Periodontal Ligament Quiz
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Questions and Answers

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

  • Apical (correct)
  • Transseptal
  • Alveolar Crest
  • Horizontal
  • What is the main function of the epithelial rests of Malassez found within the periodontal ligament?

  • Contribute to the formation of cementum
  • Remain dormant and are capable of forming a new periodontal ligament if the original periodontal ligament is damaged (correct)
  • Contribute to the development of the pulp
  • Secrete collagen fibers for periodontal ligament formation
  • Act as undifferentiated mesenchymal cells for tissue repair
  • Which of the following statements accurately reflects the role of glycosaminoglycans (GAGs) in the periodontal ligament (PDL)?

  • GAGs are primarily responsible for the calcification of cementum.
  • GAGs are primarily involved in the attachment of PDL fibers to the tooth surface.
  • GAGs primarily facilitate the diffusion of nutrients and waste products within the PDL. (correct)
  • GAGs primarily provide structural support and tensile strength to the PDL.
  • GAGs primarily provide the bulk of the collagen fibers found in the PDL.
  • Which of these is associated with the production of the entire attachment apparatus of the tooth, including cementum, periodontal ligament, and bone?

    <p>Undifferentiated mesenchymal cells (UMC) in the periodontal ligament (B)</p> Signup and view all the answers

    What is the primary reason for the variability in the thickness of the periodontal ligament as seen on radiographs?

    <p>The level of function of the tooth (E)</p> Signup and view all the answers

    Which of the following characteristics correctly describes the nature of cementum?

    <p>Cementum is avascular and receives its nourishment from the adjacent periodontal ligament. (D)</p> Signup and view all the answers

    What consequence can occur due to the removal of the cementum layer during scaling and root planing?

    <p>Increased sensitivity due to dentin exposure (A)</p> Signup and view all the answers

    What is the role of the alveolar process in relation to teeth?

    <p>It supports and forms tooth sockets (B)</p> Signup and view all the answers

    What type of bone is described as being adjacent to the periodontal ligament and containing Sharpey’s fibers?

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

    What process describes the changes in the shape and resistance of bone over time?

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

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

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

    What is the term for isolated areas where the root is denuded of bone?

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

    What are the two main types of tissue that cover the outer surface and the internal cavities of the bone?

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

    What percentage of teeth lack a cemento-enamel junction (CEJ)?

    <p>10% (A)</p> Signup and view all the answers

    What is the primary inorganic component of cementum?

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

    Which type of cementum does not incorporate cells in its formation?

    <p>Acellular afibrillar cementum (A), Acellular extrinsic fiber cementum (C)</p> Signup and view all the answers

    At which location is cementum typically thinnest?

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

    Which type of cementum predominantly contains cellular remnants and lies near the cementodentinal junction?

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

    What percentage of the cementum typically overlaps the cervical end of the enamel?

    <p>60-65% (A)</p> Signup and view all the answers

    Which statement about cementum is accurate regarding its resistance to resorption?

    <p>Cementum is more resistant to resorption than bone. (A)</p> Signup and view all the answers

    Which of the following structures is primarily responsible for the anchorage of the tooth?

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

    What characteristic shapes do the cell bodies of cementocytes have?

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

    What is the ideal depth of the gingival sulcus in healthy gingiva?

    <p>0 mm or close to 0 mm (A)</p> Signup and view all the answers

    What is the width of the attached gingiva at the maxillary incisor?

    <p>3.5 mm - 4.5 mm (A)</p> Signup and view all the answers

    Which of these is NOT a part of the gingiva?

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

    What is the typical thickness of the free gingiva?

    <p>1.56 mm +/- 0.39 mm (B)</p> Signup and view all the answers

    What is the difference between the marginal gingiva and the attached gingiva?

    <p>The marginal gingiva is unattached and the attached gingiva is firmly bound to the underlying tissue. (D)</p> Signup and view all the answers

    What is the shape of the interdental gingiva?

    <p>Pyramidal or Col (C)</p> Signup and view all the answers

    What is the purpose of the free gingival groove?

    <p>To mark the border between the free gingiva and the attached gingiva. (D)</p> Signup and view all the answers

    What is the term for the junction between the attached gingiva and the alveolar mucosa?

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

    What is the primary function of the junctional epithelium?

    <p>To aid in the attachment of the gingiva to the teeth (A), To provide a barrier against bacterial penetration (C)</p> Signup and view all the answers

    Which of the following cell types is most abundant in the gingival epithelium?

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

    What is the approximate ratio of melanocytes to keratinocytes in the gingival epithelium?

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

    Which type of epithelium is found in the sulcular epithelium?

    <p>Stratified squamous non-keratinized epithelium (B)</p> Signup and view all the answers

    What is the unique feature of the junctional epithelium that allows it to function as a seal?

    <p>It has two basement membranes – the internal and external basal lamina. (B)</p> Signup and view all the answers

    Which of the following statements about the turn-over rate of different types of epithelium in the oral cavity is true?

    <p>The turn-over rate of keratinized epithelium is slower than non-keratinized epithelium. (C)</p> Signup and view all the answers

    What is the primary function of the Langerhans cells found in the gingival epithelium?

    <p>To function as antigen-presenting cells. (A)</p> Signup and view all the answers

    What is the function of the rete pegs found in the oral epithelium?

    <p>To increase the strength and stability of the epithelium. (D)</p> Signup and view all the answers

    In the context of periodontal health, the interdental col is considered a weak point as it is comprised of non-keratinized epithelium. How does this characteristic contribute to the initiation of periodontal disease?

    <p>The thinner epithelium allows for easier bacterial attachment and biofilm formation. (A), The lack of keratinization in the col makes it a favorable environment for the proliferation of bacteria. (C), The non-keratinized epithelium lacks a tight barrier, allowing bacteria to penetrate deeper into the gingiva. (D)</p> Signup and view all the answers

    What is the primary cell type found in the gingival connective tissue, responsible for the production of collagen fibers?

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

    The periodontal ligament (PDL) is a highly cellular and vascular connective tissue that surrounds the tooth root. How does the width of the PDL space vary depending on the tooth's function?

    <p>The PDL space narrows around functional teeth, aiding in efficient load transfer. (A)</p> Signup and view all the answers

    What is the function of Sharpey's fibers in the periodontal ligament?

    <p>Sharpey's fibers provide a direct connection between the cementum and alveolar bone. (A)</p> Signup and view all the answers

    Gingival crevicular fluid (GCF) plays a crucial role in maintaining periodontal health. Which of the following is NOT a protective role attributed to GCF?

    <p>GCF provides lubrication for tooth movement during mastication. (D)</p> Signup and view all the answers

    The turnover rate of the junctional epithelium (JE) is typically between 1 and 6 days. What is the significance of this rapid turnover rate in the context of periodontal health?

    <p>All of the above. (D)</p> Signup and view all the answers

    What is the correct order of the histological layers found in the gingiva, starting from the outermost layer?

    <p>Oral epithelium, sulcular epithelium, junctional epithelium (D)</p> Signup and view all the answers

    The mucogingival junction (MGJ) is a distinct boundary between two types of oral mucosa. Which two types of oral mucosa are separated by the MGJ?

    <p>Masticatory mucosa and alveolar mucosa (D)</p> Signup and view all the answers

    Flashcards

    Epithelial components of gingiva

    Gingiva consists of oral, sulcular, and junctional epithelium.

    Turnover rate of gingival epithelium

    Gingival epithelium turnover occurs every 10 to 12 days.

    Oral epithelium

    Primary barrier of the gingiva; stratified squamous, keratinized or parakeratinized.

    Sulcular epithelium

    Thin, non-keratinized, stratified squamous epithelium in the gingival sulcus.

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    Junctional epithelium

    Collar-like band with two basement membranes, attaches to tooth surface.

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    Keratinization

    Biochemical process where keratinocytes migrate and differentiate, forming keratin.

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    Melanocytes

    Cells that produce pigment, present in the basal and spinous layers of gingiva.

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    Lining mucosa

    Type of mucosa that is non-keratinized.

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    Oral Mucosa

    The mucous membrane lining the oral cavity, including different types such as masticatory and lining mucosa.

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    Gingiva

    The part of the oral mucosa covering the alveolar processes and surrounding the neck of the teeth.

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    Marginal Gingiva

    The edge of the gingiva that forms a collar around the tooth, also known as free gingiva.

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    Gingival Sulcus

    The shallow crevice around the tooth, defined by the tooth surface and the gingival epithelium.

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    Attached Gingiva

    The part of the gingiva firmly connected to the underlying alveolar bone, extending from the mucogingival junction.

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    Gingival crevicular fluid

    Fluid from the gingival sulcus that contains inflammatory exudate.

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    Interdental col

    Non-keratinized epithelial area between adjacent teeth.

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    Interdental Gingiva

    The gingival tissue that occupies the gingival embrasure between adjacent teeth.

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    Masticatory mucosa

    Type of mucosa that includes the gingiva.

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    Mucogingival Junction

    The boundary between the attached gingiva and the alveolar mucosa.

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    Free Gingival Thickness

    The average thickness of the free gingiva, typically around 1.56 mm.

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    Periodontal ligament

    Connective tissue surrounding tooth roots, attaching them to alveolar bone.

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    Sharpey's fibers

    Terminal portion of periodontal fibers that attach to cementum and bone.

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    Collagen type I

    Most common type of collagen found in periodontal ligament.

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    Cementum Composition

    Cementum consists of 45-50% inorganic materials (calcium, phosphate) and 50-55% organic materials (type 1 collagen).

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    Types of Cementum

    There are four types: acellular afibrillar, acellular extrinsic fiber, cellular mixed stratified, and cellular intrinsic fiber cementum.

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    Acellular Cementum

    Acellular cementum lacks cells and covers root dentin from CEJ to apex, but can be thin around the apex.

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    Cellular Cementum

    Includes cells (cementocytes) and is mainly found in the apical third of the root; thicker than acellular cementum.

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    Cementoenamel Junction (CEJ)

    CEJ is where the cementum overlaps enamel; 60-65% overlaps, 30% meets sharply, and 5-10% has no cementum.

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    Cementum Function

    Cementum is essential for anchoring the tooth and is more resistant to resorption than bone.

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    Cementum and Orthodontics

    Cementum's resistance to resorption allows for safe orthodontic tooth movement.

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    Intermediate Cementum

    A poorly defined zone at the cementodentinal junction, containing remnants of Hertwig's sheath.

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    Scaling and root planing

    Procedure to remove calculus and bacterial deposits from teeth.

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    Cementum loss effects

    Loss of cementum can expose dentin and cause sensitivity.

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    Cemental deposition

    Compensatory growth in cementum occurs in response to occlusal attrition.

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    Alveolar process

    The bone structure that supports tooth sockets in the jaw.

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    Cortical bone

    The external layer of dense bone in the alveolar process.

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    Lamina dura

    The inner alveolar bone seen as a radiographic line.

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    Fenestrations

    Areas where root is denuded of bone, covered only by periosteum and gingiva.

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    Remodeling

    The process of bone resorption and formation for homeostasis and repair.

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    Calcification process

    The process where tissues become hardened by calcium deposition.

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    Osteopontin

    A non-collagenous protein associated with bone that aids in calcification.

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    PDL cellular elements

    Includes fibroblasts, cementoblasts, osteoblasts, and stem cells.

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    Ground substance of PDL

    Area with glycosaminoglycans, glycoproteins, and high water content.

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    Functions of PDL

    Physical support, formative, nutritional, and sensory roles of the periodontal ligament.

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    Cementum

    Calcified tissue covering the tooth root, providing attachment for fibers.

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    Cementum characteristics

    Cementum is softer than dentin, light yellowish, and less lustrous.

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    Study Notes

    Clinical Correlations of Periodontal Anatomy

    • This presentation covers the clinical and microscopic features of the periodontium.
    • The periodontium is a complex structure that includes the gingiva, periodontal ligament, cementum, and alveolar process.

    Contents

    • Oral Mucosa and Gingiva: This section details various types of oral mucosa (masticatory, specialized, lining) and focuses on the gingiva, its definition, anatomical divisions (marginal, attached, interdental), and the gingival sulcus.
    • Periodontal Ligament: Describes the periodontal ligament (PDL) as a complex connective tissue that surrounds the tooth root and connects it to the alveolar bone. It includes its average width (0.2mm), variations in width related to tooth function, and the principle fibers (Sharpey's).
    • Cementum: Details cementum as a specialized, calcified tissue that covers the tooth root. It classifies it as either Acellular or Cellular and discusses its clinical significance and role in tooth anchorage.
    • Alveolar Process: Discusses the alveolar process's role in forming tooth sockets (alveoli) and providing attachment to the periodontal ligament. It includes histological features, radiographic appearance, and clinical considerations like dehiscences, fenestrations and remodeling.

    Oral Mucosa

    • Oral mucosa is categorized into masticatory, specialized, and lining mucosa.
    • Masticatory mucosa covers areas subjected to significant stress, such as the gingiva and hard palate.
    • Specialized mucosa has distinct characteristics, such as the dorsum of the tongue.
    • Lining mucosa covers internal surfaces of the oral cavity, like the cheeks, lips, and soft palate.

    Gingiva

    • Gingiva is the oral mucosa covering the alveolar processes and surrounding the tooth neck.
    • Anatomically, the gingiva is divided into marginal, attached, and interdental gingiva.
    • Marginal gingiva is the free gingiva, it is unattached to the tooth.
    • Free gingival thickness is 1.56mm +/- 0.39mm
    • Attached gingiva is tightly bound to the tooth, spanning the area from the free gingival groove apical to the mucogingival junction.
    • Interdental gingiva occupies the embrasure between adjacent teeth, with shapes varying according to contact with adjacent teeth.

    Gingival Sulcus

    • A shallow crevice around the tooth, bordered by the tooth surface and the gingival margin epithelium.
    • Ideal sulcus depth is 0mm, with a typical range of 1-3mm in healthy gingiva.
    • The probing depth generally overestimates the actual sulcus depth due to probe penetration through inflamed tissues.

    Attached Gingiva

    • Attached gingiva is resilient, thick and tightly bound
    • Mucogingival junction - the intersection between the attached gingiva and oral mucosa.
    • Width of attached gingiva varies between 1.8 - 4.5 mm in max & Man incisor and 1.9mm to 1.8 mm in premolar regions.
    • Thickness of attached gingiva is 1.25mm (+/- 0.42mm).

    Interdental Gingiva

    • Occupies the gingival embrasure.
    • Its form is pyramidal or col-shaped depending upon the contact relations with adjacent teeth.

    Microscopic Features of Gingiva

    • Gingiva comprises epithelial and connective tissue components.
    • The epithelial components consist of oral epithelium, sulcular epithelium, and junctional epithelium.
    • Turnover rates of epithelial cells in various regions of the oral cavity show significant variation.
    • Keratinized epithelium characteristics differ from non-keratinized.

    Oral Epithelium

    • The primary function is a physical barrier.
    • Stratified squamous, keratinized or parakeratinized.

    Sulcular Epithelium

    • Thin, non-keratinized, stratified squamous epithelium.
    • Lacks rete pegs (finger-like projections).
    • Semipermeable membrane.

    Junctional Epithelium

    • Collar-like attachment to the tooth.
    • Stratified squamous, non-keratinized.
    • Varies between 0.25 -1.25 mm in length.
    • Widest at the coronal portion, gradually thinning towards the cement-enamel junction (CEJ).

    Keratinization

    • Keratinization is a series of biochemical and morphological events that occur in cells as they migrate from the basal layer.
    • Keratinocytes constitute a predominant cell type (about 90%).
    • Other cell types include melanocytes, Langerhans cells, and Merkel cells.
    • These cells play varying but essential roles in the periodontium.

    Gingival Connective Tissue

    • Primarily composed of dense collagen fibers (type I and III).
    • Classification is based on location and insertion.
    • Functions to brace the marginal gingiva against masticatory forces, provide rigidity, and unite free marginal gingiva to cementum of adjacent teeth.
    • Fibers are arranged in three groups: gingivodental, circular, and transseptal.

    Cell Types in Gingival Connective Tissue

    • Fibroblasts account for 65% of the volume
    • Other connective tissue cells include neutrophils, lymphocytes, plasma cells, macrophages, and mast cells.
    • Glycosaminoglycans, like dermatan sulfate, are crucial constituents of the ground substance.

    Vascular Supply

    • The gingival connective tissue receives its vascular supply from supraperiosteal arterioles, vessels of the periodontal ligament, and arterioles emerging from the crest of alveolar septa.
    • A juxta-epithelial plexus is present adjacent to the papillary projections of the gingival epithelium.

    Color

    • Color variations are due to vascular supply, tissue thickness, keratinization, and pigment-containing cells.
    • Lighter color is observed in individuals with fair complexions compared to those with swarthy, dark hair.

    Size

    • Gingival size is determined by the sum total of cellular and intercellular elements and their vascular supply.
    • Alterations in gingival size are often associated with periodontal diseases.

    Gingival Biotypes

    • Ochsenbein and Miller highlighted the distinction between thick and thin gingiva in restorative treatment planning.
    • Thick and flat biotypes account for 85%, while thin and scalloped biotypes make up 15%.
    • Characteristics of thick and thin gingiva differ in architecture, soft tissue density, amount of attached gingiva, and response to trauma and disease.

    Gingival Zenith

    • Gingival zenith is the most apical point of the marginal gingival scallop.
    • Locations of the zenith on various teeth are presented in the slides.

    Surface Texture

    • Gingival surface texture is often described as stippled, similar to the texture of an orange peel.
    • Stippling is more prominent in the attached portion of gingiva compared to the marginal gingiva.

    Passive Eruption

    • Describes Gottlieb & Orban's stages of passive eruption, outlining the progression of the junctional epithelium (JE) relative to enamel and cementum during tooth eruption.

    Connective Tissue Grafts

    • Grafting is performed to create new gingiva when there is a deficiency.
    • Gingival tissue is more stable relative to alveolar mucosa when attached to restorations.

    Periodontal Probing

    • Periodontal probing measurements may not accurately reflect the actual anatomic sulcus depth.
    • The depth is often overestimated due to probing through inflamed tissues.

    Gingival Crevicular Fluid

    • Gingival crevicular fluid (GCF) is formed as an inflammatory exudate.
    • It contains components like serum, structural cells, plasma proteins, electrolytes, inflammatory and immune cells.
    • Plays a protective role through cleansing action, antibacterial action and adhesive properties.

    Interdental Col

    • The interdental col is not a strong bacterial barrier.
    • It is covered by non-keratinized epithelium, making it a potential site of disease initiation.

    Key Points Summary

    • The presentation summarized key anatomical and histological concepts of various periodontal components.
    • Included is information on the average width of PDL, importance of different cell types and fibers for periodontal function, and clinical correlations.

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    Description

    Test your knowledge on key concepts related to the periodontal ligament. This quiz covers the principles of fiber types, the function of epithelial rests of Malassez, and the role of glycosaminoglycans in the periodontal structure. Dive into the complexities of the periodontal ligament and its associated functions.

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