Periodontology Quiz: Gingival Anatomy & Function
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Questions and Answers

What is the average depth of the gingival sulcus in normal, clinically healthy gingiva?

  • 1 to 3 mm (correct)
  • 1.8 mm
  • 0 mm
  • 3.5 to 4.5 mm
  • Which type of epithelium lines the gingival sulcus?

  • Oral epithelium
  • Junctional epithelium
  • Keratinized epithelium
  • Sulcular epithelium (correct)
  • What is the main function of the attached gingiva?

  • To provide a blood supply to the gingiva
  • To protect the underlying bone
  • To provide a barrier against bacteria
  • To support the teeth (correct)
  • Which part of the gingiva is known as the 'collar'?

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

    Which of the following statements is TRUE about the turnover rate of epithelial cells in the mouth?

    <p>Keratinized epithelium &gt; Non keratinized epithelium (D)</p> Signup and view all the answers

    What is the average width of attached gingiva in the mandibular premolar region?

    <p>1.8 mm (A)</p> Signup and view all the answers

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

    <p>To facilitate the movement of the gingiva during chewing (B)</p> Signup and view all the answers

    Why is the interdental gingiva important?

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

    Which of these statements about acellular cementum is correct?

    <p>Acellular cementum is found only at the apical third of the root. (C)</p> Signup and view all the answers

    What is the primary function of cementum?

    <p>To provide a strong attachment for the tooth to the alveolar bone. (B)</p> Signup and view all the answers

    How does cementum contribute to orthodontic tooth movement?

    <p>Cementum is more resistant to resorption than bone, allowing for tooth movement without damaging the tooth. (D)</p> Signup and view all the answers

    What is the most abundant organic component of cementum?

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

    What is the significance of incremental lines in cementum?

    <p>They represent periods of rest and inactivity during cementum formation. (B)</p> Signup and view all the answers

    Which type of cementum is characterized by the presence of cementocytes within lacunae?

    <p>Cellular mixed stratified cementum (C), Cellular intrinsic fiber cementum (D)</p> Signup and view all the answers

    What is the typical relationship between cementum and enamel at the cementoenamel junction (CEJ)?

    <p>Cementum and enamel may overlap, meet at a sharp line, or there may be a gap between them. (A)</p> Signup and view all the answers

    Which of the following is NOT a clinical consideration related to cementum?

    <p>Cementum plays a crucial role in the formation of dentin. (D)</p> Signup and view all the answers

    What is the principle cell type found in the Juntional Epithelium?

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

    Which of the following accurately reflects the relationship between probing depth and anatomic sulcus or pocket depth?

    <p>Probing depth generally overestimates the actual anatomic sulcus or pocket depth. (D)</p> Signup and view all the answers

    Which of the following accurately reflects the components of the gingiva?

    <p>Gingiva is composed of the Free Gingiva, Attached Gingiva, and Interdental Papilla (D)</p> Signup and view all the answers

    What is the principle cell type found in the Connective Tissue of the Periodontium?

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

    Which of the following is TRUE about the interdental col?

    <p>The interdental col can be considered a site where disease initiation may occur due to the presence of non-keratinized epithelium. (D)</p> Signup and view all the answers

    What is the most common collagen fiber present in the periodontal ligament?

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

    Which of the following is NOT a function of the gingival crevicular fluid?

    <p>Nerve impulse transmission (B)</p> Signup and view all the answers

    What is the average width of the Periodontal Ligament space?

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

    What is the primary type of cell found in the described cellular composition?

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

    Which glycosaminoglycan is most prevalent in the ground substance?

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

    What percentage of the population is estimated to have thick and flat periodontal biotypes?

    <p>85% (C)</p> Signup and view all the answers

    Where is the gingival zenith typically located on a central incisor?

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

    The stippled texture of the gingiva is best observed under which condition?

    <p>When the gingiva is dry (D)</p> Signup and view all the answers

    The vascular supply to the gingiva is primarily derived from which of the following?

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

    Which feature does NOT contribute to the color of gingiva?

    <p>Texture of the gingiva (B)</p> Signup and view all the answers

    Which of the following is characteristic of the attached gingiva based on its appearance?

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

    What type of fibers are primarily found in the periodontal ligament?

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

    Which of the following is NOT a function of the periodontal ligament?

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

    What is the primary characteristic of acellular cementum?

    <p>It is considered primary cementum (C)</p> Signup and view all the answers

    Which cell type in the periodontal ligament is primarily involved in the formation of cementum?

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

    Which component of the periodontal ligament is associated with a high water content of approximately 70%?

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

    Which statement accurately describes the periodontal ligament's visibility in radiographs?

    <p>It appears radiolucent in PA radiographs. (A)</p> Signup and view all the answers

    Which type of cementum is less hard than dentin?

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

    What role do undifferentiated mesenchymal cells (UMC) play in the periodontal ligament?

    <p>They act as precursor cells for regeneration. (A)</p> Signup and view all the answers

    What structure is primarily responsible for supporting the tooth sockets in both maxilla and mandible?

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

    What happens as a result of scaling and root planing procedures?

    <p>Loss of cementum leading to dentin exposure (D)</p> Signup and view all the answers

    What term describes the bone adjacent to the periodontal ligament that contains numerous Sharpey’s fibers?

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

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

    <p>Resorption of alveolar process occurs (A)</p> Signup and view all the answers

    How does the alveolar bone proper appear in radiographs?

    <p>As lamina dura (C)</p> Signup and view all the answers

    Which structure disappears gradually after the tooth is lost?

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

    What is a fenestration in dental terminology?

    <p>An area with exposed root covered only by periosteum (A)</p> Signup and view all the answers

    What is the role of remodeling in the bone?

    <p>It is essential for calcium and phosphate homeostasis (A)</p> Signup and view all the answers

    Flashcards

    Transseptal fibers

    Fibers connecting adjacent teeth across the alveolar bone.

    Cell types in periodontal tissue

    Includes fibroblasts, neutrophils, lymphocytes, plasma cells, macrophages, mast cells.

    Ground substance composition

    Composed mainly of glycosaminoglycans like dermatan sulfate and chondroitin sulfate.

    Gingival biotypes

    Categorized into thick & flat (85%) and thin & scalloped (15%) types.

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    Gingival zenith

    The most apical point of the marginal gingival scallop.

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    Surface texture of gingiva

    Normally stippled (orange peel texture); varies by age and sex.

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    Vascular supply sources

    Includes supraperiosteal arterioles, PDL vessels, and alveolar septa arterioles.

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    Color variations in gingiva

    Depends on vascular supply, keratinization, and pigmentation.

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    Junctional Epithelium (JE)

    A unique structure that attaches the gingiva to the tooth surface, with a turnover rate of 1 to 6 days.

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    Periodontal Ligament (PDL)

    A complex connective tissue surrounding the tooth root, connecting it to the alveolar bone.

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    Keratinocyte

    The principal cell type found in the junctional epithelium of the gingiva.

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    Gingival Sulcus

    The space between the tooth and the surrounding gum, measuring 1-3 mm in depth.

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    Gingival Grafts

    Procedures to create new gingival tissue when there is a deficiency.

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    Sharpey’s Fibers

    The terminal portion of principal periodontal ligament fibers that attach to cementum and bone.

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    Inflammatory Exudate

    Fluid derived from serum and cells in the gingival sulcus, increased in inflammation.

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    Interdental Col

    A non-keratinized epithelial area between teeth that is prone to disease.

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    Masticatory Mucosa

    Oral mucosa covering the gingiva and hard palate.

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    Gingiva

    Part of oral mucosa covering the alveolar process and neck of teeth.

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    Marginal Gingiva

    Free gingiva that forms a collar around the teeth.

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    Attached Gingiva

    Firm, resilient gingiva tightly bound to the alveolar bone.

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    Interdental Gingiva

    Gingiva occupying the space between adjacent teeth.

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    Junctional Epithelium

    The non-keratinized epithelium at the base of the gingival sulcus.

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    Oral Epithelium

    The primary barrier in the mouth, stratified squamous epithelium.

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    Chemical composition of cementum

    Cementum is 45-50% inorganic (mostly hydroxapatite) and 50-55% organic (mainly type 1 collagen).

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    Acellular cementum

    Type of cementum without incorporated cells, covering root dentin from CEJ to apex, thinnest at CEJ.

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    Cellular cementum

    Type of cementum containing cementocytes, primarily present at the apical third of the root.

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    Cemento-enamel junction (CEJ)

    Area where cementum overlaps enamel; it can be complete, partial, or absent.

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    Importance of cementum

    Cementum is crucial for tooth anchorage, providing resistance to resorption during orthodontic movements.

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    Acellular vs. Cellular cementum

    Both types are layered, but acellular lacks cells while cellular contains cementocytes in lacunae.

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    Intermediate cementum

    A poorly defined zone near the cementodentinal junction containing remnants of Hertwig’s sheath.

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    Cementum resorption

    Cementum is more resistant to resorption than bone, allowing safe tooth movement during orthodontics.

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    Scaling and Root Planing

    A dental procedure to remove calculus and bacteria from teeth, often exposing dentin.

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    Cementum Loss Effects

    Loss of cementum from scaling leads to dentin exposure and sensitivity.

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    Alveolar Process

    Bone structure supporting tooth sockets, formed at tooth eruption.

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    Lamina Dura

    The inner wall of the tooth socket seen radiographically.

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    Cancellous Bone

    The spongy inner bone of the alveolar process that supports nerves and vessels.

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    Fenestrations

    Areas where the root is uncovered by bone but protected by periosteum and gingiva.

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    Bundle Bone

    Bone adjacent to the periodontal ligament, rich in Sharpey’s fibers.

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    Bone Remodeling

    The process of bone resorption and formation that occurs throughout life.

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    Calcification

    The process of depositing calcium in tissues, common in bone formation.

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    Types of PDL fibers

    Includes transseptal, alveolar crest, horizontal, oblique, apical, and interradicular fibers.

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    Cementum

    Specialized, calcified tissue covering the roots of teeth.

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    Functions of PDL

    Includes physical support, remodeling, nutritional supply, and sensory functions.

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    Glycosaminoglycans (GAGs)

    Long-chain carbohydrates that help retain water and support tissue structure in PDL.

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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.

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