Oral Anatomy and Histology Quiz
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Questions and Answers

Which of the following is NOT a function of gingival fibers?

  • To unite the free marginal gingiva to the cementum.
  • To brace the marginal gingiva firmly against the tooth.
  • To provide rigidity to withstand masticatory forces.
  • To connect the cementum to the enamel. (correct)
  • Which cells are responsible for tactile sensation in the oral mucosa?

  • Keratinocytes
  • Langerhans cells
  • Merkel cells (correct)
  • Melanocytes
  • What is the purpose of the external basal lamina in the junctional epithelium?

  • To facilitate the migration of keratinocytes.
  • To anchor the epithelium to the underlying connective tissue. (correct)
  • To provide a barrier against bacterial penetration.
  • To regulate the flow of nutrients and waste products.
  • What type of collagen fiber is most commonly found in the gingival connective tissue?

    <p>Type I (C)</p> Signup and view all the answers

    Where is the junctional epithelium located?

    <p>Between the gingiva and the tooth. (D)</p> Signup and view all the answers

    In non-keratinized oral mucosa, what is the innermost layer called?

    <p>Stratum basale (D)</p> Signup and view all the answers

    What is the ratio of melanocytes to keratin-producing epithelial cells in the basal and spinous layers?

    <p>1:36 (B)</p> Signup and view all the answers

    Which type of gingival fiber is responsible for connecting the free marginal gingiva to the cementum of the tooth?

    <p>Dentogingival fibers (D)</p> Signup and view all the answers

    What is the most common glycosaminoglycan found in the ground substance of the gingiva?

    <p>Dermatan sulfate (B)</p> Signup and view all the answers

    Which of the following is a common feature of gingival disease?

    <p>Decreased stippling (C)</p> Signup and view all the answers

    What is the primary source of color variation in the gingiva?

    <p>Vascular supply and pigmentation (A)</p> Signup and view all the answers

    Which of the following best describes the gingival zenith of a lateral incisor?

    <p>Distal third (A)</p> Signup and view all the answers

    Which of the following is the most prevalent gingival biotype?

    <p>Thick and flat (A)</p> Signup and view all the answers

    Which of the following cell types is responsible for synthesizing collagen fibers in the gingiva?

    <p>Fibroblasts (B)</p> Signup and view all the answers

    What is the name of the capillary plexus located near the gingival epithelium?

    <p>Juxta-epithelial plexus (D)</p> Signup and view all the answers

    What is the term for the process of the junctional epithelium moving from the enamel to the cementum?

    <p>Passive eruption (A)</p> Signup and view all the answers

    Which of the following is NOT a principle fiber of the periodontal ligament?

    <p>Apical (A)</p> Signup and view all the answers

    What is the main difference between cellular and acellular cementum?

    <p>Acellular cementum contains no cementocytes, while cellular cementum contains cementocytes (C)</p> Signup and view all the answers

    Which of the following is a function of the periodontal ligament?

    <p>Sensory perception of pressure and pain (B)</p> Signup and view all the answers

    What is the term for the epithelial cells that remain in the periodontal ligament after tooth eruption?

    <p>Epithelial rests of Malassez (D)</p> Signup and view all the answers

    Which of the following statements is TRUE about the periodontal ligament?

    <p>It is thicker in functioning than non-functioning teeth (B)</p> Signup and view all the answers

    What is the main component of the ground substance of the periodontal ligament?

    <p>Glycosaminoglycans (A)</p> Signup and view all the answers

    What is the role of the cementoblasts in the periodontal ligament?

    <p>Formation of cementum (A)</p> Signup and view all the answers

    Which of the following is NOT a clinical consideration for the periodontal ligament?

    <p>The periodontal ligament is not visible on a panoramic radiograph (D)</p> Signup and view all the answers

    What is the function of the alveolar process?

    <p>To provide support and attachment for the teeth. (C)</p> Signup and view all the answers

    What is the lamina dura?

    <p>The thin, compact bone that forms the inner socket wall. (D)</p> Signup and view all the answers

    What is the function of Sharpey's fibers?

    <p>To connect the periodontal ligament to the cementum of the tooth. (D)</p> Signup and view all the answers

    What is the term for the tissue that lines the internal bone cavities?

    <p>Endosteum (D)</p> Signup and view all the answers

    What is the average distance between the crest of the alveolar bone and the cemento-enamel junction in young adults?

    <p>1.08 mm (C)</p> Signup and view all the answers

    What is the term for an isolated area where the root is denuded of bone and covered only by periosteum and overlying gingiva?

    <p>Fenestration (D)</p> Signup and view all the answers

    Which of the following is true about the alveolar process?

    <p>It is formed when the tooth erupts and gradually disappears after the tooth is lost. (B)</p> Signup and view all the answers

    What happens to the distance between the crest of the alveolar bone and the cemento-enamel junction with age?

    <p>It increases. (B)</p> Signup and view all the answers

    What are the main cell types present in the Junctional Epithelium?

    <p>Keratinocytes and Fibroblasts (A)</p> Signup and view all the answers

    How does probing depth generally compare to the actual sulcus or pocket depth?

    <p>Probing depth typically overestimates the sulcus or pocket depth. (A)</p> Signup and view all the answers

    What is the average width of the Periodontal Ligament space?

    <p>0.2mm (C)</p> Signup and view all the answers

    What is the most common collagen fiber type found in the Periodontal Ligament?

    <p>Type I (D)</p> Signup and view all the answers

    Which of these statements about the interdental col is NOT correct?

    <p>It acts as a strong barrier against bacteria. (C)</p> Signup and view all the answers

    Which of the following statements correctly describes the relationship between the gingiva and restoration margins?

    <p>Gingiva has a more stable relationship with restoration margins than alveolar mucosa. (A)</p> Signup and view all the answers

    What is a key difference between Stage 3 and Stage 4 JE attachment?

    <p>Stage 3 JE is attached to cementum, while Stage 4 JE is attached to both cementum and enamel. (D)</p> Signup and view all the answers

    Which of the following is a characteristic feature of cellular cementum?

    <p>It is typically found at the apical third of the root. (D)</p> Signup and view all the answers

    How does the thickness of cementum vary along the root?

    <p>Cementum is thinnest at the CEJ and thickens towards the apex. (C)</p> Signup and view all the answers

    What is the primary inorganic component of cementum?

    <p>Hydroxyapatite (C)</p> Signup and view all the answers

    What is the significance of the incremental lines observed in both cellular and acellular cementum?

    <p>They represent periods of growth and formation. (D)</p> Signup and view all the answers

    What is the primary role of cementum in tooth anchorage and movement?

    <p>Cementum provides a strong attachment site for periodontal ligaments. (B)</p> Signup and view all the answers

    Which of the following is NOT a type of cementum?

    <p>Extrinsic fiber cementum (D)</p> Signup and view all the answers

    Which of the following best describes the cementoenamel junction (CEJ)?

    <p>Can vary in morphology, including overlap and butt joint. (D)</p> Signup and view all the answers

    What makes cementum more resistant to resorption compared to bone, leading to tooth movement in orthodontics?

    <p>The higher mineral content of cementum makes it less susceptible to resorption. (C)</p> Signup and view all the answers

    Flashcards

    Junctional epithelium

    A collar-like band of stratified squamous non-keratinizing epithelium that forms the junction between the tooth and the gum.

    Keratinization

    The process where keratinocytes migrate and transform into keratinized cells during epithelial growth.

    Major cell type in keratinization

    The principal cell in keratinization, making up 90% of the epidermis.

    Non-keratinized epithelium

    A type of epithelium that lacks keratin and is thicker than keratinized mucosa.

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    Lamina propria

    Connective tissue layer beneath the epithelium, consisting of cells, blood vessels, and fibers.

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    Gingival fibers functions

    Connective tissues that support and attach the gingiva to the tooth.

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    Types of gingival fibers

    Groups of fibers in gingival connective tissue: gingivodental, circular, and transseptal.

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    Gingival collagen types

    Collagen in gingival connective tissue, primarily type I, followed by type III, providing strength.

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    Transseptal fibers

    Fibers connecting adjacent teeth across the interproximal space, providing support.

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    Peripheral fibers

    Fibers anchoring the gingiva to the underlying alveolar bone.

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    Gingival Zenith

    The most apical point of the marginal gingival scallop.

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    Gingival Biotypes

    Classification of gingiva into thick and thin biotypes affecting treatment decisions.

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    Stippling of Gingiva

    Textured appearance of healthy attached gingiva resembling orange peel.

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    Cell types in gingiva

    Different cells present in gingiva; e.g., fibroblasts, neutrophils contribute to health.

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    Gingival Color Variation

    Color impacted by blood supply, keratinization, and pigmentation textures.

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    Vascular supply sources

    Main sources include supraperiosteal arterioles, PDL vessels, and alveolar septa arterioles.

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    Junctional Epithelium (JE)

    A unique tissue structure attaching gingiva to tooth, turns over in 1-6 days.

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    Gingival Crevicular Fluid

    Fluid in the gingival sulcus derived from blood and contains inflammatory cells.

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    Interdental Col

    Area between teeth covered by non-keratinized epithelium, susceptible to disease.

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    Periodontal Ligament (PDL)

    Connective tissue surrounding tooth root, connecting tooth to alveolar bone.

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    Gingival Grafts

    Surgical procedure to restore deficient gingival tissue using grafts.

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    Probing Depth

    Measurement may overestimate actual sulcus/pocket depth due to inflamed tissues.

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    Keratinized Gingiva

    Part of gingiva that is keratinized, critical for protecting oral tissues.

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    Calcification of PDL

    The process where the periodontal ligament undergoes calcification, influenced by non-collagenous proteins like osteopontin.

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    Cells in PDL

    The periodontal ligament is made up of connective tissue cells including fibroblasts, cementoblasts, osteoblasts, and more.

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    Glycosaminoglycans (GAGs)

    A component of PDL ground substance, includes hyaluronic acid and proteoglycans, crucial for structure.

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    PDL functions

    The periodontal ligament provides physical support, nutrition, sensory feedback, and remodeling of structures.

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    Radiolucency of PDL

    In periapical radiographs, the periodontal ligament appears radiolucent due to its high water content.

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    Cellular vs. Acellular Cementum

    Acellular cementum is primary and without cells, while cellular cementum is secondary and contains cementocytes.

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    Characteristics of Cementum

    Cementum is lighter and less hard than dentin and is permeable under certain conditions, not glossy like enamel.

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    Unique PDL feature

    The periodontal ligament contains undifferentiated mesenchymal cells, allowing for regeneration of tooth-supporting structures.

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    Scaling and Root Planing

    A dental procedure for removing calculus and bacterial deposits from teeth, potentially exposing dentin.

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    Cementum Loss

    The removal of the cementum layer can expose dentin, causing tooth sensitivity.

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    Cementicles

    Small calcified structures that may form in the periodontal ligament or on the root surface.

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    Alveolar Process

    Bone that supports tooth sockets, forming during tooth eruption and decreasing after tooth loss.

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    Cortical Bone

    An external plate of dense bone forming the outer walls of the alveolar process.

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    Lamina Dura

    The inner socket wall seen as a thin, compact bone layer on radiographs.

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    Fenestrations

    Isolated areas where the root is uncovered by bone, only covered by gum tissue.

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    Bone Remodeling

    The process of bone resorption and formation, crucial for bone health and shape.

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    Chemical composition of cementum

    Cementum comprises 45-50% inorganic materials (mainly calcium and phosphate) and 50-55% organic materials (type 1 collagen and proteoglycans).

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    Types of cementum

    Cementum is classified into acellular afibrillar, acellular extrinsic fiber, cellular mixed stratified, and cellular intrinsic fiber types.

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    Acellular cementum

    Covers root dentin from CEJ to apex, lacks cementocytes in some layers, and is thinnest at CEJ (20-50µm).

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    Cellular cementum

    Contains cementocytes within lacunae, mainly present at the apical third of the root, and thicker than acellular cementum.

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    Cementoenamel junction (CEJ)

    The junction where cementum overlaps enamel in 60-65% of teeth and can meet or have no overlap.

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    Cementum thickness

    Cementum is thinnest at the CEJ (20-50µm) and thickest at the root apex (150-200µm).

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    Cementum's role in tooth stability

    Cementum is crucial for anchoring teeth and is more resistant to resorption than bone.

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    Orthodontic tooth movement

    Cementum's resistance to resorption allows for effective orthodontic adjustments without damaging the tooth.

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    Study Notes

    Clinical Correlations of Periodontal Anatomy

    • This presentation covers the clinical and microscopic features of the periodontal anatomy
    • Topics include: Oral mucosa and gingiva, periodontal ligament, cementum, alveolar process, and correlations of normal clinical and microscopic features
    • The presentation also references a textbook: Newman & Carranza's Clinical Periodontology, Chapter 3, pages 19-49

    Oral Mucosa and Gingiva

    • Oral mucosa is divided into three types: masticatory, specialized, and lining mucosa
    • Gingiva is part of the masticatory mucosa
    • Gingiva covers the alveolar processes of the jaws and surrounds the teeth's neck, collar-like fashion

    Gingiva

    • Definition: The part of oral mucosa covering the alveolar processes of the jaws and encircles the teeth.
    • Anatomically: Divided into marginal, attached, and interdental gingiva
    • Marginal gingiva: free or marginal gingiva, marginal groove
    • Attached gingiva: firm, resilient, tightly bound
    • Interdental gingiva: fills the embrasure (space between teeth). Shape is dependent on contact between adjacent teeth
    • Gingival sulcus (v-shaped): shallow crevice around the tooth; ideal depth 0mm. Normal clinically healthy gingiva (1.8 mm histologic), average 1 to 3mm.

    Anatomical areas of gingiva

    • MGJ (Mucogingival junction): the area where attached gingiva meets the alveolar mucosa
    • MG (Marginal gingiva): the free gingiva along the tooth
    • AG (Attached gingiva): the firm tissue connecting to the tooth
    • IDG (Interdental gingiva): tissue between the teeth
    • AM (Alveolar mucosa): the tissue that covers the alveolar bone

    Gingipa Structure

    • Soft tissue wall.
    • Gingival sulcus: V-shaped space between tooth and gingiva
    • Free gingiva: the portion of the gingiva that is not attached to the tooth.
    • Free gingival groove : groove at the base of the free gingiva.
    • Attached gingiva: firm, tightly bound gingiva adjacent to the tooth.
    • Mucogingival junction : junction between attached gingiva and alveolar mucosa.
    • Alveolar mucosa: the tissue below the attached gingiva.

    Microscopic features of Gingiva

    • Gingiva is composed of epithelial and connective tissue
    • Epithelial components: oral epithelium, sulcular epithelium, junctional epithelium
    • Turnover rates vary among sites (palate, tongue, cheek, gingiva, junctional epithelium)
    • Keratinized epithelium takes longer to turn over than non-keratinized epithelium

    Oral epithelium

    • Primary barrier against external factors.
    • Characterized by layers of stratified squamous cells
    • Keratinized or parakeratinized types

    Sulcular epithelium

    • Thin, non-keratinized stratified squamous epithelium
    • Absence of rete pegs
    • Characterized as semipermeable

    Junctional epithelium

    • Collar-like band of stratified squamous non-keratinizing epithelium.
    • Length: 0.25 to 1.25mm
    • Widest at the coronal portion (15-20 cell layers) and thinnest (3-4 cells) towards the cemento-enamel junction.
    • Unique for possessing two basement membranes (internal and external basal lamina).

    Keratinization

    • Keratinization is a series of biochemical and morphological changes within cells, from the basal layer
    • Primary cell type: keratinocyte (90%)
    • Secondary cell types: melanocytes, Langerhans cells, Merkel cells, and inflammatory cells

    Non-keratinization

    • The lining mucosa is characterized by thickness and intercellular bridges, unlike keratinized mucosa
    • Divided into three layers (basale, intermedium, superficiale/distendum)

    Lamina Propria

    • Gingival connective tissue
    • Two layers: superficial (papillary) and deep (reticular).
    • Components include cells, blood vessels, neural elements, fibers, and ground substance.

    Gingival Connective Tissue

    • Primarily composed of dense collagen fibers, type I being more common than type III.
    • Classified by location and insertion

    Function of Gingival Fibers

    • Brace the marginal gingiva to the tooth
    • Provide rigidity for mastication
    • Unites free margin gingiva to cementum

    Gingival Collagen Fibers

    • Numerous types; examples: dentogingival, alveolar-gingival, interpapillary, transgingival, circular, semicircular, dentoperiosteal, transseptal, periodontosgingival, intercircular, intergingival

    Cell types

    • Fibroblasts (65%), neutrophils, lymphocytes, plasma cells, macrophages, mast cells

    Ground substance of PDL

    • Glycosaminoglycans (GAGs) - hyaluronic acid, proteoglycans
    • Glycoproteins – fibronectin and lamini
    • High water content (70%)
    • Cementicles, present in the periodontium

    Vascular Supply

    • Supraperiosteal arterioles
    • Vessels of PDL
    • Arterioles emerging from crests of alveolar septa
    • Juxta-epithelial plexus: capillary plexus adjacent to gingival epithelium

    Color

    • Color is produced by vascular supply, thickness, degree of keratinization, and presence of pigmented cells
    • Variation possible between persons. Variation correlates with cutaneous pigmentation (e.g., lighter in blond individuals with fair complexions vs. dark-haired individuals).

    Size

    • Corresponds to cellular and intercellular elements and their vascular supply. Alterations in size can be indicative of associated gingival disease

    Gingival Biotypes

    • Ochsenbein and Miller emphasized the significance of Gingival Biotype differences (thick vs. thin) in restorative treatment.
    • Population distribution of biotypes: 85% thick, flat periodontal biotypes; 15% thin, scalloped periodontal biotypes

    Thick Gingival Biotype

    • Relatively flat tissue architecture
    • Dense fibrous tissue
    • Abundant amount of attached gingiva
    • Relatively resistant to trauma, less reactive to disease and less likely to develop pockets

    Thin Gingival Biotype

    • Highly scalloped and delicate architecture
    • Minimal amount of attached gingiva
    • Susceptible to trauma and disease leading to recession
    • Thin underlying bone

    Gingival Zenith

    • Defined as most apical point of the marginal gingival scallop. Examples include incisors (distal third), lateral incisors (central region), canines (distal third), and premolars (central third).

    Surface Texture

    • Gingiva has a stippled texture, similar to an orange peel, most notable in the attached gingiva; marginal gingiva lacking this pattern.
    • Prominently seen on the facial aspect and less apparent on the lingual aspect; may be absent in some individuals

    Stippling of attached gingiva

    • Orange-peel appearance/texture
    • Easily visualized by drying the gingival tissue
    • Varying degrees of coarseness associated with age and gender

    Passive Eruption

    • Gottlieb & Orban (1933) stages of passive eruption of the tooth.
    • The stages of eruption encompass the relationships of the junctional epithelium and the sulcus base to enamel and cementum, transitioning over time

    Connective Tissue Grafts

    • Gingival tissue, which exhibits greater stability compared to alveolar mucosa in relation to dental restorations, can be augmented through grafts
    • Connective tissue epithelial interaction may facilitate this structural adaptation

    Periodontal Probing

    • Does not accurately measure the anatomical depth of the sulcus or pocket
    • Probe penetration through inflamed tissues often overestimates the actual depth

    Gingival Crevicular Fluid

    • Inflammatory exudate from serum, structural cells, plasma proteins, electrolytes, and inflammatory/immune cells.
    • Increasing levels indicative of gum inflammation
    • Protective role through cleansing, antibacterial activity, and adhesive properties. (A transudate or exudate)

    Interdental COL

    • Interdental "col" (a hollow/depression) is not a strong barrier against bacteria
    • Non-keratinized epithelium = site for disease initiation

    Key Points

    • Gingiva is part of masticatory mucosa.
    • Gingiva combines marginal, attached, and interdental gingiva (anatomically)
    • Free gingiva= combination of marginal gingiva and interdental gingiva
    • Keratinzed gingiva= attached gingiva + free gingiva
    • MGJ = mucogingival junction

    Key Points: Junctional Epithelium

    • Turnover rate: 1 to 6 days
    • Principle cell type: Keratinocyte (epithelial) and Fibroblast (connective tissue).
    • Common collagen fibers = type I
    • Transseptal fibers

    Periodontal Ligament

    • Complex, highly cellular connective tissue - surrounds the tooth root, anchors to the inner wall of alveolar bone
    • Average width of PDL space: 0.2mm
    • Thicker in functional teeth (versus non-functional). Thicker around teeth in hyperfunction

    Periodontal ligament fibers

    • Principle fibers – collagenous; organized into bundles forming a wavy pattern
    • Sharpey's fibers: part of principle fibers entering the cementum and bone

    Principal fibers (PDL)

    • Transseptal, alveolar crest, horizontal, oblique, apical, interradicular

    Cellular elements of PDL

    • Connective tissue cells (fibroblasts, cementoblasts, and osteoblasts)
    • Undifferentiated mesenchymal cells (UMCs)
    • Epithelial rests of Malassez
    • Immune system cells
    • Cells associated with neurovascular elements

    Ground substance of PDL

    • Glycosaminoglycans (GAGs), hyaluronic acid, proteoglycans
    • Glycoproteins, fibronectin, and laminin
    • 70% water content
    • Cementicles. Calicified tissues

    Functions of PDL

    • Physical support, and formative and remodeling functions
    • Nutritional and sensory functions, formative, and remodeling.

    Periodontal ligament clinical considerations

    • Appears radiolucent in PA radiographs
    • Thicker in functioning teeth versus non-functioning teeth
    • Cells are capable of remodeling the ligament and bone
    • Exfoliated teeth can be replanted.
    • Precursor cells for the entire attachment apparatus – (i.e., cementum, PDL, and bone).

    Cementum

    • Specialized, calcified mesodermal tissue covering the tooth root.
    • Begins at the CEJ and extends to the apex.
    • Provides attachment for periodontal ligament fibers

    Cementum Characteristics

    • Less hard than dentin
    • Light yellow/beige, lacks enamel's luster (darker)
    • Permeable under certain experimental conditions

    Chemical composition

    • Inorganic portion (45–50%): mainly calcium and phosphate in the form of hydroxyapatite
    • Organic portion (50-55%): type I collagen, proteoglycans, and water
    • The highest fluoride content of mineralized tissues

    Schroder's Classification

    • Acellular afibrillar cementum
    • Acellular extrinsic fiber cementum
    • Cellular mixed stratified cementum
    • Cellular intrinsic fiber cementum
    • Intermediate cementum

    Acellular Cementum

    • The term acellular is not completely accurate, because cells contribute to the structure at all times.
    • Covers the root dentin from CEJ to the apex, but often absent in the apical third.
    • Thinnest at CEJ (20–50 μm), thicker toward the root apex (150–200 μm)

    Cellular Cementum

    • Primarily observed in the apical third of the root,
    • Cemetocytes are similar to osteocytes
    • Cemetocytes are present in lacunae, exhibiting numerous canaliculi directed towards the periodontal surface
    • Separated by incremental lines/layers

    Cementoenamel Junction

    • 60-65% of cementum overlaps the cervical end of enamel
    • 30% - butt joint; 5-10 % absence of CEJ but enamel epi covers the root
    • The other aspect of this page is a diagram showing the percentages (i.e., 65% and 35%) of the overlap between enamel and cementum

    Cementum Clinical Considerations

    • Essential for tooth anchorage.
    • More resistant to resorption than bone, crucial for orthodontic treatment
    • Scaling and root planing can remove thin cementum, which can lead to sensitivity.

    Alveolar Process

    • The part of maxilla and mandible that forms the tooth sockets (alveoli).
    • Forms during tooth eruption; resorbs after tooth loss

    Alveolar Process Consists of the Following:

    • External plate of cortical bone (Haversian bone and compacted bone lamellae)
    • Inner wall of thin, compact bone called alveolar bone proper, (which appears radiographically as the lamina dura)
    • Openings (cribriform plate) through which vascular and neural bundles connect to periodontal ligament and cancellous bone

    Alveolar Bone Clinical Considerations

    • Remodeling can displace the alveolar bone.
    • Lamina dura interruptions are significant.
    • Alveolar resorption tends to occur following tooth extraction
    • Dental implants decrease ridge resorption.
    • Fenestration can turn into dehiscence leading to gingival recession

    Key points

    • Average width of PDL space is 0.2mm
    • Undifferentiated mesenchymal cells (UMCs)
    • Functions of PDL
    • Cemento-Enamel Junction (CEJ)
    • Alveolar Bone terminology

    Homework: Periodontum Drawing

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    Description

    Test your knowledge on oral anatomy and the functions of gingival fibers, junctional epithelium, and the structural components of gingival tissue. This quiz covers various aspects of gingival health and histology, including the types of collagen fibers and the features of gingival disease.

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