Lecture 01 - DH 308 Anatomy of The Periodontium CV.pptx

DH 308 ANATOMY OF INTRODUCTION TO PERIODONTICS THE PERIODONTIUM 1  PERIODONTIUM WHAT ARE THE 4 COMPONENTS OF PERIODONTIUM? 1. GINGIVA 2. PERIODONTAL LIGAMENT 3. CEMENTUM 4....

DH 308 ANATOMY OF INTRODUCTION TO PERIODONTICS THE PERIODONTIUM 1  PERIODONTIUM WHAT ARE THE 4 COMPONENTS OF PERIODONTIUM? 1. GINGIVA 2. PERIODONTAL LIGAMENT 3. CEMENTUM 4. ALVEOLAR BONE 2 NAME LANDMARKS 3  COMPONENTS OF HEALTHY GINGIVA 1. MARGINAL GINGIVA UNATTACHED OR FREE GINGIVA 2. GINGIVAL MARGIN MOST CORONAL PORTION OF GINGIVA. 3. GINGIVAL GROOVE PRESENT IN ONLY 50% OF GINGIVA 1.0-1.5 MM APICAL TO THE GINGIVAL MARGIN 4  COMPONENTS OF HEALTHY GINGIVA 4. GINGIVAL SULCUS SPACE FORMED BY TOOTH AND SULCULAR EPITHELIUM 1-2 MM FACIAL/LINGUAL, 1-3 MM INTERPROXIMAL 5. INTERDENTAL GINGIVA COL IS ABSENT WHEN TEETH ARE NOT IN CONTACT 6. ATTACHED GINGIVA WIDTH VARIES AVERAGE 3.5 TO 4.5 MM MAXILLA AVERAGE 3.3 TO 3.9 MM IN MANDIBLE 1.9 MM IN MAXILLARY AND 1.8 MM IN MANDIBLE FOR FIRST PREMOLARS 5 6  SULCULAR EPITHELIUM = CREVICULAR EPITHELIUM (CE) NONKERATINIZED STRATIFIED SQUAMOUS EPITHELIUM SEMIPERMEABLE MEMBRANE FUNCTION AS A SELECTIVE BARRIER BACTERIAL BYPRODUCT CAN PASS THROUGH PM = Junctional Epithelium 7  JUNCTIONAL EPITHELIUM (JE) NONKERATINIZED STRATIFIED SQUAMOUS EPITHELIUM SURROUNDS THE TOOTH ON ONE SIDE AND ATTACHES ON GINGIVAL CONNECTIVE TISSUE. NEW CELLS ORIGINATE FROM APICAL PORTION. EPITHELIAL CELLS SHED AT THE CORONAL PORTION 8 JUNCTIONAL EPITHELIUM (JE) MORE PERMEABLE TO CELLS AND FLUIDS THAN OTHER ORAL EPITHELIUMS. A PASSAGE FOR BACTERIA TO INVADE INTO CONNECTIVE TISSUE. LENGTH RANGES 0.25-1.35MM  CONTINUOUS RENEWAL OF CELLS 9  EPITHELIAL ATTACHMENT INTERNAL BASAL LAMINA: LAMINA DENSA LAMINA LUCIDA 10  EPITHELIAL ATTACHMENT HEMIDESMOSOMES FIRM ATTACHMENT OF THE CELLS TO THE INTERNAL BASAL LAMINA ON THE TOOTH SURFACE. ES, enamel space HD, hemidesmosomes IBL, internal basal lamina11 FUNCTIONS OF JUNCTIONAL EPITHELIUM 1. AN EPITHELIAL BARRIER AGAINST BIOFILM BACTERIA. 2. ACCESS TO GINGIVAL FLUID, INFLAMMATORY CELLS, AND COMPONENTS OF THE IMMUNOLOGIC HOST DEFENSE TO THE GINGIVAL MARGIN. 3. RAPID REPAIR OF DAMAGED TISSUE. 12 MIGRATION OF JUNCTIONAL EPITHELIUM & LONG JUNCTIONAL EPITHELIUM 13 THE COL FIGURE 01.F11: INTERDENTAL COL. APICAL TO THE CONTACT AREA BETWEEN TWO TEETH, THE INTERDENTAL GINGIVA HAS A CONCAVE (DEPRESSED) FORM. THE CONCAVITY, THE “COL” IS LOCATED BETWEEN THE FACIAL AND LINGUAL PAPILLAE AND EXTENDS BENEATH THE CONTACT AREA OF TWO ADJACENT TEETH. 14 GINGIVAL CREVICULAR FLUID (GCF) FLOWS FROM THE UNDERLYING CONNECTIVE TISSUE INTO SULCUS. THE FLUID ESCAPES FROM THE CAPILLARIES AND SEEPS OUT BETWEEN THE EPITHELIAL CELLS INTO THE SULCUS. CLEANING AND ANTIMICROBIAL PROPERTIES 15 GINGIVAL CONNECTIVE TISSUE LAMINA PROPRIA = CONNECTIVE TISSUE OF THE GINGIVA PAPILLARY LAYER RETICULAR LAYER 60% COLLAGEN FIBERS 5 % FIBROBLASTS 35 % VESSELS, NERVES, MATRIX 16 FUNCTIONS OF GINGIVAL CONNECTIVE TISSUE (LAMINA PROPRIA) PROTECTING AND SUPPORTING THE JUNCTIONAL EPITHELIUM MAINTAINING THE TONE OF THE ATTACHED GINGIVA PROTECTING THE PERIODONTAL LIGAMENT HOLDS NERVES AND BLOOD SUPPLIES 17  GINGIVAL FIBER BUNDLES GINGIVODENTAL FIBERS (1) EMBEDDED IN THE CEMENTUM BETWEEN CEJ AND CREST OF BONE ATTACH GINGIVA TO TOOTH CIRCULAR FIBERS (5) ENCIRCLE EACH TOOTH WITHIN THE FREE GINGIVA TRANSSEPTAL FIBERS (7) RUN A HORIZONTAL PATH FROM ADJACENT TEETH EMBEDED BETWEEN CEMENTUMS DENTOPERIOSTEAL FIBERS (6) FROM CEMENTUM OVER ALVEOLAR CREST ALVEOLOGINGIVAL FIBERS (2) FROM CREST OF ALVEOLAR PROCESS TO FREE GINGIVA 18 CELLULAR ELEMENTS OF THE CONNECTIVE TISSUE FIBROBLASTS PREDOMINANT CELLS PRODUCE VARIOUS TYPES OF FIBERS SYNTHESIZE AND SECRETE THE COLLAGEN FIBERS PLAY A ROLE IN WOUND HEALING MAST CELLS PARTICIPATE IN THE EARLY PHASE OF INFLAMMATION MACROPHAGES HOST DEFENSE AND REPAIR POLYMORPHONUCLEARLEUKOCYTES (PMNS) LYMPHOCYTES PLASMA CELLS HOST DEFENSE 19  PERIODONTAL LIGAMENT (PDL) CONNECTIVE TISSUE SURROUNDS THE ROOT AND CONNECTS IT WITH THE ALVEOLAR BONE CONTINUOUS WITH THE CONNECTIVE TISSUE FIBERS OF GINGIVA. FROM ALVEOLAR BONE TO THE CEMENTUM SHARPEY’S FIBERS (CONNECT CEMENTUM TO ALVEOLAR BONE) 5 PRINCIPAL FIBER GROUPS (A) Transseptal gingival fiber group (not ligament), (B) Alveolar crest, (C) Horizontal, (D) Oblique, (E) Apical, and (F) Interradicular 20 FUNCTIONS OF PDL PHYSICAL ATTACHMENT OF THE TOOTH (CEMENTUM) TO THE ALVEOLAR BONE ABSORPTION OF THE IMPACT OF OCCLUSAL FORCES 21 FUNCTIONS OF PDL FORMATION AND RESORPTION OF CEMENTUM AND BONE SENSORY FUNCTIONS NUTRITIVE AND METABOLIC TRANSPORT 22  CLINICAL FEATURES OF PDL THICKNESS VARIES FROM 0.05 TO 0.25MM (MEAN 0.2 MM) THICKEST IN APICAL REGION Widening of PDL 23  CLINICAL FEATURES OF PDL REMODELING LIGAMENT BY FORMATION OF NEW COLLAGEN (FIBROBLASTS), AND RESORPTION OF OLDER COLLAGEN (FIBROCLASTS), AND RESORPTION OF ADJACENT BONE (OSTEOCLASTS) WHEN ALTERED FORCES ARE APPLIED (E.G. ORTHODONTICS) Widening of PDL 24 CEMENTUM CALCIFIED MESENCHYMAL TISSUE THAT COVERS THE SURFACE OF THE ROOT FUNCTION: ATTACH THE FIBERS OF PERIODONTAL LIGAMENT TO THE TOOTH NO BLOOD OR LYMPH VESSELS, AND NERVE IT CONTINUOUSLY DEPOSITED THROUGHOUT LIFE (SECONDARY CEMENTUM) MADE UP BY HYDROXYAPATITE (ABOUT 50%) 25 COMPONENTS OF ALVEOLAR PROCESS ALVEOLAR BONE PROPER THIN LAYER OF INNER ALVEOLI WALL, PERFORATION FOR VASCULAR SYSTEM IDENTIFIED AS LAMINA DURA ON RADIOGRAPH BUNDLE BONE ADJACENT TO THE PDL CONTAINS SHARPEY’S FIBERS (LINING THE ALVEOLUS) 26 COMPONENTS OF ALVEOLAR PROCESS ALVEOLAR CREST CORONAL RIM OF THE ALVEOLAR BONE CORTICAL PLATES SUPPORTS ALVEOLAR PROPER CANCELLOUS TRABECULAR BONE BETWEEN THE CORTICAL PLATES AND ALVEOLAR BONE PROPER 27  FEATURES OF ALVEOLAR PROCESS SUPPORTS THE TOOTH SOCKETS (ALVEOLI). ALVEOLI APPEARS AS LAMINA DURA ON THE RADIOGRAPHS. (RADIOPACITY) ALVEOLAR CREST FOLLOWS PALLAREL TO THE CEJ, 0.5-2 MM APICAL TO CEJ AND 0.5 TO 1.5 MM APICAL TO THE JUNCTIONAL EPITHELIAL. 28  FEATURES OF ALVEOLAR PROCESS THICKER CORTICAL PLATES ON MANDIBULE THAN MAXILLA. THICKER ON POSTERIOR AREAS THINNER ON ANTERIOR AREAS COVERED BY PERIOSTEUM (CONNECTIVE TISSUE OUTER SIDE OF ALVEOLAR PROCESS) AND ENDOSTEUM (CONNECTIVE TISSUE INNER SURFACE OF ALVEOLAR PROCESS) 29  BLOOD SUPPLY TO THE PERIODONTIUM ORIGINATES FROM INFERIOR AND SUPERIOR ALVEOLAR ARTERIES THERE ARE 3 SOURCES 1. INTERDENTAL ALVEOLAR ARTERIOLE 2. SUPRAPERIOSTEAL ARTERIOLE 3. VESSELS OF PERIODONTAL LIGAMENT NUMEROUS GINGIVAL PLEXUS (ANASTOMOSES) EXISTS IN THE GINGIVA 30 NERVE SUPPLY AND LYMPHATIC DRAINAGE OF THE PERIODONTIUM FOLLOWS PATHWAYS SIMILAR TO THOSE OF THE VESSELS THAT SUPPLY BLOOD TO THE PERIODONTIUM. NERVE SUPPLY DERIVED FROM BRANCHES OF TRIGEMINAL NERVE (SENSORY NERVE) NERVE BRANCHES TERMINATE IN PERIODONTAL LIGAMENT, SURFACE ALVEOLAR BONE AND WITHIN GINGIVAL CONNECTIVE TISSUE FOR PAIN AND PRESSURE. 31  SUPRACRESTAL TISSUE ATTACHMENT (REPLACED THE TERM: BIOLOGIC WIDTH) THE CONNECTIVE TISSUE ATTACHMENT OCCUPIES 1.07 MM OF SPACE ABOVE THE CREST OF THE ALVEOLAR BONE. THE JUNCTIONAL EPITHELIUM ATTACHMENT BELOW THE BASE OF THE GINGIVAL SULCUS OCCUPIES ANOTHER 0.97MM OF SPACE ABOVE THE CONNECTIVE TISSUE ATTACHMENT. THE COMBINATION OF THESE TWO MEASUREMENTS IS CALLED SUPRACRESTAL TISSUE ATTACHMENT* ~2.04 MM (AVERAGE). * The 2017 AAP/EFP World Workshop recommended the term IT CAN RANGES FROM 0.75 Supracrestal Tissue Attachment to replace the term Biologic MM TO 4.3 MM Width 32 "SUCCESS IS NOT FINAL, FAILURE IS NOT FATAL: IT IS THE COURAGE TO CONTINUE THAT COUNTS." — WINSTON CHURCHILL 33 34