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Questions and Answers
What is the average depth of the gingival sulcus in normal, clinically healthy gingiva?
What is the average depth of the gingival sulcus in normal, clinically healthy gingiva?
Which type of epithelium lines the gingival sulcus?
Which type of epithelium lines the gingival sulcus?
What is the main function of the attached gingiva?
What is the main function of the attached gingiva?
Which part of the gingiva is known as the 'collar'?
Which part of the gingiva is known as the 'collar'?
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Which of the following statements is TRUE about the turnover rate of epithelial cells in the mouth?
Which of the following statements is TRUE about the turnover rate of epithelial cells in the mouth?
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What is the average width of attached gingiva in the mandibular premolar region?
What is the average width of attached gingiva in the mandibular premolar region?
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Which of the following is NOT a function of the gingival sulcus?
Which of the following is NOT a function of the gingival sulcus?
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Why is the interdental gingiva important?
Why is the interdental gingiva important?
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Which of these statements about acellular cementum is correct?
Which of these statements about acellular cementum is correct?
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What is the primary function of cementum?
What is the primary function of cementum?
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How does cementum contribute to orthodontic tooth movement?
How does cementum contribute to orthodontic tooth movement?
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What is the most abundant organic component of cementum?
What is the most abundant organic component of cementum?
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What is the significance of incremental lines in cementum?
What is the significance of incremental lines in cementum?
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Which type of cementum is characterized by the presence of cementocytes within lacunae?
Which type of cementum is characterized by the presence of cementocytes within lacunae?
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What is the typical relationship between cementum and enamel at the cementoenamel junction (CEJ)?
What is the typical relationship between cementum and enamel at the cementoenamel junction (CEJ)?
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Which of the following is NOT a clinical consideration related to cementum?
Which of the following is NOT a clinical consideration related to cementum?
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What is the principle cell type found in the Juntional Epithelium?
What is the principle cell type found in the Juntional Epithelium?
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Which of the following accurately reflects the relationship between probing depth and anatomic sulcus or pocket depth?
Which of the following accurately reflects the relationship between probing depth and anatomic sulcus or pocket depth?
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Which of the following accurately reflects the components of the gingiva?
Which of the following accurately reflects the components of the gingiva?
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What is the principle cell type found in the Connective Tissue of the Periodontium?
What is the principle cell type found in the Connective Tissue of the Periodontium?
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Which of the following is TRUE about the interdental col?
Which of the following is TRUE about the interdental col?
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What is the most common collagen fiber present in the periodontal ligament?
What is the most common collagen fiber present in the periodontal ligament?
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Which of the following is NOT a function of the gingival crevicular fluid?
Which of the following is NOT a function of the gingival crevicular fluid?
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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 primary type of cell found in the described cellular composition?
What is the primary type of cell found in the described cellular composition?
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Which glycosaminoglycan is most prevalent in the ground substance?
Which glycosaminoglycan is most prevalent in the ground substance?
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What percentage of the population is estimated to have thick and flat periodontal biotypes?
What percentage of the population is estimated to have thick and flat periodontal biotypes?
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Where is the gingival zenith typically located on a central incisor?
Where is the gingival zenith typically located on a central incisor?
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The stippled texture of the gingiva is best observed under which condition?
The stippled texture of the gingiva is best observed under which condition?
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The vascular supply to the gingiva is primarily derived from which of the following?
The vascular supply to the gingiva is primarily derived from which of the following?
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Which feature does NOT contribute to the color of gingiva?
Which feature does NOT contribute to the color of gingiva?
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Which of the following is characteristic of the attached gingiva based on its appearance?
Which of the following is characteristic of the attached gingiva based on its appearance?
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What type of fibers are primarily found in the periodontal ligament?
What type of fibers are primarily found in the periodontal ligament?
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Which of the following is NOT a function of the periodontal ligament?
Which of the following is NOT a function of the periodontal ligament?
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What is the primary characteristic of acellular cementum?
What is the primary characteristic of acellular cementum?
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Which cell type in the periodontal ligament is primarily involved in the formation of cementum?
Which cell type in the periodontal ligament is primarily involved in the formation of cementum?
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Which component of the periodontal ligament is associated with a high water content of approximately 70%?
Which component of the periodontal ligament is associated with a high water content of approximately 70%?
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Which statement accurately describes the periodontal ligament's visibility in radiographs?
Which statement accurately describes the periodontal ligament's visibility in radiographs?
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Which type of cementum is less hard than dentin?
Which type of cementum is less hard than dentin?
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What role do undifferentiated mesenchymal cells (UMC) play in the periodontal ligament?
What role do undifferentiated mesenchymal cells (UMC) play in the periodontal ligament?
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What structure is primarily responsible for supporting the tooth sockets in both maxilla and mandible?
What structure is primarily responsible for supporting the tooth sockets in both maxilla and mandible?
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What happens as a result of scaling and root planing procedures?
What happens as a result of scaling and root planing procedures?
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What term describes the bone adjacent to the periodontal ligament that contains numerous Sharpey’s fibers?
What term describes the bone adjacent to the periodontal ligament that contains numerous Sharpey’s fibers?
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What causes the distance between the crest of the alveolar bone and the cemento-enamel junction to increase with age?
What causes the distance between the crest of the alveolar bone and the cemento-enamel junction to increase with age?
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How does the alveolar bone proper appear in radiographs?
How does the alveolar bone proper appear in radiographs?
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Which structure disappears gradually after the tooth is lost?
Which structure disappears gradually after the tooth is lost?
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What is a fenestration in dental terminology?
What is a fenestration in dental terminology?
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What is the role of remodeling in the bone?
What is the role of remodeling in the bone?
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Flashcards
Transseptal fibers
Transseptal fibers
Fibers connecting adjacent teeth across the alveolar bone.
Cell types in periodontal tissue
Cell types in periodontal tissue
Includes fibroblasts, neutrophils, lymphocytes, plasma cells, macrophages, mast cells.
Ground substance composition
Ground substance composition
Composed mainly of glycosaminoglycans like dermatan sulfate and chondroitin sulfate.
Gingival biotypes
Gingival biotypes
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Gingival zenith
Gingival zenith
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Surface texture of gingiva
Surface texture of gingiva
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Vascular supply sources
Vascular supply sources
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Color variations in gingiva
Color variations in gingiva
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Junctional Epithelium (JE)
Junctional Epithelium (JE)
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Periodontal Ligament (PDL)
Periodontal Ligament (PDL)
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Keratinocyte
Keratinocyte
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Gingival Sulcus
Gingival Sulcus
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Gingival Grafts
Gingival Grafts
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Sharpey’s Fibers
Sharpey’s Fibers
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Inflammatory Exudate
Inflammatory Exudate
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Interdental Col
Interdental Col
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Masticatory Mucosa
Masticatory Mucosa
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Gingiva
Gingiva
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Marginal Gingiva
Marginal Gingiva
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Attached Gingiva
Attached Gingiva
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Interdental Gingiva
Interdental Gingiva
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Junctional Epithelium
Junctional Epithelium
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Oral Epithelium
Oral Epithelium
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Chemical composition of cementum
Chemical composition of cementum
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Acellular cementum
Acellular cementum
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Cellular cementum
Cellular cementum
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Cemento-enamel junction (CEJ)
Cemento-enamel junction (CEJ)
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Importance of cementum
Importance of cementum
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Acellular vs. Cellular cementum
Acellular vs. Cellular cementum
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Intermediate cementum
Intermediate cementum
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Cementum resorption
Cementum resorption
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Scaling and Root Planing
Scaling and Root Planing
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Cementum Loss Effects
Cementum Loss Effects
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Alveolar Process
Alveolar Process
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Lamina Dura
Lamina Dura
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Cancellous Bone
Cancellous Bone
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Fenestrations
Fenestrations
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Bundle Bone
Bundle Bone
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Bone Remodeling
Bone Remodeling
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Calcification
Calcification
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Types of PDL fibers
Types of PDL fibers
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Cementum
Cementum
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Functions of PDL
Functions of PDL
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Glycosaminoglycans (GAGs)
Glycosaminoglycans (GAGs)
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Study Notes
Clinical Correlations of Periodontal Anatomy
- This presentation covers the anatomy of the periodontium, focusing on its clinical and microscopic features.
- Key components of the periodontium are oral mucosa, gingiva, periodontal ligament, cementum, and alveolar process.
- The presentation also discusses correlations of normal clinical and microscopic features.
Oral Mucosa and Gingiva
- Oral mucosa includes masticatory, specialized, and lining mucosa.
- Masticatory mucosa: Gingiva and hard palate
- Specialized mucosa: The dorsum of the tongue
- Lining mucosa: Oral mucosa covering the soft tissues.
Gingiva
- Definition: Gingiva is the oral mucosa that covers the alveolar processes of the jaws and surrounds the necks of the teeth. It forms a collar-like fashion around the teeth.
- Anatomically: Divided into marginal gingiva, attached gingiva, and interdental gingiva.
- Marginal gingiva (Free gingiva): The portion of the gingiva that borders the tooth.
- Attached gingiva: The portion firmly attached to the underlying alveolar bone.
- Interdental gingiva: The gingiva in between the teeth.
- Includes the Gingival sulcus, Marginal (free) gingiva, Free gingival groove, Attached gingiva, Mucogingival junction, Alveolar mucosa.
Anatomical Areas of Gingiva
- Diagrams and labels of MGJ (Mucogingival junction), MG (Marginal gingiva), AG (Attached gingiva), and IDG (Interdental gingiva) are presented.
Gingival Sulcus
- A V-shaped crevice surrounding the tooth.
- Ideal depth: 0 mm or close to 0 mm, typical of clinically healthy gingiva.
- Normal depth: 1.8 mm (histological), average 1 to 3 mm.
Attached Gingiva
- Firm, resilient, and tightly bound.
- Mucogingival junction is part of this section
- Width varies by location.
Interdental Gingiva
- Occupies gingival embrasure between teeth
- Pyramidal or collar-shaped
Microscopic Features
- Gingiva is composed of epithelial and connective tissues.
- The epithelial component includes the oral epithelium, sulcular epithelium, and junctional epithelium.
- Gingiva turnover rate varies by location.
- Palate, tongue, and cheeks: 5-6 days
- Gingiva: 10-12 days
- Junctional epithelium: 1-6 days
- Oral epithelium is a primary barrier that is stratified squamous epithelium; keratinized or parakeratinized.
- Sulcular epithelium is non-keratinized, stratified squamous epithelium, without rete pegs, and semipermeable.
- Junctional epithelium is a collar-like band of stratified squamous non-keratinizing epithelium; length ranges from 0.25-1.25 mm; widest portion at crown; thin by the cement-enamel junction.
- Note that junctional epithelium is unique because possesses two basement membranes (internal and external basal lamina)
Keratinization
- Keratinization is a series of biochemical and morphological events that occur in cells as they migrate from the basal layer.
- Keratinocytes comprise 90% of the cells.
- Other cell types, include melanocytes, Langerhans cells, and Merkel cells.
Non-keratinization
- Lining mucosa is non-keratinized.
- It is thicker than keratinized mucosa, with larger cells and intercellular bridges.
- It consists of three layers: stratum basale, stratum intermedium, and stratum superficiale/distendum.
Lamina Propria
- Two layers (superficial/papillary and deep/reticular) of the gingival connective tissue.
- Components include gingival connective tissue composed of cells(blood vessels, neural elements, fibers, ground substance).
Gingival Connective Tissue
- Mostly dense collagen fibers (Type I, followed by Type III).
- Fibers are classified by location.
Function of Gingival Fibers
- Support and stabilize the marginal gingiva against forces of mastication.
- Connect free marginal gingiva to cementum and adjacent attached gingiva.
- Gingival fibers arranged in three groups: gingivodental, circular, and transseptal.
Gingival Collagen Fibers
- List of fibers: Dentogingival, Alveologingival, Interpapillary, Transgingival, Circular & Semicircular, Dentoperiosteal, Transseptal, Periostogingival, Intercircular, and Intergingival
Cell Types
- Fibroblasts (65%), neutrophils, lymphocytes, plasma cells, macrophages, mast cells comprise the cells, by volume
- Ground substance consists of glycosaminoglycans (most common dermatan sulfate -60%, followed by chondroitin 4-sulfate 28%).
Vascular Supply
- Supraperiosteal arterioles, vessels of the PDL, and arterioles from the alveolar crests.
- Juxta-epithelial plexus: capillary plexus adjacent to the papillary projections of the gingival epithelium.
Correlations of Normal Clinical and Microscopic Features
- Color is produced by vascular supply, epithelial thickness, keratinization, and presence of pigment-containing cells.
- Color varies among people and may correlate with cutaneous pigmentation (lighter in fair-complected individuals).
- Size correlates with the total bulk of cellular and intercellular elements plus vascular supply.
Gingival Biotypes
- Ochsenbein and Miller described the importance of thick versus thin gingiva in restorative treatment planning.
- Populations are predominantly 85% thick and flat periodontal biotypes and 15% thin and scalloped periodontal biotypes.
Thick Gingival Biotype
- Characterized by relatively flat soft tissue and bony architecture.
- Dense fibrotic tissue.
- Large amount of attached gingiva
- Thick underlying osseous form
- Resistant to acute trauma
- Reacts to disease with pocket formation and infrabony defects.
Thin Gingival Biotype
- Characterized by highly scalloped soft tissue and bony architecture.
- Delicate and friable soft tissue.
- Minimal amount of attached gingiva
- Thin, dehiscence, and fenestration underlying osseous form
- Reacts to disease or insults with gingival recession.
Gingival Zenith
- The most apical point of the marginal gingival scallop.
- Examples include central and lateral incisors, canines, and premolars with their respective tooth regions.
Surface Texture
- Gingiva is stippled (textured like an orange peel).
- Attached gingiva exhibits stippling; marginal gingiva does not.
- Less prominent on the lingual surface compared to the facial surface and can be absent in some individuals
Stippling of Attached Gingiva
- Orange peel-like appearance, best viewed in dried gingiva.
- Variations in fineness or coarseness may exist between individuals and correlate with age and sex.
- Primarily located in the attached gingiva and the central part of the interdental papillae.
Passive Eruption (Gottlieb & Orban 1933)
- Four stages of connective tissue growth and healing after tooth eruption.
- Stage 1: junctional epithelium and the base of the sulcus are on the enamel.
- Stage 2: part of the junctional epithelium is on the cementum, the base of the sulcus remains on the enamel.
- Stage 3: the entire junctional epithelium lies on the cementum, with the base of the sulcus at the cemento-enamel junction.
- Stage 4: Both the junctional epithelium and the base of the sulcus are on the cementum.
Periodontal Grafts
- Gingiva can have a stable connection with restoration margin than alveolar mucosa.
- Grafts are used to regenerate or repair deficient gingival tissue.
Periodontal Probing
- Probing depth typically overestimates the actual depth of the sulcus or pocket due to penetration into inflamed tissues.
Gingival Crevicular Fluid
- Inflammatory exudate containing serum, structural cells, proteins, and electrolytes.
- Increased level in presence of inflammation; a protective role.
- Transudate/exudate with cleaning, antibacterial, and adhesive properties
Interdental COL
- The interdental col is not a powerful barrier against bacteria since it has non-keratinized epithelium.
- A site for initiation of disease.
Periodontal Ligament
- Composed of highly cellular connective tissue surrounding the tooth root.
- Connects the root to the alveolar bone.
- Width: 0.2 mm, narrower in nonfunctional teeth and wider in hyperfunctional teeth.
Periodontal Ligament Fibers
- Collagen in bundles, arranged in a wavy pattern.
- Sharpey's fibers: Collagen portion attached to the cementum and bone, undergo calcification.
- Related non-collagenous protein: Osteopontin and bone sialoprotein.
- Oxytalan & eluanin fibers are other fiber types.
Principle Fibers
- Includes groups such as Transseptal, Alveolar crest, Horizontal, Oblique, Apical, and Interradicular fibers.
Cellular Elements of PDL
- Connective tissue (Fibroblasts, cementoblasts, and osteoblasts).
- Undifferentiated mesenchymal cells (UMCs).
- Epithelial rests of Malassez.
- Immune system cells.
- Cells associated with neurovascular elements.
Ground Substance of PDL
- Consists of glycosaminoglycans (GAGs) like hyaluronic acid and proteoglycans.
- Glycoproteins (fibronectin and laminin)
- High water content (70%).
- Calicified structures such as cementicles.
Functions of PDL
- Physical, formative, and remodeling, nutritional, and sensory functions.
- Essential for tooth anchorage.
- Resistant to resorption
Periodontal Ligament Clinical Considerations
- Radiolucent in radiographs
- Thicker in functioning teeth,
- Cell function for remodeling ligament and bone
- Replantable exfoliated teeth.
Cementum
- Hard, calcified connective tissue covering the tooth root, of mesodermal origin.
- Begins at the cemento-enamel junction and extends to the apex.
- Supports periodontal attachment elements.
- Classification: Acellular afibrillar, Acellular extrinsic fibers, Cellular mixed stratified, and Cellular intrinsic fibers
Cementum Characteristics
- Less hard than dentin
- Light yellowish color; less luster than dentin.
- May be permeable to several materials
- Chemical composition; Inorganic portion (45-50%): Calcium and phosphate (hydroxyapatite); the highest fluoride content of all mineralized tissues.
- Organic portion (50-55%): Primarily Type I collagen, protein polysaccharides (proteoglycans), and water.
Schroeders Classification
- Acellular afibrillar, Acellular extrinsic fiber, Cellular mixed stratified, Cellular intrinsic fiber cementum.
- Intermediate cementum - a layer near the cementodentinal junction in some teeth, comprised of calcified ground substance and remnants of the Hertwig's epithelial root sheath.
Acellular Cementum
- The term "acellular" is not precise.
- Does not incorporate cells (spiderlike cementocytes) initially
Cellular Cementum
- Primarily found in the apical third of the root,
- Cells are similar to osteocytes (cementocytes)
- Located in spaces called lacunae.
- Numerous processes (canaliculi) that extend toward the PDL and cementum surfaces.
- Separated from other cementum types by incremental lines, indicative of periodic formation.
Cemento-Enamel Junction (CEJ)
- Region where cementum and enamel meet.
- Varies by individual, with the cementum overlapping the enamel in 60-65%, a sharp line (butt joint) for approximately 30%, and a region devoid of cementum overlapped by enamel epi for ~5-10%.
Cementum Clinical Considerations
- Vital to the tooth's function as an anchorage point
- More resistant to resorption than bone
- Removal of calculus, bacterial deposits in scaling & root planing also removes cementum, potentially exposing dentin and increasing tooth sensitivity.
- Deposition in apical area compensates for occlusal attrition.
Alveolar Process
- Mandibular and maxillary portions supporting tooth sockets (alveoli).
- Formed during tooth eruption; disappears with tooth loss.
Alveolar Process Structure
- External cortical plate made of Haversian bone and compacted lamellae.
- Inner lining of socket walls (alveolar bone proper); seen as lamina dura in radiographs.
- Histology: contains channels (cribriform plates), where neurovascular bundles connect the PDL to the cancellous (central) bone portion.
Alveolar Bone Clinical Considerations
- Remodeling can displace alveolar bone
- Interruptions in lamina dura in the apical region have implications
- Tooth extraction: alveolar bone resorption may occur.
- Dental implant placement: reduces the rate of ridge resorption
- Fenestration may convert to dehiscence, potentially resulting in gingival recession.
Key Points
- Average width of PDL space: 0.2 mm
- Undifferentiated mesenchymal cells (UMCs)
- Functions of PDL
- Cemento-Enamel Junction (CEJ)
- Alveolar Bone terminology
Homework
- Draw the periodontium.
Reference Textbook
- Newman & Carranza's Clinical Periodontology (Chapter 3, Pages 19-49).
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Description
Test your knowledge on the anatomy and functions of gingiva with this quiz. Questions cover various aspects, including the gingival sulcus depth, types of epithelium, and the role of cementum. Perfect for dental students or anyone interested in periodontology.