Cementum PDF

DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY
MRDC
CEMENTUM
LRM 25 I BDS,U.G CURRICULUM-DEPT. OF ORAL PATHOLOGY AND MICROBIOLOGY ,MRDC

MRDC
LECTURE TOPIC : Cementum
LEARNING OBJECTIVES
Section I
1. Introduction
2. Cementogenesis
3. Physical characteristics
4. Chemical Characteristics
Section II
1. Composition
2. Types
3. Cementocytes
4. Hyaline layer of Hopewell & Smith, Incremental lines
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 Section 3
1. Cemento enamel Junction
2. Functions of Cementum
3. Clinical Considerations

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AT THE CONCLUSION THE STUDENT IS EXPECTED TO UNDERSTAND

AND ANSWER-
1.The process of development of cementum and its

maturation.
2.Structure and composition of cementum.
3.Histological aspects of cementum.
4.Clinical considerations of cementum.

MRDC

MRDC
Introduction
• Definition:
It is a thin, avascular, hard, mineralized dental tissue covering
the anatomic roots of human teeth.
• Derived from Latin word caementum “quarried stone”

meaning chips of stone used for making mortar.
• First demonstrated microscopically in 1835.

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Introduction
 Furnishes medium for attachment of collagen fibers
that bind the tooth to surrounding structures
 It extends from cemento-enamel junction up to

apical foramen
 Though anatomically it is a part of teeth,

functionally it is a part of periodontium

Physical characteristics
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 It is a calcified structure
 Hardness: Less than dentin
 Colour: Light yellow with dull surface & is lighter

than dentin
 Thickness: Variable, thinnest at CEJ (20 – 50μm) &

thickest at apex (150 – 200μm). Apical foramen is
surrounded by cementum. Some times cementum
extends to the inner wall of root dentin
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Chemical characteristics
• On dry weight basis, cementum of fully formed
permanent teeth contains
Cementum
Inorganic substances Organic substances + water
45 – 50% 50 – 55%

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Inorganic portion
• Hydroxyapatite (Calcium & Phosphate)
• Trace elements like

- Copper
- Fluorine
- Iron
- Lead
- Potassium
- Silica
- Sodium
- Zinc
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Organic portion
• Collagen: Type I predominant
- Others include type III, V, XII & XIV
• Matrix proteins
• Proteoglycans
• Proteolipids
• Osteopontin
• Osteonectin
• Osteocalcin
• Fibronectin
• Vitronectin
• Bone sialoprotein
• Growth factors & alkaline phosphatase
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Cementogenesis
HERS sends an inductive message to

ectomesenchymal cells of pulp
These cells differentiate into odontoblasts &

produce a layer of root dentin beneath HERS
HERS breaks
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Newly formed dentin come in direct

contact with dental follicle
Undifferentiated mesenchymal cells from

adjacent connective tissue differentiate
into cementoblasts
Cementoblast synthesize collagen &

proteoglycans
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Uncalcified matrix
(Cementoid)
Mineralization of matrix
Mature Cementum

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Primary Cementum Formation

 Fragmentation of HERS
 Follicular cells differentiate into cementoblasts.

 Increase in size.
 Development of cytoplasmic organelles.

 Cytoplasmic processes insert into unmineralized hyaline
layer
 Collagen fibers deposited at right angle to root surface.

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 Root surface covered by nonmineralized layer formed
from an admixture of ectomesenchymal and epithelial
products.
 Cementoblasts migrate away from hyaline layer
 Collagen deposition continues
 Fine fiber bundles lengthen to maintain the fibrous fringe

and thicken to form fibrous matrix of acellular cementum.

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• Simultaneous secretion of noncollagenous
proteins such as sialoprotein and osteocalcin.
• First formed cementum is acellular, consisting

of mineralized layer with fibrous fringe
extruding from it.

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• Cementoblasts drift away cementum surface.
• Forming periodontal ligaments fibers become

stitched to fibrous fringe.
• Further deposition of mineral on root surface around

and within collagen fiber bundle resulting in
continuous increase in width of cementum

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Secondary Cementum Formation
• Cementoblasts bud off matrix vesicles
• Cells get trapped in the matrix they are

forming to occupy lacunae.
• Secretory activity declines and cells become

“cementocytes”
• Cellular cementum continues to be deposited

around ligament fiber bundles and partially
mineralize them.
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Secondary Cementum Formation
 Cementoblasts bud off matrix vesicles
 Cells get trapped in the matrix they are

forming to occupy lacunae.
 Secretory activity declines and cells become

“cementocytes”
 Cellular cementum continues to be deposited

around ligament fiber bundles and partially
mineralize them.
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Types of cementum
Cementum is classified according to 3 factors
Based on time of formation
 Primary cementum
 Secondary cementum
Based on presence / absence of cells within its matrix

 Acellular cementum
 Cellular cementum
Based on origin of collagenous fibers of matrix

 Intrinsic fiber cementum
 Extrinsic fiber cementum

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• INTRINSIC FIBRES
 Produced by cementoblasts.
 Parallel to the surface.
 1-2µ diameter.
• EXTRINSIC FIBRES
 Produced by the PDL fibroblasts.
 Oriented perpendicular to the surface.
 5-7µ diameter.
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• Accordingly there are following types of

cementum
1. Primary acellular intrinsic fiber cementum

2. Primary acellular extrinsic fiber cementum
3. Secondary cellular intrinsic fiber cementum
4. Secondary cellular mixed fiber cementum
5. Acellular afibrillar cementum

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• Based on location & pattering there are 2

more types
1. Intermediate cementum
2. Mixed stratified cementum

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ACELLULAR CEMENTUM
• Acellular cementum do not incorporate cells.
• All canaliculi are located towards PDL, so

that it takes nutrition from PDL.
• They have incremental lines of Salter.
• Usually seen in coronal 2/3rd of the root.

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CELLULAR CEMENTUM
• Seen usually in apical 1/3rd of the root.
• Cellular cementum frequently formed

on surface of acellular cementum.

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Acellular
cementum
Cellular
cementum
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Cellular cementum Acellular cementum

Secondary Primary
Thickness more Thickness less
Entrapped cells in the No entrapped cells

lacunae
Present at apical 1/3rd Present at coronal 2/3rd
More intrinsic fibers More extrinsic fibers

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Rate of deposition faster Slower rate of deposition
Distance between Incremental lines are closer

incremental lines more
CDJ is more distinct CDJ is less distinct
Cementoid layer is wide Cementoid layer is narrow
Cementoblast are non Cementoblast are follicular

follicular origin origin
Adaptive function Attachment apparatus

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Primary Acellular Intrinsic Fiber Cementum

• Collagenous matrix of first formed cementum is
result of cementoblastic activity.
• Following it intrinsic fiber fringes become connected
to PDL fiber bundles
• First layer 15 to 20 μm
• Elaborated before PDL forms

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Primary Acellular Extrinsic Fiber Cementum

• PDL fiber bundles are formed and connected
to intrinsic fiber of cementum.
• Deposition of minerals within the bundles
results in formation of acellular exrinsic fiber
cementum.
• Principal tissue of attachment
• Cervical margin of tooth to at least 2/3rd of
root
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• Incisors and Canines – Only form present and

may extend upto apical portion
• Cervical Margin – 50 μm thick
• Apically – 200 μm (Increases progressively)
• Light microscopically : 2 sets of straitions
• Parallel to root surface : Incremental deposition
• Right angle to root surface : Inserted mineralized PDL
collagen fiber budles.

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• No cementoid.
• Overall mineralization – 60 %
• Innermost layer is less mineralized than outer layer.

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Secondary Cellular Intrinsic Fiber
Cementum
• The collagenous matrix of the first formed cementum
is the result of cementoblast activity & hence
considered intrinsic
 Confined to apical and interradicular region.
 Cementoblasts deposit oraganic matrix directly on
the root surface which gets mineralized.
 Cementoid is present
 PDL is unorganized.

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Secondary Cellular Mixed Fiber
Cementum
• Deposition of cellular cementum
incorporates ligament fiber bundles of PDL
creating secondary cellular mixed fiber
cementum
• Bulk of secondary cementum.
1. Cementocytes within lacunae. Identification

characteristics
2. Laminated structure.
in light
3. Presence of cementoid on its surface. microscope
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Acellular Afibrillar Cementum

• Limited to enamel surface
• Seen as spurs or isolated patches on enamel
surface close to CEJ.
• Developmental anomaly.
• Local disruption of REE that permit follicular
cells to come in contact with enamel surface.

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Intermediate Cementum
• Form of secondary cellular intrinsic fiber
cementum restricted to apex of tooth.
• Contains entrapped debris derived from either
root sheath or odontoblastic layer.
• No involvement in tooth anchorage and no
functional significance.

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Mixed Stratified Cementum

• Layered arrangement of apical cementum
• Contains alternate layers of acellular extrinsic

and cellular intrinsic fiber cementum
• It contributes for both adaptation to tooth

wear, movement & attachment

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Cementocytes
 They are spider shaped cells & are the characteristic
feature of cellular cementum
 During the formation of cellular cementum,

cementoblasts become entrapped with in their own
matrix due to rapid deposition & are now called
cementocytes
 They are similar to osteocytes & they lie in spaces

known as lacunae
 They are haphazardly arranged & widely dispersed
 A typical cementocyte has a cell body & numerous cell

processes known as canaliculi
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 These processes branch & frequently anastomose

with those of neighboring cell
 These processes are directed towards the PDL for

nutrition
 The cementocyte contain cytoplasm & few cellular

organelles which indicate that they are
degenerating or marginally active cell
 Deeper layers of cementum, cementocytes shows

definite signs of degeneration such as cytoplasmic
clumping, vesiculation & sometimes empty
lacunae

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Incremental lines of cementum
 Incremental lines of cementum are referred to as
“incremental lines of salter”
 They represent rhythmic periodic deposition of

cementum
 Appear as dark lines running parallel to root surface
 Seen in both acellular & cellular cementum but more

prominent in acellular cementum

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• Best seen in decalcified sections under light

microscopy
• These are highly mineralized areas with less collagen

& more ground substance

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Hyaline layer of Hopewell smith
 Controversy exists to whether it is a form of dentin,

cementum or a separate tissue
 It is thought that the HERS before degeneration release

protein rich substance into the organic matrix of the dental
papilla which gets mineralized
 It acts as a cementing substance between cementum &

dentin
 Unique organic matrix that includes enamel – like protein.

 More mineralized than cementum or dentin

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A - Acellular cementum
B - Hyaline layer of Hopewell-Smith
C - Granular layer of Tomes
D - Root dentine.

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SHARPEY’S FIBERS
• Connective Tissue fibers from PDL pass
b/w cementoblasts into cementum.
• These fibers are embedded in cementum

& serve to attach tooth to surrounding
bone. Embedded portions are Sharpey’s
Fibers.
• Sharpey’s Fibers in primary acellular

cementum are mineralized fully, while
those in cellular cementum & bone
generally mineralized at their periphery.

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Cementoid Tissue
• Cementum formation is a rhythmic

process, a layer of cementoid is
formed, calcifies.
• Cementoid is lined by cementoblasts.

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FUNCTIONS OF CEMENTUM
• Attachment
• Reparative (in case of injury,
trauma)
• Functional Adaptation
• Primary Function of Cementum is to furnish a medium for
attachment of collagen fibers that bind the tooth to alveolar bone.
• Cementum serves as major reparative tissue for root surfaces.

Damage to root such as fractures and resorption can be repaired by
deposition of new cementum.
• Cementum may be viewed as tissue that makes functional

importance. For ex. - deposition of cementum in an apical area
can compensate for loss of tooth substance from occlusal wear.
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Cemento – Dentinal Junction
 It is the interface between the root dentin & cementum
 It is smooth in permanent teeth while it is scalloped in

deciduous teeth
 The collagen fibers of cementum & dentin interwine at

the interface in a complex manner thus providing the
attachment between the 2 structures

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• CD junction consists of a wide zone consisting of

collagen associated with GAG (chondroitin sulphate
& dermatan sulphate)
increased water content
stiffness
Redistribution of load to the bone.

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CEMENTO ENAMEL JUNCTION

 60%: Cementum overlaps enamel.
Degeneration of the Enamel Epithelium at it’s cervical
termination.
 30%: Butt joint (knife edge)
 10%: Gap type ( Do not meet).

Enamel Epithelium in cervical portion of root is delayed
in its seperation from dentin.

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Clinical Considerations
• Cementum is more resistant to resorption
than bone.
• Resorption occurs after trauma or excessive

occlusal forces.
• Anatomic repair (complete regeneration)

• Functional repair ( thin cementum, bony
projection)
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HYPERCEMENTOSIS
 Abnormal thickening
 Diffuse/ circumscribed.
 Effects all / one / part of tooth.
 Localised hypertrophy-
spur/ prong –like extension
More attachment area
Firm anchorage of tooth to surr. Alveolar bone
This condition is found in teeth which are exposed
to great stress.
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Prong like excementosis

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Causes
• Inflammation around the
root
• Form of tooth repair
• Occlusal trauma
• Non-functional teeth
• Pagets disease

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Clinical feature:
 When the involved tooth is extracted the root
appears larger & presents a rounded apex
X ray :
 Thickening of roots
 Rounding of apex
Histopathology:
 Excessive amount of cellular cementum is
deposited over the thin layer of acellular
cementum

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Treatment:
 No specific treatment. Removal of primary cause is
necessary
Note:
 Cementum hypertrophy: The over growth occurs in a
functional teeth & is correlated with increased
function
 Cementum hyperplasia: The overgrowth occurs in

non functional teeth & is correlated with decreased
function

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• Generalized Hypercementosis occurs in Paget’s Disease.
• Hypophosphatasia: rare hereditary disease in which loosening

and premature loss of anterior deciduous teeth occurs, exfoliated
teeth are characterized by almost total absence of cementum.

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• Osteocyte vs Cementocyte
Osteocyte Cementocyte
Lacunae shape ovoid Ovoid or tubular
canaliculi -Radiating -Facing PDL
-Dense -sparse
-Complex arrangement -less complicated
IHC + fibromodulin -fibromodulin

+ lumican - lumican

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TYPE ORIGIN OF FIBRES LOCATION FUNCTION
Acellular (1) Extrinsic fibre Cervical margin to anchorage

apical third
Cellular (2) Intrinsic Middle to apical Adaptation and

third & furcations repair

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TYPE ORIGIN OF FIBRES LOCATION FUNCTION
Mixed fibre Intrinsic + Extrinsic Apical portion and Adaptation

furcation
Acellular Afibrillar - Spur and patch over No known

enamel and dentin Function

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Q-1 Cementum?
A.Is derived from the sheath of hertwig
B.Is acellular in the apical third of the tooth
C.Often overlaps the enamel
D.Does not contain collagen fibres
Ans- C
Q-2 Inorganic content of cementum is?
A.Less than bone B. More than bone
C. Equal to that of bone D.More than that of enamel
Ans- C
Q-3 Cementum is?
A.Avascular B. Vascular
C. Has blood supply initially only D. None of the above
Ans- A
Q-4 Which dental tissue doesn’t contain nerves?
A.Bone B. Dentin
C. Cementum D. Pulp
Ans- C
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Q-5 Which of the following is least mineralized?
A.Cementoid B. Incremental lines
C. Cellular cementum D. Acellular cementum
Ans- A
Q-6 Maximum fluoride content is seen in?
A.Dental cementum B. Dental pulp
C. Enamel D. Dentin
Ans- A
Q-7 Secondary cementum is generally confined to?
A.Cervical third of the root
B.Middle third of the root
C. Apical third of the root
D. No secondary cementum is formed
Ans- C
Q-8 Acellular cementum is typically found in?
A.Coronal half of the root
B.Apical half of the root
C.Apex of root
D.Entire root
Ans- A
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Q-9 If cementum is not formed?

A.Ankylosis may occur B. Exfoliation of teeth occur
C.Delayed eruption D. No change occur
Ans- B
Q-10 At the CEJ cementum overlaps enamel about?
A. 55-60% B. 60-65%
C. 65-70% D. 70-75%
Ans- B
Q-11 The region in which cementum formation is most rapid is?
A. Middle B. Coronal
C. Apical D. Interradicular
Ans- A
Q-12 Which of the following is rare occurrence?
A. Enamel meets cementum at a point
B. Enamel overlaps cementum
C. Cementum overlaps enamel
D. Both never meet
Ans- B LRM 25 I BDS,U.G CURRICULUM-DEPT. OF ORAL PATHOLOGY AND MICROBIOLOGY ,MRDC
MRDC
Q-13 Butt joint in CEJ seen in how many percent of cases?
A.10% B. 30%
C. 60% D. 90%
Ans- B
Q-14 Intermediate cementum is?

A.Between enamel and cementum
B.Found at DEJ
C.Apical third
D.Coronal third
Ans- B
Q-15 Root lenghtning is contributing to?

A.Celular cementum B. Acellular cementum
C. Intermediate cementum D. All of the above
Ans- A
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SHORT NOTE
Q-1 Age changes in cementum?
Q-2 Hopewell smith’s layer?
Q-3 Sharp’s fibers?
Q-4 Difference between cellular and acellular cementum?
Q-5 Short note on cementocytes?
LONG QUESTION
Q-1 Discuss cementogenesis and type of cementum?

MRDC
• Thank You

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DEPARTMENT OF ORAL PATHOLOGY AND MICROBIOLOGY

LRM 25 I BDS,U.G CURRICULUM-DEPT. OF ORAL PATHOLOGY AND MICROBIOLOGY ,MRDC

LRM 25 I BDS,U.G CURRICULUM-DEPT. OF ORAL PATHOLOGY AND MICROBIOLOGY ,MRDC

AT THE CONCLUSION THE STUDENT IS EXPECTED TO UNDERSTAND

1.The process of development of cementum and its

2.Structure and composition of cementum.

3.Histological aspects of cementum.

4.Clinical considerations of cementum.

LRM 25 I BDS,U.G CURRICULUM-DEPT. OF ORAL PATHOLOGY AND MICROBIOLOGY ,MRDC

LRM 25 I BDS,U.G CURRICULUM-DEPT. OF ORAL PATHOLOGY AND MICROBIOLOGY ,MRDC

• Derived from Latin word caementum “quarried stone”

• First demonstrated microscopically in 1835.

LRM 25 I BDS,U.G CURRICULUM-DEPT. OF ORAL PATHOLOGY AND MICROBIOLOGY ,MRDC

 It extends from cemento-enamel junction up to

 Though anatomically it is a part of teeth,

LRM 25 I BDS,U.G CURRICULUM-DEPT. OF ORAL PATHOLOGY AND MICROBIOLOGY ,MRDC

 Hardness: Less than dentin

 Colour: Light yellow with dull surface & is lighter

 Thickness: Variable, thinnest at CEJ (20 – 50μm) &

Inorganic substances Organic substances + water

LRM 25 I BDS,U.G CURRICULUM-DEPT. OF ORAL PATHOLOGY AND MICROBIOLOGY ,MRDC

• Trace elements like

HERS sends an inductive message to

These cells differentiate into odontoblasts &

Newly formed dentin come in direct

Undifferentiated mesenchymal cells from

Cementoblast synthesize collagen &

LRM 25 I BDS,U.G CURRICULUM-DEPT. OF ORAL PATHOLOGY AND MICROBIOLOGY ,MRDC

LRM 25 I BDS,U.G CURRICULUM-DEPT. OF ORAL PATHOLOGY AND MICROBIOLOGY ,MRDC

Primary Cementum Formation

 Follicular cells differentiate into cementoblasts.

 Development of cytoplasmic organelles.

LRM 25 I BDS,U.G CURRICULUM-DEPT. OF ORAL PATHOLOGY AND MICROBIOLOGY ,MRDC

Primary Cementum Formation

 Fine fiber bundles lengthen to maintain the fibrous fringe

LRM 25 I BDS,U.G CURRICULUM-DEPT. OF ORAL PATHOLOGY AND MICROBIOLOGY ,MRDC

Primary Cementum Formation

• First formed cementum is acellular, consisting

LRM 25 I BDS,U.G CURRICULUM-DEPT. OF ORAL PATHOLOGY AND MICROBIOLOGY ,MRDC

Primary Cementum Formation

• Forming periodontal ligaments fibers become

• Further deposition of mineral on root surface around

LRM 25 I BDS,U.G CURRICULUM-DEPT. OF ORAL PATHOLOGY AND MICROBIOLOGY ,MRDC

• Cells get trapped in the matrix they are

• Secretory activity declines and cells become

• Cellular cementum continues to be deposited

 Cementoblasts bud off matrix vesicles

 Cells get trapped in the matrix they are

 Secretory activity declines and cells become

 Cellular cementum continues to be deposited

Based on presence / absence of cells within its matrix

Based on origin of collagenous fibers of matrix

LRM 25 I BDS,U.G CURRICULUM-DEPT. OF ORAL PATHOLOGY AND MICROBIOLOGY ,MRDC

• Accordingly there are following types of

1. Primary acellular intrinsic fiber cementum

LRM 25 I BDS,U.G CURRICULUM-DEPT. OF ORAL PATHOLOGY AND MICROBIOLOGY ,MRDC

• Based on location & pattering there are 2

LRM 25 I BDS,U.G CURRICULUM-DEPT. OF ORAL PATHOLOGY AND MICROBIOLOGY ,MRDC

• All canaliculi are located towards PDL, so

• They have incremental lines of Salter.

• Usually seen in coronal 2/3rd of the root.

LRM 25 I BDS,U.G CURRICULUM-DEPT. OF ORAL PATHOLOGY AND MICROBIOLOGY ,MRDC

• Seen usually in apical 1/3rd of the root.