This review tries to come up with an understanding of the role of diseased cementum plays in the loss of attachment and reattachment of tissues to root.
Gottlieb believed that there was a loss of cementum vitality as the primary etiologic factor in apical migration of the epithelial attachment. The authors feel that this concept as of 1978 was not with the current thinking and a more up to the times view would indicate enzymes of the inflammatory process affect not only the tooth surface in relation to the pocket epithelium but also the tooth surface in relation to the tooth surface abutting the junctional epithelium and gingival connective tissue.
Selvig identified zones in the soft tissues and cementum demonstrating the stages of the disease process. The process involves the breakdown of the gingival fiber apparatus external to the cementum and a more extensive breakdown involving the cemental hard tissue to varying depths. The process of disease can cause structural changes in the hard and soft tissues leading to demineralization of the cemental matrix and resorption of collagenous and matrical elements of cementum which once the dentinal tubules are exposed to the oral environment, bacteria may be demonstrated in intra tubular sites as an extreme result of this sequela.
The presence of endotoxin has been demonstrated and the question which remains is if this toxin is actually adsorbed to or trapped in the tissue. The cementum-bound endotoxin when studied in vitro is effective in depressing fibroblast proliferation and viability. Enzymes range from bacterial source hyaluronidase and collagenase and hydrolytic enzymes originating from neutrophils. The addition of iron onto cementum or other minerals is dependent on the location to the oral environment and bacterial and inflammatory levels the cementum finds itself adjacent to. The softening of cemental tissues is related to demineralization by acids of the inflammatory exudate and enzyme activities. But once the cementum is exposed to the oral cavity due to recession, remineralization may occur.
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