INTRODUCTION Periodontium Is defined as the connective tissue organ that attaches the teeth to bone of jaws and provides

a continually adapting apparatus for the support of teeth during function. Periodontium comprises of four connective tissue Two of which are mineralized - Cementum - A.B. Two are fibrous - eriodontal ligament - !. of gingiva Periodontal ligament periodontal ligament is the connective tissue that surrounds the roots and connects the tooth to the bone. It is continuous with the connective tissue of the gingiva and communicates with the marrow and space this vascular channels in the bone. In a healthy tooth it covers the root up to the cemento-enamel junction. In radiograph periodontal ligament appears as a radiolucent line paralleling the root surface.

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!amina dura in radiograph appear as a radio-dense line which represent the alveolar bone fibres.

The average width of periodontal ligament is about #."$ to #.%&mm. periodontal ligament is thinnest in middle portion of root and its width decrease with age.

At age of ""-"' years #.("mm. %(-$( years #."&mm $(-') years #."$mm Periodontal space: This space lies between two hard tissue i.e. cementum and bone within this space periodontal ligament is present. Its rot measures appro*imately %#mm% + "##mm% single root '$-"$#mm% multirooted teeth The width of periodontal space varies from end to end and from tooth to tooth and on different location on same tooth. ,ith increase in function space widens and with loss of function thinning and atrophy of fibres ta-es place.

Synonyms: The other name used for periodontal ligament are .esmodont /homphosis ericementum0 Alveodental ligament1 periodontal

membrane0 .ental periosteum. 2ost commonly used are periodontal ligament and periodontal membrane0 both neither of them3well describes structure and function. eriodontal ligament is most appropriate term as it provides continuously between two mineralized tissues bone and cementum. Development The periodontal ligament forms from dental follicle soon after root deviation begins. 4ormation of periodontal ligament starts0 after 5ertwig6s epithelial rest sheath cells are separated forming strands -nown as epithelial cell rest6s of malassez. This separation permits the cells of dental follicle to migrate to the e*ternal surface of newly formed root dentine.

 These cells show high degree of mitotic activity0 thus differentiating into different types of cells which give rise to cells of periodontal ligament namely7 Cementoblast deposit cementum on deviated root. 8steoblast of the developing alveolar bone. 4ibroblast to synthesize collagen and ground substance of periodontal ligament. The fibroblasts cells are oriented obli9uely at early stages and thus fibres secreted by them have the same orientation. These obli9uely oriented fibre bundles get entrapped in bone and cementum as they are deposited and this give rise to principal fibres of periodontal ligament. Before eruption Alveolar bone crest is above cementoenamel junction thus fibres are laid down obli9uely in a coronal direction giving rise to obli9ue fibres. As eruption begins Alveolar crest coincides with the cemento-enamel junction and fibres are aligned horizontally. ,hen the tooth eruption is completed and it is in full function0 alveolar crest below cemento-enamel junction near ape* thus fibres are again aligned obli9uely but in an

opposite direction to first laid fibre bundles0 thus forming alveolar crest fibres. As the tooth is in function0 fibres begin to thic-en and are remodeled constantly over a period of time. Evolution: There is fundamental difference between ;epitilian and 2ammalian teeth attachment. In reptiles teeth are an-ylosed to bone. In mammals teeth are suspended in soc-ets by ligament. The central point of these changes is <reconstruction of mandible=. In reptiles mandible consisting of several bones united by sutures. In mammals the newly ac9uired cartilage of condyle is the most important growth site for mandible. In reptiles the mandibular teeth more with the bones to which they are fused but in mammals they move as independent units and this movement is made possible by remodeling of periodontium. The evolutionary change from reptiles to mammals replaces the an-ylosis of tooth and bone to a ligamentous suspension of the tooth.

Structure Cellular >*tracellular connective tissue Components

Cellular eriodontal ligament comprise of three groups of cells. These are7 ?ynthetic cells. ;esorptive cells. rogenitor cells.

Apart from these periodontal ligament comprises of 7 >pithelial cells + >pithelial cell rests of malassez. .efence cells derived from hemopoietic line.

Synt etic cells: These include7 4ibroblast. 8steoblast. Cementoblast.

!i"ro"last These cells are the most numerous and densely pac-ed in periodontal ligament.

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 They appear as ovoid or flattened with numerous cytoplasmic processes. ?hape of these cells vary according to the orientation of fibres0 where active fibres and fibroblasts are densely pac-ed cells appear elongated along the fibre length. In the loose connective tissue cells are ovoid0 or spindle shaped. These cells are surrounded by fibres and ground substance. periodontal ligament fibroblasts are attached to one another by a. gap junction. b. ?implified desmosomes. They are involved in both synthesis and resorption of collagen fibres. Osteo"lasts: These cells are found on surface of alveolar bone in periodontal ligament. They constitute modified endosteum instead of periosteum as an outer layer i.e. outer layer is cellular instead of fibrous as seen in osteoblasts found elsewhere in body. A prominent nucleus lies towards the base of these cells.

 Collagen fibres of periodontal ligament penetrating the bone intervene between these cells. Cemento"lasts These cells resemble osteoblasts. These cells are found in portion of dental follicle adjacent to root and at the boundary between the periodontal ligament and tooth surface. These cells have a diameter of about &-"(@m and display several cytoplasmic processes. Resorptive cells 8steoclasts. 4ibroblasts 3 fibroclasts. Cementoclasts.

Osteoclasts These are the bone resorbing cells and tend to be large and multinucleating but may be small and mononuclear. .erived from circulating monocytes. Ander light microscope These are present in 5owship6s lacunae.

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 Ander electron microscope e*hibit numerous mitochondria0 lysosomes0 /olgi sacules0 few ribosomes and few rough endoplasmic reticulum. The part of plasma membrane of these cells adjacent to bone is continually resorbed and has characteristic folds giving rise to ruffled or striated border. This border is separated from the rest of plasma membrane by a zone of specialized membrane devoid of organelles -nown as clear zone. ;esorption of bone margin occurs in two stages7 ". ;emineralization of bone margin. (. .isintegration of orgenic matri*. 8steoclasts are rich in acid phosphatase Bpresent in lysosomesC. The presence of osteoclasts in periodontal ligament indicates active resorption or previous resorption in that area. !i"roclasts Collagen fibres of the mammalian periodontal ligament are resorbed under normal physiologic conditions by mononuclear fibroblasts.

These cells contain lysosomes + which bring about resorption.

There presence indicate active resorption occurring during physiologic turnover or remodeling of periodontal ligament.

Cemento"lasts: ;esembles osteoclasts and are occasionally found in periodontal ligament. 8rigin is un-nown. ;esorption of cementum may ta-e place under certain circumstances and in such instances these cells are present in 5owships lacunae on the surface of cementum. Progenitor cells: !i-e all connective tissues periodontal ligament also contain progenitor cells or undifferentiated mesenchymal cells that undergo mitotic division. But very little is -nown about progenitor cells of periodontal ligament. ?uch as it is not -nown whether a single population of progenitor cells give rise to all the synthetic cells of periodontal ligament or there are a number of population.

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There presence is evident from mitosis occurring after the application of a pressure such as in orthodontic treatment and after wounding.

These cells lie close to blood vessels. These cells have a close-faced nucleus and very less cytoplasm.

Epit elial Cell Rests of #alasse$ eriodontal ligament contains epithelial cells that lie close to cementum. .escribed by malassez in "&&:. They are remnants of 5ertwig6s epithelial rest sheath that are embedded in periodontal ligament during deviation. Ander electron microscope these cells e*hibit tonofilaments and are attached to each other by desmosomes. ;ole of these cells under normal physiologic conditions is un-nown0 but under pathologic condition. These cells may proliferate to give rise to cysts such as periapical and lateral root cysts and tumours of jaws. ?een in form of islands 3 clumps 3 tubules.

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Defence cells 2ast cells. 2acrophages. >osinophils.

#ast cells These cells are sometimes seen in periodontal ligament. These are small round 3 oval in shape about "(-"$ @m in dia. Contain numerous cytoplasmic granules such as heparin0 serotonin0 histamine /ranules have a dia-#.$-"@m and are membrane bound. These granules play a role in inflammation reaction especially histamine. Cells degenerate in response to Ag-Ab reaction.

#acrop ages These cells may also be present in the ligament. These are delivered from blood monocytes. These cells need to be differentiation from fibroblasts. 4ibroblasts contains phagocyted mat in their cytoplasm. 2acrophages have a nucleus with regular contour.

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Cell surface is raised because of microvilli. Cytoplasm has numerous free ribosomes0 lysosomes. !ess of ;>;0 and /olgi apparatus not well developed.

Relations ip "et%een cells Cells of periodontal ligament form a three dimensional networ- and there processes surround collagen fibres and these are attached to one another and to cells of bone0 cementum by gap junction. E&tracellular su"stances: Fibres - Collagen - 8*ytalan - >lavanin !i"res Collagen These comprise the majority of fibres of periodontal ligament. Collagen is a specific high molecular weight protein. Ground substance - /lycosaminoglycans - /lycoproteins

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rotein macromolecules are clustered to form fibrils which are pac-ed to form fibres. These fibres are gathered into bundles having clear orientation relative to periodontal space and are -nown as principal fibres of periodontal ligament.

Collagen are of five types periodontal ligament consists of Type I collagen predominantly and a little of type III collagen.

Principal fi"res 1. These comprise of five groups of fibres. Alveolar crest fibres: Alveolar crest fibres e*tend obli9uely from cementum below the functional epithelium to the alveolar crest. 4unction + these fibres prevent e*trusion and lateral tooth movement of tooth. There incision does not significantly increase tooth mobility. 2. Horizontal group ;estricted to coronal E of periodontal ligament. These fibres run horizontally at right angles to long a*is of tooth from cementum to alveolar bone. 4unction7 prevent lateral tooth movement

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Oblique group 8ccupy middle (3%rd of periodontal ligament. These fibre bundles account for the main attachment of tooth. These fibres e*tend in a coronal direction obli9uely from cementum to bone.

Function: These fibres bear the forces of vertical masticatory stresses and transform them into tension on the alveolar bone. . Apical group These fibres are irregularly arranged and radiate from cementum to bone at the fundus of soc-et. 4unction7 ;esist forces of lu*ation0 prevent tooth tipping. rovide for protection of blood vessels and nerves of periodontal ligament. !. "nter#radicular group: 4rom the crest of inter-radicular septum0 bundles e*tend to furcation of multi-rooted teeth. Function: ;esist tooth tipping0 tor9ue and lu*ation of tooth.

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Transeptal group + These fibres e*tend interpro*imally over the alveolar crest to be embedded into the cementum of adjacent teeth. Collagen fibres are embedded on one side into cementum and on the other into bone. These embedded fibres are -nown as <?harpey6s fibres=. The principal fibres run a wavy course from cementum to bone. These fibres appear to join in mid-region of ligament giving rise to a zone of distinct appearance -nown as <Intermediate ple*us=. reviously considered to be zone of remodeling this zone is an artifact as seen under electron microscope which arises due to plane of sectioning. O$%talan: This is an immature elastic fibre restricted to walls of blood vessels. Their orientation differ from that of principal fibres. These fibres run a*ially i.e. one end is in either bone3cementum and other in blood vessels. They from a comple* networ- close to ape*. 4unction is un-nown but may play a role in supporting blood vessels of periodontal ligament. &luanin: "'

 This is the other form of immature elastic fibres and along with collagen fibres it forms a meshwor- e*tending from cementum to bone and sheathing the collagen fibre bundles. Ground substance The space between cells0 fibres0 blood vessels0 nerves in periodontal ligament is occupied by ground substance. 4unction >*change of metabolites between microcirculation and cells. >nables tooth to withstand stress along with fibres. Comprises of )#F water Two major components are7 /lycosaminoglycans roteoglycans and 5yaluronic acid. /lycoproteins 4ibronectin and laminin. Both components comprise of proteins and polysaccharides but of different nature and arrangement. They can be demonstrated by histochemical method under electron microscope and light microscope. Chemicals used for >lectron microscope ;uthenium ;ed !ight microscope Alcian blue0 &/G and toulidiene blue. /lycoproteins contain a group "0( glycol which can be demonstrated in light microscope by use of periodic Acid ?chiff method. ")

In electron microscope by techni9ue.

eriodic acid silver methanamine

periodontal ligament contains a glycoprotein <fibronectin= which is present in filamentous form. It contains chemical groups that attach to surface of fibroblasts0 collagen proteoglycans and fibrin. Clinical and p ysiologic aspect of ground su"stance roteoglycans play a role in transmitting pressure and thus dispersing mechanical forces to protect periodontal ligament from damage. Changes in ground substance are seen during tooth eruption. /round substance are also found to play a role in tooth mobility as studied by icton in "D&:. Interestitial tissue ?ome of blood vessels0 lymphatics0 and nerves of periodontal ligament are surrounded by loose connective tissue -nown as interstitial tissue.

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Structures in connective tissue Contains7 Blood vessels !ymphatics Herves Cementicles

'lood vessels The arterial vessels of periodontal ligament are delivered from three sources7 ". pulp. (. Branches from intra-alveolar vessels that penetrate the alveolar bone horizontally to enter periodontal ligament. %. Branches of gingival vessels. They enter periodontal ligament from coronal direction. The arterioles and cappaliries form a rich networ- adjacent to bone. There is a rich vascular ple*us also at the ape* and cervical part of ligament. Ienous ple*us run a*ially to drain to the ape*. Branches from apical vessels that supply dental

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(ymp atics A networ- of lymphatic vessels along the blood vessels provides the lymph drainage of periodontal ligament. The flow is from periodontal ligament toward and into adjacent alveolar bone. Nerves Associated with blood vessels and nerves pass through the foramina in the alveolar bone including apical foramen to enter the ligament. In region of ape*0 they run toward the cervi*0 whereas along the length of root run both coronally and apically. Herves are of both large BmyelinatedC diameter as well as small Bmay or may not myelinatedC diameter. !arge fibres are concerned with sense of touch and end in different type of endings such as -nob li-e0 spindle-li-e etc. small are responsible for pain. Cementicles Calcified bodies cementicles are sometimes found in periodontal ligament seen commonly in old people. These may join to form large calcified masses. As cementum thic-ens0 it envelops these masses. 8rigin is not -nown0 but it is thought that degenerated epithelial cells form nidus for their calcification.

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!unctions of periodontal ligament The functions of periodontal ligament are7 ". hysical

(. Hutritive %. ?ensory :. 5omeostatic Bformative and remodelingC. "C following7 a. Transmission of occlusal forces to bone. b. Attachment of teeth to bone. c. 2aintenance of gingival tissue in the proper relationship to the teeth. d. ;esistance to impact of occlusal forces. e. rovision of a soft tissue cassing to protect the vessels and nerves from injury by mechanical forces. As a result of forces0 Bon toothC during mastication or due to orthodontic forces0 part of . space is narrowed and periodontal ligament gets compressed. 8ther parts are widened. Compressed part provides support for the loaded tooth. Collagen fibres acts as a cushion for the displaced tooth. hysical functions of periodontal ligament include the

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Sensory The periodontal ligament is abundantly supplied with sensory nerve

fibres capable of transmitting tactile pressure and pain sensation by the trigeminal pathways. This proprioceptive mechanism0 allows the organism to detect the application of most delicate forces to the teeth and very slight displacement of the teeth. >.g.0 Bitings on a small hard object such as stone while eating. +* Nutritive : The periodontal ligament supplies nutrients to the cementum BCementocytesC bone B?uperficial osteocyctesC gingiva and metabolites to other cells of ligament via blood vessels. ,* -omeostatic Cells of periodontal ligament participate in the formation and resorption of cementum and bone and occur in physiologic tooth movement in the accommodation of periodontium to the occlusal forces and in the repair of injuries. eriodontal ligament is constantly undergoning remodeling. 8ld cells are replaced by new ones. The rate of formation and the differentiation of fibroblasts affect the rate of formation of collagen0 cementum and bone.

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;ate of collagen synthesis is faster than other any connective tissue of the body. ,hen homeostatic mechanism0 is upset derangement of

periodontium occurs. If periodontal ligament is irrepairably damged an-ylosis may occur due to bone deposition in periodontal space. T eories in periodontal ligament Three theories relative to the mechanism of tooth support have been considered7 .* Tensional t eory It states that principal fibres of periodontal ligament have major responsibility in supporting the tooth and transmitting forces to the bone. ,hen a force is applied to the crown0 principal fibres first unfold and straighten and then transmit forces to the alveolar bone0 causing an elastic deformation of the bony soc-et finally when alveolar bone has reached its limit0 load is transmitted to basal bone. 2any investigators do not agree to this theory. 2' (iscoelastic s%ste) t*eor% This theory states that fluid movement is mainly responsible for displacement of tooth1 fibres have the secondary role.

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,hen forces are applied on tooth e*tracellular fluid from periodontal ligament passes into marrow spaces of bone through foramina in the cortical layer. After the depletion of tissue fluids0 the fibre bundles absorb the slac- and lighten0 causing blood vessel stenosis0 arterial bac- pressure cause ballooning of the vessels and passage of blood ultrafiltrates into the tissues0 thereby replenishing the tissue fluids. 3' +*i$otropic t*eor% It states that periodontal ligament behaves li-e a thi*otrophic gel i.e. property of becoming fluid when sha-en or stirred and then becoming semi-solid again. hysiologic response of periodontal ligament is e*plained by changes in the viscosity of biologic system. According to ?chroeder0 presence of organized collagen fibres ma-es the theory untenable. /ge C anges in periodontal ligament The principal fibres of the periodontal ligament are thic-er in aging human than in younger individuals. Interfibrillar areas are reduced in size. There is a decrease in ratio of ground substance to collagen. 4ewer cells are seen. eriodontal ligament show hyalinization and chondroid

degeneration related to reduced vascular supply. (:

Calcified bodies are common in periodontal ligament of elderly humans.

8ccassionally they increase in number and appear to calcify a complete fibre bundle producing an-ylosis.

>pithelial cell rests may undergo calcification with age.

Clinical Consideration: rimary role of periodontal ligament is to support tooth in soc-et. Thic-ness of periodontal ligament varies and decrease with age. eriodontal ligament is wide in tooth under function and is thin in functionless teeth. Thus the tooth long out of function is poorly adapted to carry the load suddenly placed on tooth by a restoration and thus may account for inability of a patient to use the restoration immediately after its placement. Acute trauma to periodontal ligament due to accidental blow condensing of a foil0 rapid tooth separation may produce pathologic changes such as7 4racture and resorption of cementum and bone. Tear of fibre bundles. 5emorrhage and necrosis. periodontal ligament widening.

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Tooth becomes loose. ;epair occurs on elimination of trauma. 8rthodontic movement depends on resorption and formation of both

periodontal ligament and bone. ressure causes bone resorption. Tension causes bone formation. The periodontal ligament in the periapical area of tooth is often the site of pathologic lesion. Infectious disease pulp progress to apical periodontal ligament and replace its fibres by granulation tissue giving rise to dental granuloma which may develop into cyst later on. Acute alveolar abscess. Acute . abscess. Diseases of periodontal ligament are often irreversi"le 4rom gingiva it progresses to periodontal ligament0 it is a slow process. 8nce destroyed .! is difficult to regenerate. Summary and Conclusion eriodontal ligament is a connective tissue structure that surrounds the roots of teeth and attaches them to bony alveolus.

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 It is composed of a group of dento-alveolar fibres called principal fibres which help to support the tooth. eriodontal ligament has rich vascular supply BnourishesC and is well innervated these nerve help prevent trauma to teeth. eriodontal ligament thus forms an important structure of dentoalveolar unit. The periodontal disease has rapidly ta-en over dental caries which was considered as the primary disease of oral cavity. .amage of periodontal ligament results in loss of tooth. Thus a thorough understanding of periodontal ligament is necessary for all health care personnel. References ". eriodontal !igament + 8ral 5istology and >mbryology by 8rban6s. (. Tencate A.;. %. Tooth supporting structures age %#0 4eemin A.Caranza Jr. and

Angela 2ABI8?0 Clinical eriodontology0 &th >dition.

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