Professional Documents
Culture Documents
M IN
DISEASE
Presented By:
Dr. Dhwanit Thakore
Guided By:
Dr. Mihir Shah
INTRODUCTION
Cementum is not static
But rather demonstrates a wide range of
pathologic changes
Why Cementum Is So
Important.?
Robinson. PJ. (1975) Possible Roles of Diseased Cementum in Periodontitis. J. Prev Dent (1975).
Changes in Cementum
Exposed Cementum
Unexposed Cementum
Hardness :
o Exposed non carious cementum is
softer than unexposed cementum.
In exposed cementum
fluoride concentration of exposed
cementum:
(9180 ppm) is about
twice that of unexposed cementum
(5570 ppm).
Organic
Ground
Substance
Changes In Permeability :
Dyes
Radioactive iodine
m in
Periodontit
is
Surface Changes
Healthy cementum
Most recently
exposed cementum
Structural Changes
Presence of Pathologic Granules:
extend 3-12 um into the surface from
overlying plaque.
Mineralization of
areas of
denatured
collagen
Decalcification
Structural Changes
Under transmitted light :
brown, highly refractile and morphologically
variable
lower refractive index than surrounding
cementum
10-50 micron thickness is seen near CDJ.
not seen in calcified ground sections of
teeth , seen only in frozen sections of
decalcified teeth
absolute alcohol : disappeared within 5 mins
seen in 96%of teeth examined
{C.C.Bass,oral. surg.1951,L.A.Benson ,oral. surg. 1963}
{Gary C.Armitage,Thomas M.Christie , JPR 1973}
Structural Changes
EM observations :
Garrett, JS. Cementum in periodontal disease Perio Abstr 23:6, 1975 [Review Article]
Areas of Demineralization :
The cementum may be softened and may
undergo fragmentation and cavitation.
{H.C.Herting JDR 1967}
Root surface caries progress around the teeth
{G.J.Mount Aus dent. j. 1986}
Appear as well defined yellowish or light brown
areas covered by plaque and have a soft or
leathery consistency on probing.
{O.Fejerskov , B.Nyvad 1986}
micro radiography,
chemical analysis,
electron microprobe analysis and
nuclear resonance reaction analysis.
Chemical Changes
The mineral content of exposed cementum is
increased.
The following minerals
diseased root surfaces.
Calcium
Magnesium
Phosphate
Fluoride
are
increased
in
Cytotoxic Changes
Earlier What Clinicians
Cementu Bacterial penetration into the cementum
mBelieve???
Bound
can be found as deep as the cemento
Endotoxin
s
dentinal junction.
Cytotoxic Changes
Daly et al in 1980..
LPS should deemed to be CEMENTUM ASSOCIATED
rather than cementum bound.
Ultrastructural Changes In
Periodontal Attachment:
Zone I A zone of intact connective tissue
fiber attachment to cementum in the apical
and middle regions of the gingival
attachment of the root.
Zone II A zone of partial destruction of the
connective tissue fibers 0.5 to 1.0 mm
beneath epithelial attachment.
Ultrastructural Changes In
Periodontal Attachment:
Zone III - A zone of complete destruction of
connective tissue in a narrow area
beneath the junctional epithelium.
Zone IV - Epithelial lining of cementum. A
space of 0.1 to 0.2 um containing some
granular material but not recognizable
fibrils can be seen between the epithelial
cells & the cementum at more cervical
levels.
ALTERATIONS OF CEMENTUM
Hypercementosis
Ankylosis
Root fracture
Root sensitivity
Root caries
Abrasion
Cemental tear
Hypercementosis
Ankylosis
Fusion
of
cementum
and
alveolar
bone
with obliteration
of
periodontal
ligament
is
termed
as
ankylosis.
Root fracture :
Root sensitivity
Root caries :
Abrasion :
Cemental Tears :
Detachment of fragment of cementum
from the root surface is known as a
cemental tear
Developmental Anomalies :
Enamel projection
Enamel pearls
Cementicles
Enamel projection
Focal apical extensions of the coronal enamel
beyond the normally smooth cervical margin
and on to the root of the tooth.
Classification of Cervical
Enamel Projections
Grade I: The enamel projection extends from the
cementoenamel junction of the tooth toward the
furcation entrance.
Grade II: The enamel projection approaches the
entrance to the furcation.
Grade III: The enamel project actually extends
horizontally into the furcation.
Masters DH, Hoskins SW: Projection of cervical enamel into molar furcations.
J Periodontal 1964;35:49.
Enamel Pearls
Small, focal excessive mass of
enamel on surface of the tooth.
Enemaloma/Enamel drop
Cementicles
These are globular masses of acellular cementum.
Neoplasm of cementum
Cementoma
Benign cementoblastoma (true
cementoma)
Gigantiform cementum
Cementoma
adiographic features
II. Cementoblastic
I. Osteolytic phase
phase
III. Mature phase
BENIGN CEMENTOBLASTOMA
(True Cementoma):
A true neoplasm of functional
cementoblasts which form a large
mass of cementum or cementum like
tissue on the tooth root.
Radiographic features
Gigantiform Cementum
HYPOPHOSPHATASIA:
o Absence of cementum
HYPERPITUITARISM:
o hypercementosis
CONCLUSION
The dynamic features of cementum are
particularly highlighted by its repair
potential. However Irreversible damage
may occur when the cementum surface
becomes exposed to environment of a
periodontal pocket, and the oral cavity. But
the ultimate goal of true periodontal
regeneration
after
treatment
for
periodontitis has revived vigorously the
interest in this unique mineralised tissue.
REFERENCES :
Thank You!