Comparisons between bone and cementum compositions and the possible basis for their layered appearances

Tooth acellular extrinsic fibre cementum incremental lines in humans are formed by parallel branched Sharpey's fibres and not by its mineral phase

In humans, the growth pattern of the acellular extrinsic fibre cementum (AEFC) has been useful to estimate the age-at-death. However, the structural organization behind such a pattern remains poorly understood. In this study tooth cementum from seven individuals from a Mexican modern skeletal series were analyzed with the aim of unveiling the AEFC collagenous and mineral structure using multimodal imaging approaches. The organization of collagen fibres was first determined using: light microscopy, transmission electron microscopy (TEM), electron tomography, and plasma FIB scanning electron microscopy (PFIB-SEM) tomography. The mineral properties were then investigated using: synchrotron small-angle X-ray scattering (SAXS) for T-parameter (correlation length between mineral particles); synchrotron X-ray diffraction (XRD) for L-parameter (mineral crystalline domain size estimation), alignment parameter (crystals preferred orientation) and lattice parameters a and c; as well as synchrotron X-ray fluorescence for spatial distribution of calcium, phosphorus and zinc. Results show that Sharpey's fibres branched out fibres that cover and uncover other collagen bundles forming aligned arched structures that are joined by these same fibres but in a parallel fashion. The parallel fibres are not set as a continuum on the same plane and when they are superimposed project the AEFC incremental lines due to the collagen birefringence. The orientation of the apatite crystallites is subject to the arrangement of the collagen fibres, and the obtained parameter values along with the elemental distribution maps, revealed this mineral tissue as relatively homogeneous. Therefore, no intrinsic characteristics of the mineral phase could be associated with the alternating AEFC incremental pattern.

Using cementochronology to assess the seasonality of catastrophic events in medieval mass graves (Kutná Hora-Sedlec, Czechia, 14th century): Preliminary results

While season-of-death estimation using cementochronology is routine in archaeozoology, its use is much less frequent in bioarchaeology. Based on the character of the outermost increment (bright or dark), two seasons (spring/summer, autumn/winter) can be distinguished. Although many studies mention its potential and possible use in forensic anthropology or bioarchaeology, few exist with estimation results. This study aimed to apply cementochronology-a histological method based on counting and assessing regular circa-annual acellular cementum increments-to 42 individuals from medieval mass graves from Kutná Hora-Sedlec (Czechia, 14th century) to estimate the season-of-death. The mass graves belong to two stratigraphically distinct groups; written and archaeological sources relate them to two catastrophic events (the famine of 1318 and the plague epidemic of 1348-1350). Using cementochronology, we distinguished two distinct seasons corresponding to the two groups of graves, with individuals from the first group dying predominantly in spring/summer, while those from the second group died in autumn/winter. Taking into account the typical seasonal dynamics of epidemics, the results would be more in line with written sources. However, during the evaluation, we faced difficulties identifying the outermost increment and detecting the dark (thinner) increment; we recommend including only young and middle-aged adults in future studies, due to the difficulty of evaluation, and to consider the readability of the tissue (often affected by diagenesis). In conclusion, cementochronology has potential in the context of estimating the season-of-death, but the technical possibilities for enhancing the outermost increment need to be addressed, and the amount of data analysed expanded.

Incremental lines in human acellular tooth cementum - new insights by SEM analysis

BACKGROUND

Tooth cementum covers the surface of the root dentine and is produced and laid down in thin layers continuously throughout life. Functionally, different types of tooth cementum can be distinguished, which can be roughly divided into acellular (primary cementum) and cellular (secondary cementum) forms. One main type is acellular extrinsic fibre cementum (AEFC), which covers the cervical and middle third of the root. Light microscopic examinations of transverse sections of AEFC show lamellar patterns of alternating light and dark lines called growth or incremental lines. Following mammalian research, a seasonal rhythm of incremental line formation is also assumed in humans. Previous attempts at visualising incremental lines in the AEFC by scanning electron microscopy (SEM) were not particularly successful. The aim of the present study was to detect incremental lines in the AEFC and to analyse their underlying structure by SEM.

METHODS

For this purpose, non-embedded and resin-embedded transverse and longitudinal sections of three single-rooted teeth obtained from different patients were investigated. The thin sections were not pre-treated (e.g. by etching, grinding or coating).

RESULTS

Lamellar structures, which could be identified as incremental lines, were detectable in both transverse and longitudinal sections, with transverse orientation in the cross-section and longitudinal orientation in the longitudinal section. The lamellar pattern was created by broad fibre-rich layers alternating with narrow fibre-poor layers. The orientation of the collagen fibres changed from layer to layer from transverse to radial direction. The visibility of the layered structure discovered varied significantly.

CONCLUSIONS

The study demonstrate that it is possible, in principle, to detect incremental lines in AEFC and to identify their basic structure using SEM. Our results suggest that the density and orientation of the fibres play an essential role in the formation of incremental lines. Functional aspects seem to be of particular importance.

Age estimation with cemental incremental lines in normal and periodontally diseased teeth using phase contrast microscope: an original research

Background

Age estimation is an important factor in forensic science for human identification. Teeth are considered to play a vital role as they resist decomposition at death unlike other tissues. This resistance and the gradual structural changes that take place throughout the life of an individual have made teeth useful indicators for age estimation. Dental cementum shows continuous apposition throughout the life of an individual. Tooth cemental annulation is a microscopic method for the determination of an individual’s age based on the analysis of incremental lines of cementum. Light microscopy as well as specialized microscopic methods have been employed to enhance the assessment of the cemental annulations. Periodontal disease is the most common dental problem affecting millions of people. Assessing the efficiency of the tooth cemental annulations method in periodontally diseased teeth is an important requisite. This study aims at assessing and evaluating the tooth cemental annulations in normal and periodontally diseased teeth using phase contrast microscopic method for age determination.

Results

A total of 60 teeth were included in the study and out of which 30 teeth were normal (sound teeth without any associated pathologies) and 30 were periodontally involved teeth respectively. Longitudinal ground sections were prepared and observed under phase contrast microscope. Measurements were made using an image analyzer software. The total width of the cementum was divided by the distance between two incremental lines. The eruption age of the tooth was then added to this to obtain the chronologic age for each individual. The results in the present study showed that tooth cemental annulations are applicable to periodontally sound teeth as well as in periodontally diseased teeth. There was no significant difference of estimated age from the actual age in both periodontally sound and periodontally diseased teeth. Normal teeth showed a reliability value of 92% and periodontally compromised teeth showed 96% respectively. There was no substantial influence of periodontal health on the estimated age.

Conclusions

The study concludes that the use of phase contrast microscopy in conjunction with image enhancement procedures improves the accuracy of age estimation and may serve as a reliable aid in forensic identification.

Tissue Engineering for Periodontal Ligament Regeneration: Biomechanical Specifications

The periodontal biomechanical environment is very difficult to investigate. By the complex geometry and composition of the periodontal ligament (PDL), its mechanical behavior is very dependent on the type of loading (compressive versus tensile loading; static versus cyclic loading; uniaxial versus multiaxial) and the location around the root (cervical, middle, or apical). These different aspects of the PDL make it difficult to develop a functional biomaterial to treat periodontal attachment due to periodontal diseases. This review aims to describe the structural and biomechanical properties of the PDL. Particular importance is placed in the close interrelationship that exists between structure and biomechanics: the PDL structural organization is specific to its biomechanical environment, and its biomechanical properties are specific to its structural arrangement. This balance between structure and biomechanics can be explained by a mechanosensitive periodontal cellular activity. These specifications have to be considered in the further tissue engineering strategies for the development of an efficient biomaterial for periodontal tissues regeneration.

Weaning, parturitions and illnesses are recorded in rhesus macaque (Macaca mulatta) dental cementum microstructure

Many open questions in evolutionary studies relate to species' physiological adaptations, including the evolution of their life history and reproductive strategies. There are few empirical methods capable of detecting and timing physiologically impactful events such as weaning, parturition and illnesses from hard tissue remains of either extant or extinct species. Cementum is an incremental tissue with post eruption annual periodicity, which covers the tooth root and functions as a recording structure of an animal's physiology. Here we test the hypothesis that it is possible to detect and time physiologically impactful events through the analysis of dental cementum microstructure. Our sample comprises 41 permanent and deciduous teeth from male and female rhesus macaques (Macaca mulatta) with known medical, lifestyle and life history information. We develop a semi-automated method of cementum histological analysis for the purpose of event detection and timing, aimed at significantly reducing the amount of intra- and interobserver errors typically associated with histological analyses. The results of our work show that we were able to detect known events including weaning, parturition, illness and physical trauma with high accuracy (false negative rate = 3.2%; n = 1), and to time them within an average absolute difference of 0.43 years (R²  = .98; p < .05). Nonetheless, we could not distinguish between the several types of stressful events underlying the changes in cementum microstructure. While this study is the first to identify a variety of life history events in macaque dental cementum, laying foundations for future work in conservation and evolutionary studies of both primates and toothed mammals at large, there are some limitations. Other types of analyses (possibly chemical ones) are necessary to tease apart the causes of the stressors.

Parturitions, menopause and other physiological stressors are recorded in dental cementum microstructure

The life history pattern of recent humans is uniquely derived in many of its aspects including an extended post-reproductive lifespan combined with short interbirth intervals. A number of theories have been proposed to explain the evolution of this unusual pattern. However most have been difficult to test due to the fragmentary nature of the hominin fossil record and the lack of methods capable of inferring such later life history events. In search of a method we tested the hypothesis that the physiologically impactful events of parturition and menopause are recorded in dental cementum microstructure. We performed histomorphological analyses of 47 teeth from 15 individuals with known life history events and were able to detect reproductive events and menopause in all females. Furthermore, we found that other stressful events such as systemic illnesses and incarceration are also detectable. Finally, through the development of a novel analytical method we were able to time all such events with high accuracy (R-squared = 0.92).

Measuring incremental line width and appearance in the tooth cementum of recent and archaeological human teeth to identify irregularities: First insights using a standardized protocol

OBJECTIVE

Irregular incremental lines (ILs) in the tooth cementum were previously associated with pregnancy and certain diseases. This study aims to identify irregular ILs and assess their patterns and reproducibility.

MATERIALS

24 recent and 32 archaeological teeth from the nineteenth century with known birth history.

METHODS

Histological sections of tooth roots were microscopically assessed. The width and appearance of 16,605 ILs were measured according to a standardized protocol.

RESULTS

Irregular appearing ILs were present in earlier deposited ILs, which correspond to younger years in life. Irregular appearances decreased as the IL number increased, whereas irregular width was spread evenly across all ILs. Within-section reproducibility was relatively high for irregular appearance (intra class correlation close to 0.70 in recent and archaeological teeth) and irregular width (intra class correlation: recent: 0.49; archaeological: 0.58), whereas the across-section reproducibility was moderate.

CONCLUSIONS

Irregular width and appearance in ILs were identified successfully with within-section reproducibility. The moderate reproducibility across sections needs to be addressed in further studies by more systematic sampling of sections.

SIGNIFICANCE

The proposed protocol identifies irregularities in a reproducible manner and may suggest that irregular ILs could be used in paleopathology to identify pregnancies and diseases.

LIMITATIONS

The correlation between the identified irregular ILs and known pregnancies has not been assessed as part of this study.

SUGGESTIONS FOR FURTHER RESEARCH

The identified irregular ILs need to be validated by correlating them with known life history data.

Cementum structure in Beluga whale teeth

A large fraction of the volume of Beluga whale (Delphinapterus leucas) teeth consists of cementum, a mineralized tissue which grows throughout the life of the animal and to which the periodontal ligaments attach. Annular growth bands or growth layer groups (GLGs) form within Beluga cementum, and this study investigates GLG structure using X-ray fluorescence mapping and X-ray diffraction mapping with microbeams of synchrotron radiation. The Ca and Zn fluorescent intensities and carbonated hydroxyapatite (cAp) diffracted intensities rise and fall together and match the light-dark bands visible in transmitted light micrographs. Within the bands of maximum Ca and Zn intensity, the ratio of Zn to Ca is slightly higher than in the minima bands. Further, the GLG cAp, Ca and Zn modulation is preserved throughout the cementum for durations >25year.

STATEMENT OF SIGNIFICANCE

Cementum is an important tooth tissue to which the periodontal ligaments attach and consists primarily of carbonated apatite mineral and collagen. In optical microscopy of cementum thin sections, light/dark bands are formed annually, and age at death is determined by counting these bands. We employ synchrotron X-ray diffraction and X-ray fluorescence mapping to show the bands in Beluga whale cementum result from differences in mineral content and not from differences in collagen orientation as was concluded by others. Variation in Zn fluorescent intensity was found to be very sensitive indicator of changing biomineralization and suggest that Zn plays an important role this process.

New Insights on the Composition and the Structure of the Acellular Extrinsic Fiber Cementum by Raman Analysis

Acellular extrinsic fiber cementum is a mineralized tissue that covers the cervical half of the tooth root surface. It contains mainly extrinsic or Sharpey's fibers that run perpendicular to the root surface to anchor the tooth via the periodontal ligament. Acellular cementum is continuously and slowly produced throughout life and exhibits an alternating bright and dark pattern under light microscopy. However, although a better understanding of the structural background of acellular cementum is relevant to many fields, such as cementochronology, periodontology and tissue engineering, acellular cementum remains rarely studied and poorly understood. In this work, we studied the acellular cementum at the incremental line scale of five human mandibular canines using polarized Raman spectroscopy. We provided Raman imaging analysis and polarized acquisitions as a function of the angular orientation of the sample. The results showed that mineral crystals were always parallel to collagen fibrils, and at a larger scale, we proposed an organizational model in which we found radial collagen fibers, "orthogonal" to the cementum surface, and "non-orthogonal" fibers, which consist of branching and bending radial fibers. Concerning the alternating pattern, we observed that the dark lines corresponded to smaller, more mineralized and probably more organized bands, which is consistent with the zoological assumption that incremental lines are produced during a winter rest period of acellular cementum growth.

The impact of Wnt signalling and hypoxia on osteogenic and cementogenic differentiation in human periodontal ligament cells

Cementum is a periodontal support tissue that is directly connected to the periodontal ligament. It shares common traits with bone tissues, however, unlike bone, the cementum has a limited capacity for regeneration. As a result, following damage the cementum rarely, if ever, regenerates. Periodontal ligament cells (PDLCs) are able to differentiate into osteoblastic and cementogenic lineages according to specific local environmental conditions, including hypoxia, which is induced by inflammation or activation of the Wnt signalling pathway by local loading. The interactions between the Wnt signalling pathway and hypoxia during cementogenesis are of particular interest to improve the understanding of periodontal tissue regeneration. In the present study, osteogenic and cementogenic differentiation of PDLCs was investigated under hypoxic conditions in the presence and absence of Wnt pathway activation. Protein and gene expression of the osteogenic markers type 1 collagen (COL1) and runt-related transcription factor 2 (RUNX2), and cementum protein 1 (CEMP1) were used as markers for osteogenic and cementogenic differentiation, respectively. Wnt signalling activation inhibited cementogenesis, whereas hypoxia alone did not affect PDLC differentiation. However, hypoxia reversed the inhibition of cementogenesis that resulted from overexpression of Wnt signalling. Cross-talk between hypoxia and Wnt signalling pathways was, therefore, demonstrated to be involved in the differentiation of PDLCs to the osteogenic and cementogenic lineages. In summary, the present study suggests that the differentiation of PDLCs into osteogenic and cementogenic lineages is partially regulated by the Wnt signalling pathway and that hypoxia is also involved in this process.

Absolute polarity determination of teeth cementum by phase sensitive second harmonic generation microscopy

The absolute sign of local polarity in relation to the biological growth direction has been investigated for teeth cementum using phase sensitive second harmonic generation microscopy (PS-SHGM) and a crystal of 2-cyclooctylamino-5-nitropyridine (COANP) as a nonlinear optic (NLO) reference material. A second harmonic generation (SHG) response was found in two directions of cementum: radial (acellular extrinsic fibers that are oriented more or less perpendicular to the root surface) and circumferential (cellular intrinsic fibers that are oriented more or less parallel to the surface). A mono-polar state was demonstrated for acellular extrinsic cementum. However, along the different parts of cementum in circumferential direction, two corresponding domains were observed featuring an opposite sign of polarity indicative for a bi-polar microscopic state of cellular intrinsic cementum. The phase information showed that the orientation of radial collagen fibrils of cementum is regularly organized with the donor (D) groups pointing to the surface. Circumferential collagen molecules feature orientational disorder and are oriented up and down in random manner showing acceptor or donor groups at the surface of cementum. Considering that the cementum continues to grow in thickness throughout life, we can conclude that the cementum is growing circumferentially in two opposite directions and radially in one direction. A Markov chain type model for polarity formation in the direction of growth predicts D-groups preferably appearing at the fiber front.

Toward the adoption of cementochronology in forensic context

Because acellular dental cementum is considered to be formed continually throughout life and to not undergo remodeling processes, cementochronology is considered to be a method with the potential for directly assessing chronological age. Considering that most previous studies on humans have assumed the superior performance of this method, it is surprising that this technique is not more widely adopted in anthropology. To understand this controversy, we highlight that there is no standardized procedure for sample preparation. The numerous technical approaches that exist impact the reliability of the method, and the recent creation of an international work group (Cementochronology Research Program) demonstrates the need for researchers to share their experience to overcome these obstacles. This paper aims to address this paradox by debating the aspects that contribute to the limited use of this method and by illustrating its potential through an application on forensic cases. A protocol, which was recently certified according to the ISO-9001, was applied to nine anthropological cases from the Forensic Medicine Institute of Lille (northern France) and compared with routine osteological and dental methods. The results show that traditional methods matched the known age due to the wide extent of their range, while the accuracy and precision of cementochronological estimates was also notable. This paper establishes that cementochronology may serve as a particularly important tool for age estimation for forensic anthropologists and should, at least, be used in addition to other methods.

Age estimation using tooth cementum annulation

In Forensic Anthropology age diagnosis of unidentified bodies significantly helps in the identification process. Among the set of established aging methods in anthropology tooth cementum annulation (TCA) is increasingly used due to its narrow error range which can reach 5 years of age in adult individuals at best. The rhythm of cementum appositions of seasonally different density provides a principal mechanism on which TCA is based. Using histological preparation techniques for hard tissues, transversal tooth root sections are produced which can be analyzed in transmitted light microscopy. Even though no standard TCA preparation protocol exists, several methodological validation studies recommend specific treatments depending on individual conditions of the teeth. Individual age is estimated by adding mean tooth eruption age to the number of microscopically detected dark layers which are separated by bright layers and stand for 1 year of age each. To assure a high reliability of the method, TCA age diagnosis has to be based on several teeth of one individual if possible and needs to be supported by different techniques in forensic cases.

Elastomeric osteoconductive synthetic scaffolds with acquired osteoinductivity expedite the repair of critical femoral defects in rats

Regenerative medicine aspires to reduce reliance on or overcome limitations associated with donor tissue-mediated repair. Structural bone allografts are commonly used in orthopedic surgery, with a high percentage of graft failure due to poor tissue integration. This problem is aggravated among elderly, those suffering from metabolic conditions, or those undergoing cancer therapies that compromise graft healing. Toward this end, we developed a synthetic graft named FlexBone, in which nanocrystalline hydroxyapatite (50 wt%) was structurally integrated with crosslinked poly(hydroxyethyl methacrylate) hydrogel, which provides dimensional stability and elasticity. It recapitulates the essential role of nanocrystalline hydroxyapatite in defining the osteoconductivity and biochemical microenvironment of bone because of its affinity for biomolecules. Here, we demonstrate that FlexBone effectively absorbed endogenously secreted signaling molecules associated with the inflammation/graft healing cascade upon being press-fit into a 5-mm rat femoral segmental defect. Further, when preabsorbed with a single dose of 400 ng recombinant human (rh) bone morphogenetic protein-2/7 heterodimer, it enabled the functional repair of the critical-sized defect by 8-12 weeks. FlexBone was stably encapsulated by the bridging bony callus and the FlexBone-callus interface was continuously remodeled. In summary, FlexBone combines the dimensional stability and osteoconductivity of structural bone allografts with desirable surgical compressibility and acquired osteoinductivity in an easy-to-fabricate and scalable synthetic biomaterial.

Synthesis and characterization of biocomposites with different hydroxyapatite-collagen ratios

Hydroxyapatite (HA)-type I collagen (Col) composite is a tissue-engineered bone graft which can act as a carrier or a template structure for cells or any other agents. In this paper, the effect of Col ratio on the scaffold structure and composition was analyzed. Scaffolds composed by HA/Col with different weight ratios (80:20; 50:50; 20:80, and 10:90) were produced by the precipitation method at pH 8-9, 37 degrees C and 6 h of ripening. Using X-ray diffraction data, the Rietveld structure refinement showed that the size of HA crystals along the c-axis direction (002) decreases significantly in the presence of Col. Thus, the HA crystal shape turned from needle-like in pure HA, into spherical, in the 10:90 composite due to Col fibrillogenesis. The homogeneity of the composite was significantly dependent on the amount of Col in it. HA/Col 20/80 composite presented HA particles in a more homogenous way. Such a biocomposite was successfully produced in a rapid way and it is potentially useful for both small tissue repairs and engineering.

Accurately shaped tooth bud cell-derived mineralized tissue formation on silk scaffolds

Based on the successful use of silk scaffolds in bone tissue engineering, we examined their utility for mineralized dental tissue engineering. Four types of hexafluoroisopropanol (HFIP) silk scaffolds-(250 and 550 microm diameter pores, with or without arginine-glycine-aspartic acid (RGD) peptide) were seeded with cultured 4-day postnatal rat tooth bud cells and grown in the rat omentum for 20 weeks. Analyses of harvested implants revealed the formation of bioengineered mineralized tissue that was most robust in 550 microm pore RGD-containing scaffolds and least robust in 250 microm pore sized scaffolds without RGD. The size and shape of the silk scaffold pores appeared to guide mineralized tissue formation, as revealed using polarized light imaging of collagen fiber alignment along the scaffold surfaces. This study is the first to characterize bioengineered tissues generated from tooth bud cells seeded onto silk scaffolds and indicates that silk scaffolds may be useful in forming mineralized osteodentin of specified sizes and shapes.

Cement lines of secondary osteons in human bone are not mineral-deficient: New data in a historical perspective

Using qualitative backscattered electron (BSE) imaging and quantitative energy dispersive X-ray (EDX) spectroscopy, some investigators have concluded that cement (reversal) lines located at the periphery of secondary osteons are poorly mineralized viscous interfaces with respect to surrounding bone. This conclusion contradicts historical observations of apparent highly mineralized (or collagen-deficient) cement lines in microradiographs. Such conclusions, however, may stem from unrecognized artifacts that can occur during scanning electron microscopy. These include specimen degradation due to high-energy beams and the sampling of electron interaction volumes that extend beyond target locations during EDX analysis. This study used quantitative BSE imaging and EDX analysis, each with relatively lower-energy beams, to test the hypothesis that cement lines are poorly mineralized. Undemineralized adult human femoral diaphyses (n = 8) and radial diaphyses (n = 5) were sectioned transversely, embedded in polymethyl methacrylate, and imaged in a scanning electron microscope for BSE and EDX analyses. Unembedded samples were also evaluated. Additional thin embedded samples were stained and evaluated with light microscopy and correlated BSE imaging. BSE analyses showed the consistent presence of a bright line (higher atomic number) coincident with the classical location and description of the cement line. This may represent relative hypermineralization or, alternatively, collagen deficiency with respect to surrounding bone. EDX analyses of cement lines showed either higher Ca content or equivalent Ca content when compared to distant osteonal and interstitial bone. These data reject the hypothesis that cement lines of secondary osteons are poorly mineralized.

Analytical technique for quantification of selected resorbable calcium phosphate bone void fillers with the use of polarized-light microscopy

Synthetic calcium phosphate bone void fillers promote varying rates of bone formation and material resorption depending on chemistry, porosity, pore structure, and implant site. The objective of this study was to quantify the resorption of a novel ultraporous beta-tricalcium phosphate cancellous bone void filler with simultaneous quantification of bone formation in a canine humerus model. Potential measurement error involved in conventional histomorphometry using Von Kossa stains inspired the development of a new technique. This technique utilizes bright-field and polarized-light microscopy in conjunction with image analysis software, allowing more accurate histomorphometry. This technique was validated with two separate controlled experiments. Scanning electron microscopy further supported the results. The findings suggest that the use of polarized-light microscopy combined with image analysis software can be an effective tool in simultaneously quantifying calcium phosphate resorption and bone formation.

Anti-cementoblastoma-derived protein antibody partially inhibits mineralization on a cementoblastic cell line

The effect of human anti-cementoblastoma-derived protein antibody during cementogenesis in vitro was investigated by using human cementoblastoma-derived cells. Cultures treated with 5 microg/ml of CP antibody from day 1 to day 15 revealed a significant decrease in alkaline phosphatase activity (ALP) 40% (p < 0.005), 44% (p < 0.001), 49% (p < 0.1), and 45% (p < 0.02) at 9, 11, 13, and 15 days, respectively. Immunoexpression of osteopontin revealed that in cultures treated with anti-CP antibody, the positive number of cementoblastoma cells was reduced by 87, 83, 69, and 52% at 5, 7, 9, and 11 days, respectively. Bone sialoprotein immunoexpression showed a decrease in positive cells of 82, 51, 60, 80, 83, and 87% at 5, 7, 9, 11, 13, and 15 days, respectively, as compared to controls. The Ca/P ratio of the mineral-like tissue deposited in vitro by cementoblastoma cells revealed that control cultures had a Ca/P ratio of 1.45 and 1.61 at 5 and 15 days, whereas experimental cultures revealed a Ca/P ratio of 0.50 and 0.79 at 5 and 15 days, respectively. Electron diffraction patterns showed inner double rings representing D-spacing that were consistent with those of hydroxyapatite in both control and experimental cultures. Examination of the crystallinity with high resolution transmission electron microscopy showed homogeneous and preferential spatial arrangement of hydroxyapatite crystallites in control and experimental cultures at 15 days. Atomic force microscopy images of control cultures at 5 and 15 days revealed small granular particles and grain agglomeration that favored the formation of crystalline plaques with a lamellar-like pattern of the mineral-like tissue. Experimental cultures at 5 and 15 days showed tiny and homogeneous granular morphology. The agglomerates maintained spherical morphology without organization of needle-like crystals to form plaque-like structures. Based on these findings, it is hypothesized that cementoblastoma-derived protein may be associated to crystal growth, compositional and morphological features during the mineralization process of cementum in vitro.