Cementoenamel Junction: Microscopic Analysis

and External Cervical Resorption

There is a lack of data regarding the shapes and distribution of the mineralized tissue
that composes the cementoenamel junction. A sample of 198 permanent human teeth
was analyzed by optical microscopy and scanning electron micros-copy. Scanning
electron microscopy showed three types of tissue interrelations: enamel overlapped
by cementum; enamel and cementum edge-to-edge; and a gap, revealing a strip of
exposed den-tin. Using optical microscopy, a fourth type of ce-mentoenamel junction
was observed: cementum overlapped by enamel. The distribution of the hard tissues
found at the cementoenamel junction is unpredictable and irregular both for any tooth
type (eg, on cuspids) and on any one individual tooth.
Based on these results and on analysis of the mechanisms involved in cervical root
resorption, it is possible to consider the cervical region as prone to external
resorption.

Analysis of the anatomy of the cementoenamel junction is helpful in explaining

pathological processes that occur in this region, as well as for the identification of
the biological phenomena involved in the initiation of pathological processes, such as
external cervical resorption.
Choquet (1), in 1899, determined the types and prevalence of tissue interrelations of
the human cementoenamel junction through optical microscopy. However, the
usefulness of this method was questioned because of incorrect interpretations due to
optical illusions from microscopic misinterpretation and the inability to evaluate the
entire outline of the cementoenamel junction. The use of scanning electron
microscopy (SEM) offers more accuracy and precision in determining the types of
interrelation between enamel, cementum, and dentin (2-5). This method of
observation, used by Akai et al. (6) to evaluate the cementoenamel junction, not only
allows a more critical study of surface morphology, but also makes analysis of the
cervical perimeter of the tooth possible.
Despite available information, there is still doubt regarding the true morphological
implications of the cementoenamel junction in the genesis of pathological processes,
especially extemal cervical resorption after dental trauma, orthodontic movement, or
internal

bleaching procedures (7-13). These can lead to local structural alterations, which
may activate chemical mediators responsible for the initiation of dental resorption.
External cervical resorption after bleaching is based on the mechanisms of action
and the physical-chemical properties of the bleaching agents (14-16), as well as on
the cervical dental permeability (4, 17). Hydrogen peroxide is the most used product,
applied either as an aqueous solution in different dilutions or a paste with sodium
perborate. Radiographic changes have shown extermal cervical resorption after
bleaching (7, 8, 10).
Research suggests an interrelation between the type of junction and dentin
permeability, especially when there is a band of exposed dentin between the
cementum and the enamel. These obser-vations, as well as investigations of altered
specific dentin proteins
(14), suggest research is indicated for better anatomical understanding of this region.
Thus, the objectives of this study were to:
(a) determine by SEM examination the types of cementoenamel junctions in different
types of teeth, as well as on the various surfaces of individual teeth; (b) compare
these data with those obtained from ground sections; and (c) correlate the
morphological findings on the cementoenamel junction with the etiological
hypothesis of external cervical resorption.

MATERIALS AND METHODS

Extracted permanent human teeth with intact cervical areas were obtained from the
Pathology Department, Bauru School of Dentistry, São Paulo University. Organic and
inorganic material were removed from the root and crown. After rinsing the
specimens in running water and drying, the integrity of the cementoenamel junction
was analyzed using a stereomicroscope (Carl-Zeiss, Germany).
Optical Microscopy
A total of 108 teeth, 60 maxillary and 48 mandibular, were distributed into 9 groups of
12 teeth each with six buccolingual and six mesiodistal surfaces to be examined. The
teeth were dehydrated in alcohol and embedded in clear fiberglass resin, and
longitudinal sections were cut with a special apparatus (Excel Technologies, Labacut
1010) using a 300-um-thick diamond impregnated disk (Excel, Diamond Wafering
Blade, XL-12205, high concentration).
The sections were then hand-polished with a series of abrasive papers (80, 100, 120,
150, and 320) to a thickness of ~ 60 um.
Representative sections were selected according to the integrity of