Cementum Oral Histology Ass. Prof. Dr/ Baleegh A.

Alkadasi
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Cementum

- Cementum is a specialized hard layer of calcified mesenchymal tissues which

forms the outer covering of the anatomical root.
-It begins at the cervical portion of
the tooth at the cemento-enamel
junction and continues to the apex.
-Unlike bone, cementum is not
vascular and exhibits little turnover.
-The cementum is the part of the
periodontium that attaches the teeth
to the alveolar bone by anchoring the
periodontal ligament.
Physical Properties:
1. Hardness :
- Hardness less than dentin.
- Least calcified.
2. Colour:
- Light yellow in colour.
- Dull surface (Lack of Lusture)
- Darker than enamel.
3. Permeability:
- More permeable than dentin.
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- Permeability decreases with age.

4. Thickness :
- Cervically: 20-50 micron.
- Apically: 150-200 micron.

Chemical properties:
Composition of the cementum is:
Organic portion is (50-55%), composed of collageneous & non-collageneous
proteins.
- The collageneous composition of the organic portion is type I (90%) & type
III (5%).
- Ground substance consist of mucopolysaccharide.
Inorganic portion is 45-50% composed of hydroxyapatite crystals.
Types of the cementum are there:
1) Acellular cementum
2) Cellular cementum
Classification of cementum:
I. according to the development:
1. Primary cementum:
It is that part of cementum that formed during the root formation.
2. Secondary cementum:
It is that part of cementum that formed after completion of the root.

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II. According to the presence or absence of cells

1. Acellular cementum: It is the first cementum forms, covers approximately

cervical third or half of the root & does not contain cells.
2. Cellular cementum: It forms after the tooth reaches the occlusal plain. It is
more irregular and contain cells (cementocytes) and in individual spaces
(lacunae)

III. According to the origin of the collagenous matrix:

1. Extrinsic fiber cementum:
Its fibers called sharpy's fibers and produced by the fibroblast of the periodontal
ligament.

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2. Intrinsic fiber cementum:

It's fibers produced by the developed cementoblasts.
3. Mixed fiber cementum:
-It's fibers cementum its fibers produced from both types of cells, fibroblast and
cementoblast
According to above findings cementum classified as :
1. Acellular Afibrillar Cementum
2. Acellular Extrinsic Fiber Cementum.
3. Cellular Mixed Stratified Cementum.
4. Cellular Intrinsic Fiber Cementum.
Acellular afribrillar cementum (AAC):
-Mineralized ground substance
-No cells nor intrinsic or extrinsic collagen
-Present as coronal cementum
Acellular extrinsic fiber cementum (AEFC):
-densely packed sharpey′s fibres
-lacks cells
-found in cervical 3rd of the roots
Cellular mixed stratified cementum (CMSC):
-contains cells, extrinsic and intrinsic fibers.
-found in the furcation area and in apical 3rd of roots

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Cellular intrinsic fiber cementum (CIFC):

-contains cells but no extrinsic fibres
-fills the resorption lacunae
Intermediate cementum:
-a poorly defined zone near the CEJ of teeth.
The differences between cellular and acellular cementum:

ACELLULAR CELLUAR CEMENTUM

CEMENTUM
1. First formed Secondary Cementum.

2. Present on cervical third or half of Mainly on apical third of root.

the root.

3. It does not contain cells. It contain cells called cementocytes in

individual spaces lacunae.

4. It is formed before the tooth reaches Formed after the tooth reaches the
the occlusal plane. occlusal plane.

5. More calcified. Less Calcified.

6. Sharpey’s fibers are main Sharpey’s fibers occupy smaller portion

compenent which inserted at & occpy other fibers that are arranged
approximately right angles onto the parallel to the root surface.
root surface.

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Histological structure:
Cementoblasts:
- Large cuboidal cells found on the surface of both cellular and acellular
cementum.
-Soon after Hertwig’s sheath breaks up, undifferentiated mesenchymal cells
from adjacent connective tissue differentiate into cementoblasts.
-Synthesize collagen & protein polysaccharides which make up the organic
matrix of cementum.
-Have numerous mitochondria, a well-formed Golgi apparatus, & large
amounts of granular endoplasmic reticulum.

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Cementocytes:
- Cementocytes are similar to the osteocytes which has a granular cytoplasm
& faintly stained nucleus
- The cytoplasms of these cells sends processes that can anastmose with
neighboring cells . these processes directed towards PDL to provide nutrition
- The cells lies in lacunae & cells processes are present in canaliculi
- Cementocytes present in the deepest layer of cementum undergo
degenerations and gradually lose their organelles and die.

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Incremental lines of cementum (Incremental lines of Salter):

-Both cellular & acellular cementum is separated by incremental lines into
layers that indicate periodic formation of cementum
- unlike other incremental lines of hard structures. They are highly mineralized
areas with less collagen & more ground substances than other portions of
cementum
- The incremental lines are parallel to the long axis of the root.

Cemento enamel junction:

-There is relation between Enamel & Cementum edges at the cervix of the tooth
-Three possible types of transitional interfaces may be present at the CEJ:
 In 60% of the teeth, cementum overlaps the cervical end of enamel for a
short distance.

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 In 30% of all teeth, cementum meets the cervical end of enamel in a

relatively sharp line.
 In 10% of the teeth, enamel & cementum do not meet. This case occure
when the epithelial root sheath of Hertwig delayed in its separation from
the dentin, a zone of the root dentin become devoid of cementum.

Cementodentinal junction:
The dentin surface upon which cementum is deposited
is relatively smooth in permanent teeth.
The cementodentinal junction in deciduous teeth,
however, is sometimes scalloped.

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Cementoid:
-It is a thin layer of cementum matrix found in the outer surface of cmentum.
-it is uncalcified matrix
Sharpey’s fibers:
Terminal portions of the principal fibers that insert into cementum & bone are
termed as “Sharpey’s Fibers”.
These have a principal role of supporting the tooth within jaw.
Functions of cementum:
1. Occlude the sensitive dentin.
2. Cementum provide a medium for the attachment to the collagen fibers of
periodontal ligament.
3. Cementum is hard & has no blood supply, It does not show resorption
under masticatory or orthodontic forces.
- Thus, during heavy orthodontic forces, tooth integrity is maintained &
alveolar bone being elastic in nature changes its shape, fulfilling the
orthodontic requirement.
4. Cementum has property of continuous formation provide repair for the
damage such as fracture or resorption of tooth surface.
5. Regular Cementum formation at the root apex, helps to compensate the
lost tooth height due to occlusal wear or helps in passive eruption of teeth

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Cementogenesis

• It takes place in two phases:

• Matrix formation

• Mineralization

There are 3 cell types responsible for the cementogenesis:

• Cementoblasts

• Cementocytes

• Fibroblasts

• All of these cells are derived from the ectomesenchymal cells.

a) Matrix formation:

1. The development of the root begins after the crown is formed.

2. The outer and inner dental epithelium forms the Hertwig's epithelial root
sheath.

3. The inner dental epithelium will induce the neighboring cells of the dental
papilla to differentiate into odontoblasts.

4. The dentin formation occur in a similar manner to that of the crown.

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5. Once the dentin formation is started, the Hertwig's epithelial root sheath will
lose its continuity and its cells became the epithelial rests of Malassez.

6. Direct contact of the cells of the dental sac with the root dentin resulted in
cementoblast differentiation.

These cells have the ultrastructural characteristics typical of cells actively

synthesis protein and polysaccharide.

The main product of cementoblasts is collagen and ground substances, both

constitute the organic component of cementum.

The inorganic material of cementum is calcium phosphate Hydroxyapatite.

Organic matrix derived from two sources, fibroblast like cells (acellular
cementum), cementoblast cells (cellular cementum) or both.

Three types of cementum collagen fibers:

- Extrinic fibers (Sharpey's fibers) if derived from fibroblast of the

periodontal ligament. These are in the same direction of the periodontal
ligament principal fibers i.e. perpendicular or oblique to the root surface.

-intrinsic fibers if derived from cementoblasts. These fibers run parallel to the
root surface and at right angles to the extrinsic fibers (Sharpey's fibers).

- Mixed fiber found at the area where both types of cells produce fibers.

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7. Some cementoblasts deposit cementum matrix at various locations around

themselves, resulting in their entrapment into the cement matrix converting
them into cementocytes.

8. First layer of cementum is actually formed by the inner cells of the Hertwig's
epithelial root sheath and is deposited on the root's surface was called
intermediate cementum.

The role of this layer is to seals of the dentinal tubules before the Hertwig's
epithelial root sheath disintegrates. The term intermediate cementum recently
found to be named as Hyaline layer of Hopewell-Smith and is considered as
an inductive influence for beginning of cementum formation.

b) Mineralization:

It begins in the depth of the cementum matrix (cementiod tissue), where, fine
hydroxypatite crystals are deposited within the collagen fibrils. The
mineralization of the outermost layer of the dentin matrix (mantle dentin),
appears to be delayed until the implantation of the cementum matrix is
established and the dential matrix completely covered with the collagen fibrils
of cementum.

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Age changes:

1. Smooth surface becomes irregular due to calcification of ligament fiber

bundles where they are attached to cementum

2. Continues deposition of cementum occur with age in the apical area.

This could be a two edges weapon as it maintains tooth length, while

obstructs the apical foramen.

3. Cementum resorption: it is active for a period of time and then stops for
cementum deposition creating reversal lines.

4. Resorption of root dentin occurs with aging which is covered by cemental

repair.

5. The permeability of cementum decreases gradually.

6. cementicles: calcified ovoid or rounded nodule found in the periodontal

ligament single or multiple near the cemental surface. It could be free aging or
at site of trauma.

-It is nidus of epithelial cell that are composed of calcium phosphate and
collagen to the same amount as cementum (45% to 50% inorganic and 50% to
55% organic).

7- hypercementosis:

- It is an abnormal thickening of cementum.

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- It may affect one tooth or may be generalized in all teeth.

- It is either limited to a small area of the root or through the whole root length.

- It has two types:

a. Cementum hypertrophy:

-It is physiologic thickening of the cementum found in the good functioning

teeth as a response to increase the function of the tooth to improve the
functional quality through increase the root surface area and thus permitting
more periodontal fibers to be attached to the tooth.

b. cementum hyperplasia:

-It is overgrowth of the cementum in a non-functioning or embedded tooth. It

is characterized by the absence of sharpey's fibers.

8- Gingival recession.

9- Abrasion of cementum by tooth

brush.

10- Increase hardness due to

withdrawal of organic component and
water and deposition of inorganic at
the surface.

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