Roles of Wnt signaling pathway in cementum formation, cementum regeneration, and cementocyte function

Cementum, a mineralized connective tissue that covers the tooth root, is crucial in protecting the root from resorption, maintaining occlusal relationships, and supporting tooth function. Cementocytes are embedded within the cementum matrix and extend dendritic processes through the canaliculi. They are thought to be mechanosensitive, responding to changes in mechanical loading, and are physiologically responsive cells associated with the formation of cellular cementum in response to variations in functional demands on the tooth. The wingless and int (Wnt) signaling pathway, which controls cell fate and regulates growth, development, and homeostasis in the body, plays a pivotal regulatory role in normal biological development and disease progression. Currently, the mechanisms by which the Wnt signaling pathway influences cementogenesis and regeneration remain controversial. Research findings on the roles of Wnt/β-catenin signaling in cementoblast differentiation and function have been mixed. Some studies indicate that activating this pathway enhances cementoblast differentiation, while others suggest that Wnt signaling may inhibit it, favoring cell proliferation instead. This paper reviews the structure and physiological roles of cementum, focusing on how Wnt signaling influences the growth and differentiation of cementoblasts. We emphasize the pivotal role of the Wnt pathway in cementum formation and development, as well as in root resorption and repair, and hypothesize that maintaining low Wnt/β-catenin levels is crucial to achieving an optimal balance between cementoblast proliferation and differentiation. Finally, we propose periodontal regeneration treatment strategies based on the Wnt signaling pathway and suggest future research directions.