Revista Científica Interdisciplinaria Investigación y Saberes
2024, Vol. 14, No. 2 e-ISSN: 1390-8146
Published by: Universidad Técnica Luis Vargas Torres
How to cite this article (APA):
Montesinos-Rivera, M., Aguilar, J., Calle, J., Calle, H. (2024) Analysis
of the amelocemental junction in premolars of an ecuadorian population, Revista Científica
Interdisciplinaria Investigación y Saberes, 14(2) 17-28
Analysis of the amelocemental junction in premolars of an ecuadorian
population
Análisis de la unión amelocementaria en premolares de una población ecuatoriana
Mayra Vanessa Montesinos-Rivera
Odontólogo. Docente Universidad Católica de Cuenca
mmontesinosr@ucacue.edu.ec
https://orcid.org/0000-0001-7991-366X
José David Aguilar Maldonado
Odontólogo. Docente Universidad Católica de Cuenca
jdaguilar@ucacue.edu.ec
https://orcid.org/0000-0001-5964-3105
Jessica Samantha Calle Álvarez
Estudiante de la Universidad Católica de Cuenca
jessica.calle.04@est.ucacue.edu.ec
https://orcid.org/0000-0002-9276-8636
Heydi Monserrath Calle Arévalo
Estudiante de la Universidad Católica de Cuenca
heydi.calle.11@est.ucacue.edu.ec
https://orcid.org/0000-0002-3065-2849
The aim was to microscopically analyse the prevalence of
amelocemental junction types in premolars according to Choquet's
classification. The study was observational, descriptive and cross-
sectional. The sample included extracted maxillary and mandibular
premolars (60 premolars). Random sampling was used to select the
teeth. As a result, it was determined that the most prevalent Choquet
case was the bis-to-bis case, which represented 35 teeth (58.33%). In
19 teeth we can observe the cement on enamel case and it gives us a
percentage of 31.66% of the sections, on the other hand, in 6 teeth
we observe the dentine between cement and enamel with a
percentage of 10%. And finally, we can observe that no tooth presents
Abstract
Received 2024-01-12
Revised 2024-02-22
Published 2024-05-01
Corresponding Author
José David Aguilar Maldonado
jdaguilar@ucacue.edu.ec
emmontesinosr@ucacue.edu.ec
Pages: 17-28
https://creativecommons.org/lice
nses/by-nc-sa/4.0/
Distributed under
Copyright: © The Author(s)
Analysis of the amelocemental junction in premolars of an ecuadorian population
Revista Científica Interdisciplinaria Investigación y Saberes , / 2024/ , Vol. 14, No. 2
18
the first case of choquet which belongs to enamel over cementum.
Concluding that the most predominant relationship between enamel
and cement was the case of Choquet Bis a Bis.
Keywords:
cemento-enamel junction, tooth neck, light microscopy.
Resumen
El objetivo fue analizar microscópicamente la prevalencia de los tipos
de unión amelo cementaría en premolares según la clasificación de
Choquet. El estudio fue observacional, descriptivo y transversal. La
muestra incluyó premolares maxilares y mandibulares extraídos (60
premolares). Para la selección de los dientes se utilizó la técnica de
muestreo aleatorio, como resultado se determinó que el caso de
choquet con más prevalencia es el de bis a bis pues represento 35
dientes (58.33%). En 19 dientes podemos observar el cemento sobre
esmalte caso y nos da un porcentaje de 31.66% de las secciones, por
otro lado, en 6 dientes observamos la dentina entre cemento y
esmalte con un porcentaje de 10%. Y finalmente podemos observar
que ningún diente presenta el primer caso de choquet que pertenece
a esmalte sobre cemento. Concluyendo que la relación entre esmalte
y cemento de más predominio fue el caso de Choquet Bis a Bis.
Palabras clave:
Unión cemento-esmalte, cuello del diente,
microscopía óptica.
Introduction
The cemento-amelocemental junction (CAJ) is the complex
anatomical area or junction where the tooth enamel meets the
cementum, where the enamel covers the crown of the tooth and the
cementum covers the root of the tooth (Ansari et al., 2019;
Arambawatta et al., 2009; Fleites et al., 2019; Roa et al., 2013; Rosa,
2003). The UAC acts as a reference point in the practice of clinical
dentistry, this site is where the gingival fibres attach to the healthy
Analysis of the amelocemental junction in premolars of an ecuadorian population
Revista Científica Interdisciplinaria Investigación y Saberes , / 2024/ , Vol. 14, No. 2
19
tooth, and there is a limitation between the hard tissues of the tooth
(Ceppi et al., 2006; Reyes-Gasga, 2021).
According to Choquet in 1899, who was the first person to describe
and classify the relationship between cementum and enamel in the
(UAC), he catalogued 4 types of relationships between these tissues
(Figure 1): A) Cement superimposed on enamel; B) Enamel
superimposed on cementum C) Cementum and enamel; edge to
edge; D) Dentin between cementum and enamel (Delgado and
Beatriz, 2021; Neuvald and Consolaro, 2000).
Figure 1.
Relationships of enamel to cementum: Choquet's cases. A)
Cementum covers enamel (60%). B) Enamel contacts cementum. C)
Enamel and cementum do not contact and D) Dentine between
cementum and enamel.
Source: Gomez de Ferraris (2013).
In young individuals, the UAC is protected by periodontal tissues,
however, as individuals age, eruption and passive destruction
progresses, creating wear of the occlusal and incisal surfaces of the
teeth, along with gingival recession, resulting in migration of the UAC
into the gingival sulcus (Botero and Bedoya, 2010; Srebrzyńska-Witek
et al., 2020).
The Amelocemental Attachment (AAU) establishes an essential and
important reference point within the dental field, serving to diagnose
the severity of various pathologies and to determine the correct
procedure for different specialties such as periodontics, endodontics
and oral rehabilitation (Simmer et al., 2012; Solis, 2014).
Analysis of the amelocemental junction in premolars of an ecuadorian population
Revista Científica Interdisciplinaria Investigación y Saberes , / 2024/ , Vol. 14, No. 2
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With regard to the importance of the CAU in oral rehabilitation, it is
mentioned that, as long as the periodontal status is not in good
condition and the CAU is not protected, no procedure should be
performed, which would prevent the aesthetic success of the
restorations, this implies the management of gingival tissues.
Furthermore, it is the area that limits between the dental enamel and
the root cementum in cervical teeth; this is where the gingival fibres
join the tooth slightly apically, because of this, it represents an
important landmark in periodontal health and constitutes the most
constant and repeatable guide to locate the pulp chamber in
endodontic treatments (Rivera et al., 2013; Alberti et al., 2007;
Arunachalam et al., 2019; Gasic et al., 2012; Lehm, 2005; Vandana
and Haneet, 2014).
On the other hand, the gingival margin is fundamental for periodontal
diagnosis and is located between 1 and 2 mm coronal to the
amelocemental junction (Fonseca and Fonseca, 2017; Grossman and
Hargreaves, 1991). This area is important because bone loss is
assessed by measuring the distance from the UAC to the bone crest
(Carvalho et al., 2004; Lehmann and Schmeisser, 1991).
Therefore, the aim of this work is to microscopically analyse the
prevalence of amelocemental junction types in premolars according
to Choquet's classification.
Methodology
The present study was a type of observational research, quantitative
approach, descriptive design and cross-sectional. It was reviewed,
analysed and approved by the Head of Research and the Formative
Research area on 08 November 2021 with resolution: UCACUE-IF-
2021-020-OF.
The sample included extracted maxillary and mandibular premolars.
The sample included extracted maxillary and mandibular premolars,
the final size for the study was 72 premolars obtained from the tooth
bank of the dental career of the UCACUE.
For the selection of the teeth, the following inclusion criteria were
used: teeth with intact cervical area; on the other hand, the exclusion
Analysis of the amelocemental junction in premolars of an ecuadorian population
Revista Científica Interdisciplinaria Investigación y Saberes , / 2024/ , Vol. 14, No. 2
21
criteria were teeth with caries, wear, abrasion, erosion and
restorations; therefore, the final sample consisted of 60 premolars.
The teeth were rinsed with sodium hypochlorite for 1 minute and
immersed in saline until sectioned. The teeth were then dried and
sectioned coronally in two halves and the central groove of the
premolars was used as a reference point. This section was carried out
with the aid of a 0.15 mm thick, superfine-grained diamond disc,
Dentaurum brand, and under constant irrigation to avoid overheating.
Each sectioned tooth was placed in boxes for identification and
enumerated for the corresponding microscopic study.
Finally, for microscopic analysis, a 40x stereomicroscope (dino-lite
edge 3.0) was used; the different choquet cases were classified into:
1) enamel on cementum; 2) bis to bis; 3) dentine between cementum
and enamel; 4) cementum on enamel.
Results
Sections of 60 teeth in total were examined, these being 10 upper
first premolars, 20 lower first premolars, 18 upper second premolars,
and 12 lower second premolars. In all teeth we could observe that the
UAC is morphologically similar.
The UAC of the 60 teeth was classified into four, according to the
enamel-cement interrelationships observed. From the analysis of the
teeth, we determined that the most prevalent case of choquet is the
bis-to-bis choquet, as it represents 35 teeth, 58.33% of the total
sample. In 19 teeth we can observe the cement on enamel case and
it gives us a percentage of 31.66% of the sections, on the other hand,
in 6 teeth we observe the dentine between cement and enamel with
a percentage of 10%. And finally we can observe that no tooth
presents the first case of choquet which belongs to enamel on cement
(Table 1).
Analysis of the amelocemental junction in premolars of an ecuadorian population
Revista Científica Interdisciplinaria Investigación y Saberes , / 2024/ , Vol. 14, No. 2
22
Table 1
. Absolute table description
CASO DE CHOQUET
N
%
1 (esmalte sobre cemento)
0
0
2 (bis a bis)
35
58,33%
3 (dentina entre cemento y esmalte)
6
10%
4 (cemento sobre esmalte)
19
31,66%
TOTAL
60
99,99%
Table 2 shows the relationship between choquet cases and premolars.
Finally, no significant correlation was observed between arch, tooth
and UAC.
Table 2
shows the relationship between choquet cases and
premolars. Finally, no significant correlation was observed between
arch, tooth and UAC.
Diente
Caso
Choquet 1
%
Caso
Choquet 2
Caso
Choquet 3
%
Caso
Choquet 4
Total
Valor
p
Primer
Premolar
Superior
0
0
7
0
0
3
10
0,111
Primer
Premolar
Inferior
0
0
14
1
1.66%
5
20
Segundo
Premolar
Superior
0
0
10
1
1.66%
6
18
Segundo
Premolar
Inferior
0
0
4
4
6.66%
5
12
Total
0
35
6
9.98%
19
60
Analysis of the amelocemental junction in premolars of an ecuadorian population
Revista Científica Interdisciplinaria Investigación y Saberes , / 2024/ , Vol. 14, No. 2
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Figure 2.
Second Choquet case: bis a bis (40x)
Figure 3.
Third Choquet case: Dentine between cementum and
enamel.
Figure 4.
Fourth Choquet's case: Cement on enamel (40x)
Analysis of the amelocemental junction in premolars of an ecuadorian population
Revista Científica Interdisciplinaria Investigación y Saberes , / 2024/ , Vol. 14, No. 2
24
The UAC is an area of great importance in clinical dentistry, as it is an
anatomical reference point for the classification of dental hard tissues,
which is why the research of certain authors discusses the relationship
between the different cases of Choquet, demonstrating the
prevalence. Thus, in the study of Arambawatta et al. showed under
observation the highest frequency of the case of choquet bis a bis
with a prevalence of 55.1%, while the lowest prevalence was 1.6%
cementum superimposed on the enamel (Arambawatta et al., 2009).
According to the studies conducted by the authors Fonseca et al.
stated the highest prevalence of Choquet case is dentin between
enamel and cementum with 39.25%, while the least frequent case was
enamel on cementum with 2.14% (Fonseca and Fonseca, 2017).
On the other hand, Carvalho et al. (2004) state that the most dominant
choquet case is cement on enamel with 42%, and the least dominant
is enamel on cement with 12%. In recent studies by Arambawatta et
al. (2021) reports that the most prevalent Choquet cases are enamel
over cementum-cement and non-contact enamel. Finally, in the
present study the most prevalent Choquet case is bis-to-bis with
58.33% of the total sample, and the least prevalent is enamel on
cementum with 0%.
Conclusions
It can be concluded that the examination of the amelocemental
junction in the premolars of an Ecuadorian population, based on the
Choquet classification, has yielded valuable information on tooth
structure. The results indicate that the predominant type of bonding
observed was the Choquet "Bis to Bis" case, which was evident in
58.33% of the teeth examined. This finding suggests a predominant
tendency towards an amelocemental junction characterised by a close
association of both tissues.
Analysis of the amelocemental junction in premolars of an ecuadorian population
Revista Científica Interdisciplinaria Investigación y Saberes , / 2024/ , Vol. 14, No. 2
25
In addition, a significant presence of cementum was observed in the
enamel, which accounted for 31.66% of the sections analysed. This
phenomenon has implications for dental health and allows a better
understanding of the processes of mineralisation and formation of
dental tissues.
It is worth noting that 10% of the sections studied showed the
presence of dentine between cementum and enamel. This underlines
the morphological diversity inherent in the amelocemental bond and
emphasises the importance of considering these variations in both
clinical and research contexts.
The absence of cases with enamel-on-cement in the sample analysed
is a noteworthy finding, suggesting a low prevalence of this type of
bond in the Ecuadorian population under study. These data have
diagnostic and therapeutic implications, as well as contributing to the
understanding of the processes of mineralisation and dental
development in this particular population.
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