Healthy Periodontium

Periodontal Morphology Healthy

Periodontium
Alveolar Bone
Root Cementum

Periodontal Ligament

Gingiva

The Periodontium
Gingiva
Periodontal
Ligament
Root Cementum
Alveolar Bone
(Alveolar Process)

Gingiva
Alveolar mucosa
Attached gingiva
Free gingiva
Interdental gingiva

Gingiva
Tissue covering the
cervical portions of the
teeth and the alveolar
processes of the jaws
Composed of thin outer
layer of epithelium and
an underlying core of
connective tissue
Provides a tissue seal
around the cervical
portions of the crowns

Clinical Anatomy of the Gingiva

Clinical Anatomy of the Gingiva

Attached gingiva
Free gingiva
Free gingival groove
Gingival margin
Gingival sulcus

(gingival crevice)
Interdental gingiva
Papilla/Papillae
Col
Alveolar mucosa
Mucogingival junction

Clinical Anatomy of the Gingiva

Free gingiva
Gingival margin
Gingival sulcus (gingival

crevice)
Attached gingiva
Mucogingival junction
Alveolar mucosa

Clinical Anatomy of the Gingiva

Interdental gingiva

Facial papilla
Lingual papilla

Clinical Anatomy of the Gingiva

Col
Proximal contact

area

Col

Proximal
contact area

Clinical Anatomy of the Gingiva

Free Gingiva
Unattached portion of the
gingiva that surrounds the
tooth in the region of the
cemento-enamel junction
(CEJ).
Located coronal to (above)
the CEJ. It surrounds the
tooth in a turtleneck or cufflike manner
Also known as the
unattached gingiva or the
marginal gingiva

Clinical Anatomy of the Gingiva

Free gingiva characteristics
Free gingiva
Fits closely around the tooth
but is not directly attached to it
May be stretched away from
the tooth surface with a
periodontal probe
Forms soft tissue wall of
gingival sulcus
Meets the tooth in a thin
rounded edge called the
gingival margin
Gingival margin follows the
contours of the teeth, creating a
scalloped (wavy) outline
around them

Clinical Anatomy of the Gingiva

Gingival Sulcus The space between the
free gingiva and the tooth
surface
V-shaped, shallow space
around the tooth
Junctional epithelium
forms base of sulcus

Clinical Anatomy of the Gingiva

This periodontal
probe is divided
into 3 millimeter
colored segments

Periodontal probe being used to

measure depth of the sulcus

Gingival Sulcus The depth is 1-3 mm for

a clinically normal
gingival sulcus
The depth is measured
using a periodontal probe

Dental floss being used to clean

the gingival sulcus and the tooth

Clinical Anatomy of the Gingiva

Gingival Sulcus Probing the sulcus depth
interproximally is best
accomplished by angling
the probe so its tip is
located at the center of the
root
A = incorrect technique for interproximal probing
B = correct probing technique
C = incorrect probing technique

Clinical Anatomy of the Gingiva

Junctional Epithelium
Specialized type of
epithelium that
attaches to the tooth
surface
Located at the base of
the gingival sulcus

Clinical Anatomy of the Gingiva

Attached gingiva
Gingiva that is tightly
connected to the
cementum on the cervicalthird of the root and to the
periosteum (connective
tissue cover) of the
alveolar bone
Lies between the free
gingiva and the alveolar
mucosa

Clinical Anatomy of the Gingiva

Attached gingiva functions
Allows the gingival tissue to
withstand mechanical forces
Mastication,
Speaking,
Toothbrushing

Prevents free gingiva from

being pulled away from the

tooth when tension is applied
to the alveolar mucosa.

Clinical Anatomy of the Gingiva

Interdental gingiva
The portion of the gingiva
that fills the area between
two adjacent teeth apical
to the contact area

Clinical Anatomy of the Gingiva

Papilla
The interdental (or
interproximal) gingiva
consists of two interdental
papillae
one facial papilla
one lingual papilla
Papilla (singular)
Papillae (plural)

Clinical Anatomy of the Gingiva

Col
Valley-like depression in
the interdental gingiva
Lies directly apical to the
contact area
The col is not present if

the adjacent teeth are not

in contact or if the gingiva
has receded

Clinical Anatomy of the Gingiva

Left = incorrect vertical technique for probing interproximal craters

Right = correct angled position of the probe to reach the depth of an interproximal crater

Clinical Anatomy of the Gingiva

Alveolar Mucosa
Movable tissue loosely attached to
underlying bone
Nonkeratinized
Thin, smooth and shiny epithelium
Dark red in color
Underlying vessels may be seen
through the epithelium.
Alveloar mucosa also covers the

vestibule and floor of the mouth

and becomes the buccal and labial
mucosa

Clinical Anatomy of the Gingiva

Mucogingival junction
The clinically visible
boundary where the
pink attached gingiva
meets the red, shiny
alveolar mucosa

Microscopic Anatomy of the

Gingival Epithelium
Gingiva
Oral epithelium (OE)
Sulcular epithelium (SE)
Junctional epithelium (JE)

Gingival connective tissue

Microscopic Anatomy of the

Gingiva
Sulcular
epithelium

Oral
epithelium

Gingival Epithelium
Oral epithelium faces
Junctional oral cavity on outer
epithelium surface of the free
gingiva and attached
gingiva
Sulcular epithelium
lines the gingival sulcus
Junctional epithelium
provides contact
between the gingiva and
the tooth. Often referred
to as the epithelial
attachment

Microscopic Anatomy of the

Gingiva
OE = oral epithelium
SE = sulcular epithelium
JE = junctional epithelium
CEJ = cementoenamel
junction

Gingival connective tissue

underlies the epithelium and

provides support through an
organization of collagen
fibers

Periodontal Ligament
Periodontal Ligament (PDL)
Layer of soft connective
tissue
Covers the root of the tooth
Attaches the root to the bone
of the tooth socket
Composed mainly of fiber
bundles
Fibers attach on one side to
the root cementum
Fibers attach on the other
side to the alveolar bone of
the tooth socket.

Periodontal Ligament
Functions of the Periodontal Ligament
Support - suspends and maintains the
tooth in its socket
Sensory - provides sensory feeling to
the tooth; pressure and pain sensations
Nutritive - provides nutrients to the
cementum and bone
Formative - builds and maintains
cementum and the alveolar bone of the
tooth socket
Resorptive - can remodel the alveolar
bone in response to pressure
Example: pressure applied
during orthodontic treatment
(braces)

Root Cementum
Root Cementum
Thin layer of hard,
mineralized connective
tissue
Covers tooth from the
cementoenamel junction
to, and around, apical
foramen
Overlies and is attached to
the dentin of the root
Periodontal ligament
attaches to the cementum

Root Cementum
Root Cementum
Light yellow in color
With normal gingival
position, it is not visible
but can be seen when
gingival recession is
present

Gingival recession is present on the

facial surface due to trauma from
overly vigorous toothbrushing

Alveolar Bone

Alveola

r proce

Basal

ss

bone

Alveolar Bone (also called alveolar

process)
The bony portion of the maxilla
or mandible that extends occlusal
to the basal bone and surrounds
and supports the roots of the teeth
The existence of the alveolar
bone is dependent on the
presence of teeth
When teeth are extracted, in
time, the alveolar bone resorbs
so only basal bone remains
If teeth do not erupt, the
alveolar bone does not develop

Alveolar Bone
Function of Alveolar Bone
Forms the bony sockets
that provide support and
protection for the roots of
the teeth
one

Alveolar B

Alveolar Bone

Anatomical Areas of the

Alveolar Bone:
Alveolar crest
Interproximal bone
Interradicular bone (bone
between the roots of the same
tooth)

Anatomical Areas of the Alveolar Bone

Alveolar Crest
Most coronal portion of the
alveolar process
Located 1-2 mm apical to the
CEJs of the teeth (in health)
Viewed from the facial
aspect, alveolar crest meets
the teeth in a scalloped
(wavy) line that follows the
contours of the CEJs

Anatomical Areas of the Alveolar Bone

Interproximal Bone
The area of bone that lies
between the proximal
surfaces of two adjacent
teeth
Also known as interdental
septum

Anatomical Areas of the Alveolar Bone

Crestal Contour of
Interproximal Bone
The contour of the crest of
the interproximal bone is a
good indicator of periodontal
health
In posterior sextants, the
contour of the interproximal
crest is parallel to an
imaginary line drawn
between the CEJs of the
adjacent teeth

Anatomical Areas of the Alveolar Bone

Radiograph showing horizontal
contour of the interproximal
bone in the maxilla due to
good tooth alignment

Radiograph showing angular

crest due to tilted mandibular
second molar

Horizontal Crest Contour

Crest has horizontal
contour when the CEJs
of the adjacent teeth are
at the same level
Angular Crest Contour
Crest has vertical contour
when one of the adjacent
teeth is tilted or erupted
to different heights

Anatomical Areas of the Alveolar Bone

jaw

Interradicular Bone
(multirooted teeth only)
Bone between the roots of
a multirooted tooth

Components of the Alveolar Bone

jaw

Cortical bone
Supporting bone
Alveolar bone proper
Alveolus
Periosteum

Components of the Alveolar Bone

Cortical bone
Forms the hard, outside
wall of the mandible and
maxilla on the facial and
lingual aspects
Buccal cortical bone
Thin in the incisor,

canine, and premolar

regions
Thicker in the molar
regions

Components of the Alveolar Bone

Defects of cortical bone
Fenestration
Window-like defect in

the cortical bone

Results in an isolated
area of the root that is
not covered by bone

Dehiscence
Cleft-like defect in the
cortical bone
Includes bone margin

Components of the Alveolar Bone

Supporting Bone
Lattice-like bone
Fills interior portion of the
alveolar process
Between the cortical bone

and the alveolar bone

proper

Also known as spongy

bone, cancellous bone

Components of the Alveolar Bone

Alveolar bone proper
Thin layer of bone that lines
each alveolus
In radiographs, the alveolar
bone proper is identified as
the lamina dura
Contains numerous holes
that allow the blood vessels
from the cancellous bone to
connect with the vessels of
the periodontal ligament
space

Components of the Alveolar Bone

Alveolus
The alveolus is the bony
socket in the alveolar bone
It is the cavity in the
alveolar bone that houses
the root(s) of a tooth
Alveolus (singular)
Alveoli (plural)

Components of the Alveolar Bone

Periosteum
The thin layer of
connective tissue that
covers bone and is
overlaid by the soft tissue
(gingiva or alveolar
mucosa)