VASCULARIZATION AND INNERVATION OF THE MARGINAL

PERIODONTIUM

Blood vessels

The blood supply of the supporting structures of the tooth is made through the lower alveolar artery
and its branches: the mental, sublingual, buccal and facial arteries. In the maxilla, the superior, anterior,
and posterior alveolar arteries, the infraorbital artery, and the palatine artery send collaterals that, like
in the mandible, through anastomoses, form the subalveolar plexus and the interalveolar network (or

plexus).
The subalveolar plexus represents the source of the ascending periodontal or longitudinal intraseptic
arterioles (among others: dental, pulpal), which have an arched path near the apex and ascending in the

desmodontium.

The interalveolar plexus located in the interdental septa sends oblique and transverse branches that
perforate the lamina cribriforma (hence its name) and by anastomosis with the ascending periodontal
arterioles form the periodontal vascular plexus.

In the coronally portion of the dento-alveolar space, the periodontal plexus joins, by fewer anastomosis,
with the gingival vascular network of the cervico-gingival plexus.

In the horizontal section, the branches of the periodontal plexus have a radial appearance. In the vertical
section they form a longitudinal plexus with numerous branches, which gives it a denticular appearance,
lower in density in the terminal, gingival portion.

The gingiva is vascularized from three sources:

- periosteal plexus;

- intraalveolar plexus;

- periodontal plexus.

Arterioles in the interalveolar plexus pass through the external cortex of the alveolar bone and reach
the gingiva through arched and tangential branches to the surface of the alveolar ridge.

These main vessels send terminal arterioles to the mucosa, with a "palisade" (fence) arrangement. The
terminal arterioles divide into capillaries, which irrigate the papillae of the connective tissue to below
the basal lamina, which separates it from the epithelium.

Vascularization of the gingiva has distinct features, highlighted on a vertical section:

- the external ridge, towards the free gingival margin, contains an arterial plexus, formed by thick
branches, anastomosed between them and from which parallel branches detach, which penetrate in the
axis of the papillae of the connective tissue until near the epithelium; here they have an arched, slightly
undulating subepithelial trajectory;

- the internal ridge, towards the tooth and the junctional epithelium presents a cervico-gingival plexus
following the periodontal plexus.
Peculiarities of the vascularization of the marginal periodontium:

- the existence of nervous conjunctiva-vascular systems

consisting of arterioles and venules, capillaries, lymphatics
and myelinated nerves,

- the terminal arterioles have a thin muscular tunic and

the axon-myoblast contacts are numerous for all muscle
cells

- vessels in the marginal periodontium have numerous

arterio-venous anastomoses in the form of vessels with a
sinuous trajectory, sometimes particularly complicated

- the vascular network of the marginal periodontium is

well represented and despite its "terminal" character, it
ensures a good vascularisation in the periodontal territory
even when some vessels are blocked or surgically
sectioned

Arterio-venous anastomotic segments often have the

appearance of an intermediate canal with a lumen two to
three times larger than that of the afferent arteriole,
which allows an efficient bypass between the arteriolar
and venular sector.

Lymphatic circulation

Lymph is an intercellular fluid that is collected by capillary lymphatic vessels through a dynamic, active
process. Along the route of the lymph vessels there are lymph nodes with a role in the process of
immune defense against various infections.

The lymphatic vessels in the gingival connective tissue (papillae, free gingival margin and attached
gingiva) penetrate between the supraalveolar ligaments and spread in a fine network on the surface of
the cementum and among the fibers of the periodontal ligament in the desmodontium being located
next to the blood vessels. At the level of the apex there are lymphatic vessels from the dental pulp
which then cross the medullary spaces of the bone towards the mandibular and infraorbital canal. The
lymphatic vessels leave the maxillary bones at the level of the chin or the infraorbital orifice.

Capillary lymphatic vessels differ from blood capillaries by:

- lack of red blood cells in the lumen;

- the absence of the basal lamina around the vessels;

- endothelium with intercellular interruptions;

- the presence of valves in the lumen (LISTGARTEN).

The route of the lymph vessels is generally parallel to that of the blood vessels and passes through the
lymph nodes before re-entering the bloodstream.

Lymph drainage is done as follows:

- from the jaw of the jaw to the deep cervical ganglia;

- from the mandibular gingiva to the submental, subangulomandibular and cervical ganglia.

Desmodontal lymphatic vessels drain lymph in the same lymph nodes

The innervation of the marginal periodontium

The afferent and efferent nerve filaments, the sensitive and sensory formations of the marginal
periodontium usually follow the path of the vessels, with which they form neural complexes, guided and
supported by bundles of connective tissue.

The gingiva of the maxillary bone is innervated by the anterior, middle and posterior superior alveolar
nerves, branches of the infraorbital nerve, the great palatine nerve (posterior), the nasopalatine nerves.

The gingiva of the mandibular bone is innervated by the buccal nerve, the mental nerve on the facial
side and the sublingual nerve on the lingual side.

The terminal branches of the lower alveolar nerve provide sensitive innervation. Nerve fibers enter the
desmodontium through the periapical area and through the orifices of the dura mater; after losing the
myelin sheath, it ends in four types of formations:

- free nerve endings of non-myelinated nerve fibers that

specialize in receiving painful stimuli;

- fusiform nerve endings surrounded by a fibrous capsule,

located mainly at the apex;

- RUFFINI and KRAUSE corpuscles, located mainly in the apical

area;

- wavy, spiral nerve endings in the middle region of the

desmodontium.