP) is an adhesion molecule unique to Cementum. It
helps in the attachment of mesenchymal cells to the extracellular matrix.
 Chondroitin sulfate, heparan sulfate, hyaluronate, keratan sulfates— fibromodulin and lumican;
versican, biglycan, and osteoadherin are proteoglycans present in Cementum.
 In Cementum, Growth Factors, TGF-β, various BMPs, fibroblast growth factor (FGF), insulin-like
growth factor (IGF), epidermal growth factor (EGF), and platelet-derived growth factor (PDGF)
are seen.
 However, a Cementum-derived growth factor is seen exclusively in Cementum.
 Osteoprotegerin (OPG) interferes with the binding of RANKL to RANK receptor in cementoblasts
and helps in the regulation of cemental resorption.
 CEMENTOGENESIS

 The internal and external enamel epithelia proliferate downward as a double-layered sheet of
flat epithelial cells called the root sheath of Hertwig.
 This root sheath induces the cells of the dental papilla to differentiate into odontoblasts.
 These cells secrete the organic matrix of first-formed root predentin consisting of ground
substance and collagen fibrils.
 As the odontoblasts retreat inward, they do not leave behind the odontoblastic process in these
first few layers of dentin. Hence, this layer is structureless and is called Hyaline layer.
 Subsequently, breaks occur in the epithelial root sheath allowing the newly formed dentin to
come in direct contact with the cells of dental follicle.
 At the ultrastructural level, breakdown of Hertwig’s epithelial root sheath involves degeneration
or loss of its basal lamina on the cemental side.
 Loss of continuity of the basal lamina is soon followed by the appearance of collagen fibrils and
cementoblasts between epithelial cells of the root sheath.
 The Cementoblasts are responsible for the formation of Cementum.

FORMATION OF PRIMARY ACELLULAR CEMENTUM

 Cementoblasts synthesize collagen and protein polysaccharides, which make up the organic
matrix of Cementum.
 At the deep surface:
 these fibrils intermingle with those of hyaline layer.
 Some sheath cells migrate away from the dentin toward the dental follicle, whereas
others remain near the developing tooth and ultimately are incorporated into the
Cementum.
 Sheath cells that migrate toward the dental follicle become the epithelial rests of
Malassez found in the periodontal ligament of fully developed teeth.

 At the superficial surface:

 The collagen fibrils produced by the cementoblasts form a fibrous fringe perpendicular
to periodontal space. These cells retreat and intermingle with the fibroblasts of the
periodontal ligament.
 Mineralization of the first-formed dentin of the hyaline layer occurs within matrix
vesicles. But the mineralization does not occur at outermost surface of hyaline layer, but
within it.
 Outermost part of the hyaline layer thus undergoes delayed mineralization.
 The delayed mineralization front of the hyaline layer spreads outward, until it is fully
mineralized and continues into the fibrous fringe secreted by the cementoblasts.

 Thus, the first few layers of acellular cementum are attached to dentin.
 The fibers in the periodontal ligament are parallel to the root surface at this stage. But in the
later stages, the principal collagen fibers of the periodontal ligament become continuous with
the fibrous fringe of Cementum.
 Once the periodontal ligament fibers get attached to the fibrous fringe from acellular
cementum, the cementum is classified as acellular extrinsic fiber Cementum (AEFC).
 In permanent teeth, the attachment occurs only after the tooth has erupted into the oral cavity
(only 2/3rd of the root would have been formed by that time).
 Thus, the acellular Cementum lining the root before this time may be considered as Acellular
intrinsic fiber Cementum.

NOTE:

• Incremental lines called as lines of Salter are seen in Cementum as during the process of
cementogenesis, there are periods of rest and periods of activity.
• The periods of rests are associated with these lines.
• The lines are closer in acellular Cementum as this Cementum is formed slowly.

INTERMEDIATE CEMENTUM

 Epithelial cell rests may be entrapped in the Cementum near cementodentinal junction. That
part of the cementum is called Intermediate Cementum.

 It usually occurs in the apical half of roots of molar teeth

FORMATION OF SECONDARY CELLULAR CEMENTUM

 After the formation of acellular cementum, a less mineralized cementum is formed called
cellular cementum.
 The cementoblasts secrete the collagen fibers and ground substance that form the intrinsic
fibers of cellular cementum.
 These fibers are parallel to the root surface and do not extend into the periodontal ligament.
 Some cementoblasts get entrapped and are called cementocytes.
 Increased rate of cementum formation results in cells getting incorporated into the matrix and a
layer of cementoid being present on the surface.These cementocytes are present in spaces
called lacunae.
 The incremental lines in the cellular cementum are widely spaced because of the increased rate
of formation.
 The development of cellular cementum can be divided into two stages:
• an early stage in which the extrinsic Sharpey’s fibers were few and intrinsic fibers were
randomly arranged, and
• a later stage in which the Sharpey’s fibers were thicker and the intrinsic fibers appeared
to encircle them.
  Since the matrix secretion occurs from different regions of the cementoblast (multipolar mode
of secretion) and the faster rate of formation are believed to be responsible for cementoblast
entrapment in its own matrix leading to the formation of cellular Cementum.

MINERALIZATION OF CEMENTAL MATRIX

 After some cementum matrix has been laid down, its mineralization begins. The uncalcified
matrix is called cementoid.
 Calcium and phosphate ions present in tissue fluids are deposited into the matrix and are
arranged as unit cells of hydroxyapatite.
 Mineralization of cementoid is a highly ordered event and not the random precipitation of ions
into an organic matrix.
 The mineralization of cementum matrix may be controlled by hydroxyapatite crystals in adjacent
dentin, periodontal ligament fibroblasts rich in alkaline phosphatase, and noncollagenous
proteins in the matrix like BSP.
 Mineralization is very slow and occurs in a linear fashion.
 Hence, there is no cementoid seen on the surface of acellular cementum.
 Mineralization of the deeper layer of cementoid of cellular cementum occurs in the linear
manner, but overall this type of cementum is less mineralized than acellular cementum.
 Gla proteins, osteocalcin and osteonectin, act as nucleators for mineralization, due to their
strong affinity for calcium.
 BSP and alkaline phosphatase promote mineralization, while osteopontin regulates growth of
apatite crystals.
 The major proteoglycans located exclusively in the nonmineralized cementum are keratan
sulfates—lumican and fibromodulin. They have a regulatory role in cementum mineralization.
 IGF present in developing and matured cementum monitors mineralization and controls cell
differentiation.

CEMENTOID TISSUE

 Under normal conditions growth of cementum is a rhythmic process, and as a new layer of
cementoid is formed, the old one calcifies.
 A thin layer of cementoid can usually be observed on the cemental surface.
 This cementoid tissue is lined by cementoblasts.
 MOLECULAR FACTORS IN CEMENTOGENESIS

Many factors are involved in cementogenesis. They are growth factors belonging to the TGF-β family
including BMPs, transcription factor core binding factor alpha 1 (Cbfa-1), and signaling molecule EGF.

 Cementoblast Differentiation: BMPs, Cbfa-1, PGE(2), F(2), α FGF, IGF, PDGF

 Downregulation of Cementoblast Differentiation: EGF
 Attachment: CAP, BSP, Laminin, Osteopontin
 Mineralization: Osteonectin, Osteocalcin, BSP, Alkaline phosphatase, Lumican, Fibromodulin,
IGF

Therefore,

1. BMPs are known to promote differentiation of cementoblasts.

2. Cbfa1 is found to be involved in cementoblast differentiation.
3. EGF receptor down-regulates signal transduction from ligands such as TGF-α and EGF to control
cell differentiation.
4. Prostaglandin E(2) and F(2) alpha enhance differentiation of cementoblasts by activating
protein kinase signaling pathway.
5. FGF is shown to promote cell proliferation, its migration and angiogenesis.
6. Dentin noncollagenous proteins stimulate dental follicle cells to differentiate into cementoblast
lineages.
7. IGF and PDGF have a regulatory function in cementoblast differentiation. These molecules
promote cementum formation by altering cell cycle activities.
8. CAP helps in the attachment of selected cells to the newly forming tissue. It is located in the
matrix of mature cementum and in cementoblasts.
9. Osteopontin and BSP contain cell adhesion molecule RGD and promote adhesion of selected
cells onto newly forming root.
10. Laminin has been identified on dentin surface at the initiation of cementum formation.