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CC BY 4.0 · Eur J Dent
DOI: 10.1055/s-0045-1806959
Original Article

A Comparative Elemental and Surface Analysis of Root Cementum in Severe Periodontitis and Healthy Teeth

Sahar M. N. Bukhary
1   Department of Oral Biology, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
,
Hisham I. Othman
2   Department of Oral Diagnostic Sciences, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
3   Department of Oral Biology, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
,
Ghada Mansour 
2   Department of Oral Diagnostic Sciences, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
4   Department of Oral Medicine, Periodontology, Oral Diagnosis and Oral Radiology, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
,
Madawi F. Alkeheli
2   Department of Oral Diagnostic Sciences, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
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Abstract

Objective

This study aims to compare the elemental composition and surface characteristics of root cementum in teeth affected by severe periodontitis with those of healthy teeth.

Materials and Methods

Forty-seven teeth, including 25 teeth affected by stage III, grade C periodontitis and 22 healthy teeth, were extracted from patients aged 17 to 34 years. The cementum surfaces were analyzed using scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDX) to evaluate surface morphology and elemental composition.

Results

SEM images revealed that healthy teeth exhibited a homogenous, smooth cementum surface, while teeth affected by periodontitis showed an irregular, uneven surface with deep crack lines and resorption areas. EDX analysis indicated significant differences in elemental composition; periodontitis-affected teeth had lower calcium and phosphorus but higher magnesium, sodium, and sulfur levels than healthy teeth.

Conclusion

Periodontitis significantly alters the surface characteristics and elemental composition of root cementum, which may contribute to disease progression and impaired periodontal health.

Keywords

elemental analysis - periodontitis - cementum surface - EDX - SEM


Publication History

Article published online:
07 May 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Nanci A, Bosshardt DD. Structure of periodontal tissues in health and disease. Periodontol 2000 2006; 40: 11-28
    Search in Google Scholar
  • 2 Hajishengallis G, Chavakis T. Local and systemic mechanisms linking periodontal disease and inflammatory comorbidities. Nat Rev Immunol 2021; 21 (07) 426-440
    Search in Google Scholar
  • 3 Nascimento GG, Leite F, Scheutz F, Lopez R. Periodontitis: from infection to inflammation. Curr Oral Health Rep 2017; 4: 301-308
    Search in Google Scholar
  • 4 Papapanou PN, Sanz M, Buduneli N. et al. Periodontitis: consensus report of workgroup 2 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Periodontol 2018; 89 (Suppl. 01) S173-S182
    Search in Google Scholar
  • 5 Tonetti MS, Greenwell H, Kornman KS. Staging and grading of periodontitis: framework and proposal of a new classification and case definition. J Periodontol 2018; 89 (Suppl. 01) S159-S172
    Search in Google Scholar
  • 6 Yamamoto T, Hasegawa T, Yamamoto T, Hongo H, Amizuka N. Histology of human cementum: its structure, function, and development. Jpn Dent Sci Rev 2016; 52 (03) 63-74
    Search in Google Scholar
  • 7 Scimeca M, Bischetti S, Lamsira HK, Bonfiglio R, Bonanno E. Energy dispersive X-ray (EDX) microanalysis: a powerful tool in biomedical research and diagnosis. Eur J Histochem 2018; 62 (01) 2841
    Search in Google Scholar
  • 8 Paknejad M, Khorsand A, Yaghobee S. et al. Cementogenesis in patients with localized aggressive periodontitis. J Dent (Tehran) 2015; 12 (05) 347-351
    Search in Google Scholar
  • 9 Cohen M, Garnick JJ, Ringle RD, Hanes PJ, Thompson WO. Calcium and phosphorus content of roots exposed to the oral environment. J Clin Periodontol 1992; 19 (04) 268-273
    Search in Google Scholar
  • 10 Couoh LR, Bucio L, Ruvalcaba JL. et al. Tooth acellular extrinsic fibre cementum incremental lines in humans are formed by parallel branched Sharpey's fibres and not by its mineral phase. J Struct Biol 2024; 216 (02) 108084
    Search in Google Scholar
  • 11 Jones CA, Bracewell T. Scanning electron microscopy (SEM) and macroscopic analysis of immature human permanent molar immersion in hydrochloric acid (HCL, 38%). J Forensic Leg Med 2022; 90: 102385
    Search in Google Scholar
  • 12 Saito MM, Onuma K, Yamakoshi Y. Cementum is key to periodontal tissue regeneration: a review on apatite microstructures for creation of novel cementum-based dental implants. Genesis 2023; 61 (3-4): e23514
    Search in Google Scholar
  • 13 Liang Y, Luan X, Liu X. Recent advances in periodontal regeneration: a biomaterial perspective. Bioact Mater 2020; 5 (02) 297-308
    Search in Google Scholar
  • 14 Menicanin D, Hynes K, Han J, Gronthos S, Bartold PM. Cementum and periodontal ligament regeneration. Adv Exp Med Biol 2015; 881: 207-236
    Search in Google Scholar
  • 15 Hoz L, López S, Zeichner-David M, Arzate H. Regeneration of rat periodontium by cementum protein 1-derived peptide. J Periodontal Res 2021; 56 (06) 1223-1232
    Search in Google Scholar
  • 16 Ramadan DE, Hariyani N, Indrawati R, Ridwan RD, Diyatri I. Cytokines and chemokines in periodontitis. Eur J Dent 2020; 14 (03) 483-495
    Search in Google Scholar
  • 17 Franco C, Patricia HR, Timo S, Claudia B, Marcela H. Matrix metalloproteinases as regulators of periodontal inflammation. Int J Mol Sci 2017; 18 (02) 440
    Search in Google Scholar
  • 18 Zahraa MN, Elhadi MA, Nada TH. Microscopic differences in cementum structure and mineral composition of teeth extracted from patients with gingivitis, chronic periodontitis and aggressive periodontitis: a preliminary comparative study. Int J Dent Sci Res 2016; 4: 90-94
    Search in Google Scholar
  • 19 Sun M, Wu X, Yu Y. et al. Disorders of calcium and phosphorus metabolism and the proteomics/metabolomics-based research. Front Cell Dev Biol 2020; 8: 576110
    Search in Google Scholar
  • 20 Martin RR, Naftel SJ, Nelson AJ, Edwards M, Mithoowani H, Stakiw J. Synchrotron radiation analysis of possible correlations between metal status in human cementum and periodontal disease. J Synchrotron Radiat 2010; 17 (02) 263-267
    Search in Google Scholar
  • 21 Martínez-García M, Hernández-Lemus E. MartíNnez-GarcíNa M. Periodontal inflammation and systemic diseases: an overview. Front Physiol 2021; 12: 709438
    Search in Google Scholar
  • 22 Andras NL, Mohamed FF, Chu EY, Foster BL. Between a rock and a hard place: regulation of mineralization in the periodontium. Genesis 2022; 60 (8-9): e23474
    Search in Google Scholar
  • 23 Grzesik WJ, Narayanan AS. Cementum and periodontal wound healing and regeneration. Crit Rev Oral Biol Med 2002; 13 (06) 474-484
    Search in Google Scholar
  • 24 Liu J, Ruan J, Weir MD. et al. Periodontal bone-ligament-cementum regeneration via scaffolds and stem cells. Cells 2019; 8 (06) 537
    Search in Google Scholar
  • 25 Ma YF, Yan XZ. Periodontal guided tissue regeneration membranes: limitations and possible solutions for the bottleneck analysis. Tissue Eng Part B Rev 2023; 29 (05) 532-544
    Search in Google Scholar
  • 26 Abu-Ta'a M, Marzouka D. Enamel matrix derivative (EMD) as an adjunct to non-surgical periodontal therapy: a systematic review. Cureus 2023; 15 (08) e43530
    Search in Google Scholar
  • 27 Angjelova A, Jovanova E, Polizzi A. et al. Insights and advancements in periodontal tissue engineering and bone regeneration. Medicina (Kaunas) 2024; 60 (05) 773
    Search in Google Scholar
  • 28 Grandfield K, Herber RP, Chen L. et al. Strain-guided mineralization in the bone-PDL-cementum complex of a rat periodontium. Bone Rep 2015; 3: 20-31
    Search in Google Scholar
  • 29 Huang TH, Chen JY, Suo WH. et al. Unlocking the future of periodontal regeneration: an interdisciplinary approach to tissue engineering and advanced therapeutics. Biomedicines 2024; 12 (05) 1090
    Search in Google Scholar