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Questions and Answers
Which of the following is NOT a function of gingival fibers?
Which of the following is NOT a function of gingival fibers?
Which cells are responsible for tactile sensation in the oral mucosa?
Which cells are responsible for tactile sensation in the oral mucosa?
What is the purpose of the external basal lamina in the junctional epithelium?
What is the purpose of the external basal lamina in the junctional epithelium?
What type of collagen fiber is most commonly found in the gingival connective tissue?
What type of collagen fiber is most commonly found in the gingival connective tissue?
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Where is the junctional epithelium located?
Where is the junctional epithelium located?
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In non-keratinized oral mucosa, what is the innermost layer called?
In non-keratinized oral mucosa, what is the innermost layer called?
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What is the ratio of melanocytes to keratin-producing epithelial cells in the basal and spinous layers?
What is the ratio of melanocytes to keratin-producing epithelial cells in the basal and spinous layers?
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Which type of gingival fiber is responsible for connecting the free marginal gingiva to the cementum of the tooth?
Which type of gingival fiber is responsible for connecting the free marginal gingiva to the cementum of the tooth?
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What is the most common glycosaminoglycan found in the ground substance of the gingiva?
What is the most common glycosaminoglycan found in the ground substance of the gingiva?
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Which of the following is a common feature of gingival disease?
Which of the following is a common feature of gingival disease?
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What is the primary source of color variation in the gingiva?
What is the primary source of color variation in the gingiva?
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Which of the following best describes the gingival zenith of a lateral incisor?
Which of the following best describes the gingival zenith of a lateral incisor?
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Which of the following is the most prevalent gingival biotype?
Which of the following is the most prevalent gingival biotype?
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Which of the following cell types is responsible for synthesizing collagen fibers in the gingiva?
Which of the following cell types is responsible for synthesizing collagen fibers in the gingiva?
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What is the name of the capillary plexus located near the gingival epithelium?
What is the name of the capillary plexus located near the gingival epithelium?
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What is the term for the process of the junctional epithelium moving from the enamel to the cementum?
What is the term for the process of the junctional epithelium moving from the enamel to the cementum?
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Which of the following is NOT a principle fiber of the periodontal ligament?
Which of the following is NOT a principle fiber of the periodontal ligament?
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What is the main difference between cellular and acellular cementum?
What is the main difference between cellular and acellular cementum?
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Which of the following is a function of the periodontal ligament?
Which of the following is a function of the periodontal ligament?
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What is the term for the epithelial cells that remain in the periodontal ligament after tooth eruption?
What is the term for the epithelial cells that remain in the periodontal ligament after tooth eruption?
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Which of the following statements is TRUE about the periodontal ligament?
Which of the following statements is TRUE about the periodontal ligament?
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What is the main component of the ground substance of the periodontal ligament?
What is the main component of the ground substance of the periodontal ligament?
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What is the role of the cementoblasts in the periodontal ligament?
What is the role of the cementoblasts in the periodontal ligament?
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Which of the following is NOT a clinical consideration for the periodontal ligament?
Which of the following is NOT a clinical consideration for the periodontal ligament?
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What is the function of the alveolar process?
What is the function of the alveolar process?
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What is the lamina dura?
What is the lamina dura?
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What is the function of Sharpey's fibers?
What is the function of Sharpey's fibers?
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What is the term for the tissue that lines the internal bone cavities?
What is the term for the tissue that lines the internal bone cavities?
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What is the average distance between the crest of the alveolar bone and the cemento-enamel junction in young adults?
What is the average distance between the crest of the alveolar bone and the cemento-enamel junction in young adults?
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What is the term for an isolated area where the root is denuded of bone and covered only by periosteum and overlying gingiva?
What is the term for an isolated area where the root is denuded of bone and covered only by periosteum and overlying gingiva?
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Which of the following is true about the alveolar process?
Which of the following is true about the alveolar process?
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What happens to the distance between the crest of the alveolar bone and the cemento-enamel junction with age?
What happens to the distance between the crest of the alveolar bone and the cemento-enamel junction with age?
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What are the main cell types present in the Junctional Epithelium?
What are the main cell types present in the Junctional Epithelium?
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How does probing depth generally compare to the actual sulcus or pocket depth?
How does probing depth generally compare to the actual sulcus or pocket depth?
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What is the average width of the Periodontal Ligament space?
What is the average width of the Periodontal Ligament space?
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What is the most common collagen fiber type found in the Periodontal Ligament?
What is the most common collagen fiber type found in the Periodontal Ligament?
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Which of these statements about the interdental col is NOT correct?
Which of these statements about the interdental col is NOT correct?
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Which of the following statements correctly describes the relationship between the gingiva and restoration margins?
Which of the following statements correctly describes the relationship between the gingiva and restoration margins?
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What is a key difference between Stage 3 and Stage 4 JE attachment?
What is a key difference between Stage 3 and Stage 4 JE attachment?
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Which of the following is a characteristic feature of cellular cementum?
Which of the following is a characteristic feature of cellular cementum?
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How does the thickness of cementum vary along the root?
How does the thickness of cementum vary along the root?
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What is the primary inorganic component of cementum?
What is the primary inorganic component of cementum?
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What is the significance of the incremental lines observed in both cellular and acellular cementum?
What is the significance of the incremental lines observed in both cellular and acellular cementum?
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What is the primary role of cementum in tooth anchorage and movement?
What is the primary role of cementum in tooth anchorage and movement?
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Which of the following is NOT a type of cementum?
Which of the following is NOT a type of cementum?
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Which of the following best describes the cementoenamel junction (CEJ)?
Which of the following best describes the cementoenamel junction (CEJ)?
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What makes cementum more resistant to resorption compared to bone, leading to tooth movement in orthodontics?
What makes cementum more resistant to resorption compared to bone, leading to tooth movement in orthodontics?
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Flashcards
Junctional epithelium
Junctional epithelium
A collar-like band of stratified squamous non-keratinizing epithelium that forms the junction between the tooth and the gum.
Keratinization
Keratinization
The process where keratinocytes migrate and transform into keratinized cells during epithelial growth.
Major cell type in keratinization
Major cell type in keratinization
The principal cell in keratinization, making up 90% of the epidermis.
Non-keratinized epithelium
Non-keratinized epithelium
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Lamina propria
Lamina propria
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Gingival fibers functions
Gingival fibers functions
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Types of gingival fibers
Types of gingival fibers
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Gingival collagen types
Gingival collagen types
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Transseptal fibers
Transseptal fibers
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Peripheral fibers
Peripheral fibers
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Gingival Zenith
Gingival Zenith
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Gingival Biotypes
Gingival Biotypes
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Stippling of Gingiva
Stippling of Gingiva
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Cell types in gingiva
Cell types in gingiva
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Gingival Color Variation
Gingival Color Variation
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Vascular supply sources
Vascular supply sources
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Junctional Epithelium (JE)
Junctional Epithelium (JE)
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Gingival Crevicular Fluid
Gingival Crevicular Fluid
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Interdental Col
Interdental Col
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Periodontal Ligament (PDL)
Periodontal Ligament (PDL)
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Gingival Grafts
Gingival Grafts
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Probing Depth
Probing Depth
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Keratinized Gingiva
Keratinized Gingiva
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Calcification of PDL
Calcification of PDL
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Cells in PDL
Cells in PDL
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Glycosaminoglycans (GAGs)
Glycosaminoglycans (GAGs)
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PDL functions
PDL functions
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Radiolucency of PDL
Radiolucency of PDL
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Cellular vs. Acellular Cementum
Cellular vs. Acellular Cementum
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Characteristics of Cementum
Characteristics of Cementum
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Unique PDL feature
Unique PDL feature
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Scaling and Root Planing
Scaling and Root Planing
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Cementum Loss
Cementum Loss
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Cementicles
Cementicles
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Alveolar Process
Alveolar Process
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Cortical Bone
Cortical Bone
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Lamina Dura
Lamina Dura
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Fenestrations
Fenestrations
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Bone Remodeling
Bone Remodeling
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Chemical composition of cementum
Chemical composition of cementum
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Types of cementum
Types of cementum
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Acellular cementum
Acellular cementum
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Cellular cementum
Cellular cementum
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Cementoenamel junction (CEJ)
Cementoenamel junction (CEJ)
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Cementum thickness
Cementum thickness
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Cementum's role in tooth stability
Cementum's role in tooth stability
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Orthodontic tooth movement
Orthodontic tooth movement
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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.