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CONTENT DEVELOPMENT OF PERIODONTAL LIGAMENT

 Introduction
 Definition
 Shape
 Cellular and Extracellular components
 Principal fibers
 Functions
 Neurovascular supply and Lymphatic
drainage
 Theories of tooth support
 Age changes
 Clinical considerations • ABP-Alveolar Bone Proper
 Science Transfer • PL-Periodontal Ligament
• RC-Root Cementum
INTRODUCTION
 The normal periodontium provides the
support necessary to maintain teeth in
function.
 It consists of three principal supporting
components: periodontal ligament,
cementum , and alveolar bone.  Immediately after tooth erruption,
DEFINITION fibroblasts alligned obliquely along the
 The periodontal ligament is long axis of the tooth, form alveolar
composed of a complex vascular and crestal fibers [at coronal third]
highly cellular connective tissue that  At first occlusal contact-horizontal
surrounds the tooth root and connects group form at coronal third.
it to the inner wall of the alveolar  At defnite occlusion, maturation of
bone. oblique fiber bundles occur.
 This later develops into the apical fiber
group with completion of root formation.
 Thus, the defnitive PDL
architecture is established.
PERIDONTAL LIGAMENT
 Principal fibers of the periodontal
ligament follow a wavy course when
 The periodontal ligament space has sectioned longitudinally
the shape of an hour glass and is
narrowest at the mid root level axis of
rotation.
 The width of the periodontal ligament
is approximately 0.25
mm (range 0.2–0.4 mm)  Appears on radiographs as radiolucent
 Progressive decrease in thickness area of 0.4-1.5mm between radioopaque
with age lamina dura of alveolar bone and
cementum

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CELLULAR AND EXTRACELLULAR 4. Appear cluster-like ducts with cells

COMPONENTS separated from surrounding connective
CELLULAR COMPONENTS tissue by basal lamina.
 Formative cells 5. Cuboidal cells with prominent nuclei.
 Resorptive cells 6. These cells may undergo calcification to
 Progenitor cells become CEMENTICLES.
 Epithelial cells PROGENITOR CELLS
 Immune system cells 1. Undergo mitotic division when
 Cells associated with neurovascular stimulated by orthodontic movement or
elements wounds.
EXTRACELLULAR COMPONENTS 2. Located in vicinity of blood vessels.
 Fibers 3. Capable of sustained renewal and tissue
 Collagen regeneration; repair and differentiation.
○ Principal group
○ Secondary group
 Elastic
○ Oxytalan
○ Elaunin IMMUNE SYSTEM CELLS
 Ground substance  Neutrophils
○ Glycosamino glycans  Lymphocytes
○ Proteoglycans  Macrophages
○ Glycoproteins-fibronectin,laminin.  Mast cells
70%water  Eosinophils
FORMATIVE CELLS COLLAGEN
 Fibroblasts  Synthesized by fibroblasts, osteoblasts,
 Osteoblasts odontoblasts.
 Cementoblasts ○ 5µm diameter bundles form
RESORPTIVE CELLS principle fibers
 Fibroblasts ○ Subunits are called collagen fibrils
 Osteoclasts have transverse striations with
 Cementoclasts periodicity of 64 nm.
EPITHELIAL CELLS ○ Mainly composed of type I-70%
 Remanents of Hertwig Epithelial Root ○ Second most common type III-20%
Sheath ○ Type V and type VI- small amounts.
○ Type IV maintains integrity and
elasticity of extracellular matrix
○ both type IV and type VII associated
with epithelial rests and blood
vessels.
○ Type XII collagen occurs only when
EPITHELIAL RESTS OF MALASSEZ
ligament is fully functional.
1. PDL cells found close to cementum
COLLAGEN FIBER
(Malassez in 1884).
2. Remanents of Hertwig’s epithelial
root sheath.
3. Abundant in furcation area and apical
and cervical area. PRINCIPAL FIBERS
 Transseptal
 Horizontal
 Apical
 Alveolar crestal
 Oblique

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  Oblique

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PRINCIPAL FIBERS  Indifferent fiber plexus-small

 Interradicular collagen fibers associated with
principal fibers
FUNCTIONS OF PERIODONTAL
LIGAMENT
1. Physical
2. Formative and Remodelling
3. Nutritional and Sensory
TRANSSEPTAL GROUP 4. Regulation of periodontal
 Transseptal fibers extend ligament width
interproximally over the alveolar bone NUTRITIONAL AND SENSORY
crest and are embedded in the FUNCTIONS
cementum of adjacent teeth  The periodontal ligament
ALVEOLAR CREST GROUP supplies nutrients to the
 extend obliquely from cementum just cementum, bone, and gingiva by
beneath junctional epithelium to way of the blood vessels and
alveolar crest . also provides lymphatic
 run from cementum over alveolar drainage.
crest to fibrous layer of periosteum BLOOD SUPPLY OF THE
covering alveolar bone. PERIODONTIUM
 Prevents extrusion of tooth  blood supply derived from the
 Resists lateral tooth movement inferior and superior alveolar
HORIZONTAL GROUP arteries to mandible and
 Horizontal fibers extend at right angles maxilla, and reaches periodontal
to the long axis of the tooth from ligament from three sources
cementum to alveolar bone ○ apical vessels
 Resists tipping forces ○ penetrating vessels from
 Prevents lateral movements the alveolar bone
OBLIQUE GROUP ○ anastomosing vessels
 largest group, extend from cementum from the gingiva
in a coronal direction obliquely to bone
 bear brunt of vertical masticatory
stresses and transform them into
tension on alveolar bone.
APICAL GROUP
 radiate in a irregular manner from
cementum to bone at apical region of
socket. LYMPHATIC SYSTEM OF THE
 do not occur on incompletely formed PERIODONTIUM
roots.  The palatal gingivaof maxilla
 Resists tipping forces and luxation. drains to deep cervical
 Protects blood vessels and nerves. lymph nodes
INTERRADICULAR GROUP  Except for third molars
 fan out from cementum to tooth in and mandibular incisors, all
furcation areas of multirooted teeth teeth with their adjacent
 Resists tipping, torquing and luxation periodontal tissues are drain to
PRINCIPAL FIBERS submandibular lymph nodes
 Located between Principal fibers  The third molarsdrain to
 located coronoapically. the jugulodigastric lymph
 Elastin fibers nodes and mandibular incisors
○ Oxytalan to submental lymph nodes.
Elaunin

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○ Elaunin

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LYMPHATIC SYSTEM OF THE
PERIODONTIUM
NERVE SUPPLY OF THE PERIODONTIUM
 Superior and Inferior alveolar nerves-
branches of Trigeminal nerve.
 Nerves pass through the apical
foramen to enter PDL
 Finer branches enter middle and
cervical portions through alveolar
bone.
 They provide sense of touch, pressure,
pain and proprioception during
mastication.
REGULATION OF PERIODONTAL LIGAMENT
WIDTH
 adaptability to rapidly changing applied
force and capacity to maintain its
width at constant dimensions lifetime.
 ability of periodontal ligament cells to
synthesize and secrete a wide range of
regulatory molecules
THEORIES PERTAINING TO MECHANISM
OF TOOTH SUPPORT
TENSIONAL THEORY
 force applied to crown cause principal
fibres first unfold and straighten and
then transmit forces to the alveolar
bone →an elastic deformation of bony
socket.
VISCO ELASTIC THEORY
Proposed by Bien.S.M.,1966 and Birn.H.1966.
displacement of the tooth is largely
controlled by fluid movements with fibres
have only a secondary role.
forces →extracellular fluid passes from pdl
into marrow spaces of bone through
foramina in cribriform plate→fibre bundles
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absorb shock and tighten→blood vessel
stenosis .
 Arterial back pressure causes ballooning
of vessels and passage of blood ultra
filtrate into tissues replenishing tissue
fluids.
THIXOTROPHIC THEORY
 Pdl behaves like a thixotrophic material -
a collagenous gel and that fibres are only
artefacts.
AGE CHANGES IN PERIODONTAL LIGAMENT
 With aging activity of PDL tissue
decreases→ restricted diets and
therefore normal functional stimulation of
tissue is diminished.
 In non functional teeth PDL width starts to
decrease.
 loss of gingival height related to gingival
and periodontal disease promotes
destructive changes in PDL.
CLINICAL CONSIDERATIONS
 primary role support the tooth in the bony
socket.
 thickness varies .
 thinnest in middle region of root →fulcrum
of physiological movement.
 thin in functionless and embedded teeth
 wide in teeth under excessive occlussal
stresses.
 The supporting tissuesof a
tooth long out of function
require time to become adapted to new
functional demands
 In acute trauma, accidental
blows, rapid mechanical separations
may produce fractures or resorption of
cementum, tears of fibre bundles,
hemorrhage, and necrosis → adjacent
alveolar bone is resorbed, periodontal
ligament is widened and tooth becomes
loose.
 In orthodontic tooth movement within
physiological limits
○ initial compression on pressure side
is compensated by bone resorption,
○ on tension side bone apposition
occurs,
○ large forces results in necrosis of
periodontal ligament and alveolar
bone.
foramina in cribriform plate→fibre bundles

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CLINICAL CONSIDERATIONS 4. William Giannobile ,Pamela Robey

 The periodontal ligament in periapical Periodontal Disease: Engineering the
area is often site of periapical Future of Care (National Institute for
granuloma which proliferates to Craniofacial Research).
produce a cyst-common pathological 5. Dangaria SJ, Ito Y, Luan X, Diekwisch TG.
lesion. Stem Cells Dev. Successful Periodontal
 The commonest pathology is chronic Ligament Regeneration by Periodontal
inflammatory periodontal disease. The Progenitor Preseeding on Natural Tooth
toxins released from bacteria in dental Root Surfaces.2011 Oct;20(10):1659-68. doi:
plaque and metabolites of the host’s 10.1089/scd.2010.0431. Epub 2011 Mar 9.
defence mechanism destroy the PDL 6. J Han,D Menicanin,S Gronthos,PM Bartold
and adjacent bone leading to tooth Stem cells, tissue engineering and
mobility and loss. periodontal regenerationJun;59 Suppl .
 Surgical techniques like Guided Tissue 2011 Oct; 20(10): 1659–1668. Aust Dent J.
Regeneration are being used for 2014
correction for PDL destruction.
 More recently tissue engineering
principles used with biological
principles like gene therapy, use of
bio- compatible scaffolds (with growth
factors) offer an alternative to existing
therapy.
 The use of progenitors cells or the
mesenchymal stem cells to
regenerate the PDL is being thought of
by the activation of the mesenchymal
stem cells towards terminal
differentiation, tissue repair and
degeneration.
SCIENCE TRANSFER
 The four research areas that hold the
key to a future of periodontal tissue
engineering and regenerative medicine

References
1. CARANZA’S CLINICAL
PERIODONTOLOGY 11th EDITION
2. CLINICAL PERIODONTOLOGY AND
IMPLANT DENTISTRY 5TH EDITION ,
JAN LINDHE
3. Orban’s Oral Histology And Embryology
12th edition

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