CEMENTUM

LESSON PLAN

Cementum

• Classification,

• Structure and function

• Age changes
Calcified mesenchymal tissue that

forms the outer covering of the

anatomic root.

Begins at the cervical portion of the tooth

at the CEJ and continues to the apex.
Development:

Dental sac (follicle)

 Functions of cementum:
 Attachment of periodontal ligament to the tooth

 Compensate for occlusal wear of tooth by apical

deposition

 Reparative tissue for root surface help in functional

adaptation of tooth

 Maintain and control width of periodontal ligament

space

 Protect underlying dentine.

Physical Characteristics
 Less hard than dentin.

 Lighter in color - Light yellow in color

 Lack of luster and darker hue compared to enamel.

 Permeable

age and the type of cementum,

cellular variety

cementum is more permeable than dentine.

 Thickness
• Coronal ½ : 16-60 µ
• Apical 1/3, furcations : 150-200 µ
• Distal > Mesial
Composition:

Inorganic : 45-50% , Organic : 50-55%

collagen type I 90%, type III 5%

Collagenous proteins: adhesion molecule(cementum attachment

protein)

Non collagenous proteins: Glycoproteins & proteoglycans ,

Osteopontin, Bone sialoprotein etc.

Cementum derived growth factors: Insulin like growth factor etc.

Compared to bone

 Cementum is only 45% Inorganic

 Has both type I & III collagen

 Is Avascular

 Lacks nerve input

 Remodelling

 Cementum is more resistant to resorption orthodontic

tooth movement
Classification

Schroeder 1986

Location
Radicular
Collagen
Coronal
Afibrillar
Cellularity Fibrillar
Acellular Extrinsic
Cellular Intrinsic
Erupti
on
 Primary Secondary
During root formation After eruption

No cells Cementocytes

Coronal portion Apical portion

Formation- slow Rapid

Fiber arrangement – Irregularly

organized
 INTERMEDIATE :

(HYALINE LAYER OF HOPEWELL SMITH)

• It is an ill defined zone extending from pre-

cementoenamel junction to the apical third of the root.
• It appears to contain cellular remnants of Hertwigs root
sheath.
• The clinical significance of the layer is that it contains
enamel like protein (amelogenin) which helps in
attachment of cementum to dentin.

• Seen in rodents.
 II. According to cellularity :
a) Acellular cementum
 Cervical or half of root
 No cells
 Before reaches occlusal plane
 30-230µm
 Sharpeys fibres: completely
calcified

b) Cellular cementum
 More irregular
 Cementocytes
 Sharpeys fibres: partially calcified
 III. According to fibres :

a) Afibrillar cementum

b) Fibrillar cementum
• Afibrillar :

Organic matrix lacks dense array of collagen fibrils

• Fibrillar :

Most common form

Contains well defined, densely packed collagen

fibrils in its matrix.
 II. Location

i)Radicular

ii) Coronal : Found over enamel

 Well developed in herbivores, where it helps in

anchoring teeth with long crowns and relatively
short roots.
Schroeder’s classification :1986

 Acellular afibrillar cementum (AAC)

 Acellular extrinsic fiber cementum (AEFC)

 Cellular mixed stratified cementum (CMSC)

 Cellular intrinsic fiber cementum (CIFC)

 Intermediate Cementum
 Acellular afibrillar cementum (AAC)
 No cells
 no extrinsic / intrinsic fibres
 Produced by cementoblasts.
 Coronal : 1-15 µm

Acellular extrinsic fiber cementum (AEFC)

 Composed entirely of sharpey’s fibers
 lacks cells
 Product of fibroblasts and cementoblasts
 found in coronal one – half : 30-230 µm
 Cellular mixed stratified cementum (CMSC)

 Composed of both extrinsic and intrinsic fibres

 Contains cells

 Product of fibroblasts and cementoblasts

 Found in apical 1/3rd and furcation areas

 100-1000 µm
 Cellular intrinsic fiber cementum (CIFC)

 Contains cells

 Collagen fibers - formed by cementoblasts

 Fills resorption lacunae

 Cementum Associated Cells
I. Cementoblasts

 Form the cementum,

 Found lining root surface

 interspersed b/w bundles of PDL fibres

When active

 Round, plump cells with basophilic cytoplasm

 Open faced nuclei.

 These cells also play role in remodeling the ligament.
Resting cementoblasts
 Closed nucleus
 Little cytoplasm
II. Cementocytes :

 Found only in cellular cementum.

 Located within lacunae

 Have numerous cytoplasmic processes -- canaliculi

directed toward the ligament. Cytoplasmic volume and
density of cytoplasmic organelles reduced compared to
BLASTS.
 Cemento Enamel junction 
• Cementum overlaps enamel:60-65%
• Cementum just meets enamel: 30%
• Small gap between cementum and enamel: 5-10%
DEVELOPMENTAL AND ACQUIRED ANOMALIES
ASSOCIATED WITH CEMENTOGENESIS

1. Enamel Projections:

 If amelogenesis is not turned off before the start of root

formation, enamel may continue to form over portions
of the root normally covered by
cementum

 Occurs in mandibular molar furcations

2. Enamel Pearls:
• Consists of globules of enamel on the root surface in the
cervical region. Resemble small pearls, upto several
mms, in diameter
• Appear due to localized failure of Hertwig’s
root sheath to separate from the dentin surface
 Promote periodontal lesions
 Mimic calculus clinically &radiographically.
 Cannot be scaled off
 Larger pearls may contain pulpal extensions.
3. Cementicles :

Globular masses of cementum arranged in concentric lamellae

that may be free in the PDL space or adhere to the tooth surface.
May develop

 Calcified epithelial rests

 Around small spicules of cementum or alveolar bone

traumatically displaced into the periodontal ligament

 From calcified sharpey’s fibers

 From calcified, thrombosed vessels within the P.L

4. Cementomas:
 Masses of cementum generally situated apical to
the teeth, may/may not be attached
 Either odontogenic neoplasms or development,
malformations.
Neoplastic & nonneoplastic conditions:
Benign cementoblastomas
Cementifying fibroma
Periapical cemental dysplasia
Florid cemento-osseous dysplasia
Hypercementosis :
 Abnormal thickening of cementum
 May be diffuse or circumscribed
 Generalized / localized to one tooth
 If overgrowth improves the functional qualities of the
cementum – Cementum Hypertrophy.

 non functional teeth or not correlated with increased

function – Cementum Hyperplasia.

 Excementosis : Knob – like projections around

degenerated epithelial rests.
Etiology of hypercementosis :
 Increased Orthodontic forces.
 Teeth without antagonists
 Low grade periapical irritation
 PAGET’S DISEASE ( entire dentition)
6. Ankylosis :

 Fusion of cementum and alveolar bone with obliteration of

the periodontal ligament.

 Occurs in – teeth with cemental resorption following

chronic periapical infection.

 Tooth replantation

 Occlusal trauma around embedded teeth

 Ankylosis results in resorption of root and replacement by

bone :- Reimplanted teeth exfoliate after 4-5 years.
Clinically:
 Primary teeth
 Lack of physiologic mobility
 Infraocclusion
 Titanium implants are ankylosed to bone for
indefinite period.
Cementum Resorption and Repair
Both erupted as well as unerupted teeth subject to resorption.
May be due to - Local, systemic, Idiopathic
• Trauma from occlusion
• Orthodontic movement
• Pressure from maligned, erupting
Local teeth, cysts, tumors , teeth without
functional antagonist
• Replanted, embedded, PA & Pdl
infection

• Calcium deficiency

Systemic • Hypothyroidism
• Hereditary fibrous dystrophy
• Paget's disease
 Cemento Clasts ( odontoclasts ) :
 Multinucleated giant cells indistinguishable from
osteoclasts.
 Responsible for primary tooth exfoliation
Microscopy :
 Bay – like concavities on root surface
 Multinucleated giant cells,
 large mononuclear macrophages adjacent to areas of
active resorption.
Repair :
Anatomical repair

 Tendency to reestablish the former outline of the

root surface by cemental deposition
Functional repair

 Thin layer of cementum is deposited over areas of deep

resorption. The periodontal space is restored with
alveolus bone projection to maintain functional relation.
 Cementum repair
 Cementum resorption is not
continuous and may alternate with
periods of repair and deposition of
new cementum.

 The newly formed cementum is

demarcated from the root by a deeply
staining irregular line termed as
reversal line

 Cementum repair requires presence

of viable connective tissue .If
epithelium proliferates into an area of
resorption repair will not take place
• Type of cementum that is formed during healing
Age Changes :
 Permeability decreases
 Cementum increases in thickness by apposition

 Transverse fractures of root may be healed by formation of

new cementum.

 Greater deposition of cellular cementum than acellular

leading to gradual constriction of apical foramen & makes
extraction difficult.

 Continuous deposition maintains tooth length lost by attrition.

Thank you…