Revision Lecture

Periodontium
 The tissues which invest & support the tooth are
collectively called periodontium

Components:
 2 Mineralized Tissues

- Alveolar Bone
- Cementum
 2 Fibrous Tissues

- Periodontal Ligament
- Lamina propria of Gingiva
Periodontal Ligament
 PDL – Definition
 Synonyms
 Macroscopic features
 Development
 Microscopic features
 Cementicles
 Functions
 Blood & Nerve supply
 Clinical consideration
 It is a fibrous connective tissue that is noticeably
cellular & vascular, which surrounds the tooth
root & anchors it to the bony socket.
 Desmodont

 Gomphosis

 Pericementum

 Dental periosteum

 Alveolar ligament

 Periodontal membrane
 Develops from DENTAL FOLLICLE.

Follicle Cells:
 Cementoblast – Cementum

 Osteoblasts – Bone

 Fibroblast – Fibres & Ground substance of

PDL
 It is a soft fibrous connective tissue

 Interposed between roots of teeth & inner wall of

alveolar socket (Periodontal space)

 It is neither a true ligament or membrane

Width - Variable
- Average: 0.15 – 0.38
- Decreases with age
- Reduced function – Reduced width of ligament
Shape
 “Hour glass” shape

 Narrowest in middle 3rd of root &

widens both apically & near the crest

 PDL

Cells Extracellular substance

 Synthetic cells  Fibers
- Osteoblasts - Collagen (type I,III & XII)
- Cementoblasts - Oxytalan
- Fibroblasts - Elaunin

 Resorptive cells  Ground substances

- Osteoclasts - Proteoglycans
- Cementoclasts - Glycoproteins
- Fibroblasts
 Progenitor cells  Structures present in Connective
tissue
 Epithelial cell rests of malassez - Blood vessels
- Lymphatics
 Connective tissue cells - Nerves
- Mast cells - Cementicles
- Macrophages
Osteoblasts
 Bone-forming cells derived from either multipotent
mesenchymal cell or perivascular cells called
preosteoblasts.
 Cover the periodontal surface of alveolar bone &
constitute a modified endosteum

Functions of Osteoblasts:
 Formation of organic matrix of bone (osteoid)
 Mineralization of matrix
Cementoblasts
Cementum forming cells derived from undifferentiated
ectomesenchymal cells of the dental follicle and they
resemble osteoblasts

 Distributed along cementum surface of PDL

Function:

Formation of cementoid
 Fibroblasts
 Most numerous connective tissue cells
 Plump spindle-shaped or fusiform
 Large cells with extensive cytoplasm containing
abundant cellular organells
 They are oriented parallel to collagen fiber bundles

Function:
Synthesis & degradation of collagen
Osteoclasts
 Multinucleated large cells,
 Approximately 20-100 in diameter
 Found in Howship’s lacunae
 Has brush or ruffled border

Function:
Resorption of bone
Cementoclasts

 Resembles osteoclasts

Function:
Resorbs cementum
 Progenetior cells
 Undifferentiated Mesenchymal Cells that have a capacity to
undergo mitotic division
 They have small close-faced nucleus & little cytoplasm
Undifferentiated Mesenchymal Cells
Daughter cell Daughter cell

Remains undifferentiated
Differentiates into
functional type Progenitor cell

Divides further
Epithelial cell rests of Malassez
 Remnants of HERS

 Found close to cementum

 Persists as a network, strands, islands or tubule like structures

near or parallel to root surface

 Most numerous in apical and cervical areas

 Cells exhibits tonofilaments & are attached to one another by

desmosomes
 They are isolated from the connective tissue cells by
a basal lamina

 Decreases with age-

 By degenerating and disappearing

 By undergoing calcification(cementicles)

 Physiologic role unknown

 Undergo rapid proliferation when stimulated & give

rise to certain pathologic conditions like cysts &
tumors of jaw
Epithelial cell rests
of malassez
 Mast cells (Labrocyte, Mastocyte )
 Small round / ovoid cell with Small, pale &
centrally placed nucleus
 Cytoplasm contain numerous metachromatic
granules
 Granules possess histamine, heparin,
serotonin and other inflammatory mediators
 Granules stain with metachromatic dyes like
Azure A & Toludine blue
Macrophages
 Scavenger cell
 Round or ovoid cell with horse shoe /
kidney shaped nucleus
 Cytoplasm contain numerous lysosomes
 Derived from blood monocytes
 Usually located near blood vessels
 Collagen fibers
 Collagen is a high molecular weight protein to
which small number of sugars are attached

 Have a transverse striation with a characteristic

periodicity of 64 nm

 Collagen are rod like macromolecules & are

arranged to form fibrils

 Fibrils are packed to form bundles

 PDL has Predominantly collagen type I , III & XII

Principle fibers
 Collagen fibers are found to be gathered into
bundles & organized into functional groups
having clear orientation relative to the
periodontal space. These are termed as
principle fibers

 They run a wavy course from cementum to

bone & straighten out under load
Principle fibers
 Alveolar crest group

 Horizontal group

 Oblique group

 Apical group

 Inter-radicular group

Accessory fibers
 Gingival fibers
 DENTOGINGIVAL
 ALVEOLOGINGIVAL
 CIRCULAR
 ALVEOLODENTAL
 TRANSSEPTAL
 Indifferent fiber plexus
 A -Transseptal

B -Alveolar crest

A C -Horizontal
B
D -Oblique
C
F
E -Apical

D F -Interradicular

E
 GINGIVAL FIBERS

Interdental view of
Frontal view of gingival
gingival fiber groups.
fiber groups. (A) Circular,
(A) Circular, (B)
(B) Dentogingival, (C)
Dentogingival, (C)
Dentoperiostal, and (D)
Dentoperiostal, and (D)
Alveologingival.
Alveologingival.
Alveolar crest group
 Fibers radiate obliquely from cementum
just beneath junctional epithelium to the
alveolar crest.
Function:
 Prevent extrusion of tooth

 Resist lateral tooth movement

Alveolar crest fibers
Horizontal group
 Fibers run at right angles to the long axis
from cementum to bone

Function:
 Resist tooth displacement against lateral

pressure
Horizontal fibers
Oblique group
 Largest group in the PDL
 Extend from the cementum in a coronal
direction oblique to the bone

Function:
 Suspend the tooth in socket

 They bear vertical occlusal forces and

transform them into tension on the alveolar

bone
Oblique fibers
 Apical group
 Fibers radiate from apical region of root to
surrounding bone
 Absent on incompletely formed roots

Function:
 Prevent oral tipping of tooth
Apical fibers
 Inter-Radicular group
 Seen in multi-rooted teeth

 Fibers fan out from the crest of

interradicular septum to the furcation
areas of multirooted tooth.
Inter-radicular fibers
Trans-septal fibers

 Extend inter-proximally over alveolar

crest & are embedded in the cementum
of adjacent teeth
Trans-septal fibers
Sharpey’s fibers
 The portion of the principal fibers that is
embedded into either cementum or bone is
called as Sharpey's fibers. They are fully
mineralized in primary acellular cementum.
These fibers occasionally pass through the
bone of the alveolar process to continue as
principal fibers of an adjacent PDL
Sharpey’s fibers
 Intermediate plexus

 Light microscopic examination of

longitudinal section of PDL gives an
appearance, that as though fibers arising
from cementum & bone are joined in mid
region of the periodontal space giving rise to
a zone of distinct appearance. This is called
as intermediate plexus
 It was belived that intermediate plexus
provides a site where rapid remodelling of
fibers occurs allowing adjustments in PDL
to accommodate small tooth movement

 After EM, radio-autography studies &

surgical experiments, intermediate plexus is
considered as an artifact arising out of the
plane of sectioning
Oxytalan & Elaunin fibers
 Immature elastic fibers found in the PDL

 Run in axial direction, one end being embedded

in cementum or bone & other in the wall of a
blood vessel
 Numerous and dense in the cervical region

Function:
Supports the blood vessels of the PDL
Oxytalan fibers
Ground substances
 Space between cells, fibers, blood vessel &
nerves in Periodontal ligament space is
occupied by ground substance

 The principal ground substance has been

estimated to be water (70%)

 Compound of proteins & polysaccharides

 Proteoglycans & glycoproteins

 Interstitial tissues
 Regions of loose connective tissue located
between periodontal fiber bundles. These
regions contain fibroblasts, blood vessels,
and nerves and are responsible for
providing nutrients to the periodontal
ligament and cells of the cementum.
Interstitial tissues
Cementicles
 Small foci of calcified tissue which lie free in the
PDL
 They represent areas of dystrophic calcification
 Commonly seen in older individuals

Size: 0.2 – 0.3mm in diameter

 Too small to be seen in x-ray

 No clinical significance
Types:
 Free

 Attached

 Embedded

Origin:
 Calcification of Degenerated epithelial cells

 Calcification of sharpey’s fibers

 Calcification of thrombosed blood vessels

 Cemental tears
Free cementicle

Embedded cementicle
I. Supportive / physical

II. Sensory

III. Nutritive

IV. Homeostatic / formative / developmental

 I. Supportive function
 Attaches the tooth to the bone
 Transmits masticatory forces to the bone
 Acts as a shock absorber against external
forces
 Maintains the proper relationship between
gingiva & the tooth
 Protects the vessels & nerves from injury by
mechanical forces by cushioning
Tooth support & Shock absorption

3 Theories

1. Tensional theory
2. Viscoelastic system theory
3. Thixotropic theory
 1. Tensional theory

 Ascribes to the principal fibres of the PDL

the major responsibility in supporting the
tooth & transmitting forces to the bone
2. Viscoelastic system theory

 According to this theory displacement of

tooth is largely controlled by fluid
movements, fibres have only secondary role
3. Thixotropic theory

 PDL has rheologic behaviour of a thixotropic

gel
II. Sensory function

 The PDL through its nerve supply

provides efficient proprioceptive
mechanism
 III. Nutritive function

 The PDL transmits blood vessels which

provide anabolites & remove catabolites
from cells of ligament, cementum, alveolar
bone
IV. Homeostatic Function
 Synthesis
 Resorption

 PDL stabilizes & reorganizes alveolar bone

& helps in cementum formation through its
cells
Blood & nerve supply
Source of arterial supply
 Apical vessels

 Inta-alveolar vessels

 Gingival vessels

Venous drainage
 Venous vessels run axially to drain to apex

 Arterio-venous anastomoses

Lymphatics
 Follow the path of blood vessel & provides lymph

drainage of PDL
 Lymph flow PDL adjacent alveolar bone
Periodontal blood supply. Left, buccolingual view (frontal
section). Right, sagittal view of interdental bone. (A)
Subepithelial capillary network of the gingiva, (B) Capillary
network of the periodontal ligament, (C) Supraperiosteal
arterial, and (D) Arterials penetrating the interdental alveolar
bone.
 Nerve supply

Nerve fibers

Large diameter Small diameter

Myelinated Myelinated
Unmyelinated
Nerve endings
 Free endings

 Ruffini endings

 Coiled endings

 Spindle type endings

Free endings
 Ramify in a tree like fashion

 Originate mainly from unmyelinated fibers

 Located at regular intervals along length of root

 Both nociceptor & mechanoreceptor

Ruffini endings
 Appear denritic

 Simple & compound

 Found around root apex

 Mechanoreceptor

Coiled endings
 Found in mid region of PDL

Spindle like endings

 Located at root apex
 Clinical consideration
 Restorative dentistry

 Prosthetic dentistry

 Orthodontic tooth movement

 Periapical inflammation

 Gingival inflammation