Ankylosis - Immobility

Cementum & Alveolar Bone fuse

PDL obliterated

Guided Tissue Regeneration

Block gingival/epithelial cell growth
Allow PDL & Bone to regenerate

(1) Aging
Decrease fibroblasts
PDL Decrease organic matrix/cells
Decrease width of PDL
Decrease Decrease repair/regeneration
Increase elastic fibres
Irregular structure

(1) Children

Increase (2) Occlusal Loading

Clinical Implications
Cementicle (Hang Around)
Result of trauma
Can be free in PDL
Masses of cementum

Cementum grows over Enamel (60%)

Dentinal Hypersensitivity
Cementum meets Enamel (30%)

Cementum does not meet Enamel (10%)

Hypercementosis
Cementum Harder to extract

(1) Tooth Grinding

(2) Functional position

(3) Age
Increase Becomes less permeable
Increase width
Increase resorption bays
Decrease

Structure:
Hourglass shape
Narrowest at mid root
Between root & lamina dura
Week 4: Stomatodeum (Primitive Oral Cavity)
Cells Types : Top: Frontal Prominence (Brain)
Ectomesenchymal cells Bottom: Developing Heart
Epithelial cell rests of Malassez Side: 1st Arch
Fibroblasts (Synthesize & Degrade)
Osteoblasts/Odontoblast/Cementoblasts Week 6: Tooth Formation
Osteoclasts/Odontoclast/Cemetoclast
Macrophage/Monocyte Oral epithelium (Gives rise to enamel epithelium)
Mesenchymal cells
Sharpey Fibres (A-H-O-A-I)
1) Placode
Alveolar Crest (Vert)
Downward growth of epithelium
Horizontal (Hori)
Oblique (Vert); Develop first
Apical (Vert) 2) Bud
Inter-radicular (Only in multi rooted; Both) Downward growth of epithelium
Components: Determines tooth morphology
Stages
PDL 3) Cap
Unequal epithelium growth
ECM
Collagen (Develop from tooth side)
Reticulin (Type 3)
(4) Cementum & PDL 4) Bell
Unequal epithelium growth
Oxytalan / Elastin Determines position/height of cusps
GAG/GP Early stage: Histodifferentiation
Advanced stage: Morphodifferentiation

Sensory Undifferentiated: Dental Follicle

Nociception Located bottom of enamel organ; Surrounds entire organ
Myeliated & Unmyelinated Nerves Cementum
PDL
Autonomic Alveolar Bone
Periodontal blood vessels
Unmyelinated Supportive: Differentiated:
Nerves Cementoblast
Blood Vessels Vessels Cementocyte
Mesenchyme Fibroblast
Lingual Artery Lingual & Palatine arteries Cementum
Palatine Artery
Undifferentiated: Dental Papilla
Dentin
Functions: Pulp
(1) Sensory Development Components
(2) Attachment Differentiated:
(3) Nutritive Odontoblast
(4) Absorb Shock Fibroblast
(5) Regenerative Macrophages/Dendritic/Lymphocytes
Undifferentiated Mesenchyme

S-A-N-A-R Enamel Organ

Undifferentiated:
IEE (Columnar) into ameloblasts
Enamel OEE (Cuboidal)
Structure Stellate Reticulum (GAGs)
Thickest at apex/root Oral Epithelium
Thinnest at cervical area Differentiated :
Continuous deposition throughout life Ameloblasts
Cementocyte will degenerate (Avascular) unlike bone

Supporting
Hertwig's Epithelial Root Sheath
NO blood vessels
NO nerves Located at cervical root of enamel organ
NO lymph Fusion of IEE & OEE
SUPPORT FROM PDL Function (1): Guides root formation
Function (2): IEE causes papilla differentiation into odontoblast
Function (3): Secretes Hyaline Layer of Hopewell Smith (Binds cementum to dentin)
Extrinsic Fibre : Fate (1): Apoptosis
Fibres operating outside Fate (2): Become Cementum
Perpendicular to root surface Fate (3): Become PDL
Fate (4): Become Epithelial cell rests of Malassez (Induce undifferentiated cells to differentiate)
Intrinsic Fibre : Cementum Fate (5): Become Cementoblasts
Fibres operating inside
Parallel to root surface

Types
Acellular Extrinsic Fibre
First formed
Mainly for Attachment
Common Type
Cellular Intrinsic Fibre
Found near root

Cementogenesis
Collagen/ECM
Cementoblast entomed
Matrix vesicles (like dentinogenesis)
Heterogeneous nucleation
Incremental lines of (Salter)

Acellular vs Cellular
LOSER
FRCS
DPH
Location: Apical/Cervical
First: First/Second
Rate: Fast/Slow (Lines)
Calcification: More/Less
Sharpey: More/Less
Demarcation(Dentin): Clear/Unclear
Precementum: Yes/No
Housing: Lacunae/Canaliculi

L-F-R-C-S-D-P-H