BIOLOGY OF THE PERIODONTIUM

Anatomy Histology

Oral Mucosa
Masticatory

mucosa Lining mucosa Specialized mucosa

Gingiva
Marginal Gingiva Interdental Gingiva Attached Gingiva -

Cross-section of the periodontium

Normal clinical condition of the gingiva

Normal features of the gingiva

Gingival Sulcus

A crevice found around the tooth Space has a depth of 1 to 2mm Foci of initial site of periodontal disease activity Receives sulcular fluid which is antibacterial

Gingival fluid
Fluid

that seeps into from the gingival connective tissue through a thin sulcular wall Antimicrobial properties Periodontal disease activity

Attached Gingiva
Firm Resilient

Attached gingiva

Variations in the width of the attached gingiva

Interdental Papillae
Confined

in the interproximal embrasure Parts are col, lingual and facial peaks Shape is determined by the contact area, width of approximal tooth surfaces, and course of the CEJ

Gingival Col / contact area

Epithelium

Outer covering of the gingiva Made up of stratified squamous epithelium Divided into oral epithelium sulcular epithelium junctional epithelium

Types of Epithelial surface

Keratinization Parakeratinization Non

keratinization

Keratinized epithelium

Parakeratinized epithelium

Nonkeratinized Epithelium

Principal cells of the epithelium

Keratinocyte Melanocyte Langerhans

cells

Merkel

cells

Layers of the epithelium

Stratum corneum Stratum granulosum Stratum spinosum Stratum basale

Dentogingival Junction

Sulcular epithelium Junctional epithelium

Development of the dentogingival junction

Ameloblast

is reduced in height Basal lamina and OE Epithelium RE Epithelium surrounds the crown Tooth erupts in to OC REE and OE forms JE Hemidesmosome == Epithelial attachment

Development of the sulcus

Junctional epithelium

Supra-alveolar Connective tissue

fibroblast, mesenchymal cells, mast cells , macrophages Connective tissue fibers collagen, elastic fibers
Cell

Gingival Fibers

Gingivo-dental fibers Dento-periosteal fibers Circular fibers Inter-papillary group of fibers Semicircular fibers

Gingival Fibers

Intergingival fibers Transgingival fibers Transseptal fibers

Gingival fibers

Lamina Propria

Dense connective tissue Interspersed with the interfibrillary ground substance

Blood supply of the Periodontium

Supra-periosteal arterioles Vessels of the periodontal ligament Arterioles from the alveolar crest

Lymphatics of the Periodontium

Connective

tissue papillae collecting network external to the periosteum of the alveolar crest regional lymph nodes (sub-maxillary group) Lymphatics beneath the epithelial attachment extend into the periodontal ligament and accompany the blood vessel

Gingival nerve supply

Meshwork

of terminal argyrophilic fibers Meissner-type of tactile corpuscles Krause-type end bulb Encapsulated spindle

Criteria of a healthy gingiva

Color Surface texture Form Consistency Position of the gingiva

Dentogingival junction

Active eruption of the tooth Passive eruption Apical shift of JE Gingival recession clinical result

Defense Mechanism of the Gingiva

Protection-epithelium

saliva and epithelial cells Cellular PMN Inflammation dentoepithelial junction

Mechanical

Periodontium
Gingiva Periodontal Cementum

ligament

Alveolar

bone

Functions of the Periodontium

Supportive Investive

Dento alveolar Unit

Cementum Bone Periodontal

Ligament

Cementum
Acellular

cementum Cellular cementum

Acellular Cementum

Structureless substance formed by cementoblast which is not embedded in the matrix

Cellular cementum
Cells caught within the matrix; thickest at the apical area

Classification of Cementum Schroeder

Acellular

afibrillar cementum AAC Acellular extrinsic fiber cementum AEFC Cellular mixed stratified cementum CMSC Cellular intrinsic fiber cementum CIFC Intermediate cementum

Type of cementum

1. Acellular afibrillar cementum Acellular extrinsicfiber cementum Cellular intrinsicfiber cementum Cellular mixed fiber cementum

Histological Elements of Cementum

Cementum

matrix Sharpeys fibers Cementocytes Lacuna and canaliculi

Cemento-dentinal Junction
Referred

to intermediate cementum Permanent teeth smooth Temporary teeth - wavy

Spatial relationship of cementum and enamel

60%-65% cementum overlaps cervical end of the enamel 30% - cervical end of cementum meets the cervical end of enamel 5%-10% - failure for E and C to meet

Clinical Considerations for cementum

Coronal

cementum Cementicles Hypercementosis

Periodontal Ligament

Fibrous attachment of the tooth inserting into cementum and alveolar bone.

Principal fibers
Collagenous content Arranged in fibers bundles Seen in a wavy form ( light microscope)
Made

up of amino-acids Tropocollagen molecule in the fibroblast ; collagen type I Tranverse striation

Structures of the PDL

Interstial

tissue Oxytalan fibers Eluanin Indifferent fiber plexus Principal fibers Cementicles

Connective

tissue

cells Epithelial rest of Malassez Defense cells

Ground substance
Fills

up the space between cells and fiber bundles Components are: > glycosaminoglycans > glycoproteins

Principal Fibers of the Periodontal ligament

Alveolar crestal group Horizontal group Oblique group Apical group Inter-radicular group

Functions of the PDL

Formative Supportive Sensory Nutrition Physical

Physical function

Resistance to the impact of occlusal forces Transmission of occlusal forces to bone Occlusal function and structure of the PDL

Alveolar Bone
Extension of mandible and maxilla which forms the sockets where the roots of the teeth are fitted

Maxilla / Mandibular bone

Type of bone

Compact bone Spongy bone

Relative proportions of cancellous and compact bone

Alveolar process
One

mm. away from the cej Position of the tooth determines the location of the alveolar socket Structural character depends on the functional demands

ALVEOLAR PROCESS

External plate of cortical bone Alveolar bone proper Cancellous trabeculae

Nomenclature according to location

Radicular

bone Interproximal bone Interradicular bone

Interdental septum

Cancellous supporting bone Enclosed with compact bone

Basal bone

Apical area of alveolus

Biologic width

1 mm sulcular area 1 mm junctional epithelium 1mm connective tissue