The thickness of the sound and periodontally diseased human cementum

Hypercementosis in Late Pleistocene Homo sapiens fossils from Klasies River Main Site, South Africa

OBJECTIVE

To examine early Homo sapiens fossils from the Late Pleistocene site of Klasies River Main Site, South Africa for evidence of hypercementosis. The specimens represent seven adult individuals dated to between 119,000 and 58,000 years ago. These observations are contextualized in relation to the incidences of hypercementosis among recent human populations and fossil human samples and the potential etiologies of hypercementosis.

DESIGN

The fossils were investigated utilizing micro-CT and nano-CT scanning to visualize and measure cementum apposition on permanent incisor, premolar and molar roots. Cementum thickness was measured at mid-root level, and the volume of the cementum sleeve was calculated for the two fossil specimens that display marked hypercementosis.

RESULTS

Two of the fossils display no evidence of cementum hypertrophy. Three exhibit moderate cementum thickening, barely attaining the quantitative threshold for hypercementosis. Two evince marked hypercementosis. One of the Klasies specimens with marked hypercementosis is judged to be an older individual with periapical abscessing. The second specimen is a younger adult, and seemingly similar in age to other Klasies fossils that exhibit only minimal cementum apposition. However, this second specimen exhibits dento-alveolar ankylosis of the premolar and molars.

CONCLUSIONS

These two fossils from Klasies River Main Site provide the earliest manifestation of hypercementosis in Homo sapiens.

THE ROLE OF PDL-CEMENTUM ENTHESIS IN PROTECTING PDL UNDER MASTICATORY LOADING: A FINITE ELEMENT INVESTIGATION

Background: The function of periodontal ligament (PDL)-cementum enthesis (PCE) in transferring the mechanical stimuli within the tooth–periodontium (PDT)–bone complex was not made clear yet. This study aimed to evaluate the effects of PCE on the mechanical stimuli distribution within the PDL and alveolar bone in the tooth–PDT–bone complex under occlusal forces using the finite element method.

Methods: A computed tomography-based model of alveolar bone and second premolar of mandible was constructed, in which the PDT was considered at the interface of alveolar bone and tooth. Under a 3 MPa distributed occluso-apical masticatory load, applied over the uppermost surface of crown, the von Mises strain (vMST) and strain energy density (SED) within PDL, and von Mises stress (vMSR) and SED within alveolar bone were calculated in two situations: 1. When the PCE was absent; and 2. When the PCE was present between the PDL and cementum.

Results: PCE levels-off SED and vMST within PDL up to 59% and 27%, respectively, compared to the model with no PCE. Moreover, in the alveolar bone, SEDs and vMSR increased up to 28% and 30%, respectively, compared to the model without PCE.

Conclusion: By including PCE in the tooth–PDT–bone model, the mechanical stimuli shifted from PDL to its surrounding alveolar bone. Thus, it can be speculated that the tooth–PDT–bone complex has the capability of reducing the risk of PDL damage, through shifting excess mechanical stimuli from PDL toward the alveolar bone, during prolonged cyclic masticatory loading, as well as while one applies nonphysiologic and therapeutic loads, such as in orthodontic tooth movement.

The permeability of human cementum in vitro measured by electron paramagnetic resonance

The structure and permeability of cementum are changed during the course of periodontal disease. In this study, the transport of water-soluble, spin-labelled molecules through cementum was studied by electron paramagnetic resonance (EPR). Cementum samples cut from different parts of the root were classified into four different groups: (A) samples exposed to the oral environment, (B) samples exposed to the periodontal-pocket environment; (C) samples cut from periodontally involved teeth but not exposed to saliva or periodontal pocket and (D) samples from sound young teeth extracted for orthodontic reasons. In order to obtain undamaged cementum, a dentine layer was left on each sample. Two methods were used to measure the diffusion coefficients of spin-labelled molecules in cementum dentine samples. First, the method of one-dimensional EPR imaging (EPRI) was used to evaluate the penetration of spin-labelled molecules into the cementum/dentine structure. Second, the diaphragm-cell method was used to determine the diffusion coefficients of the labelled molecules through the cementum under steady-state conditions. The results indicate that the interface between cementum and dentine is a barrier to diffusion. A set of diffusion (D) and partition (K) coefficients to describe the molecular transport in cementum, barrier and dentine was generated from the experimental data of both methods. For cementum (c), the barrier (b) and dentine (d) these coefficients were: Dc= 10(-8)cm2/s, Db= 10(-10)cm2/s, Dd= 10(-6)cm2/s and K=0.1. For the particular periodontally involved and uninvolved teeth the value of the rate-limiting barrier was DbA= 0.3 +/- 0.03 x 10(-10)cm2/s, DbB= 1 +/-0.3 x 10(-10)cm2/s, DbC= 0.3 +/- 0.03 x 10(-10)cm2/s, DbD= 0.4 +/- 0.05 x 10(-10)cm2/s. The largest diffusion flux across the dental hard tissue was found in the samples that had been exposed to the pocket environment (3.1 +/- 0.2) x 10(-9)cm2/s (p < 0.01), which coincided with the permeability calculated from the data evaluated by EPRI. The transport of the labelled molecules into and through the cementum dentine samples depends on the structure of the dental hard tissues, which changes during the course of periodontal disease. Knowledge of molecular diffusion across the tooth cementum/dentine structure is likely to be important for planning new treatments for periodontal disease.