Seminar on

CEMENTUM

Shreya Das
Intern
Department of periodontia
 INTRODUCTION
• Cementum was first demonstrated
microscopically in 1853 by Frankel and
Raschkow.
• It is one of the components of periodontium
other than the gingiva ,periodontal ligament
and alveolar bone.
 DEFINITION
• Cementum is the calcified mesenchymal tissue
that forms the outer covering of the anatomic
root.
• According to orbans; cementum is a
mineralized dental tissue covering the
anatomic roots of human teeth.
 PHYSICAL CHARACTERISTICS
1. It is less calcified and hard than dentin.
2. It is more permeable than dentin.
3. Begins at cervical portion of tooth at the CEJ
and continues to the apex.
4. Thickness at CEJ is 20 to50 micrometer.
(thinnest)
5. . Thickness at apex is 150 to 200 micrometer
( thickest)
 CHEMICAL COMPOSITION
• Organic content and water:50 to 55%
• Inorganic content: 45 to 50%
• Organic content:
The collagen fibers are embeddeed in the interfibrillar
ground substance consisting of glycoproteins. The
various types of ground substance found are-
Type 1, 3, 5, 9,14
Interspersed between the collagen fibrils are the
glycosaminoglycans, chondroitin sulfate and dermatan
sulfate.
• Non collagenous proteins found are alkaline
phosphatase, bone sialoprteins, fibronectin,
osteocalcin, osteopontin,vitronectin,
cementum dervied attachement proteins and
insulin like growth factor.
 INORGANIC CONTENT
1. Calcium phosphate in the form of
hydroxyapatite.
2. Trace elememts like copper, fluorine, iron,
lead, potassium, silica, sodium and zinc in
varying amounts.
3. Cementum has the highest fluoride content.
 CEMENTUM CELLS
The following are the major cell types associated
with cementum:
• Cementoblasts
• Cementocytes
• Periodontal ligament fibroblasts
• Odontoclasts (cementoclasts)
• Transmission electron micrograph of
cementoblast (CB) in periodontal
ligament (PDL), adjacent to root
cementum (C). Cementoblasts
initially originate from
ectomesenchymal cells in the dental
follicle. Later in life, cementoblasts
may arise from undifferentiated cells
in the periodontal
ligament. Cementoblasts are
morpholgically similar to
fibroblasts. However, they are
located in close proximity to the
cemental surface and frequently
extend cytoplasmic processes (CP)
toward the cementum. They
produce the intrinsic collagen fibers
and ground substance which,
together with the extrinsic fibers
constitute the bulk of the
cementum. Active cementoblasts,
like this one, have a well-developed
rough-surfaced endoplasmic
reticulum and Golgi region.
• Transmission electron micrograph of
cementocyte (CC) within a lacuna (L)
imbedded in cellular, mixed fiber
cementum (CMFC). During periods
of rapid cementogenesis,
cementoblasts may become trapped
as cementocytes within lacunae.
Cytoplasmic processes extend
toward cementum surface through
canaliculi in the
cementum. Cementocytes have a
markedly reduced cytoplasmic
volume and diminished number of
cytoplasmic organelles, features that
reflect a marked decrease in
metabolic activity.
 CEMENTOGENESIS
• Phase 1: laying down of cementoid tissue/
matrix formation.
• Phase 2: mineralization
Apatite crystals are deposited along the fibrils.
Cementum formation take place rhythmically.
 DEVELOPMENT OF CORONAL
CEMENTUM
• In human teeth, coronal cementum is formed on
the cervical portion of the crown. Its presence is
restricted to localized areas of reduced enamel
epithelium degeneration. The enamel exposed as a
result of epithelial degeneration provides a surface
on which cementoblasts from the dental follicle are
able to deposit cementum. In humans, coronal
cementum serves no anchoring function. Generally,
coronal cementum in humans is acellular and
afibrillar, although cellular coronal cementum has
been reported in association with impacted teeth.
Diagram of unerupted tooth. The enamel
of the crown is almost entirely covered
with a layer of reduced enamel
epithelium (areas 1 and 2), with the
exception of patchy areas near the
cervical region (area 3).
The reduced enamel epithelium no longer
cover for the deposition of coronal
cementum by cells from the adjacent
connec tive tissue of the dental follicle.s the
enamel in the cervical region. The denuded
enamel surface provides a suitable site
 DEVELOPMENT OF RADICULAR
CEMENTUM
• As root formation proceeds, Hertwig's epithelial root sheath
becomes perforated by ectomesenchymal cells of the dental follicle
which traverse the sheath to reach the dentin surface. These cells
lay down a collagenous matrix, which enlarges the perforations of
the sheath and gradually displaces it away from the dentin surface.
Hertwig's epithelial root sheath eventually breaks up into a network
of more or less interconnected epithelial strands, located within the
future periodontal ligament. These epithelial remnants are known
as the epithelial cell rests of Malassez.
•
• Prior to tooth eruption the collagen adjacent to the dentin surface
becomes remodeled into thin fibers, perpendicular to the dentin
surface. These fibers slowly mineralize from the dentin surface
outward. The non-mineralized end of the fibers extending into the
future periodontal ligament space eventually form the principal
fibers of the periodontal ligament.
• ectomesenchymal cells from the
dental follicle (DF) pass through
Hertwig's epithelial root sheath
to assume a position close to the
dentin of the root
surface. These cells serve as
precursors of the cementoblasts
(CB) responsible for the
production of radicular
cementum. Their main
functions are (1) to produce
intrinsic collagen fibers that are
orientated more or less parallel
to the root surface, and (2) to
produce the ground substance
that will imbed the intrinsic and
extrinsic fibers of cementum and
allow the tissue to mineralize.
•
• Early stage of cementogenesis.
Cementogenesis begins with
the production of small bundles
of collagen fibers (EF)
orientated perpendicularly to,
and interdigitated with, the
superficial, non-mineralized
collagen fibrils of the dentin
(D). At this early stage, the
fibroblasts in the dental follicle
(DF) are orientated with their
long axis parallel to the root
surface. Their orientation will
change later, as the periodontal
ligament matures, to one that is
more or less perpendicular to
the root surface. The
periodontal fibroblasts
contribute the extrinsic fibers
that become incorporated into
the cementum
• Higher magnification of early stage of
cementogenesis. Extrinsic fibers (EF) become
interdigitated with the superficial collagen fibers of
the root dentin (D). Cementoblasts (CB) provide the
ground substance that will imbed the fibers and allow
mineralization to proceed.
•
• As the dental follicle (DF) becomes remodelled into a
periodontal ligament, most of the collagen fibers that
become embedded in cementum originate from the
periodontal ligament fibroblasts as extrinsic
fibers. The cementoblasts provide the ground
substance, in which these fibers are embedded prior
to mineralization, and some intrinsic fibers that
surround and fill the space between the extrinsic
fibers.
•
• As new cementum is deposited on the surface, the
cementoblasts are displaced toward the periodontal
ligament, thereby avoiding entrapment. This gives rise
to the acellular, fibrillar cementum, most commonly
found on the cervical two-thirds of the root. This
cementum is laid down comparatively slowly.
• Junction of root dentin (D)
and cementum (C).
With transmission electron
microscopy, the dentino-
cemental junction is readily
identified (arrows), as the
orientation and
arrangement of the matrix
fibrils is quite different in
the two tissues. In dentin,
individual fibrils run a
haphazard course, whereas
in the cementum, the fibrils
are arranged in bundles
that are orientated more or
less perpendicularly to the
dentino-cemental
junction.
Cementum is laid down much slowly while the tooth is
erupting. This cementum is acellular or primary . The
mineral content is seen as thin plates or lamina away
from cementoblats.

When the tooth comes in occlusion more cementum

forms around the apical two third of the root which has
greater proportion of collagen. The cementoblasts
become trapped in the lacunae within this matrix. This
cementum is called cellular or secondary. The mineral
content is seen as globules scattered throughout the
matrix and also between the cementoblasts.
The rate of formation of cellular cementum is
much more rapid than that of acellular
cementum.
 CLASSIFICATION OF CEMENTUM
Based upon:
1. Location
2. Presence or absence ofcells
3. Origin of collagenous fibers of the matrix.
4. According to schroeder.
 location

Radicular Coronal
cementum cementum
• On the basis of presence or absence of cells:
1. Acellular cementum or primary cementum-
• First formed cementum.
• Forms the cervical third of root.
• Formed before the tooth reaches the occlusal
plane.
• Thickness ranges from 30 to 230 microns.
• Sharpey’s fibers make up most of the
structure of acellular cementum.
 2. Cellular cementum or secondary cementum
 Formed after the tooth reaches the occlusal
plane.
 Covers the apical two third of tooth.
 More irregular and contains cells (
cementocytes)
 Less calcified than acellular cementum.
 Sharpey’s fibers occupy a smaller portion of
cellular cementum.
 Less mineralized and more permeable.
Origin of collagenous fibers of the matrix:
Organic matrix dervied from 2 sources:-
1. Periodontal ligament (sharpey’s fibers)
2. Cementoblasts
• Extrinsic fibers is dervied from PDL. These are in the same
direction of the PDL principal fibers i.e perpendicular or
oblique to the root surface. Plays a major role in
anchorage.
• Intrinsic fibers is derived from cementoblasts. Run parallel
to the root surface and at right angles to the extrinsic
fibers. This form of cementum is located predominantly at
sites undergoing repair, following surface resorption. It
plays no role in tooth anchorage.
• The area where both extrinsic and intrinsic fibers is called
mixed fiber cementum.
 SCHOREDER CLASSIFICATION
• Acellular afibrillar cementum.
• Acellular extrinsic fiber cementum.
• Acellular intrinsic fiber cementum.
• Cellular mixed stratified cementum.
• Cellular intrinsic fiber cementum.
 Acellular afibrillar cementum
• Consist of mineralized matrix.
• Contains neither cells nor extrinsic or intrinsic
collagen fibers.
• Has no function in tooth attachment.
• Found in coronal cementum.
• A product of cementoblasts.
 ACELLULAR EXTRINSIC FIBER
CEMENTUM
• Confined to coronal half of root.
• Its formation commences shortly after crown
formation is completed.
• Product of fibroblast and cementoblasts.
• Has the potential to adapt to functionally
dictated alterations such as mesial tooth drift.
 CELLULAR INTRINSIC FIBER
CEMENTUM
• Contains cells but no collagen fibers/lacks
sharpey’s fibers.
• Formed by cementoblasts.
• Fills resorption lacunae.
 CELLULAR MIXED STRATIFIED
CEMENTUM
• Contains cells.
• Composed of extrinsic and intrinsic fibers.
• Contains products of fibroblasts and
cementoblasts.
• Appears primarily in the apical 3rd of the root
and the apices and in the furcation areas.
 CEJ
The relationship of the cementum to
the apical enamel border is variable.
1. Cementum just meets enamel- 30%
2. small gap between cementum and enamel – 10%
3. Cementum overlaps enamel- 60%
 CEMENTODENTINAL JUNCTION
• The cementum is attached to dentin firmly.
• CDJ is scalloped in deciduous teeth and is
smooth in permanent teeth.
• Near apical end, sometimes an intermediate
layer intervenes between cementum and
dentin which does not look neither like
cementum nor dentin.
 AGING OF CEMENTUM
• Smooth surface becomes irregular.
• Continuous deposition of cementum occurs
with age in the apical area.
• Cementum resorption remains active for a
period of time and then stops for cementum
deposition creating reversal lines.
 FUNCTIONS
• Medium of attachment of PDL fibers to tooth.
• Tooth wear compensation.
• Repair: fracture or resorption of root surface.
• Does not resorb under masticatory or
orthodontic forces as it is harder than bone.
During heavy orthodontic forces, tooth
integrity is maintained and alveolar bone
being elastic in nature changes its shape,
fulfilling the orthodontic requirement.
 CEMENTUM REPAIR
• When root surfaces undergo external resorption, i.e.
resorption mediated by cells in the gingiva or
periodontal ligament, the damage may be limited in
time and extent. Such damage is often followed by a
reparative phase, with new cementum deposited over
the previously resorbed surface. In the early phase of
repair, reparative cementum is typically composed of
cellular, intrinsic fiber cementum. Because it lacks
Sharpey's fibers, this type of cementum does not
contribute to tooth anchorage. New anchorage can be
provided by extrinsic or mixed fiber cementum that
forms over the layer of intrinsic fiber cementum.
CEMENTUM RESORPTION AND REPAIR
• Causes:
Local- TFO, orthodontic movement, pressure
from malaligned erupting teeth, cysts,
tumours, teeth without functional antagonist,
periapical disease and periodontal disease.
Systemic- calcium deficiency, hypothyroidism,
hereditary fibrous osteodystrophy and paget’s
disease.
• Cementum resorption appears microscopically
as baylike concavities in root surface.
Multinucleated giant cells and large
mononuclear macrophages are found
adjacent to cementum undergoing resorption.
• The newly formed cementum is demarcated
from the root by a deeply staining irregular
line termed as reversal line, which delineates
the border of the previous resorption.
• Reorptive changes may be of microscopic
proportions or sufficiently extensive to
present a radiographically detectable
alteration in the root contour.
ANOMALIES IN CEMENTUM
 CEMENTICLES
• These are globular masses of cementum less
than 0.5mm in diameter which form within
the PDL.
• Maybe free or attached.
• Originate from degenerating cells or epithelial
cell rests.
 ENAMEL PROJECTIONS
• If amelogenesis is not
turned off after
enamel formation is
complete, the enamel
organ may continue to
produce enamel over
the root dentin.
• It may project in the
furcation areas of
multirooted teeth.
 ENAMEL PEARL
• Enamel pearls are localized
masses of enamel that
develop ectopically,
typically over the root
surface, in close proximity
to the cemento-enamel
junction.
• they may promote
periodontal diseases by
acting as a plaque retentive
structure.
 HYPERCEMENTOSIS
• Hypercementosis (HC)
refers to abnormally large
cellular cementum
deposits on the apical
third of one or more
teeth. Such deposits form
bulbous enlargements on
the roots that may
interfere with dental
extractions, should these
become necessary. The
cause of this anomaly is
not known
 ANKYLOSIS
• Fusion of cementum
with alveolar bone
with obliteration of
PDL.
• May occur due to
cemental resorption,
chronic periapical
inflammation, tooth
replantation,occlusal
trauma.
 OSTEITIS DEFORMANS
• Paget’s disease of
bone.
• Generalized skeletal
disease characterized
by deposition of
excessive amount of
secondary cementum
on the roots of teeth
and by apparent
disappearnce of
lamina dura.
CONCRESCENCE
MESODERMAL TUMORS OF
ODONTOGENIC ORIGIN
RELATED TO CEMENTUM
 CEMENTOMA
• Cementoma is a relatively
uncommon odontogenic
neoplasm, occurring in
relation to the periapical
bone and cementum at the
root apex.
Clinical presentation
The lesions are mostly
asymptomatic and are
detected only during routine
dental x rays. These are small
and multiple in number and
associated teeth are always
vital
CENTRAL CEMENTIFYING FIBROMA
• Also known as
cemento ossifying
fibroma.
• Most frequently they
arise from the
premolar region of the
mandible.
Peripheral cemento ossifying fibroma.
 BENIGN CEMENTOBLASTOMA
• True neoplasm of functional
cementoblastoma.
• Mandible is more affected( generally first
permanent molar)
• May cause expansion of cortical plates.
 GIGANTIFORM CEMENTOMA
• Familial multiple
cementoma.
• Inherited as an autosamal
characteristic in adult
black females.
• Dense, highly calcified,
almost total acellular
cementum which is poorly
vascularised and becomes
infected followed by
suppuration and
sequestration.
 CLINICAL CONSIDERATIONS
• Cementum is essential for normal anchorage of the tooth.
• Cementum also provides a protective function to the tooth
itself, as it is less susceptible to resorption than bone. This
allows pressure induced movement of the tooth through
bone, as in orthodontics, while minimizing resorptive damage
to the tooth.

• . Cemental deposition in the apical portion of the root

compensates to some degree for the slow tooth eruption that
takes place throughout life to compensate for occlusal
attrition.
 CONCLUSION
• Cementum by virtue of its structural dynamic
qualities provide tooth attachment and
maintains occlusal relationship. Fibers in
cementum helps in tooth anchorage. Certain
pathologic factors may cause irreversible
damage to cementum else it is self reparative
to small disturbances.