Robinson, PJ. Possible Roles of Diseased Cementum in Periodontitis. J. Prev. Dent. 2:May-June, 1975

Aim

To discuss the nature of root changes, and cytotoxic changes and how this will stimulate periodontal breakdown.

Discussion

• Cementum is not static but rather demonstrate a wide range of pathologic changes. The changes in the cementum include
  1. Softer root surface
  2. Removal of collagen
  3. Diminution in the organic portion
  4. Dissolution of the dentinoenamel junction
  5. Cemental splitting
  6. Resorption
  7. Deminaeralization
  8. Hypermineralization
• Aleo et al concluded that the incorporation of bacterial products within the cementum as well as cemental structural changes may contribute to the pathogenesis. There is no conclusive clinical evidence that directly correlates these cemental changes with the progression of periodontal disease. Diseased cementum may indirectly cause destruction of the surrounding tissues by triggering the immune mechanism. The cementum is essentially collagenous. Based on this, Willoughby and Di Rosa proposed the hypothesis on the role of damaged tissue in chronic inflammation. They suggested that the immune response to the diseased damaged collagen (denatured) can perpetuate the cycle of chronic inflammation.

Conclusion

• There is strong evidence to indicate that diseased cementum can cause cell and tissue damage.
  1. There is a direct toxic effect by the bacterial products (endotoxins).
  2. Indirect effect of bacterial products (initiation of a cytotoxic immune response).
  3. There are morphological and biochemical changes in the cementum interfering with the repair of normal connective tissue attachment.
  4. There are biochemical changes in the collagenous structure of cementum initiating an autoimmune response.

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