CEMENTUM

NORMAL MICROSCOPIC FEATURES

- It is the calcified mesenchymal tissue

that forms the outer covering of the anatomical root

Two main forms of root cementum

Acellular or Primary Cementum - is the first to be formed and covers approximately the cervical twothirds of the root and doesnt contain cells - formed before the tooth reaches the occlusal plane - contains other collagen fibers that are calcified and irregularly arranged or parallel to the surface

Cellular or Secondary Cementum

- formed after the tooth reaches the occlusal plane - more irregular and usually contains cells in individual spaces (lacunae) that - communicate with each other through a system of anatomizing canaliculi - less calcified and Sharpeys fibers occupy a smaller portion of cellular cementum

Both acellular and cellular cementum are arranged in lamellae separated by incremental lines parallel to the long axis of the root These lines represent rest periods in cementum formation and are more mineralized than the adjacent cementum Sharpeys fibers make up most of the structures of acellular cementum, which has a principal role in supporting the tooth

CEMENTO-ENAMEL JUNCTION

THICKNESS OF CEMENTUM
The thickness of cementum on the coronal half of the root varies from 16 to 60 microns, or the thickness of a hair It attains its greatest thickness (up to 150 to 200 microns) in the apical third and also in furcations areas

DEVELOPMENT AND ACQUIRED ANOMALIES ASSOCIATED WITH CEMENTOGENESIS

Enamel Projection continuous enamel formation over root surface normally covered by cementum from odontogenic epithelium destined to form Hertwigs root sheath and frequent in furcations in mandibular molars

Enamel pearls
Globules of enamel on root surface in cervical region and resemble small pearls, up to several millimeters in diameter Its clinical relevance is that is promotes periodontal lesions by acting as plaque retentive structures It may mimic calculus clinically and radiographically and can be scaled off or can be removed by grinding Large pearls may contain pulpal extensions

Cementicles
Globular masses of acellular cementum generally less than 0.5 mm in diameter, which form within the periodontal ligament Cementicles are not of clinical significance unless they become exposed to the oral environment where they may act as sites for plaque retention

Types:
Free cementicles lie free in periodontal ligament Attached / Sessile cementicles fused or attached to radicular cemental surface Interstitial cementicles totally incorporated or embedded in cementum

Hypercementosis Hyperplastic cementum

Formation of abnormally thick radicular cementum May take the form of multiple, localized, knoblike or spike shaped projections, which give the root an irregular contour May occur as a thickening of the cementum layer, generally more marked in the apical third of the root Generalized hypercementosis may be hereditary or may be associated with Pagets disease Localized hypercementosis may be observed in impacted teeth and teeth without antagonists

Cementoma
Masses of cementum generally located apical to the teeth, to which may or may not be attached Considered either odontogenic neoplasm or developmental malformation Occur more frequently in females and more often found in the mandible than in the maxilla Harmless

Ankylosis
It is the fusion of the mineralized root surface with alveolar bone with obliteration of the periodontal ligament Generalized injury or removal of the periodontal ligament may lead to the condition Results in resorption of the root and its gradual replacement by bone tissue

ALVEOLAR BONE
ALVEOLAR PROCESS It is the part of the maxilla or mandible that forms and supports the teeth ALVEOLAR BONE PROPER It consists of a thin lamella of bone (cortical bone) surrounding the root. Fibers of the periodontal ligament are embedded in this bone SUPPORTING BONE It consists of cancellous trabeculae and surrounds the alveolar bone proper and provides additional support

In radiographs the alveolar bone proper (inner wall of the socket or inner cortical plate) appears as an opaque line called the lamina dura The alveolar bone proper is perforated by many openings through which the blood vessels, lymphatics, and nerves of the periodontal ligament pass and also called the cribriform plate because of these perforations The outer cortical plate is covered by a fibrous and cellular periosteum The interdental septa (singular, septum) are bony partitions that separate adjacent alveoli Alveolar bone proper is formed for the express purpose of supporting and attaching the teeth. The alveolar process depends on the presence of teeth for its existence

Alveolar dehiscence is a dipping of the crestal bone margin exposing the root surface Alveolar fenestration is a circumscribed hole in the cortical plate over the root and does not communicate with

PERIOSTEUM
It is a lining at the outer surface of the alveolar process It contains the neural, vascular, as well as the cellular elements necessary for the maintenance of normal bone function and repair On the alveolar surface, the periodontal ligament serves in the same capacity as the periosteum The endosteum is the corresponding cellular layer found within marrow spaces

PHYSIOLOGIC TOOTH MIGRATION

Under physiologic conditions teeth migrate continuously in a mesial direction towards the midline. This is called physiologic mesial drift The migration leads to a resorption of the inner wall of the alveolus on the mesial side of the tooth and the formation of new bone on the distal surface Physiologic tooth migration continues throughout life but slows or halts in old age The alveolar bone adapts and reconstructs itself continuously Pathologic changes occur when this process of adaptation is disturbed

BLOOD SUPPLY
Branches of the alveolar artery

Periodontal Structure in Aging Humans

Age changes affect the following periodontal tissues: 1. Vasculature 2. Periodontal ligament 3. Cementum 4. Alveolar bone 5. Gingiva and alveolar mucosa

VASCULATURE
In advancing age, there is a reduction in blood flow a decrease in connective tissue cellularity and an increase in the number of coarseness of collagenous fibers principal fibers of the periodontal ligament are thicker in ageing humans than in younger individuals fewer fibroblasts, osteoblasts, and cementoblasts degenerative hyaline changes calcified bodies are common in the periodontal ligament of elderly humans

CEMENTUM
Cemental deposition slows in old age The attachment of cementum to dentin may be weakened Spurring of cementum is sometimes the result of the fusion of calcospheroid bodies near cementum or of the calcification of epithelial rest aggregates

ALVEOLAR BONE
Physiologic tooth migration may be slow or halt in old age The vascularity of bone appears to be diminished Osteoporosis may be observed in aging, particularly in the alveolar bone of postmenopausal women There is slowing and even a halt in bone remodeling Thus the replacement of extracted teeth with prostheses in order to prevent overeruption, malpositioning, and tilting of neighboring teeth may not be necessary Function and esthetics will be the principal

GINGIVA AND ALVEOLAR MUCOSA

The gingiva becomes fibrotic in old age