Periodontics

Lec.1 ‫ بيداء الالمي‬.‫د‬

Periodontics: That branch of dentistry that deals with diagnosis and
treatment of diseases and condition of the supporting and surrounding
tissues of the teeth or their implanted substitutes.

Periodontology: The scientific study of the periodontium in health and

disease.

Periodontium:Is the tissue that invest and support the teeth.It is a Latin
term (Pert= around, odontos= tooth). Periodontium comprises the
following tissues:
1- The gingiva.
2- The periodontal ligament.
3- The root cementum.
4- The alveolar bone.
The main function of periodontium is to
attach the tooth to the bone tissue of the jaws
and to maintain the integrity of the surface of
masticatory mucosa of the oral cavity.
The periodontium is also called:
1) The attachment apparatus.
2) The supporting tissues of the teeth.

The gingiva:
The gingiva is defined as the part of the oral mucosa that covers the
alveolar processes of the jaws and surrounds the necks of the teeth.
The oral mucosa consists of three zones;
1) The gingiva and the covering of the hard palate termed (the
masticatory mucosa).
2) The dorsum of the tongue, covered by (specialized mucosa).
3) The oral mucous membrane lining the remainder of the oral cavity.

Macroscopical anatomy:
In the coronal
direction the coral pink
gingiva terminates in the
(free gingival margin)
which has a scalloped
outline. In the apical
direction the gingiva is
continuous with the loose,
darker red alveolar
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mucosa (lining mucosa) from which the gingiva is separated by a border
line called mucogingival junction or line.
 There is no mucogingival line in the palate since the hard palate
and the maxillary alveolar process are covered by the same type of
masticatory mucosa.
The gingiva is divided into 2 parts:
1) The free gingiva (FG).
2) The attached
gingiva (AG).
The Free gingiva: Is
coral pink, has a dull
surface and firm
consistency and
comprises the gingival
tissue at the vestibular
and lingual/ palatal
aspects of the teeth, and
the interdental gingiva
or papillae.
FG extends from
the gingival margin apically to the (free gingival groove) which is
positioned at a level corresponding to the level of cementoenamel
junction (CEJ).
The FG margin is rounded, and forms a sulcus between the tooth
and the gingiva. In clinically healthy gingiva, it is in close contact with
enamel so there is no gingival pocket or crevice (but it’s artificially
opened by periodontal probe during examination).
After complete eruption of tooth, the FG margin is located on the
enamel surface approximately 0.5-2 mm coronal to the CEJ.
Gingival Sulcus The gingival sulcus is the shallow crevice or space
around the tooth bounded by the surface of the tooth on one side and the
epithelium lining the free margin of the gingiva on the other side.

The attached gingiva:

Extends from free gingival groove in coronal direction to
mucogingival junction apically where it becomes continuous with the
alveolar (lining mucosa) (AM).
It’s firm, coral pink and often shows a fine surface stippling giving
it the appearance of orange peel. Stippling is only present in 40% of
adults. Attached gingiva is firmly attached to the underlying alveolar
bone and cementum by connective tissue fibers so it’s immobile in
relation to the underlying tissue.
Interdental papillae(I.D.P):Is that portion of gingiva that fills the
interproximal space between adjacent teeth.
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 It is determined by:
1) The contact relationships between the teeth.
2) The width of approximal surfaces.
3) The course of the CEJ.
In anterior regions of dentition the I.D.P. is of pyramidal form
while in the molar regions they are flattened in buccolingual direction.
In premolar
and molar regions
the teeth have
contact surfaces
rather than contact
points so the I.D.P.
has a shape in
conformity with the
contact surfaces, so concavity is (col region) is established in the
premolar and molar separating the I.D.P. in one vestibular and one
lingual/palatal portion.

The width of the gingiva:

In the maxilla the vest. gingiva is widest in incisors area and
narrowest in premolar area.
In the mandible (lingual aspect) the gingiva is narrow in the incisor
area and wide in the molar region. The range of variation is 1-9 mm.
The width of the gingiva tends to increase with age since the MGJ
remains stable throughout the life in relation to the lower border of the
mandible, the increasing width of the gingiva may suggest that the teeth,
as a result of occlusal wear, the teeth slowly erupt through out the life.
Microscopic anatomy:
The gingival epithelium is stratified squamous epithelium which is
supported by fibrous connective tissue which is called lamina properia.
The epithelium covering the gingiva may be differentiated as
follows:
1) Oral epith.
which faces the
oral cavity.
2) Oral sulcular
epi. which faces
the tooth without
touching it.
3) Junctional epi.
which provides
the contact
between the

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 gingiva and the tooth surface.
The boundary between the oral epithelium (OE) and the underlying
connective tissue (C.T.) has a wavy course. The C.T. portions project into
the epi. are called C.T. papillae and are separated from each other by
epithelial ridges- so- called rete pegs.

In normal non-inflamed gingiva, rete pegs and C.T. papillae are lacking at
the boundary between J.E. and its underlying C.T. So that, a characteristic
feature of the O.E. and the O.S.E. is the presence of rete pegs, while these
structures are lacking in
J.E.
The oral epi. is a
keratinized stratified,
squamous epi. can be
divided into the following:
1) Stratum basale: basal
layer of cuboidal cells along
the basement membrane.
This is where epithelial cell
replication and
differentiation begins.
Melanocytes are found in this layer

2) Stratum spinosum: the cells appear to have cytoplasmic spines. This is

the thickest cell layer and Langerhans cells are found in this layer.

3) Stratum granulosum: keratohyaline granules may be seen in this

layer. Cells appear to be flattened

4) Stratum corneum: this is the layer where both para and

orthokeratinization occur. It is the most superficial layer.

The epithelial cells are formed as basal cells and gradually they undergo
the process of keratinization, this is achieved by proliferation and
differentiation of these cells as they migrate toward the surface layer

In the outer cell layers the nuclei are lacking. Such an epi. is called
(orthokeratinized), but often the cells of st. corneum of human
masticatory mucosa contain remnants of nuclei and in such a case the epi.
is denoted parakeratinized.

Other cells of OE:

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In addition to previously mentioned keratin producing cells which
comprise about 90% of total cells population there are three types of cells
1) Melanocytes: pigment producing cells.
2) Langerhans cells: play a role in defense mechanism.
3) Merkel cells: located in the deeper layers of the epithelium, harbor
nerve endings. They have been identified as tactile receptors.
All the 3 types of cells are stellate and lighter in color than keratinocytes
so they are called (clear cells).
Under normal conditions there is complete equilibrium between cell
renewal and desquamation (cell turn over). It takes approximately 3-4
weeks for keratinocytes to migrate from basal layer until reach the outer
epithelium surface, where it becomes desquamated from stratum
corneum. The basal cells are found immediately adjacent to the
connective tissue and are separated from this tissue by a basement
membrane (basal lamina).
The basement membrane consists of:
1. Lamina lucida: which is located immediately beneath the basal
layer?
2. Lamina densa: located beneath the lamina lucida, from this
structure the anchoring fibers project into the connective tissue.

The epithelial cells are attached to each other by numerous desmosomes

(pairs of hemidesmosomes), and the basal layer is attached to the
underlying basement membrane also by hemidesmosomes. The presence
of large number of desmosomes indicates that the adhesion between the
epithelial cells is solid.

The composition of desmosomes:

A desmosome consists of two
adjoining hemidesmosomes separated by
a zone containing electron-dense
granulated material (GM), and a
hemidesmosome comprises the following
structural components:

1) The outer leaflets (OL) of the cell membrane of two adjoining cells.
2) The thick inner leaflets (IL) of the cell membrane.
3) The attachment plaques (AP), which represent granular and
fibrillar material in the cytoplasm.

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