Shaju Jacob

Shaju_Jacob@imu.edu.my
Extension 2755
Senior Lecturer Dentistry
(Periodontology)

LEARNING OBJECTIVE
This presentation is a continuation from the previous
lecture on healthy periodontium, in this lecture
cementum and bone will be discussed.
At the end of this lecture you will be able to:
Describe clinical and macroscopic features of
cementum and bone
Describe the microscopic feature of cementum and
bone
Discuss its function and its importance

CEMENTUM
IN HEALTH

Definition: Cementum is calcified, avascular

mesenchymal tissue that forms the outer covering of
the anatomic root.
It is also called as substantia ossea.
It was first discovered microscopically demonstrated
by two pupils of Purkinje in 1835.

CEMENTUM

It serves to invest and

attach the periodontal
fibers

To maintain the thickness of

root in apical region

COMPOSITION
INORGANIC:
Calcium and phosphate in the form of HYDROXYAPATITE
crystals
These crystals are 55nm wide,8nm thick
Highest fluoride content
Calcium and magnesium
TRACE AMOUNT:
Copper, Fluorine, Iron, Lead,
Potassium, Silicon, Sodium and Zinc

ORGANIC:

Collagen:
Type I - 90%
Type III - 5%

Non-Collagenous Protein:
Cementum is rich in glycoconjugates, which represent
either glycolipids, glycoproteins or proteoglycans and harbors
a variety of other proteins.

The predominant noncollagenous proteins are:

1) Bone sialoprotein
2) Osteoponitin

3) Osteonectin
4) Fibronectin, Tenasin

CELLS OF CEMENTUM:
a) Cementoblast
b) Cementocytes
c) Cementoclast

CEMENTOCYTES

CEMENTOBLASTS

Cemental Fibers
Sharpeys Fibers (extrinsic):
These fibers are embedded
portions of the principal fibers
of the periodontal ligament and
are formed by fibroblasts.

Intrinsic Fibers: these are

fibers that belong to the
cemental matrix and are
produced by cementoblasts.

Structure of cementum
Under light microscope, two types of cementum
are visible. Based on the presence or absence
of cells they are classified as:

Acellular Cementum ( Primary

cementum)
Cellular cementum ( Secondary
cementum)

It will be seen under two headings:

Formation
Anatomical Characteristics

Formation of Acellular Extrinsic fiber cementum

The first cells that align along the newly
formed, but not yet mineralized, mantle
dentin
surface
exhibit
fibroblastic
characteristics.
Mineralization of the mantle dentin takes
place
Intermingling of collagen fibers at cementum
and dentin interface.
Then fiber fringe extends towards PDL.

Initial acellular extrinsic fiber

cementum thus consists of a thin
mineralized layer with a short
fringe of collagen fibers
implanted perpendicular to the
root surface inserting in mantle
dentin

Cells on the root surface

secrete noncollagenous
matrix proteins that fill in the
spaces between the
collagen fibers and regulate
mineralization of the
forming cementum layer.

Bone sialoprotein

This activity continues until about

1520 um of cementum has been
formed, at which time the intrinsic
fibrous fringe becomes connected to
the developing periodontal ligament
fiber bundles.

Anatomic characteristics of acellular

cementum

It is the first formed cementum and is therefore

referred to as primary cementum.
It covers approximately the cervical third or half of
the root. It does contain any cell.
This cementum is formed before tooth reaches the
occlusal plane and its thickness ranges from 30 to
230 microns.
It is thinnest at the cementoenamel junction and
thickest towards root apex.
Sharpeys fibers make up most of the structure of
acellular cementum.
Acellular cementum also contains intrinsic collagen
fibrils that are calcified and are irregularly arranged
or parallel to the surface.

Formation cellular Intrinsic Fiber

Cementum
Cementoblasts start forming a less mineralized
layer.
Matrix proteins that fill in the spaces between the
collagen fibrils, regulate mineral deposition and
impart cohesion to the mineralized layer.
A layer of unmineralized matrix, termed
cementoid.
Collagen fibrils are produced rapidly and
deposited haphazardly during the initial phase;
however, subsequently the bulk of fibrils organize
as bundles oriented mostly parallel to the root
surface.

cementoblasts start forming a

less mineralized variety of
cementum

As the process proceeds, some

cementoblasts become trapped in the
matrix they form. These entrapped cells,
with reduced secretory activity, are
called cementocytes and sit in lacunae.

Cellular
Cementum

Canaliculi of
cementocytes
Lacunae of
cementocyte

Some cementoblasts
become trapped in the matrix
to form cementocytes and sit
in lacunae.

Cementoid

Cementocyte

Cementum

Anatomic Characteristics of
Cellular cementum
It is the cementum is formed after the tooth
reaches the occlusal plane.
It is more irreglular and contains cells within
its matrix called cementocytes.
Cellular cementum is more on the apical half
of the root.
It is less calcified than acellular cementum.
Sharpeys fibers make up smaller portions and
are separated by collagen fibers.

Formation of cementum continues throughout the life, it is

the cellular cementum which continuously contributes to
the length of root.

Classification of Cementum:
Based on the findings Schroeder 1985
classified cementum:
Acellullar afibrillar cementum: (AAC):

Acellular extrinsic fiber cementum:(AEFC)

Cellular mixed stratified cementum; (CMSC):

Cellular intrinsic fiber cementum (CIFC):

Intermediate cementum:

1. Acellular Afibrillar
cementum
2. Acellular Extrinsic fiber
cementum
3. Cellular intrinsic fiber
cementum
4. Cellular Mixed stratified
cementum

Intermediate Cementum or hyaline layer of Hopewell Smith.

Periodontal
ligament

cementum

Intermediate
cementum

Dentin

Clinical Significance: hyaline layer contains epithelial derived enamel like

proteins and has an important role in the attachment of cementum to the
dentin surface.

CEMENTO ENAMEL JUNCTION:

60% to 65% Cementum overlapping the enamel
30% End-to-end relationship of enamel and cementum

5% to 10% space between enamel and cementum with dentin

Cementodentinal Junction:
The terminal apical areas of the
cementum where it joins the internal root
canal dentin is known as the
cementodentinal junction (CDJ).
When root canal treatment is performed
the obturating material should be at CDJ.
It remains stable without any increase or
decrease.
The CDJ is 2 to3 um wide.

FUNCTIONS:

Anchorage

Attachment

Adaptive and reparative function

Walling in filled canals

Repairing roots (horizontal fracture)

Sealing of necrotic pulps by occluding apical foramen

Protecting underlying dentin

ALVEOLAR
BONE IN
HEALTH

Bone is a mineralized connective tissue.

About 60% of its weight is inorganic material, about

25% organic material and about 15% water.

The mineral phase is carbonated hydroxyapatite,

distributed both within the spaces between and on the
surfaces of the collagen fibrils.

The cells through their capacity for osteosynthesis and

resorption, have a pivotal role in the maintenance of the

matrix.

Bone consists of two-thirds inorganic

matter and one-third organic matrix.

INORGANIC MATTER:

ORGANIC MATTER:

90% of collagen Type I

Calcium & Phosphate,

Hydroxyl

Non collagenous proteins;

Osteocalcin

Osteonectin

Bone morphogenetic protein

Phosphoproteins

Proteoglycans.

Carbonate

Citrate

Organization of Adult Bone

Inner and outer

circumferential lamellae

Osteons (Haversian
lamella)
Cementing lines
Haversian canal
Blood vessels,

nerves,
mesenchymal

tissue, endosteum

Interstitial lamella

ALVEOLAR PROCESS
The alveolar process is the portion of the maxilla and mandible
that forms and supports the tooth sockets (alveoli). Develops in
response to presence or absence of teeth.
The alveolar process consists of the following:
1. An external plate of cortical bone formed by haversian bone
and compacted bone lamellae.
2. The inner socket wall of thin, compact bone called the
alveolar bone proper, which is seen as the lamina dura in radiographs.
3. Cancellous trabeculae, between these two compact layers,
which act as supporting alveolar bone.

In addition, the jaw bones consists of the basal bone, which is the
portion of the jaw located apically but unrelated to the tooth

ALVEOLAR PROCESS
Cortical plate.
Dense outer covering of the spongy bone.
Provides strength and protection.

Serves as attachment site for muscles.

Spongy bone.
Less dense and cancellous bone.
Makes up the central portion of the alveolar process

Compact and Spongy Bone

INTERDENTAL
SEPTUM:
Interdental
septum consists of
cancellous bone

bordered by the
socket wall cribriform
plates of
approximating teeth
and the facial and
lingual cortical plates.

Lamina dura

Thin compact bone

that lines the
tooth socket.
Has many small

openings for
blood vessels
and nerve fibers.

CELLS AND INTERCELLULAR MATRIX:

OSTEOBLASTS

OSTEOCLASTS

Osteoid
(or prebone)

Mineralized matrix

Osteoid

Cell process

SOCKET WALL:

The socket wall consists of dense, lamellated bone, some

of which is arranged in haversian systems, and bundle bone.

Bundle bone is the term given to bone adjacent to the

periodontal ligament that contains a great number of sharpeys
fibers.

Bundle bone is not unique to the jaws; it occurs through

the skeletal system wherever ligaments and muscles are

attached.

BONE MARROW:
In the embryo and newborn, the cavities of all bones are
occupied by red hematopoietic marrow.

The red marrow gradually undergoes a physiologic change

to the fatty or yellow inactive type of marrow.

Foci of red bone marrow are occasionally seen in the

jaws, like maxillary tuberosity, maxillary and mandibular molar
and premolar areas, and the mandibular symphysis and ramus
angle, which may be visible radiographically as zones of
radiolucency.

Periosteum

The tissue covering the outer surface of bone is termed

periosteum. It consists of;
1. Inner layer composed of osteoblasts surrounded
by osteoprogenitor cells.
2. Outer layer rich in blood vessels and nerves and
composed of collagen fibers and fibroblasts.
Bundles of periosteal collagen fibers penetrate the
bone, binding the periosteum to the bone.

Endosteum

The tissue lining the internal bone cavities is called

endosteum.

It consists of
1) Inner layer osteogenic layer
2) Outer layer fibrous layer.

Fibrous layer
of periosteum

Periosteum Osteoblasts

Osteogenic or
cellular layer
of periosteum

Osteocyte in lacuna

Copyright 2007, Thomas G. Hollinger, Gainesville, Fl

Endosteum
(Osteoblasts)

REMODELLING:
It is the major pathway of bony changes in shape,
resistance to forces, repair of wounds, and calcium and phosphate
homeostasis in the body.
The interdependency of osteoblasts and osteoclasts in

remodeling is called coupling.

The bone matrix that is laid down by osteoblasts is

nonmineralized osteoid.
Bone resorption is a complex process morphologically

related to the appearance of eroded bone surfaces (Howships

lacunae) and large, multinucleated cells- Ostoclasts.

REMODELING OF ALVEOLAR BONE

Alveolar bone is the least stable of the periodontal
tissues because its structure is in a constant state of
flux.

A considerable amount of internal remodeling

takes place by means of resorption and formation, which
are regulated by local and systemic influences.
The remodelling of the alveolar bone affects its
height, contour, and density.

REFERENCES

Antonia Nanci, Ten Cates Oral Histology, 7th edition.

Antonia Nanci and Dieter D Boohardt: Structure of
periodontal tissues in health and disease.
Periodontology 2000 2003; 31: 12-31
Michael G. Newman , Henry Takei, Perry R.
Klokkevold, Clinical Periodontology, 10 edi
Jan Lindhe, Karring, Lang, Clinical Periodontology
and Implant Dentistry., 5th Edition.
Thomas G. Wilson Fundamentals of Periodontics, 2nd
edition, Anatomy of Periodontium.
Bhaskar SN, Orbans Oral Histology and Embryology,
11 th edition