MacNeil, R. L.; Somerman, M. J.; Molecular Factors Regulating Development and Regeneration of Cementum. Journal of Periodontal Research; 28: 550-9, 1993.

Review articles main points:

• Studies suggest that without the presence of cementum the periodontium cannot be restored to health. Thus, a requirement for clinical regeneration of the periodontium, i.e. formation of new bone, new cementum and connective tissue attachment, may include treatments directed at stimulating or augmenting cementum formation.
• The same process's involved in development may be needed for regeneration: Migration, attachment, proliferation, differentiation, matrix synthesis, thus the developing tooth acts as a perfect model for examining repair process'.
• Migration by chemotaxis of precementoblasts is thought to occur by fibronectin and laminin located on the root aspect of Hertwig's epithelial root sheath.
• Attachment could be mediated through integrins and or fibronectin.or a whole host of other proteins.
• Differentiation : Hertwig's epithelial root shealth - derived proteins are required for cementoblast differentiation. While this hypotheis may explain the role of epithelium in the complex phenomenon of the primary cementum formation, it fails to elucidate the mechanism of regeneratinve cementum formation in the apparent absence of epithelial cells; although remnants of HERS cells remain in the mature PDL as epithelial cell rests of Malassez, it is currently unknown if these cells participate in regenerative cementum formation.
• Matrix synthesis: the temporal and spatial expression of growth factors during tooth development may contribute to attachment and proliferation; growth factors present in bone and possibly cementum are fibroblast growth factor, insulin growth factor I and II, platelet derived growth factor.
• Conclusion is that the factors which regulate cementum activity remain ill-defined.

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