Emslie, RD. Some Considerations of the Role of Cementum in Periodontal Disease. J. Clin. Periodontol., 5:1-12, 1978

Aim

Findings

1. Acellular Cementum
   • Usu. at coronal portion of root
   • Lamellated and characterized by numerous incremental lines running parallel to the root surface (Selvig).
   • Formation is slower than cellular cementum
   • Contains mostly radially oriented fibers.
   • Lining the surface is a .25 to 5.0 micron layer of precementum containing densely packed collagen fibrils (Stern).
2. Cellular Cementum:
   • Usu. at more apical portion of root
   • Contains more irregularly arranged collagen fibrils than are seen in acellular cementum which are not directly engage in attachment (Selvig). Many calcified fibers are oriented parallel to the root surface.
   • On the surface is precementum which contains meshworks of single collagen fibrils and bundles of fibrils.
   • Deposition of cellular cementum is more rapid than acellular cementum. Zander notes that the highest rate of continuous cemental apposition may take place at the apex.
3. Intermediate Cementum:
   • At the dentocemental interface, organic materials such as cells, cellular debris and collagen have been noted.
   • May play a function in the formation of cementum (Diab).

1. Exposed Cementum:
   • Increased mineralization from salivary components or...
   • Demineralization (root caries) or...
   • Presence of refractile granules which may represent areas of collagen degeneration...
   • Possible bacterial penetration (Furseth).
2. Unexposed Cementum:
   • Below the most apical border of the JE, observed is a loss of cementoblasts and a reduction or loss of the precemental layer.
   • Selvig has observed partial destruction of collagen in a zone 0.5 to 1 mm below the apical border of the JE and complete destruction of collagen immediately below the epithelium. This area contained granular debris.
   • Exhibits a reduction in number and size of mineralized crystals. Hurzeler reported that periodontally diseased teeth showed less cemental apposition than teeth without disease.
   • It is reasonable to assume that gingival inflammation acting either alone or in concert with other mechanisms may affect acellular cementum at the site of inflammation.

• The constant remodeling of cellular cementum stimulates similar remodeling responses seen in bone. Acellular cementum resorbs slowly and is protected against too rapid resorption by its surface layer. However, gingival inflammation creates a change in state of the attachment apparatus at the site of inflammation which may allow apical migration of the JE.
• Most authors suggest that resorption must precede apposition, but this is not a universal finding.
• That cellular cementum is usually the repairing tissue found in resorption bays and nicks suggests that there is a need for rapid functional reconstruction of a damaged tooth surface and that acellular cementum reflects more prolonged remodeling.

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