EMBRYOLOGY &

HISTOLOGY OF
CEMENTUM

Dr.Kemer K.
 STAGES OF TOOTH
DEVELOPMENT
1. Bud stage
(epithelial ingrowth into ectomesenchyme)

2. Cap stage
(further epithelial growth)

3. Bell stage
(histo- and morpho-differentiation)

4. Appositional stage (mineralization)

(formation of enamel and dentin of crown)

5. Root formation
(formation of dentin and cementum of root)

6. Eruption

Oral Histology and Embryology

 CEMENTUM
 Is mineralized dental tissue covering the anatomic roots of
human teeth.

 Begins at cervical portion of the tooth at the cementoenamel

junction & continues to the apex.

 Furnishes a medium for the attachment of collagen fibers that

bind the tooth to surrounding structures.

 Makes functional adaptation of the teeth possible.

 Unlike bone, human cementum is avascular.

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• One of the main functions of cementum is to anchor the
principal collagen fibers of the periodontal ligament to the root
surface, but it also has important adaptative and reparative
functions, playing a crucial role to maintain occlusal
relationship and to protect the integrity of the root surface.
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THICK CEMENTUM ON ROOT APICES IN
AN ELDERLY PERSON

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 PHYSICAL CHARACTERSTICS

Hardness is less than that of dentin.

Yellowish in color.

Can be distinguished from enamel by its lack of luster & its

darker hue.

Semi-permeable to a variety of materials.

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 CHEMICAL COMPOSITION
Contains 45% to 50% inorganic substances & 50% to 55% organic
materials & water.
Cementum is generally less mineralized than root dentin from the same
teeth, although not without exception.

As in other hard tissues, the hydroxyapatite of cementum is not pure, but
contains other elements (ions) incorporated into mineral phase during
mineralization, depending on their concentration in the fluid environment.

Cementum has the highest fluoride content of all the mineralized tissues.

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 ORGANIC COMPOSITION
• Organic portion consists primarily of type I collagen & protein
polysaccharides (proteoglycans).

• Type I collagen plays structural as well as morphogenic roles and provides

scaffolding for mineral crystals; it is the major component, accounting for
90% of all collagens. The type III collagen, which coats type I collagen
fibrils, accounts for only 5%. Cementum contains two major non-
collagenous proteins, bone sialoprotein (BSP) and osteopontin (OPN). Both
are phosphorilated and sulfated glycoproteins. These proteins, which are
prominently expressed in acellular cementum.
CELLULAR COMPONENTS OF
CEMENTUM

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 CEMENTOBLASTS
Soon after Hertwig’s sheath breaks up, undifferentiated
mesenchymal cells from adjacent connective tissue
differentiate into cementoblasts.

Synthesize collagen & protein polysaccharides which

make up the organic matrix of cementum.

Have numerous mitochondria, a well-formed golgi

apparatus, & large amounts of granular endoplasmic
reticulum.

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FORMATION OF ROOTS
Hertwig epithelial root sheath
(HERS)
- Apical extension of cervical loop
- Inner+outer enamel ep.
- Not making enamel
- Framework of root formation

root sheath epithelial diaphragm

(size/shape/number of roots)

Oral Histology and Embryology

 FORMATION OF ROOTS

odontoblasts root dentin

cementoblasts cementum
fibroblasts periodontal ligament
osteoblasts alveolar bone

disintegrated

Oral Histology and Embryology

 FORMATION OF ROOTS

2 HERS cementoblasts 4
dental sac cells cementum 5
3 becoming
cementoblasts
odontoblasts

dental sac dentin 1

1. Formation of root dentin by odontoblasts
2. Disintegration of HERS
3. Migration of ectomesenchymal cells from dental sac to the root dentin through the
disintegrated HERS
4. Differentiation of ectomesenchymal cells into cementoblasts and fibroblasts
5. Formation of cementum and collagen fibers
- cementoblasts : secret cementoid (matrix) and mineralize cementum on root dentin
- fibroblasts : synthesis of collagen fibers of periodontal ligament
* Sharpey’s fiber : collagen fibers embedded in cementum
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ULTRASTRUCTURE OF CEMENTOCYTE
NEAR CEMENTUM SURFACE.

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ULTRASTRUCTURE OF CEMENTOCYTE
DEEP IN CEMENTUM

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 CEMENTOID TISSUE
The uncalcified matrix is called cementoid.

Mineralization of cementoid is a highly ordered event & not the random

precipitation of ions into an organic matrix.

Fibers are embedded in the cementum & serve to attach the tooth to
surrounding bone. Their embedded portions are known as Sharpey’s fibers.

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 SCHROEDER’S CLASSIFICATION
Acellular afibrillar cementum
- Contains neither cells nor extrinsic or intrinsic collagen
fibers, except for mineralized ground substance. Coronal
cementum.(1-15um)
 Acellular extrinsic fiber cementum
- Composed almost entirely of densely packed bundles of
Sharpey’s fibers. Cervical third of roots. (30-230um)
 Cellular mixed stratified cementum
- Composed of extrinsic & intrinsic fibers & may contain
cells. Co-product of cementoblasts & fibroblasts. Apical
third of roots, apices & furcation areas. (100-1000um)
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Cellular intrinsic fiber cementum
- Contains cells but no extrinsic collagen fibers. Formed by
cementoblasts.

 Intermediate cementum
- Poorly defined zone near the cementodentinal junction. Contains
cellular remnants of Hertwig’s sheath embedded in calcified
ground substance.

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Cementum can be differentiated into: acellular & cellular
cementum.
Acellular cementum does not have spiderlike cementocytes
incorporated into it.

Acellular cementum is found at the coronal half whereas the cellular

cementum is found at the apical half.

Cementum is thinnest at the cementoenamel junction & thickest

toward the apex.

Cementocytes are either degenerating or are marginally active cells.

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ACELLULAR CEMENTUM

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CELLULAR CEMENTUM

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 INCREMENTAL LINES

• Are highly mineralized areas with less collagen and more

ground substance than other portions of the cementum.

• The thickness of cementum does not enhance functional

efficiency by increasing the strength of attachment of the
individual fibers.

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 CEMENTODENTINAL JUNCTION
Smooth in permanent teeth.

Scalloped in deciduous teeth.

Dentin is separated from cementum by a zone known as the intermediate

cementum layer.

This layer is predominantly seen in apical two-thirds of roots of molars &

premolars.

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 CEMENTOENAMEL JUNCTION

In 60% of the teeth, cementum overlaps the cervical end of

enamel for a short distance.

In 30% of all teeth, cementum meets the cervical end of

enamel in a relatively sharp line.

In 10% of the teeth, enamel & cementum do not meet.

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RELATION OF CEMENTUM TO ENAMEL AT
THE CEMENTOENAMEL JUNCTION

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 CLINICAL CONSIDERATIONS

Cementum is more resistant to resorption than is bone, & it is for

this reason that orthodontic tooth movement is made possible.

It is because bone is richly vascularized, whereas cementum is

avascular.

Cementum resorption can occur after trauma or excessive occlusal

forces.

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In most cases of repair, there is a tendency to re-establish
the former outline of the root surface by cementum. This is
called anatomic repair.

However, if only a thin layer of cementum is deposited on

the surface of a deep resorption, the root outline is not
reconstructed.

In such areas the periodontal space is restored to its

normal width by formation of a bony projection, so that a
proper functional relationship will result. The outline of the
alveolar bone in these cases follows that of the root
surface. This is called functional repair.
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 HYPERCEMENTOSIS
Is an abnormal thickening of cementum.

May be diffuse or circumscribed.

May affect all teeth of the dentition, be confined to a single tooth, or

even affect only parts of one tooth.

If the overgrowth improves the functional qualities of the

cementum, it is termed cementum hypertrophy.

If the overgrowth occurs in non-functional teeth or if it is not

correlated with increased function, its termed hyperplasia.

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• Extensive hyperplasia of cementum is occasionally
associated with chronic periapical inflammation.

• Hyperplasia of cementum in non-functioning teeth is

characterized by a reduction in the number of Sharpey’s
fibers embedded in the root.

• Spur or prong like extension of cementum is found in

teeth that are exposed to great stress.

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 Cellular
Cementum,
Cementocytes
, and Dentin
Dentin
Cementum
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ATTACHED CEMENTICLES ON SURFACE OF
CEMENTUM

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