Cementum

Aditya S.Patel

CEMENTUM IS STRUCTURALLY PART OF TOOTH & FUNCTIONALLY PART OF PERIODONTIUM.

INTRODUCTION

A part of Periodontium that attaches Teeth to Alveolar bone. It begins at the cervicle portion of the tooth that is the CementoEnamel junction and continues upto apex. First described in 1853.

INTRODUCTION

Definition

Cementum is a non uniform, mineralized connective tissue and is avascular, and forms the outer covering of the root. Bone like connective tissue that covers tooth from CEJ to and surrounding apical foramen. (James Avery)

DEVELOPMENT OF CEMENTUM (CEMENTOGENESIS)

Pre-fuctional: During tooth development

Functional: When the tooth is about to reach the occlusal level. Continous thoughout life.

CEMENTOGENESIS

Cementum formation occurs along the entire tooth Hertwigs epithelial root sheath (HERS) Extension of the inner and outer dental epithelium HERS sends inductive signal to ectomesenchymal pulp cells to secrete predentin by differentiating into odontoblasts

CEMENTOGENESIS

HERS becomes interrupted Ectomesenchymal cells from the inner portion of the dental follicle come in with predentin by differentiating into cementoblasts
Cementoblasts lay down cementum

The first formed cementum or cementoid is not only acellular but the fibrils take their origin from two sources, cells of the dental follicle and later from the newly differentiated cementoblast.
After fibrillogenic phase, the matrix maturation that is second phase is initiated and soon completed. Last phase is the calcification phase that is phase III.

CEMENTOGENESIS

How cementoblasts get activated to lay down cementum is not known

3 theories:

1)Infiltrating dental follicle cells receive reciprocal signal from the dentin or the surrounding HERS cells and differentiate into cementoblasts 2)HERS cells directly differentiate into cementoblasts

3)What are the function of epithelial cell rests of Malassez?

CEMENTOGENESIS

Proteins associated with Cementogenesis

Growth factors

TGF PDGF FGF Bone sialoprotein Osteopontin

Adhesion molecules

Proteins associated with Cementogenesis

Epithelial/enamel-like factors Collagens Gla proteins

Matrix Bone

Collagens Transcription factors

Cbfa 1 and osterix Alkaline phosphatase

Other

PRECEMENTUM (CEMENTOID)

Its the unmineralised tissue which begins initially at the Cemento-dentinal junction and persist for the life of the tooth as the outermost layer of Cemental matrix.
located between calcified matrix and Cementoblast.

PRECEMENTUM (CEMENTOID)

Width 3-5 micron meters In H&E stain Eosinophplic

Protective function Composition: mainly collagenous

MINERALISATION

Begins in the depth of Precementum.

Hydroxyapatite crystals deposition. Cemental crystals are plate like structures that appears as fine, electron dense threads when standing on edge. Oriented with their long axis parallel to the direction of the collagen fibrils.

The mineral content of this tissue does not change significantly which age.

COMPOSITION OF CEMENTUM

Dry weight basis:

Inorganic Organic and Water -- 45-50% -- 50-55% -- 65% -- 23% -- 12%

Matured Cementum
Inorganic Organic Water

COMPOSITION

ORGANIC MATERIAL (50-55%)

Collagens Ground Substance

Glycoproteins Proteoglycans.

COMPOSITION

Collagen

Two typical fibrial formed colagens present

Type I collagen: 90% Type III collagen: 5%

Two fiber System present

Intrinsic fiber

Extrinsic fiber (sharpyes fibers)

COMPOSITION

Ground substance (Noncollagenous proteins )

Rich in glycoconjugates which represent either glycolipids, glycoproteins or proteoglycans and other proteins.

COMPOSITION

INORGANIC MATERIAL: (45-50%)

Cementum is less mineralized than the root dentin. Hydroxyapatite crystals Magnesium 0.5 to 0.9% Fluoride 0.9% Sulfur 0.1 to 3%

STRUCTURAL COMPOSITION OF CEMENTUM

CEMENTOBLAST

Derive from dental follicle Transformation of epithelial cells cemento-progenitor cells synthesizes collagen and protein polysaccharide

CEMENTOCYTE

Cementocytes in lacunae and the channels that their processes extend are called the canaliculi

The central cells mass may appear rounded, oval or sqamoid, diameter ranges from 8 to over 15 cm. The cytoplasm is palely basophilic and the nucleus is centrally located

PHYSICAL CHARACTERISTIC OF CEMENTUM

Pale yellow with a dull surface More permeable than other dental tissues Hardness of the full mineralized cementum is less than that of dentin Knoops Hardness number is 40. Relative softness and the thinness at the cervical portion means that cementum is readily removed by the abrasion when gingival recession exposes the root surface to the oral environment

Permeability of cementum
Permeability of cellular cementum is greater than that of acellular

Thickness of cementum

Varies in thickness: thickest in the apex and In the inter-radicular areas of multirooted teeth, and thinnest in the cervical area 10 to 15 m in the cervical areas to 50 to 200 m (can exceed > 600 m) apically

CEMENTO-DENTINAL JUNCTION

The dentin surface upon which cementum is deposited in relatively smooth in permanent teeth In deciduous teeth C-D junction is sometimes scalloped or wavy. The attachment of cementum to dentin is quite firm. Mucopoly sacchrides might have an important role in cemento-dentinal junction formation.

Hyaline layer of Hopewell-Smith (Intermediate Cementum)

Sometimes dentin is seperated from cementum by zone called intermediate cementum Dosent exhibits charaters of either cementum or dentin Predminantly seen on apical two thirds of roots of molars and premolars Represents areas where cells of hertwigs epithelial root sheath get trapped in rapidly depositing cemental matrix

Intermediate cementum is situated between the granular dentin layer of Tomes and the secondary cementum Approximately 10 m thick and mineralizes greater than the adjacent dentin or the secondary cementum

CEMENTO ENAMEL JUNCTION

CLASSIFICATION

According to location on teeth (Kronfeld 1938)

Radicular cementum Coronal cementum

According to cellularity (Gottlieb 1942)

Acellular cementum (Primary cementum) Cellular cementum (Secondary cementum)

CLASSIFICATION

According to presence of cells and organization of collagen fibrils Acellular afibrilar cementum (AAC) Acellular extrinsic fiber cementum Cellular intrinsic fiber cementum Cellular mixed stratified cementum Acellular intrinsic fiber cementum

Cellular and Acellular Cementum

1)Acellular cementum: It is the first to be formed and covers approximately the cervical third or half of the root and it does not contains cells formed before the tooth reaches the occlusal plane thickness larges from 30 to 230m (Schroeder 1986) 1)CELLULAR CEMENTUM: formed after tooth reaches the occlusal plane is more irregular and contains cells (cenontocytes) restricted to the apical segment of root thickness of cellular cementum is greater than accelular

A: Acellular cementum B: Hyaline layer of Hopwell-Smith C: Granular layer of Tomes D: Root dentin

Variations where acellular and cellular reverse in position and also alternate

Acellular afibrilar cementum (AAC):

contains neither cells, nor extrinsic or intrinsic fibers, apart from a mineralised ground substance It is a product of cementoblast and is found as deposited on the enamel thickness is about 1 to 15m. Lacks collagen so plays no role in attachment

Acellular extrinsic fiber cementum

composed almost entirely of densely packed bundle of sharpeys fibers and no cells product of fibroblast and cemetnoblast found in the cervical third of roots thickness is between 30 to 230m. high numerical density of fibers inserting into acellular extrinsic fibes cementum (approx 30,000/mm2) primary function is tooth anchorage

Cellular intrinsic fiber cementum

contains cells but no extrinsic (sharpeys) fibers formed by cementoblast form of resorptive cementum repair a resoraptive defect occurs in the furcation and on the apical root portions

Cellular mixed stratified cementum

contains both collagen fibers and calcified matrix co-product of cementoblast and fibroblast consists of both extrinsic and intrinsic fibers appears primarily in the apical third of the roots and the apices and in furcation areas

Acellular intrinsic fiber cementum

acellular variant of cellular intrinsic fibers cementum deposited during adaptive responses to external force forms without leaving cells behind (Bossharati and Schroeder 1990)

Distribution of Cementum on the Root

Acellular afibrillar: cervical enamel Acellular extrinsic: Cervix to practically the whole root (incisors, canines) increasing in thickness towards the apical portion 50200m Cellular: Apical third, furcations

FUNCTIONS OF CEMENTUM

Anchorage:- medium for the attachment of collagen fibers that bind the tooth to alveolar bone