Attachment Apparatus (Part I)

Periodontal Ligament
Dr. Sunaina Shetty
BDS, MDS, Ph.D., MFDS RCPS (Glasgow)
Learning Objectives
End the end of the lecture student should be able
➢ To understand the normal anatomy of Attachment Apparatus
( Periodontal Ligament, alveolar bone & Cementum).
➢ To enumerate the normal Function of each part.
➢ To understand the pathology in each part to distinguish it from
normal physiology of the attachment apparatus.
Periodontium
Periodontium
The periodontium includes:
The gingiva
The gingival attachment
Cementum
Periodontal ligament
Alveolar bone
PERIODONTAL LIGAMENT
•Periodontal ligament is composed of a complex vascular & highly
cellular connective tissue that surrounds the tooth root &connects it to
the inner wall of alveolar bone.

•Continuous with connective tissue of gingiva & communicates with the

marrow spaces through vascular channels in the bone.

• Average width is 0.2mm.

• The ligament has an hourglass
shape; it’s narrowest aspect at the
middle third of the root.
On X-ray--- it appears
as a radiolucent line
surrounding the root
Composition
1. Fibers
2. Cellular elements
3. Ground substance
Composition

PDL

Extracellular
Cells
substances

Progenitor Differentiated Ground

others Fibers
cells cells substances

Resorptive
Synthetic cells
cells
Mature PDL can be subdivided into:-

1.A bone-related region – rich in cells and blood vessels.

2.A cementum-related region - characterized by dense well-ordered
collagen bundles.
3.A middle zone – containing fewer cells and thinner collagen fibrils.
Cellular Elements
• Four type of cells have been identified in the
periodontal ligament :
•Connectivetissue cells
• Epithelialrest cells
• Immune system cells
•Cells associatedwith neurovascular elements
 1. Synthetic Cells

a) Osteoblasts
b) Fibroblasts
c) Cementoblasts
2. Resorptive Cells
a) Osteoclasts
b) Cementoclasts
c) Fibroblasts
ConnectiveTissue Cells:
Includes fibroblasts, cementoblasts , and osteoblasts.
Fibroblasts synthesize collagen and degrade old collagen fibers.
Osteoblasts, cementoblasts, cementoclast and osteoclasts are also seen in
the cemental and osseous surfaces of the periodontal ligament
Defense Cells
Include neutrophils, lymphocytes, macrophages,mast cells
and eosinophils
Ground Substance

•The periodontal ligament also contains a large proportion of ground

substance that fills the space between the fibers and cells.

•It consists of two main components: glycosaminoglycans, and

glycoproteins .

•It may have calcified masses called Cementicles, which are adherent
or detached from the root surfaces.
 CEMENTICLES
• Calcified bodies.
• Older individuals.
• Free, attached or embedded.
• Degenerated epithelial cells as nidus.

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• Binds the tissues & fluids.
• Major substance that fills the space between cells,
fibers, nerves & blood vessels.
• Consists of

Proteoglycans Glycoproteins

Hyaluronic acid Fibronectin

Proteodermatan Tenascin
sulphate Laminin
• Most abundant cells.
• Derived from estomesenchyme of dental follicle & dental
papilla.
• Fusiform in shape,motile & contratile.
• RER to golgi apparatus via
secretory vescicles(Grant 1981)
• Transit time.(Tencate).
• Junctions present are macular
adherens & gap junctions type.
I. Synthesis & degradation.
II. Osteoblast like fibroblasts.
III. Prevent encroachment of bone & cementum.
IV. Adaptive responses to mechanical loading.
V. High rate of turnover proteins.
• Remanats of hetwigs epithelium
root sheath.

• Exhibits tonofilaments & atttached

to each other by desmosomes.

• Found on mesial surface of molars

more & their number tends to
decrease with age
•.
• Can produce cysts & tumors.
• Collagen & oxytalan fibers.
❖ COLLAGEN FIBERS
▪ Glycine, proline, hydroxylysin, hydroxyproline.
▪ Type I(70%), Type III(20%)
▪ Fibroblast tropocollagen microfibrils fibrils Fiber.
▪ Each bulble resmbles rope.
▪ More in cementum.
▪ Follow a wavy course.
▪ Principle fibers – Type I
Reticular fibers – Type II
• TRANSEPTAL FIBERS:
I.Over alveolar bone.
II.Reconstructed even after destruction of alveolar bone.
III.May be considered as gingival fibers.

• ALVEOLAR CREST:
I.Prevent extrusion.
II.Resist lateral tooth movement.

• HORIZONTAL:
I.Extent along right angles.
• OBLIQUE:
I.Largest group.

• APICAL:
I.Irregularly arranged
II.Not formed in incompletely formed root.

• INTER – RADICULAR GROUP

I.Found in multirooted teeth, forming crest
of interradicular septum.
 INTERMEDIATE PLEXUS
• Separate tooth related & bone related fibers intercalate in the middle to form
intermediate plexus.
• Intermediate zone where fibers intermesh. This area showed high metabolic
activity
• PDL contains alveolar fibers, dental fibers & an intermediate plexus
• Fibers run across the whole width & give a branch to join with neighboring
fibers to form 3D complex network.
• Seen in longitudinal section &not in transverse section.
OXYTALAN FIBERS

• Immature elastic fibers, attached to cementum.

• Cervical region follow coarse of gingival &
transeptal fibers, but in PDL proper crosses'
oblique
fiber perpendicularly.
• Terminates in apical complex of arteries, veins
& lymphatics.
• May also be associated with neural elements.
• Support blood vessels.
PHYSICAL FUNCTIONS:
1. Soft tissue casing
2. Transmission of occlusal forces.
3. Attachment of teeth to bone.
4. Maintenance of gingival tissues.
5. Shock absorption.

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 SHOCK ABSORPTION

1.Tensional Theory:-The principal fibers of the PDL bear the major

responsibility in supporting the tooth and transmitting forces to the bone.

2.Viscoelastic system theory:-The displacement of the tooth to be largely

controlled by fluid movements, with fibers having only a secondary role.

3.Thixotropic theory :- Periodontal ligament has the rheologic behavior of a

thixotropic gel (i.e., the property of becoming fluid when shaken/stirred and
then becoming semisolid again)
 39

Abier.Ab. 10/11/20
 Transmission of occlusal forces to the bone

• The arrangement of the principal fibers is like a suspension bridge or

hammock.
• When an axial force is applied to a tooth, a tendency towards displacement
of the root into the alveolus occurs.
• The oblique fibers alter their wavy, untensed pattern; assume their full
length; and sustain the major part of the axial force.
• But when the horizontal or tipping force is applied, two phases of tooth
movement occur.
• One is within the confines of the periodontal ligament, and the other
produces a displacement of the facial and lingual bony plates. The tooth
rotates about an axis that may change as the force is increased.
 FORMATIVE AND REMODELING FUNCTION
• Human PDL has a rapid turnover and high remodeling capacity.

• Turnover and remodeling in PDL involve rapid synthesis and breakdown of

collagenous meshwork.

• Remodelling in intermediate plexus(Sicher 1942)

• Throughout PDL(Beersten 1977, Ripin 1976)

• Because collagen in PDL appears to form a complex meshwork, breakdown

processes can occur at different sites without compromising tissue integrity.
 NUTRITIONAL AND SENSORY FUNCTION

• Provides anabolites & remove catabolites.

• Supplied with sensory nerve fibers capable of transmitting tactile,

pressure and pain sensations by the trigeminal pathway.

• Proprioceptive mechanisms.
1. Blood vessels
2. Lymphatics
3. Nerves
4. Cementicles
BLOOD VESSELS
• Main supply is by superior & inferior alveolar arteries.
• Also by
I.Apical vessels
II.Transalveolar vessels
III.Gingival vessels
• Presence of fenestrations in capillaries for diffusion/filteration.
• Venous drainage accompanys arterial supply.
 PDL INNERVATION

10/11/20 Abier.Ab.
FEATURES OF BLOOD SUPPLY
• Increases from incisors to the molars
• Is greatest in the gingival third of a single-rooted teeth, less in the apical
third and least in the middle third.
• Is equal in apical and middle thirds of multirooted teeth
• Is slightly greater on mesial and distal surfaces than on the facial and
lingual.
• Is greater on mesial surfaces of mandibular molars than on the distal.
• Blood vessels are in greater no. in mandibular than in maxillary teeth.
 NERVE SUPPLY
• Sensory & autonomic.
• Sensory with nociception & mechanoreception.
• Autonomic with supply to blood vessels.
• Root apex & opening through alveolar walls
• Myelinated & nonmylinated.
• Myelinated for touch & nonmylinated for pain perception &
autonomic.
• Apical region more.
 ⚫ The periodontal ligament is abundantly supplied with
sensory nerve fibers that are capable of transmitting
tactile, pressure, and pain sensations via the
trigeminal pathways.
⚫ Nerve bundles pass into the periodontal ligament
from the periapical area and through channels from
the alveolar bone that follow the course of the blood
vessels.

Abier.Ab. 10/11/20
 ⚫ Nerves register pressure, touch,
temperature, pain
⚫ PDL can register pain and pressure

Abier.Ab. 10/11/20
1. Clinical Periodontology 10th edition. F.A. Carranza, M.G. Newman
2. Clinical Periodontology and Implant Dentistry, 5TH edition. Jan Lindhe, Thorkild Karring, Niklaus P.
Lang.
3. Development and general structures of the periodontium- Periodontol 2000;24,2000;9-22.
4. Oral Anatomy, Histology and Embryology.3rd edition. B.K.B. Berkovitz, G.R. Holland, B.J. Moxham.
5. periodontics medicine, surgery, & implants: Rose & Mealey
6. Tencate’s Oral histology, Development, Structure and function. 6th edition.
7. The PDL : a unique, multifunctional connective tissue. Periodontol 2000;Vol. 13:1997;20-40.
8. Role of physical forces in regulating the form and function of the periodontal ligament. Periodontol
2000;Vol. 24,2000:56-72.