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CEMENTUM

&
CEMENTOGENESIS
CONTENTS
• Introduction

• Functions of cementum

• Composition of cementum.

• Classification of cementum.

• Cemental junctions

• Cementogenesis

• Applied & Clinical aspects.


INTRODUCTION
• Is mineralized dental tissue covering the anatomic
roots of human teeth.

• Begins at cervical portion of the tooth at the cemento-


enamel 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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FUNCTIONS OF CEMENTUM

1. Attach periodontal
ligament fibers to the
root surface.

2. It serves as a protective
layer over the dentin.

3. Compensates for rapid


wear at the occlusal
surface.

4. Cementum is thought to
contribute to repair in
fracture of root.
PHYSICAL CHARACTERSTICS

Hardness is less than that of dentin.

Light yellow in color.

Can be distinguished from enamel by its


lack of luster & its darker hue.

Semi-permeable to a variety of materials.


COMPOSITION OF CEMENTUM

By Weight - Inorganic : 45 % - 50 %

Organic and water : 50%


• Inorganic is in the form of hydroxyapatite
crystals.

• Cementum has the highest fluoride


content of all the mineralized tissues.

• Organic portion consists primarily of type I


collagen & protein polysaccharides
(proteoglycans).
CLASSIFICATION OF CEMENTUM

1. Time of formation
Primary & Secondary.

2. Location
Coronal & Radicular

3. Cellularity
Acellular & Cellular.

4. Presence of collagen fibrils


    Fibrillar cementum & 
    Afibrillar cementum
5. Origin of the matrix fibers
- Extrinsic fiber cementum
- Intrinsic fiber cementum
- Mixed fiber cementum

6. Schroeder’s classification
- Acellular Afibrillar.
- Acellular Extrinsic Fibers.
- Cellular Intrinsic Fibers.
- Cellular Mixed Stratified.
- Intermediate Cementum.
CELLS OF CEMENTUM

• Cementoblasts

• Cementocytes

• Periodontal fibroblasts

• Cementoclasts
Schroeder’s classification
• Acellular afibrillar cementum
- Contains neither cells nor extrinsic or intrinsic collagen
fibers, except for mineralized ground substance. Cervical
enamel surface.
• Acellular extrinsic fiber cementum
- Composed almost entirely of densely packed bundles of
Sharpey’s fibers. Cervical margin to 2/3 rd of root.
(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)
• Cellular intrinsic fiber cementum
- Contains cells but no extrinsic collagen fibers.
Formed by cementoblasts. It fills resorption
lacunae.

• Intermediate cementum
- Poorly defined zone near the cementodentinal
junction. Contains cellular remnants of Hertwig’s
sheath embedded in calcified ground substance.
Cementum can be differentiated into: acellular & cellular
cementum.

Acellular cementum does not have spider-like cementocytes


incorporated into it.

Acellular cementum is found at the coronal 2/3 rd whereas


the cellular cementum is found at the apical 1/3 rd.

Cementum is thinnest at the cementoenamel junction &


thickest toward the apex.

Cementocytes are either degenerating or are marginally active


cells.
ACELLULAR CEMENTUM
CELLULAR CEMENTUM
Cellular components of cementum
Cementoblasts
Soon after Hertwig’s sheath breaks
up, undifferentiated mesenchymal
cells from adjacent connective tissue
differentiate into cementoblasts.

• Synthesize collagen and protein


polysaccharides which make up the
organic matrix of the cementum.

• Contains numerous Mitochondria,


well formed Golgi apparatus and
large amount of granular ER.
Cementocytes
• Cementoblasts after laying
down cementum on the surface
of Root Dentin gets embedded
in the Cementum, these cells
are called Cementocytes.

• Cementocytes are housed in


hollow spaces in the Cementum
called lacunae.

• The process of the


cementocytes project toward
the periodontal ligament in the
form of small tubes called
canaliculi.
Cementoclasts

• These are multinucleated giant cells.

• Play an active role in cemental resorption.

• They are indistinguishable from osteoclasts.


Periodontal Fibroblasts

• These are part of the periodontal ligament.

• They produce collagen fibers that become mineralized, as


they become incorporated into cementum.

• Therefore, periodontal ligament fibroblasts contribute to


cementum formation and are considered as cementum cells.
COLLAGEN
CEMENTOID TISSUE

• The uncalcified Cementum


matrix is called Cementoid tissue.

• The Cementoid tissue is lined by


Cementoblasts.

• Always a thin layer of Cementoid


can be observed on the
Cementum.
CEMENTOENAMEL JUNCTION
• The cementum and the
enamel can form a butt
joint in 30% of the cases.

• The cementum and the


enamel may be separated
by a gap with exposed
dentin in 10% of the cases.

• The cementum on the root


may be continuous with a
patch of coronal
cementum, so that the
cementum overlaps the
enamel in 60% of the
cases.
RELATION OF CEMENTUM TO
ENAMEL AT THE CEMENTOENAMEL
JUNCTION

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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.
CEMENTOGENESIS
1) Deposition and 2) Maturation of cementum.

DEPOSITION
• Cementum formation in the developing tooth is preceded
by the deposition of Dentin along the inner aspect of
Hertwig’s Epithelial Root Sheath.

• Once Dentin formation is under way, breaks occur in the


Epithelial Root Sheath allowing the newly formed Dentin
to come in direct contact with connective tissue of the
Dental Follicle.
• 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.
Mineralization / Maturation

• The presence of hydroxyapatite crystals in the adjacent


Dentine initiates mineralization in Cementum.

• Initial formation of cementum is closely associated with


the Mineralisation of the Hyaline layer.

• The adjacent periodontal ligament fibroblasts, which are


rich in Alkaline Phosphatase, may also play a role in
Mineralization.
1) Primary / Acellular cementum formation.

2) Secondary / Cellular cementum formation.


Acellular cementum
Cellular cementum
DIFFERENCES BETWEEN AEFC AND CIFC
Located from cervical to apical third. In apical third and furcation
Formed earlier-primary cementum Formed later and during repair.
Noncollagenous proteins-tenacin, fibronection, present

osteocalcin absent
Growth factors-TGFb, IGF not seen seen
Proteoglycans, versican, decorin, byglycan and Seen
lumican- not seen
Cementoid absent Present
Only extrinsic fibres of Pdl Intrinsic fibres present
Function anchorage Adaptation and repair
Slow fromation Rapid
Increnental lines closer Farther apart
Cementocytes not seen Present to varying degrees and
depth
Cementoblasts derived from HERS Inner cells of dental follicles.
Incremental lines of Salter

• Cementogenesis occurs rhythmically, with


periods of alternating activity and
quiescence.

• These are believed to have a higher content


of ground substance and mineral and a
lower content of collagen.

• The Incremental lines are closer together in


acellular than corresponding lines seen in
Cellular cementum.
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.
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 & a bay like recess remains.

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.
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.
• 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.

• Knob like projections are designated as excementoses.


ATTACHED CEMENTICLES ON
SURFACE OF CEMENTUM

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