Cementum

Definition; Cementum is a
mineralized
dental
tissue
covering the anatomical part of
the root of the human teeth, it
begins at the amelo-cemental
junction and continues to the
apex. it serves as a medium for
theattachmentofcollagenfibers
of the periodontal ligament that
bindthetoothtothesurrounding
structures.

Physical characteristics
Cementumhumancementumisavascularandwithnonervesupply.
Thickness: thethicknessofcementumatthecervicalareaisabout
20-50micronsandit graduallyincreasesinthicknesstillitreachesits
maximum about (150-200u) at the apex and at the bifurcation of the
root.Sometimescementumextendstotheinnerwalloftherootdentin
forshortdistanceandsoaliningoftherootcanal.
Colour:islightyellowinColouritissomewhatlighterincolourthan
dentin. It can be distinguished from enamel by its lack of lustre and
darkerhue.
Permeability:Cementumhasbeenshowntobepermeabletoavariety
ofmaterials, itis permeable from thedentin sideas well asfromthe
periodontalligamentside,thepermeabilitydecreasewithagefromthe
ligament

 Chemical

composition

In fully formed permanent teeth, cementum contains

45%-50% inorganic substances and to 55% organic
material.
The inorganic substances consist mainly of calcium and
phosphate in the form of hydroxy apatite, while the
organic portion consists mainly of collagen type I and
protein polysaccharides forming the ground substance.
The matrix fibers are oriented with their long axis
parallel to the root surface. These fibers are produced
by the cementoblasts and they are at right angles to the
Sharpeys fibers. Numerous trace elements are found in
varying amounts. A of interest is that cementum
contains the greatest amount of fluoride in all
mineralized tissues.

 Classification

of cementum and histological

structure;
Cementumofhumanteethisclassifiedinto;
1-cellularcementum
2-Acellularcementum
2-intermediatecementum
4-Afibrillarcementum

Acellular cementum

it is clear and structureless it directly over the granular layer of Tomes. It covers root
dentin starting from the amelocemental junction to the apex, but it is often missing at
the apical third of the root, where the cementum may be entirely of the cellular type.
In general a cellular cementum usually predominates at the coronal half of the root,
whereas cellular cementum is more frequent on the apical half. Alternating layers of
cellular and acellular cementum could be present in decalcified specimens.
Collagen fibrils form the main bulk of the organic portion, in between the collagen
fibrils there are protein polysaccharide materials which form the ground substance.
Collagen fibrils in both a cellular and cellular cementum are arranged in a very
complex fashion.
When cementum is thin, Sharpey's fibers cross the entire thickness of the cementum,
with increase deposition of the cementum a larger part of the fibers is incorporated in
the cementum. It has to be noted that the increase in thickness of cementum does not
enhance the functional efficiency by increasing the strength of attachment of the
individual fibers, because the deeper portion of the fibers is calcified and the
attachment proper is confined to the superficial cementum only.

Cellular cementum
It has the same structure as the a cellular cementum hut
contains cells (cementocytes) the cementocytes are cells
incorporated into cellular cementum, these cells are similar
to the osteocytes. cementocytes has granular cytoplasm and
faintly stained nucleus the cell body lies in space called
lacunae and their processes present in canaliculi. these
processes may branch an~ anastomose with those of the
neighboring cells. Most of these processes are directed
toward the periodontal surface of the cementum, to provide
nutrition for the cement. Cementocytes present in the deepest
layer of cementum show signs of degeneration, the cytoplasm
contains organelles, the endoplasmic reticulum is dilated and
mitochondria are spaced.
signs of degeneration such as cytoplasmic climping are seen
among cementocytes present in the most deep layers.
Cementocytes are best demonstrated in dry ground section
where the cells are degenerated.

Incremental lines of Salter

Both cellular, and acellular cementum are

separated by incremental lines into layers which
indicate periodic formation. Histochemical studies
indicate that incremental lines are highly
mineralized areas with less collagen and more
ground substance than other portions cementum.
the incremental lines are roughly parallel to the
long axis of the root. llw eellul& ocmentti m is
formed at a fluster rate than the accl In lar
cementum and the Incremental lines au there tin-c
located further apart than in a cellular cementum.

Intermediate cementum
dentin in is separated from cementum by a zone
known as the intermediate cementum layer:
This intermediate cementum does not resemble
either dentin or cementum Usually it is present
in the apical two thirds of the roots of molars
and premolars, rarely seen in incisors or
deciduous teeth. It is believed that this layer
represents areas where cells of Hertwig's
epithelial root sheath become trapped in a
rapidly deposited dentin or cementum matrix.
Some times the intermediate cementum is found
as a continuous layer and sometimes it is found
yin isolated areas.

Cemento dentinal junction

The cemento dentinal junction is relatively

smooth in permanent teeth but in deciduous
teeth it is scalloped. The attachment of
cementum to dentin in either case is quite firm,
although nature of this attachment is not fully
understood, the collagen fibrils of cementum
are arranged in relatively distinct bundles,
while those of dentin are arranged somewhat
hazardly. The collagen fibrils of cementum and
dentin interwine at their interface in a very
complex fashion, so it is not possible to
precisely determine which fibrils are of
dentinal origin d which are of cemental origin.

cemento-enamel junction
Therelationbetweencementumandenamelatthecervicalregionofteeth
is variable. In 30% of all teeth, cementum meets the cervical end of
enamelinarelativelysharpline.
When the epithelial root sheathof Hertwig'sis delayed in its separation
fromthedentin,azonetherootisdevoidofcementum.Insuchacasethe
cemento enamel junction here consists only a layer of dentin without
enamelandcementum.Thisoccursinabout10%oftheteeth.
Inabout60%oftheteethcementumoverlapsthecervicalendofenamel
for a short distance. is occurs when the reduced enamel epithelium
degeneratesatthecervicaltermination
ittingtheundifferentiatedmesenchymalcellsofthedentalsactocomein
directcontactThtheenamelsurface.
They differentiate and produce cells that produce a laminated electron
dense reticular erial called aflbrillar ceinentum. It does not contain
collagenfibers.Ifitcontinuesincontact~hconnectivetissuecellsfibrillar
cementumwithcollagenfiberswillformoverit.

Function of cementum;
1- the main function f cementum is to form a medium for
attachment of collagen fibers that bind the tooth to the
alveolar bone . the cementum is a continuous deposits and is
not liable for resorption by existence of cementoid tissue , this
keep the attachment apparatus intact
2- cementum serves as the major reparative tissue for root

Cementogenesis

Thiscomprisesmatrixformationandmineralization.
matrix formation The development of the root begins a the crown is formed. The outer and
inner dental epithelium form the epithelial root sheath Hertwig's. The inner dental epithelium
will induce the neighboring cells of the dental papilla to differentiate into odontoblasts. The
predentinanddentinformationoccurinasimilarmannertothatofthecrown.
Once the dentin formation is started, the epithelial root sheath of Hertwig's will loose its
continuity, undifferentiated mesenchymal cells from adjacent connective tissue of the tooth
folliclewilldifferentiateintocementoblasts.
The cementoblasts have the ultrastructural characteristics typical of cells actively synthesizing
protein-polysaccharide complexes i.e. an abundant endoplasmic reticulum, a well developed
Golgi apparatus and several mitochondria. The ultrastructural features are not unique to
cementoblasts and can be observed in other cells actively producing proteins and
polysaccharides. The main product of cementoblast is collagen which constitutes the major
pm.oforganicmatrix.alsocementoblastsproducethegroundsubstances.
The remnants of the epithelial root sheath of Hertwig's migrate toward the dental sac and
becometheepithelialrestsofMalassezfoundintheperiodontalligamentofthefullydeveloped
tooth.Epithelialcellswhichfailtomigratefromthedentinsurfacemaybeincorporatedinthe
cementum. Growth of cementum is a rhythmic process and as a new layer of cementoid is
formed,theoldonecalcifies.Athinlayerofcementoidcanusuallybeobservedoncementum
surfacewhichiscoveredbycementoblasts.

Mineralization

Mineralizationoccursaftersomematrixproductionhastaken
place. The mineral originate from tissue fluids, where
calciumandphosphateionsarepresent.Themineralcrystals
are deposited within, on the surface of and between the
collagen fibers. The long axes of the crystals are arranged
parallel to the long axes of the collagen fibers.Thecrystals
are composed of unit cells of hydroxy apatite. In order to
form one single crystal in cementum, several thousands of
unit cells are required. The crystals are plate-like in shape
andtheymeasureabout530Along.

Age changes of cementum;

1) Permeability ; by aging the permeability of
cementum decreases gradually, the permeability
from the periodontal ligament side is lost except in
the most recent formed layers of cementum, while
permeability from the dentin side remains only in
the apical region
2) Hypercementosis ; is an abnormal thickening
of cementum it may affect all teeth.of dentition.
The increase in cement thickness is around the
apex of all teeth and in the furcation of multirooted
teeth and on other areas of the root .
Hypercementosis is viewed in two forms ;

Cementum hypertrophywhentheincreaseofthe
cementthicknessimprovethefunctionalqualitiesof
thecementum.Thistypeofcementumistypicalform
ofcellularcementum.
Cementum hyperplasia;itoccursinnonfunctioning
orembeddedteeth.thistypeofhypercementosisis
characterizedbycalcificationofSharpey'sfibersand
isaccompaniedbynumerouscementicles
.Cementicles;theyareovoidorroundcalcified
structurethatexhibitsbydystrophiccalcificationofthe
degeneratedperiodontaltissueortheepithelialrestsof
Malasseztheyhavenidusfavoringthedepositionof
concentriclayersofcalcospheritesaroundthe
degeneratedorhemorrhagicareas.

Types of cementum

According to formation;
Primary cementum (acellular cementum)
Secondary cementum (cellular cementum)
According to cellularity:
Cellular cementum: Cementum containing cementocytes in lacunae within the cementum matrix.
Acellular cementum: Cementum without any cells in its matrix.
By the presence of collagen fibrils in the matrix:
Fibrillar cementum: Cementum with a matrix that contains well-defined fibrils of type I collagen.
Afibrillar cementum: Cementum that has a matrix devoid of detectable type I collagen fibrils. Instead, the
matrix tends to have a fine, granular consistency.
According to the origin of the matrix fibers (applies only to fibrillar forms of collagen):
Extrinsic fiber cementum: Cementum that contains primarily extrinsic fibers, i.e. Sharpey's fibers that are
continuous with the principal fibers of the periodontal ligament. Since the fibers were originally produced by
periodontal ligament fibroblasts, they are considered "extrinsic" to the cementum. These fibers are orientated more
or less perpendicularly to the cementum surface and play a major role in tooth anchorage.
Intrinsic fiber cementum: Cementum that contains primarily intrinsic fibers, i.e. fibers produced by
cementoblasts and that are orientated more or less parallel to the cementum surface. This form of cementum is
located predominantly at sites undergoing repair, following surface resorption. It plays no role in tooth anchorage.
Mixed fiber cementum: Cementum that contains a mixture of extrinsic and intrinsic fiber cementum.
A fibrillar type cementum (cement overlap enamel)
Intermediate cement type

The descriptors for the classes of cementum described above can be used in various
combinations to more precisely describe a specific type of cementum. Examples follow:
1. Acellular, afibrillar cementum
This cementum is mostly composed of mineralized matrix, without detectable collagen
fibrils or cementocytes. It is produced exclusively by cementoblasts. It is typically found
as coronal cementum on human teeth.
2. Acellular, extrinsic fiber cementum

TOOTH TISSUES: CEMENTUM

WABeresford

ENAMEL
DENTINE

GINGIVA

PULP
CEMENTUM
ALVEOLAR BONE

PERIODONTAL
LIGAMENT/ PDL

TOOTH DESIGN: Spear me

Blade
ENAMEL

Shaft
DENTINE

Grip
CEMENTUM

TOOTH DESIGN: Spear me

Refinements
ENAMEL

DENTINE

Shaft is hollow for

PULP
CEMENTUM

Hand represented by
PERIODONTAL LIGAMENT
& ALVEOLAR BONE

Closertotrueproportions

CEMENTUM: Role
Cementum is the hard covering of the
root that can:
fuse to dentine, but
be alive and
grow outwards to trap the periodontalligament fibers, and thus
attach the tooth to the alveolar bone.
It is itself a kind of bone, but is less
susceptible to erosion

Bone matrix = collagen fibrils +

mineral crystals

REMINDER -BONE

CELLS

Active Osteoblasts

Bonecanal

vessels
Periosteum

Osteoclast
Restingcells

Osteocyte

Ca2+

CEMENTUM-BONE DIFFERENCES
FORMING CELLS ARE
CEMENTOBLASTS
IMBEDDED CELLS ARE
CEMENTOCYTES
ACELLULAR CEMENTUM
EXISTS
NO PERIOSTEUM

Bone matrix = collagen fibrils +

mineral crystals

Active Osteoblasts

Bonecanal

vessels
Periosteum

Osteocyte

Osteoclas
t
Restingcells

Ca2+

COLLAGEN FIBERS
NO TRABECULAE
PERPENDICULAR TO
NO MARROW
SURFACE
NO VESSELS OR CANALS
WITHIN CEMENTUM
ALMOST NO REMODELING

BONE-CEMENTUM SIMILARITIES
MATRIX MATERIALS

Bone matrix = collagen fibrils +

mineral crystals

LACUNAE WITH
CANALICULI FOR CELLS &
CELL PROCESSES

Bonecanal

vessels

SIMILAR APPEARANCE IN Periosteum

STAINED & GROUND
SECTIONS
APPOSITIONAL GROWTH
FROM SURFACE
INCREMENTAL GROWTH
LINES IN MATRIX

EROSION BY
OSTEOCLASTS
(cementoclasts)

ORIENTATION: Terms
CUSPAL/
OCCLUSAL

Enamel
CORONAL

CERVICAL

P
U
L
P
A
L
RADICULAR

APICAL

Cementum

CEMENTUM: Position
ENAMEL

}
}

CROWN

DENTINE
PULP
CEMENTUM

Cervix
ROOT

Cementum is on the root, but can extend slightly

onto enamel. Cementum also can be exposed to
the oral cavity, if the gingiva recedes too far

CEMENTUM: types & width

10 m
thick

P
U
L
P
A
L

The left of this Fig is

misleading in
suggesting that all
cementum is cellular.
The cervical half is
thin and acellular no cementocytes

Cementum
700 m
thick

APICAL

INTER-RADICULAR CEMENTUM

Multi-rooted teeth usually

have particularly thick &
cellular cementum
between the roots in an
inter-radicular position

CEMENTUM: Boundaries

Cemento-enamel junction CEJ

Dentino-cemental junction DCJ

Ligamento-cemental junction
APICAL FORAMEN

CEMENTUM: CEJ VARIATIONS

E

CEMENTUM
OVERLAP C/E
most frequent

BUTT JOINT
end-to-end

GAP
dentine
exposed

GROWTH OF CEMENTUM = PDL anchoring

E

PDL
fibers

Reactivated cementoblasts
lay down cementoid
Cementoid becomes
another layer of cementum.
Cells make more cementoid

PDL fibers become

imbedded in newly
formed cementum
-Sharpeys fibers

GROWTH OF CEMENTUM III

Further down the root

cementoblasts
proliferate

Further down the root

cementoblasts proliferated
so that one cell can
become imbedded as a
cementocyte, while
another remains on the
surface as a cementoblast

PDL fibers omitted.

CEMENTUM MATRIX
Fine collagen fibrils - intrinsic
PDL fibers (extrinsic)
become imbedded in
newly formed cementum
MATRIX
PROPORTIONS
collagen fibrils and
glycoproteins &

Imbedded PDL fibers

-Sharpeys fibers - not
specific to cementum

35%
Organic

proteoglycans

mineral crystals 65%

Inorganic

ROOT FORMATION
REDUCED
DENTAL
EPITHELIUM

DENTINE

HERTWIGS
ROOT
SHEATH
Epithelialdiaphragm

Root sheath
breaks up, allowing
sac mesenchymal
cells to contact
root dentine

Odontoblastrecruitmentsite

CEMENTOGENESIS START

DENTINE
Root sheath breaks up & lifts,
allowing sac mesenchymal cells
to contact root dentine

PULP

Dentine &/or Epithelial root

sheath induces mesenchymal
cells to become cementoblasts

Odontoblastrecruitmentsitebyroot sheath: pulp signaling

SEQUENCES

Directions of
cemental
growth outwards &
apicalwards

Dentine formed before

cementum
& cervical before apical

Occlusal wear

FUNCTIONAL ERUPTION
& TOOTH MOVEMENT

Osteoclasts
resorbing bone

Bony
interdental
septum

Osteoblasts
laying down
bundle bone

PDL fibers
incorporated in bone
as Sharpeys fibers
Cellular cementum added to apex
Compensates for occlusal wear?

Basil

CEMENTUM: Defects

CORONAL CEMENTUM
spurs, etc, on enamel
P
U
L
P
HYPERCEMENTOSIS
-excess deposition
CEMENTICLES
IN PDL

CEMENTOCLASIA - eroded
cementum (occurs normally
in decidual-tooth shedding)

CEMENTUM: Repair

P
U
L
P

P
U
L
P

After cementoclasia,
cementoblasts may fill
in the defect with new
cementum.
This cycle can be repeated,
and also occurs a little
during shedding & after
root fracture

EXFOLIATION of DECIDUOUS MOLAR III

ENAMEL
DENTINE

Erosion of bone and the deciduous root is not steady &

continuous, but may cease briefly, when some repair of
eroded cementum & dentine can occur (by cementum).

CEMENTICLES
Hard mineralized bodies found in
the periodontal ligament or
partially imbedded in cementum

P
U
L
P