Romanian Journal of Oral Rehabilitation
Vol. 6, No. 1, January - March 2014
THE ASSESMENT OF THE RELATION BETWEEN RETENTION OF
BACTERIAL BIOFILM AND THE
ANATOMO-CLINICAL FEATURES OF CERVICAL AREA
Galina Pancu, Sorin Andrian, Gianina Iovan, Angela Ghiorghe,
Claudiu Topoliceanu, Antonia Moldovan, Andrei Georgescu, Irina Nica,
Silvia Teslaru, Simona Stoleriu
“Grigore T. Popa" University of Medicine and Pharmacy - Iasi, Romania, Faculty of Dental
Medicine, Department of Odontology, Periodontology and Fixed Prothesis
*Corresponding author:
Galina Pancu, Assistant Professor, DMD, PhD
“Grigore T. Popa" University of Medicine and Pharmacy
- Iasi, Romania
e-mail: [email protected]
ABSTRACT
The aim of this study was to identify the anatomo-clinical features of tissues relations in the cervical area and
to establish the presence and retention of bacterial biofilm related to the types of cementoenamel junction (CEJ).
Material and methods: The study included 16 extracted teeth (4 incisors, 2 canines, 4 bicusps, 6 molars). The
teeth, having unaffected cervical area, were cut in 4 sections preserving the bucal, lingual, mesial and distal
cervical areas. The dental sections were assessed regarding the aspect and the morphology of the
cementoenamel junction using SEM. Also the retention degree of bacterial biofilm was examined. Results: The
highest percent (62%) CEJ are represented by the type of edge-to-edge. The bicusps present a percent of 76% of
edge-to-edge CEJ, with a 14% percent of CEJ junctions associated with enamel covered by cement.
Conclusions The type of cementoenamel junction varies accordingly to dental type and topography. The
retention of bacterial biofilm was highest in cementoenamel junctions with exposed dentine.
Keywords: root dental caries, cementoenamel junction, dentine-enamel junction, biofilm.
patients, influencing also the immunity and
salivary protective environment.
The researches of Keerthana S, Simon R.et
al. (2011) (1) show the direct correlation
between the periodontal pocket depth and the
significant level of bacterial biofilm and
calculus. The cement-enamel junction is one
of the areas presenting frequently biofilm and
calculus, after root scaling. In most cases,
cervical area is accessible for periodontal
therapy, but a few studies aimed to research
cement-enamel junction as a possible trap for
bacterial biofilm and calculus.
The researchers and dental practitioners
agree that root scaling reduce the loading of
INTRODUCTION
The epidemiological studies show that
developed countries are confronted with an
increase of dental caries prevalence to the old
patients category and a decrease of dental
caries rate in the young patients category.
The researches of Carlos(1985) and
Banting(1985) show that root dental caries
affect root surfaces in a report of 1/9 for
patients with age 20-64 and 50% of
population with age 41-50.
Literature data highlight that the
prevalence of dental caries on root surfaces
represents a significant problem for old
25
Romanian Journal of Oral Rehabilitation
Vol. 6, No. 1, January - March 2014
subgingival root areas with biofilm and
mesial and distal cervical areas. The cementcalculus (2).
enamel junction was preserved unaffected.
The relation between root cement and
The dental sections were assessed, using
enamel at the CEJ level was assessed by
SEM (SEM model VEGA II LSH, TESCAN),
studies using various methods (microscopy,
regarding the aspect and morphology of the
morphopathological methods, embryology)
cement-enamel junction, CEJ categories and
(3-8).
the retention degree of bacterial biofilm.
The specific features of cervical areas and
the morphological and anatomical diversity
RESULTS AND DISCUSSION
The results regarding the distribution of
raised the attention of those interested in
enamel, dentine, and cement reports to the
fundamental dental anatomy. It is important
cervical level, on different dental groups and
to find about the clinical implications of the
dental surfaces, are presented in tables 1 and
various relations between enamel, cement and
2.
dentine at the level of CEJ, and what degree
For maxillary teeth (Table 1):
of retention for bacterial biofilm is related to
- buccal and oral surfaces
the anatomical diversity. Also it is important
to find out the implications of these
 Incisors-edge-to-edge CEJ is present in
anatomical variations on the initiation and
highest percent, followed by exposed
development of root caries. Diverse
dentine, enamel covered by cement and
researches reported various results regarding
enamel covered by enamel.
the prevalence of these relations, for
 Canines- exposed dentine is present in
individual teeth and for different dental
highest percent, followed by junction
groups (9,10)
edge-to-edge CEJ and enamel covered by
Some authors sustain that CEJ become an
cement.
important clinical area, considering the
 Bicusps- the distribution of junction
increasing prevalence of cervical and root
categories is similar to that of canines.
dental caries as well as non-cariogenic dental
 Molars- enamel covered by cement is
lesions. The increasing number of old patients
present in highest percent, followed by
is related to the increased CEJ relation with
enamel covered by enamel and, in lowest
cervical dental caries and periodontal diseases
percent, exposed dentine.
(11).
- for maxillary teeth, proximal surfaces
 Cement covered enamel most frequently to
The aim of study
molar dental group, followed by incisors,
The aim of this study was to identify the
canine and bicusps.
anatomic-pathological features of enamel Edge-to-edge CEJ was present in similar
cement and enamel-dentine reports at the
percents for all dental groups.
cervical level, and tissues changes following
 Exposed dentine was present only to
therapeutic procedures.
incisors and molars.
 Cement covered by enamel was present in
MATERIALS AND METHOD
highest percent to canines followed by
The study included 16 extracted teeth (4
incisors, bicusps and molars.
incisors, 2 canines, 4 bicusps, 6 molars). The
teeth, having unaffected cervical area, were
cut in 4 sections preserving the bucal, lingual,
26
Romanian Journal of Oral Rehabilitation
Vol. 6, No. 1, January - March 2014
Table 1. Types of enamel/cement/dentine junctions for maxillary teeth
Cement covers
enamel
Central incisive (IC)

buccal

oral

mesial

distal
Lateral incisive (IL)

buccal

oral

mesial

distal
Edge-to-edge
CEJ
Jonction with
exposed
dentine
Enamel covers
cement
+
+
+
+
+
+
+
+
Canine (C)




buccal
oral
mesial
distal
Bicusp 1(PM1)




buccal
oral
mesial
distal
Bicusps 2 (PM2)




buccal
oral
mesial
distal
Molar 1(M1)




buccal
oral
mesial
distal
+
+
Molar 2 (M2)




buccal
oral
mesial
distal
+
+
+
Molar 3 (M3)




buccal
oral
mesial
distal
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+

For mandibular teeth (Table 2):
- On buccal and oral surfaces there is
no exposed dentine;
27
Edge-to-edge CEJ a was found most
frequently to bicusps, followed by
incisors, canines and molars.
Romanian Journal of Oral Rehabilitation
Vol. 6, No. 1, January - March 2014

 Cement covered by enamel was present
in similar percents for all dental groups.
Cement covered enamel most frequently
to molars, followed by incisors, bicusps
and canines.
Table 2. Types of enamel/cement/dentine junctions for mandibular teeth.
Cement
covers enamel
Central incisive (IC)
 buccal
 oral
 mesial
 distal
Lateral incisive (IL)
 buccal
 oral
 mesial
 distal
Canine (C)
 buccal
 oral
 mesial
 distal
Bicusp 1(PM1)
 buccal
 oral
 mesial
 distal
Bicusps 2 (PM2)
 buccal
 oral
 mesial
 distal
Molar 1(M1)
 buccal
 oral
 mesial
 distal
Molar 2 (M2)
 buccal
 oral
 mesial
 distal
Molar 3 (M3)
 buccal
 oral
 mesial
 distal
Edge-toedge CEJ
Exposed
dentine
Enamel
covers
cement
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
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Romanian Journal of Oral Rehabilitation
Vol. 6, No. 1, January - March 2014


On proximal surfaces:
Incisors- most frequently enamel covered
cement, followed by cement covered
enamel, edge-to-edge CEJ; lowest percent
of jonctions was exposed dentine.

Edge-to-edge CEJ was present in highest
percent to molars and in lowest percent to
incisors and canines.
Enamel covered cement most frequently
to molars followed by bicusps, canines
and incisors.
Figures 1, 2. Edge-to-edge CEJ (SEM aspects)
Figures 3, 4. CEJ with exposed dentine (SEM aspects)
Figures 5, 6. CEJ with superposition of cement over enamel (SEM aspects)
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Romanian Journal of Oral Rehabilitation
Vol. 6, No. 1, January - March 2014
Figures 7, 8. CEJ with enamel covered by cement (SEM aspects)
Figures 9, 10. SEM aspects of CEJ covered with calculus deposits and bacterial biofilm
Most cases are associated with a retentive
structure of CEJ, favorable for the deposition
of bacterial biofilm and calculus (Fig. 9,10).
The rough surface pattern of enamel and the
exposed dentine or cement in some situations,
are responsible for the acceleration of
bacterial biofilm and calculus deposition (Fig.
1-10).
In our study, CEJ is covered by gingival
tissue. In the case of old patients, the cervical
area become an exposed area to the oral
environment and is submitted to the action of
chemical and physical factors that alter the
cement morphology.
Our study proved the existence of high
percent of edge-to-edge enamel-cement
junctions. For example, in the case of bicusps
this type of CEJ is found in 76% percent, with
cement covering enamel in 14% percent.
The existence in low percents of cement
covered by enamel is not yet explained from
an embriologic perspective. The presence of
areas with exposed dentine was found
especially on maxillary teeth, suggesting that
CEJ in this category of teeth is prone to the
apparition of pathological changes during
therapeutical acts like scaling, teeth
whitening, the application of matrices,
prosthetic restorations or direct restorations.
The foregoing observations indicate the
existence of a significant morphological
diversity of anatomic patterns of CEJ, related
both to dental groups and dental surfaces of
the individual teeth.
The results of our study agree with
literature data and prove that distribution and
reports between enamel, dentine and cement
in cervical area are various and unregulated.
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Romanian Journal of Oral Rehabilitation
Vol. 6, No. 1, January - March 2014
Literature data describe three possible
hypoplasia, or exposed dentine, offer
relations in cervical area: exposed dentine
favorable areas for the deposition of bacterial
because cement has no contact with enamel in
biofilm and calculus. Moreover, these
10% percent, edge-to-edge interrelation
features can hamper a proper instrumentation
between cement and enamel in 30% percent
during professional cleaning. On the other
and cement covers enamel in 60% percent.
way, overinstrumentation can conduct to
The use of SEM is requested because of its
enamel/cement micro-fractures that increase
accuracy in interpretation of relation between
the retentive topography and accelerate the
enamel, dentine and cement.
formation and deposition of bacterial biofilm
The previous researches suggested a
and calculus. The dental practitioner has an
interrelation between junction category and
important role to prevent this phenomenon by
dentine permeability, especially in those cases
performing gentle and efficient periodontal
associated with exposed dentine band
therapy. To maximize the bacterial biofilm
between
enamel
and
cement.
The
removal, periodontal therapy can be
vulnerability of CEJ requires a careful
completed with ozone-therapy, laser-therapy
management during therapeutical acts. The
and the application of antimicrobial
CEJ injury could conduct to cervical
medication. The prevention of root dental
hypersensitivity and cervical root resorptions.
caries must be also performed by the
The bacterial biofilm adherence is
application of remineralisation products based
significantly influenced by the texture and
on the release of fluorine, calcium, phosphate.
topography of cervical surface. Quirynen şi
van Steenberghe proved that on smooth
CONCLUSIONS
cervical enamel surfaces, bacterial biofilm is
The data presented in our study indicate
accumulating in parallel with gingival
the presence of three major types of tissues
margin. The same authors reported that in the
relations at the cementoenamel junction level:
presence of unregulated surface the
cement covers enamel, edge-to-edge relation
accumulation of bacterial biofilm is
and exposed dentine between cement and
accelerated. The conclusion was that the
enamel. A low percent of cases is associated
pattern of biofilm development is directly
with enamel covering cement. The
correlated with degree of roughness and
cementoenamel aspects varies in relation with
irregularity of dental surfaces (11-14).
dental type (incisive, canine, bicusp, molar)
The region of cemento-enamel junction is
and topography (buccal, oral, proximal). The
frequently associated with presence of dental
presence of cementoenamel junction with
caries and non-cariogenic cervical lesions.
exposed dentine was frequently seen to
The preventive or therapeutical dental acts
maxillary teeth.
can also generate aditionally lesions that
The highest retentive bacterial biofilm was
contribute further to the increase of retention
recorded to the cementoenamel junction with
degree of bacterial biofilm and raise the
exposed dentine band. The adherence of
probability of dental caries formation(15-16).
bacterial biofilm is influenced by the texture
CEJ presents a significant clinical challenge,
and topography of surface and is highly
because of its diversity of forms and
correlated with roughness coefficient of
unregulated surface. The unregulated
dental surface.
contours of cementoenamel junction, the
presence of unformed enamel, enamel
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Romanian Journal of Oral Rehabilitation
Vol. 6, No. 1, January - March 2014
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