Cementum also commonly known as root cementum , is a highly mineralized tissue covering the entire root surface. Cementum is also often referred to as a bone-like tissue. Cementum contains two types of fibers, mainly extrinsic (Sharpey's) fibers and intrinsic fibers. Fibroblasts and cementoblasts are the fiber secreting cells.

1. CEMENTUM
DR. OINAM MONICA DEVI

2. CONTENTS
1. Introduction And Definition
2. History
3. Physical Characteristics
4. Functions Of Cementum
5. Formation Of Cementum (Cementogenesis)
6. Cementoid Tissue
7. Incremental Lines In Cementum
8. Classification Of Cementum
9. Mineralisation
10. Biochemical Composition

3. 11.Thickness Of Cementum
12.Cementoenamel Junction
13.Cementodentinal Junction
14.Age Changes
15. Cementum Resorption And Repair
16.Alterations Resulting From Periodontal Pathology
17.Hypercementosis
18.Alterations In Cementum
19.Neoplasm associated with Cementum
20.Applied Anatomy of Cementum on Periodontal health
21.References

4. INTRODUCTION
• Derived from Latin “caementum”, quarry stone.
• Component of tooth as well as periodontium.
• Provides anchorage for collagen fibre bundles of periodontal ligament and
supra-alveolar fibres of the gingiva.
• Root surface area covered by it represents the ground available for connective
tissue attachment.
• Present irrespective of functional status.

5. DEFINITION
• It is the calcified, avascular, mesenchymal tissue that forms the outer
covering of the anatomic root. [ CARRANZA ]
• Cementum is a hard, avascular connective tissue that covers the roots
of teeth. [TEN CATE’S]

6. HISTORY
EXAMINED FIRST BY-
FRANKEL - 1835
RASCHKOW -1835
BY HISTOLOGIST
ANDERS ADOLF
RETZIUS - 1837

7. PHYSICAL CHARACTERISTICS
• Less than dentin
Hardness
• Light yellow (enamel: darker hue and
luster)
Colour
• Lighter in colour than dentin.
Dentin
• Permeable to dyes in young animals
Permeability:

8. FUNCTIONS OF CEMENTUM
1.Anchorage
• A medium for the attachment of collagen fibers that bind
the tooth to alveolar bone.
2.Adaptation
• Functional adaptation of teeth possible. For example,
deposition of cementum in an apical area can compensate
for loss of tooth substance from occlusal wear.
3.Repair
• Damage to roots such as fractures and resorptions can be
repaired by the deposition of new cementum.

9. CEMENTOGENESIS
(Formation of Cementum)
-Pre-functional Developmental Stage
During root development.
Time range 3.75 to 7.75 years.
-Functional Developmental Stage
Commences when tooth reaches the occlusal plane.
Continues throughout the life.

10. -Initiation of Cementum Formation
Restricted 200-300 micrometer coronally from the advancing
root end.
-Origin of Cementoprogenitor Cells
1.) From the Dental Follicle
2.) From Hertwig’s Epithelial Root Sheath[HERS]

11. Hertwig’s epithelial root sheath: inner and outer
epithelium
Send an inductive message to the facing
ectomesenchymal cells of pulp
Odontoblasts develop and Predentin layer forms
Epithelial root sheath interrupted, cells of dental follicle
in contact with predentin form cementoblasts
CEMENTUM FORMS

13. CEMENTOBLASTS
• Cementoblasts derived from dental follicle involved in the formation of Cellular
Intrinsic Fiber Cementum (CIFC).
• Cementoblasts derived from HERS involved in the formation of Acellular Extrinsic
Fiber Cementum (AEFC).
• Some cementoblasts get entrapped and are called Cementocytes.
• Cementocytes are present in spaces called lacunae. Present in the deeper layers are
non viable as the distance from the surface increases and diffusion of nutrients
decreases.

14. Some key molecules in the Periodontium
GROWTH FACTORS
• Transforming growth factor
•Platelet derived growth factor
•Insulin like growth factor
Promote cell differentiation during cementogenesis
ADHESION MOLECULES
•Bone sialoprotein
•Osteopontin
Promote adhesion of selected cells to newly forming root
EPITHELIAL/ ENAMEL PROTEINS Promote follicle cells along cementoblasts pathway
COLLAGENS Types-I, II,I XII regulate periodontal tissues during development and regeneration
GLA PROTEINS
•Matrix Gla Protein/ Bone Gla Protein
Prevent abnormal ectopic calcification
TRANSCRIPTION FACTORS
•Runt-related transcription factor 2
•Osterix
Cementoblast differentiation
SIGNALLING MOLECULES
•Osteoprotegerin
•Receptor activated kappa B Ligand
Mediate bone and root resorption by osteoclasts
CEMENTUM-SPECIFIC PROTEINS
•Cementum Protein 1
Local regulator of cell differentiation and extracellular matrix mineralisation

15. CEMENTOID
• Under normal conditions, growth of
cementum is a rhythmic process and
as a new layer of cementoid is
formed, the old one calcifies.
• A thin layer of cementoid can
usually be observed on the cemental
surface and lined by cementoblasts.
• Connective tissue fibers from the
periodontal ligament pass between
the cementoblasts into the
cementum.

16. INCREMENTAL LINES OF CEMENTUM
•Incremental lines,seen in cementum
(Lines of Salter ), as during the
process of cementogenesis.
•In cementogenesis,there are periods
of rest and periods of activity.
•The periods of rests are associated
with these lines. The lines are
closer in acellular cementum as this
cementum is formed slow.

17. CLASSIFICATION OF CEMENTUM
Presence or Absence of Cells
Time of Formation
Location
Presence or Absence of Fibers
Origin of Fibers
Schroeder’s Classification

18. Presences & Absence Of Cells
ACELLULAR CEMENTUM CELLULAR CEMENTUM
1.Found on cervical third of tooth. Mainly seen at apical third and
inter radicular area though a thin
layer is present all over root.
2.Embedded cementocytes are absent. Embedded cementocytes are
present.
3.Deposition rate is slower. Deposition rate is faster.
4.First formed layer Formed after acellular cementum.
5.Width is more or less constant. Highly variable.
6.Sharpey’s fibres are well mineralised. Sharpey’s fibres are partially
mineralised.
7.Incremental lines are regular and closed packed. Irregular and placed wide apart.

19. Based On Location
• Root Surface
Radicular
Cementum
• Forms on the
enamel
covering the
crown
Coronal
Cementum

20. Origin Of Fibres
EXTRINSIC FIBERS INTRINSIC FIBERS
1.Derived from PDL Derived from Cementum.
2.Formed by Fibroblast. Formed by Cementoblast.
3.Run in same direction of the PDL
principal fibers i.e. perpendicular or
oblique to the root surface.
Run parallel to the root surface and
at right angles to the extrinsic
fibers.

21. Presence /Absence Of Fibres
 Fibrillar Cementum: Cementum with a matrix that
contains well-defined fibrils of type I collagen.
 Afibrillar Cementum: Cementum that has a matrix
devoid of detectable type I collagen fibrils. Instead, the
matrix tends to have a fine, granular consistency.

22. SCHROEDER & PAGE CLASSIFICATION
(1986)
Classified CEMENTUM on the basis of :
• Location
• Morphology
• Histological Appearance

23. 1.Acellular Afibrillar Cementum (AAC)
2.Acellular Extrinsic Fiber Cementum (AEFC)
3.Cellular Intrinsic Fiber Cementum (CIFC)
4.Cellular Mixed Stratified Cementum (CMSC)
5.Intermediate Cementum

24. 1-15 um
30-230 um

25. MINERALISATION
• Mineralization begins in the depth of precementum.
• Fine hydroxyapatite crystals are deposited, first between and then within
the collagen fibrils by a process that is identical to the mineralization of
bone tissue.
• Zander & Hurzeler examined the thickness of cementum on extracted
human teeth from individuals of varying ages & concluded that the
mean, linear rate of cementum deposition on single-rooted teeth is
about 3 µm per year (but varying greatly with tooth type, root surface
area, and type of cementum being formed).

26. • A similar rate has been found for acellular extrinsic fiber cementum in premolars
and in nonfunctioning, impacted teeth.
• The width of the precementum layer is about 3-5 µm.
• Process of establishing the appropriate condition for crystallization & growth of
the individual crystals in cementum normally are extremely slow and extend
over a period of several months.
CMSC-LOWER MINERAL
CONTENT THAN AEFC.

27. BIOCHEMICAL COMPOSITION
• 45-50% inorganic substances which consists of
calcium and phosphate in the form of
hydroxyapatite crystals
• 50-55% organic material and water.
Dry weight
• Type I collagen ( 90%)
• Type III collagen ( 5% )
• Non collagenous proteins
Organic matrix
• 35% organic
• 20% water
• 45% inorganic
By volume

28. CEMENTUM PROTEINS
-Glycosaminoglycans(GAGs):
 Proteoglycans creates the cemental incremental lines only in
cellular cementum.
 Major GAGs: hyaluronic acid, dermatan sulfate, chondratin
sulfate & keratan sulfate.
 Play major regulatory roles during cementum mineralization
and are associated with initial phase of cementum formation.

29. -Bone Sialoprotein & Osteopontin:
 Play a major role in filling spaces created during collagen assembly.
 Regulators of hydroxyapatite crystal nucleation and growth.
 Role in differentiation of cementoblast progenitor cells to cementoblasts.
 Osteopontin regulates cell migration, differentiation & survival.
 Sialoprotein modulates the process of cementogenesis & is involved in the process of
chemoattraction, adhesion & differentiation of pre-cementoblasts.

30. -Alkaline Phosphatase:
 Play important role in skeletal mineralization.
 Regulate tissue turnover & cell proliferation, differentiation, maturation.
 Major function: hydrolysis of inorganic pyrophosphate, a
potent inhibitor of hydroxyapitite formation.
 Plays key biological role in the mineralization of bone &
cementum.

31. CEMENTUM SPECIFIC PROTEINS
Cementum- Derived Growth Factor:
 Insulin- like ,growth factor-1 like molecule.
 Repair or regulate tissues.
 Ability of cell migration, adhesion, mitogenic activity &
differentiation, essential for periodontal regeneration.
 Cementum has the potential to regulate the metabolism & turn over of
surrounding tissues because of this growth factor.

32. Cementum Attachment Protein (Cap):
 Promotes the attachment of gingival fibroblasts, endothelial cells & smooth muscle
cells, but not oral sulcular epithelial cells .
 Capacity to direct cell migration of alveolar bone cells.
 Binds selectively to periodontal ligament cells and supports periodontal
ligament cell attachment to root surfaces.

33. Enamel- Associated Proteins In Cementum:
 Synthesized by Hertwig’s epithelial root sheath cells.
 Results in the formation of a cellular- like tissue or bone with the characteristics of
cellular intrinsic fiber cementum.
 Functions: promotion of cell proliferation, differentiation & up-regulation of
extracellular matrix production.
 Involved in root formation.

34. Osteonectin
 Mainly secreted by osteoblasts .
 Important for mineralization process.
 Found in the PDL.
Osteocalcin
 Also known as bone Gla protein as it contains carboxyglutamic acid (Gla)
residues.
 Mainly secreted by osteoblasts (Mariotti, 1993), regulate
mineralization process, prevent hypercalcification of the cementum
surface.

35. MINERAL COMPONENT
• Magnesium: 0.5- 0.9% , half than dentin, more in deeper layers.
• Fluoride : 0.9% weight more on surface layer and more in apical cementum
• Sulfur: 0.1-0.3% as a constituent of organic matrix.

36. THICKNESS OF CEMENTUM
• 16-60µm coronal half = 16-60µm
• apical third and furcation = 150-200 µm
• Thicker on distal than on mesial surfaces.
• Between 11 to 70 years of age, thickness increases 3 times.
• Cemental deposition continues throughout life.
• Deposition most rapid in apical areas.

37. CEMENTOENAMEL JUNCTION
Vandana and Haneet: Cementoenamel junction: An insight,2019
60% =cementum
overlaps the cervical
end of enamel
30% = cementum
meets the cervical
end of enamel
10% = enamel and
cementum do not
meet
1.6% = enamel
overlaps
cementum

38. VARIOUS METHODS OF CEJ LOCATION
CONVENTIONAL
METHODS
•Visual
• Tactile
 By straight explorer
 By periodontal probe
• Radiographic :
 Intraoral periapical
(IOPA)
radiograph
 Bite wings
 RVG
MODIFIED METHODS
•Computer linked electronic constant
pressure probes
• Florida probe
• Inter probe/Perio probe
• Birek probe/Toronto automated probe
• Jeff coat probe/Foster miller probe.

39. CEMENTODENTINAL JUNCTION
The terminal apical area of cementum where
it joins the internal root dentin is called
cementodentinal junction (CDJ).
The nature of CDJ is of particular
importance, being of interest biologically
because it forms an interface (a fit) between
two very different mineralized tissues.
Clinical importance - Involved in the
processes maintaining tooth function while
repairing a diseased root surface.
Width of CDJ is 2 to 3µm and remains
relatively stable .

40. CEMENTIODENTINAL JUNCTION
Smooth in permanent teeth Scalloped in deciduous teeth

41. AGE CHANGES
CONTINOUS DEPOSITION
• Forms on roots throughout life.
• More apically than cervically.
• Reduces root surface concavities thicker layer in root
surface grooves and in furcations.
• Variation in tooth position influence pattern of deposition.

42. • Cementum although is less susceptible to
resorption than bone.
• Resorption is carried out by multinuclear
odontoclasts & may continue into the root
dentine.
SYSTEMIC FACTORS
–Calcium deficiency
–Hypothyroidism
–Hereditary fibrous
osteodystrophy,
–Paget's disease.
•IDIOPATHIC
LOCAL FACTORS
–Trauma from occlusion.
– Orthodontic movement
–Pressure from malaligned
erupting teeth,
–Cysts and Tumors
–Teeth without functional
antagonists;
–Embedded teeth;
–Replanted and transplanted
teeth;
–Periapical and periodontal
disease

43. • MICROSCOPICALLY: Bay like concavities in the root surface.
• Multinucleated giant cells and large mononuclear macrophages
found.
• Newly deposited cementum is demarcated from old by deeply
staining irregular line k/a Reversal line.
• Reversal line has few collagen fibrils and highly accumulated
proteoglycans with mucopolysaccharides.

44. REPAIR
• Needs viable connective tissue.
• If epithelium proliferates no repair.
• Origin of Cementoblasts and factors regulating their recruitment
not understood.
• Only odontogenic cells in PDL Epithelial rests of Malassez

45. ALTERATIONS RESULTING FROM
PERIODONTAL PATHOLOGY
1.EFFECT OF GINGIVAL
INFLAMMATION
• Loss of collagen fibres of the gingiva
• Dissolution of mineral crystals
• Cervical root resorption

46. 2.EXPOSURE OF CEMENTUM TO ORAL ENVIRONMENT
•Non-carious cementum is permeable
to organic and inorganic ions.
•Bacterial invasion is common.
•Bacterial lipopolysaccharides detected .
•Hypermineralized surface zone depends
on the inorganic ion concentration.

47. CHANGES ASSOCIATED WITH
PERIODONTAL POCKETS

49. ALTERATIONS IN
CEMENTUM

50. ANKYLOSIS
• Fusion of cementum and alveolar bone with
obliterated PDL.
• Occurs in teeth with cemental resorption.
• After periodontal inflammation, tooth
replantation, occlusal trauma.
• Resorption of root and its gradual
replacement by bone.
• Lack physiological mobility, metallic
percussion.
• No proprioception.

51. CONCRESCENCE
• Fusion of teeth by cementum .
• After root formation has been completed.
• Traumatic injury or crowding of teeth with
resorption of the interdental bone.
• Difficulty in extraction.

52. ROOT CARIES
• Initiates on mineralized
cementum and dentin surfaces
which have greater organic
component than enamel tissue.
• Occurs most frequently on the
buccal and lingual surfaces of
roots.

53. ABRASION
•Pathologic wearing of tooth substance through
some abnormal mechanical process.
• Occurs on the exposed root surfaces of teeth, but
under some circumstances, it may be seen
elsewhere on tooth.
•Abrasion caused by dentrifrice manifests as
a “V-shaped or wedge shaped” ditch on the
root side of CEJ in teeth with recession.

54. CEMENTICLES
• Abnormal, calcified bodies in the
periodontal ligament
• Form from remnants of HERS
• Usually ovoid or round
• Size ranges from 0.1- 0.4 mm
• Classified as Free, Attached or
Embedded
• Local trauma
• Appear in increasing numbers in the
aging person

55. ENAMEL PEARLS
• If some HERS cells remain
attached to forming root surface,
they can produce focal deposits of
enamel like structures called
ENAMEL PEARLS.
CLINICAL SIGNIFICANCE:
• Plaque retentive structures.
• Promote periodontal disease.
• Look similar to calculus, but
cannot be scaled off.
• Only grinding will help in
elimination .

56. CEMENTAL TEARS
• Small spicules of cementum torn from the root surface—i.e. cemental tears—or
fragments of bone detached from the alveolar plate
• If found lying free in the periodontal ligament CEMENTAL TEARS may resemble
cementicles, particularly after they have undergone some remodeling through
resorption and subsequent repair.

57. ENAMEL PROJECTIONS
• Common tooth anomaly that can act as a contributing factor in the
development and progression of periodontitis.
• Flat, ectopic deposits of enamel apical to the normal cemento-enamel
junction (CEJ) level in molar furcation areas.
• Triangular shape and a tapering form.
• Extend apically into furcation areas.
• Most commonly found at the buccal surfaces of mandibular molars.

58. Classification of Cervical enamel projection (Masters and Hoskins 1964)
• Grade I: The enamel projection extends from the CEJ of the tooth toward
the furcation entrance.
• Grade II: The enamel projection approaches the entrance to the furcation.
It does not enter the furcation and therefore no horizontal component is
present.
• Grade III: The enamel projection extends horizontally into the furcation.

59. HYPERCEMENTOSIS
• Non-neoplastic deposition of excessive cementum that is continuous with the
normal radicular cementum.
Factors Associated with Hypercementosis
LOCAL FACTORS
• Abnormal occlusal trauma
• Adjacent inflammation
• Unopposed teeth [e.g., impacted, embedded, without antagonist)
SYSTEMIC FACTORS
• Neoplastic and non-neoplastic conditions including benign cementoblastoma
• Cementifying fibroma
• Cemental dysplasia
• Acromegaly and pituitary gigantism
• Paget's disease of bone
• Rheumatic fever
• Thyroid goiter

60. • Acceleration in the elongation of a tooth owing to loss of an antagonist is
accompanied by hyperplasia of the cementum. This hypercementosis is most
prominent in the apex of the root.
• Inflammation in the root apex, as a result of pulpal infection ,sometimes,
stimulate excess deposition of cementum. Cementum is laid down on the root
surface at some distance above the apex.
• Occlusal trauma results in mild root resorption. Such resorption is repaired by
secondary cementum.

61. CLINICAL FEATURES:
• Occurs predominantly in adulthood &
the frequency increases with age.
• Occurrence has been reported in
younger patients with familial
clustering demonstration suggesting
hereditary influence.
RADIOGRAPHIC FEATURE:
• Affected teeth demonstrate a thickening
or blunting of the root .
• Radiolucent shadow of PDL and
radiopaque lamina dura always seen.
• NO TREATMENT REQUIRED.

62. NEOPLASMS ASSOCIATED
WITH CEMENTUM

63. CEMENTOBLASTOMA
The benign
cementoblastoma is
probably a true
neoplasm of
functional
cementoblasts which
form a large mass of
cementum or
cementum-like tissue
on the tooth root.
Clinical features-
Under age of 25
years,mostly in
mandible.Mostly in
mandibular 1st
permanent
molar.Slow
growing,may cause
expansion of cortical
plates
Radiographically,
well circumscribed
dense radioopaque
mass often
surrounded by a thin
,uniform
radioluscent line.
Treatment
:Extraction of tooth
though pulp is vital-
it might cause
expansion of jaws

64. CEMENTIFYING FIBROMA
• Resemble focal cemento-osseous dysplasia.
• The neoplasm is composed of fibrous tissue that contains a variable
mixture of bony trabeculae, cementum like spherules or both.
• Origin - Odontogenic or from PDL.
CLINICAL FEATURE:
• 3rd &4th decades, female predilection.
• Most common site- mandibular premolar and molar area.
• Seldom cause any symptoms and are detected only on radiographic
examination.

65. Radiographically, the lesion most often is well defined and unilocular.
TREATMENT: Enucleation of the tumor.

66. PAGET’S DISEASE
• Characterized by enhanced resorption of bone.
• Etiology: unknown, viral infection, inflammatory cause, autoimmune, connective
tissue and vascular disorder.
CLINICAL FEATURES:
• Middle age and both males and females are effected.
• Involvement of facial bone- LEONTIASIS OSSEA.
• MAXILLA- progressive enlargement, alveolar ridge widened, palate flattened,
tooth become loosened.
• MANDIBLE: findings are similar but not as severe as maxilla.
• GENERALISED HYPERCEMENTOSIS of the tooth seen.
RADIOGRAPHIC FINDING:
• COTTON-WOOL appearance of paget’s bone.
CHARACTERISTIC HISTOLOGIC FEATURE: JIGSAW OR MOSAIC
PATTERN.
TREATMENT:
• No specific treatment.

67. HYPOPHOSPHATASIA
• Rare metabolic bone disease that is characterized by a deficiency of
tissue -nonspecific alkaline phosphatase.
• One of the first presenting sign may be the premature loss of the
primary teeth caused by a lack of cementum on the root surfaces.
• The histopathologic examination of either a primary or permanent
tooth that has been exfoliated from an affected patient often shows
an absence or a marked reduction of cementum that covers the
root's surface.
TREATMENT:
• Symptomatic because the lack of alkaline phosphatase cannot be
corrected

68. HYPERPITUITARISM
• Gigantism is the childhood version of growth hormone excess and is
characterized by the general symmetrical overgrowth of the body parts.
-Prognathic mandible, frontal bossing, dental malocclusion, and interdental
spacing are the other features.
-Intraoral radiograph may show hypercementosis of the roots.
 Acromegaly is characterized by an acquired progressive somatic
disfigurement, mainly involving the face and extremities, but also many
other organs, that are associated with systemic manifestations.
-Dental radiograph may demonstrate large pulp chambers and excessive
deposition of cementum on the roots.

69. APPLIED ANATOMY OF CEMENTUM ON
PERIODONTAL HEALTH
• Cementum is the site where soft-tissue attachment has to be re-
established.
• Cementum matrix is a rich source of many growth factors which
influence the activities of various periodontal cell types (Narayanan
and Bartold, 1996; Saygin et al., 2000)

70. • Alteration in the biochemical composition of cementum during
periodontal disease results in loss of active substances and deposition of
inhibitors such as endotoxins.
• Diseased cementum inhibits connective tissue cell attachment and growth
and promotes epithelial attachment (Terranova and Martin, 1982;Polson,
1986)
• This was the rationale for new therapeutic approaches in which diseased
roots are conditioned to promote connective tissue attachment (Bartold et
al., 2000).

71. POSSIBLE ROLE OF CEMENTUM IN REGENERATION
Cementum And Periodontal Wound Healing And Regeneration by Wojciech J. Grzesik,
A.S. Narayanan , 2002

72. • Preservation of root cementum as a goal in periodontal therapy may be an
important factor to avoid root structure loss and dentin hypersensitivity in
maintenance patients and to prevent root resorption.
• Root cementum may act in three directions, associated or not, as
1) A source of growth factors from its matrix.
2) Barrier, avoiding the undesirable interaction of dentin matrix proteins
with the healing site.
3) By cementoblast modulation of cementum regeneration.

73. REFERENCES
• Carranza’s Clinical Periodontology (9TH Edition): Carranza F. A, Newman M.G.,
Takei H.H. and Klokkevold P.R.
• Clinical Periodontology And Implant Dentisitry (5TH Edition): Jan Lindhe, Niklaus P.
Lang and Thorkild Karring tion
• Orban’s oral histology and embryology- 13th Edi
• Nanci A: Periodontium. Ten Cate’s Oral Histology: Development,Structure, and
Function, 8th ed. Elsevier, 2008.
• Bosshardt DD, Selvig KA. Dental cementum: the dynamic tissue covering of the root.
Periodontol 2000 1997; 13: 41-75
• The Periodontium- Schroeder
• Shafer’s textbook of oral pathology-7th edition

74. • Oral and Maxillofacial Pathology,4th Edition.By Neville
• Diekwisch TG, Thomas GH:Developmental Biology of Cementum. Int. J.
Dev. Biol. 45: 695-706 (2001)
• Patricia Furtado Gonçalves.et al. Dental cementum reviewed: development,
structure,composition,regeneration and potential functions. Braz J Oral Sci.
January/March 2005 - Vol.4 - Number 12
• Kharidi Laxman Vandana, Ryana Kour Haneet.Cementoenamel junction: An
insight.J Indian Soc Periodontol 2014;18:549-54.
• Aggarwal P, Saxena S, Bansal P. Incremental lines in root cementum of
human teeth: An approach to their role in age estimation using polarizing
microscopy. Indian J Dent Res 2008;19:326-30.
• Zenóbio,E.G., Vieira T.R.,R.P.C., Bustamante,H.E., Gomes,Shibli,J.A.,&
Soares,R.V(2015).Enamel Pearls Implications on Periodontal Disease.Case
reports in dentistry,2015.

75. THANK YOU