Cementum

Dr.
Omar Husham ‫المرحله الرابعه‬
periodontology
Cementum:-
It is a thin specialized calcified tissue covering the roots

surfaces of the teeth.
It has many features similar to the bone tissue but differs

from bone in the following aspects
It is microscopic organization.
Has no innervation
Has no blood or lymph vessels.
Does not undergo physiological remodeling
(resorption and deposition),but it is characterized by

continuous deposition throughout life.
Functions of cementum:-
Anchorage of the tooth in the alveolus
To attach the PDL fibers to the teeth
To contribute to the process of repair after damage to the

root surface and following regenerative periodontal surgical
procedures.
Cemento-enamel junction (C.E.J)
Three types of relationships involving the cementum may

exist at the C.E.J:-
Dr.Omar Husham ‫المرحله الرابعه‬
Cementum overlaps the enamel (60%-65%)
Edge-to edge (butt joint (30%)
Cementum and enamel fail to meet (5%-10%)
In the last condition,there is a possibility of gingival recession

which may result in sensitivity because the dentin is exposed.
There are two types of cementum:
1.Primary (acellular cementum):-
Is the first to be formed in conjunction with root formation

and tooth eruption , it does not contain cells and sharpey's
fibers make up most of its structure . Generally it covers the
cervical third of the root
2.Secondary (cellular cementum):-
Which is formed after tooth eruption and in response to

functional demands, therefore it grows faster and over a thin
layer of acellular cementum at the apical third of the root and
furcations of multirooted teeth . This type of cementum
contains cells (cementocytes), but sharpey's fibers occupy a
smaller portion of this type of cementum. Cellular cementum
is less calcified than the acellular type.
Both acellular cementum and cellular cementum are arranged

in lamellae separated by incremental lines parallel to the long
axis of the root.These lines represent “rest periods” in
cementum formation and they are more mineralized than the
adjacent cementum.
Structures of cementum:- cementum consist of
Fibrous elements (collagen fibers) which is composed of type I

(90%) and type III (about 5%) collagens.
Cellular elements
Calcified interfibrillar matrix
Fibrous elements:-there are two types
a.Extrinsic fibers (sharpey's fibers): which are the embedded

portion of the principal fibers of the PDL and are formed by
the fibroblast cells . Sharpey's fibers make up most of the
structure of acellular cementum and they are inserted at right
angles to the root surface and penetrate deep into the
cementum.
b.Intrinsic fibers: These fibers are produced by cementoblast

cells and are oriented more or less parallel to the long axis of
the root and form a cross banding arrangement with
sharpey's fibers
2.Cellular elements: The cells associated with
cementum are few and generally resides within the PDL.
a.cementoblast cells:responsible for the formation of both

cellular and acellular cementum
b.cementocyte cells:are found only in cellular cementum ,

they are located within spaces (lacunae) that communicate
with each other through canaliculi for transportation of
nutrients through the cementum and contribute to the
maintenance of the vitality of this tissue.
C.fibroblast cells:these cells belong to the PDL where they are

responsible for synthesis of principal fibers but since these
fibers become embedded in cementum, fibroblasts indirectly
participate in the formation of cementum
d.cementoclast cells:these cells are responsible for extensive

root resorption that lead to primary teeth exfoliation.
Permenant teeth do not undergo physiologic resorption but
localized cemental resorption may occur which appears as
concavities in the root surface and may be caused by local or
systemic causes.local conditions include,trauma from
occlusion, orthodontic movement, cyst and occur on mesial
surfaces in association with mesial drift. Among systemic
conditions are calcium deficiency and hypothyroidism.
Reversal line:The newly formed cementum is demarcated

from the root by a deeply staining irregular line which
delineates the border of the previous resorption.
Both acellular cementum and cellular cementum are

arranged in lamellae separated by incremental lines
parallel to the long axis of the root.These lines represent
“rest periods” in cementum formation and they are
more mineralized than the adjacent cementum.
Trauma from occlusion:Forces that exceed the adaptive

capacity of the periodontium and produce injury.
Interfibrillar matrix:These are proteoglycans, glycoproteins

and phosphoproteins formed by cementoblast
cells.Proteoglycans are most likely to play a role in regulating
cell-cell and cell-matrix interactions both during normal

development and during the regeneration of cementum.
Mineralization of cementum:occurs by the deposition of

hydroxyapatite crystals,first within the collagen fibers,later
upon the fiber surface and finally in the interfibrillar
matrix.Cellular cementum is less calcified than acellular
cementum and cementum mineralizalion is less than that of
the bone, enamel and dentin
Permeability of cementum:-
In very young animals,acellular cementum and cellular

cementum are very permeable and permit the diffusion of
dyes from the pulp and external root surface.The canaliculi in
cellular cementum is some areas are contagious with the
dentinal tubule.The permeability of cementum diminishes
with age.
Exposure of cementum to the oral environment:-
Cementum becomes exposed to the oral environment in cases

of gingival recession and as a result of the loss of attachment
in pocket formation.The cementum is sufficiently permeable
to be penetrated in these cases by organic substances,organic
ions and bacteria.Bacterial invasion of the cementum occurs
frequently in individuals with periodontal disease,and
cementum caries can develop.
Development of cementum:Both cellular and acellular

cementum are produced by cementoblast cells.Cementoid is
first formed which is a non-calcified tissue containing collagen
fibrils distributed in matrix.Cementum is characterized by
continuous deposition and increase in thickness throughout
life.A thin layer of cementum noted on recently erupted tooth

will tend to increase thickness with age.Cementum formation
is most rapid in the apical regions to compensates for tooth
eruption and attrition. The thickness of cementum is more
pronounced in the apical third and in the furcation areas than
the cervical portion.Cementum is thicker in distal than in
mesial surfaces because of functional stimulation from mesial
drift over time.
Hypercementosis:refers to a prominant thickening of the

cementum.It is largely an age-related phenomenon and it may
be localized to one tooth e.g.tooth without antagonists or
with periapical lesion , and sometimes affect the entire
dentition that may occur in patients with paget's disease.It
could pose a problem if an affected tooth requires extraction.
Cemental aplasia or hypoplasia:refers to an absence or

paucity of cellular cementum.
Ankylosis:Fusion of the cementum and alveolar bone with

obliteration of the PDL.It results in resorption of the
cementum and its gradual replacement by bone tissue and it
may develop after chronic periapical inflammation and
occlusal trauma.Clinically,ankylosed teeth lack the physiologic
mobility of normal teeth as well as proprioception is lost
because pressure receptors in the PDL.are deleted or do not
function correctly.Furthermore,the physiologic drifting and
eruption of teeth can no longer occur .When implants are
placed in the jaw,healing results in bone that is formed in
direct apposition to the implant without intervening CT,this
maybe interpreted as a form of ankyloses.
‫‪Dr.Omar Husham‬‬ ‫المرحله الرابعه‬

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Dr.

Omar Husham ‫المرحله الرابعه‬

It is a thin specialized calcified tissue covering the roots

It has many features similar to the bone tissue but differs

Has no blood or lymph vessels.

Does not undergo physiological remodeling

(resorption and deposition),but it is characterized by

Anchorage of the tooth in the alveolus

To attach the PDL fibers to the teeth

To contribute to the process of repair after damage to the

Cemento-enamel junction (C.E.J)

Three types of relationships involving the cementum may

Cementum overlaps the enamel (60%-65%)

Edge-to edge (butt joint (30%)

Cementum and enamel fail to meet (5%-10%)

In the last condition,there is a possibility of gingival recession

There are two types of cementum:

1.Primary (acellular cementum):-

Is the first to be formed in conjunction with root formation

2.Secondary (cellular cementum):-

Which is formed after tooth eruption and in response to

Both acellular cementum and cellular cementum are arranged

Structures of cementum:- cementum consist of

Fibrous elements (collagen fibers) which is composed of type I

Calcified interfibrillar matrix

Fibrous elements:-there are two types

a.Extrinsic fibers (sharpey's fibers): which are the embedded

b.Intrinsic fibers: These fibers are produced by cementoblast

2.Cellular elements: The cells associated with

cementum are few and generally resides within the PDL.

a.cementoblast cells:responsible for the formation of both

b.cementocyte cells:are found only in cellular cementum ,

C.fibroblast cells:these cells belong to the PDL where they are

d.cementoclast cells:these cells are responsible for extensive

Reversal line:The newly formed cementum is demarcated

Both acellular cementum and cellular cementum are

Trauma from occlusion:Forces that exceed the adaptive

Interfibrillar matrix:These are proteoglycans, glycoproteins

cell-cell and cell-matrix interactions both during normal

Mineralization of cementum:occurs by the deposition of

In very young animals,acellular cementum and cellular

Exposure of cementum to the oral environment:-

Cementum becomes exposed to the oral environment in cases

Development of cementum:Both cellular and acellular

life.A thin layer of cementum noted on recently erupted tooth

Hypercementosis:refers to a prominant thickening of the

Cemental aplasia or hypoplasia:refers to an absence or

Ankylosis:Fusion of the cementum and alveolar bone with

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