Normal periodontium

The normal periodontium provides the support necessary to maintain teeth in function

• Each of these periodontal components is distinct in its location, tissue

architecture, biochemical composition, and chemical composition, but all of these
components function together as a single unit.

• the pathologic changes that occur in one periodontal component may have
significant ramifications for the maintenance, repair, or regeneration of other
components of the periodontium.

• Is one of oral soft tissue which are known as oral mucosa consists of the
following three zones:

• 1. masticatory mucosa the covering of the hard palate and gingiva (The gingiva is
the part of the oral mucosa that covers the alveolar processes of the jaws and
surrounds the necks of the teeth.)

• 2. specialized mucosa covered The dorsum of the tongue,

• 3. lining mucoas:The oral mucous membrane lining the remainder of the oral
cavity

• The gingiva : In an adult, normal gingiva covers the alveolar bone and tooth root
to a level just coronal to the CEJ.

• Free marginal gingiva/The marginal or unattached gingiva is theterminal edge

or border of the gingiva that surrounds the teeth in collarlike fashion. It is
demarcated from the adjacent attached gingiva by a shallow linear depression
called the free gingival groove

• The most apical point of the marginal gingival scallop is called the gingival zenith

• 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. It is V-shaped, and it barely permits the entrance of a
periodontal probe.
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• The so-called probing depth of a clinically normal gingival sulcus in humans is 2
to 3 mm

• Interdental gingiva/occupies the gingival embrasure, which is the interproximal

space beneath the area of tooth contact. can be pyramidal, or it can have a “col”
shape. In the former, the tip of one papilla is located immediately beneath the
contact point;

• Interdental col presents a valleylike depression that connects a facial and

lingual papilla and that conforms to the shape of the interproximal contact.

• Attached gingiva/ The attached gingiva is continuous with the marginal gingiva.
It is firm, resilient, and tightly bound to the underlying periosteum of alveolar
bone. The facial aspect of the attached gingiva extends to the relatively loose and
movable alveolar mucosa; it is demarcated by the mucogingival junction

• The width of the attached gingiva and the width of keratinized gingiva is
another important clinical parameter. It is the distance between the mucogingival
junction and the projection on the external surface of the bottom of the gingival
sulcus or the periodontal pocket.

• It is generally greatest in the incisor region (i.e., 3.5 to 4.5 mm in the maxilla, 3.3
to 3.9 mm in the mandible) and narrower in the posterior segments (i.e., 1.9 mm
in the maxillary first premolars and 1.8 mm in the mandibular first Premolars ).

• Microscopic Features

• GINGIVA formed from :STRATIFIED SQUAMOUS EPITHELIUM &

CENTRAL CORE OF CONNECTIVE TISSUE

GINGIVAL EPITHELIUM

• ORAL (OUTER EPITHELIUM

• SULCULAR EPITHELIUM

• JUNCTIONAL EPTHELIUM

FUNCTIONS OF GINGIVAL EPITHELIUM

• PHYSICAL BARRIER TO INFECTION

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• SIGNALING FURTHER HOST REACTIONS

• INTEGRATING INNATE AND ACQUIRED IMMUNE RESPONSE

• INNATE HOST RESPONSE

Oral epithelium

• EXTENT: Covers crest and outer surface of marginal gingiva and surface of
attached gingiva.

• THICKNESS: 0.2-0.3mm

• KERATINIZATION: keratinized or parakeratinized

• cells of gingival epithelium: keratinocyte, non keratinocyte

• Keratinocyte: Main function

• PROLIFERATION

• DIFFERENTATION: involves the process of keratinization, which consists of

progressions of biochemical and morphologic events that occur in the cell as they
migrate from the basal layer .

• Morphologic changes:

• 1.Progressive flattening of the cell with an increasing prevalence of tonofilaments

• 2.Intercellular junctions coupled to the production of keratohyaline granules

• 3.Disappearance of the nucleus

STRATUM BASALE

• cylindrical basal cells

• Contact with basement membrane

• Mitotic cell division

• Stratum Germinativum

• Progenitor cell compartment

• Show ribosomes and rough endoplasmic reticulum

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• The epithelium is joined to the underlying connective tissue by a basal lamina

• The basal lamina consists

of lamina lucida and lamina densa.

• Hemidesmosomes of the basal epithelial cells abut the lamina lucida, which is
mainly composed of the glycoprotein laminin. The lamina densa is composed of
type IV collagen.

STRATUM SPINOSUM: SPINY OR PRICKLELIKE APPEARANCE

• Cells frequently shrink away from each other ,remaining in contact only at points
known as INTERCELLULAR BRIDGES OR DESMOSOMES

• CELLS- Irregular polyhedral cells larger than basal cells

STRATUM GRANULOSUM

• CELLS- larger and flatter show increase maturation

• NUCLEUS signs of degeneration and pyknosis

• CYTOPLASM- tonofilaments and tonofibrils

• KERATINOHYALINE GRANULES)Small granules that stain with acid dyes

such as hematoxyline.

• Thus basophilic in nature .

• ODLAND BODIES are present

STRATUM CORNEUM

• Outermost layer of keratinized oral mucosa

• Cells--. Flat and tightly packed

• Nuclei- no nuclei

• Keratohyaline granules disappeared.

• Acidophilic –red staining with hematoxylin and eosin.

Non keratinocyte

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 Melanocytes

• Dendritic cells

• Basal & spinous layers

• Premelanosomes/melanosomes

Langerhan cells

 Dendritic cells

 Modified monocytes

 Suprabasal layer

 g-specific granules (Birbeck’s granules)

 Antigen presenting cell for lymphocyte

 Found: Oral epithelium & sulcular epithelium

 Absent: Junctional epithelium

 Merkel cells: Deeper layer, Harbor nerve endings, Tactile perceptors

Sulcular epithelium

 Lines gingival sulcus

 STRUCTURE-Thin non-keratinized stratified squamous epithelium without rete

pegs

 EXTENT- Coronal limit of junctional epithelium to crest of gingival margin

 SEMIPERMEABLE MEMBRANE, INJURIOUS BACTERIAL PRODUCTS

TISSUE FLUID FROM GINGIVA

Junctional epithelium: COLLARLIKE BAND OF STRATIFIED SQUAMOUS

NON KERATINIZING EPITHELIUM, Which is located at the CEJ in healthy
tissue.

• CORONALLY- 10 -30 cells thick

APICALLY- 1-2 cells

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• LENGTH- 0.25-1.35mm

• Numerous migrating PMN’s

• Larger intercellular spaces

Strata of JE: basal layer : facing gingival CT, suprabasal layer facing tooth surface

EPITHELIAL ATTACHMENT APPARATUS

Attachment apparatus ie internal basal lamina +

hemidesmosomes that connects junctional epithelium to tooth surface

EPITHELIAL ATTACHMENT APPARATUS: The attachment of the junctional

epithelium to the tooth is reinforced by the gingival fibers, which brace the marginal
gingiva against the tooth surface. For this reason, the junctional epithelium and the
gingival fibers are considered together as a functional unit referred to as the
dentogingival unit.

MECHANISM OF JE CELLS TURNOVER 1-6 days

Daughter cells are produced by dividing DAT(DIRECTLY ATTACHED TO

TOOTH) and replace degenerating cells on tooth surface

Daughter cells enter the exfoliation pathway and gradually migrate coronally
between the basal cells and DAT cells to eventually break off into the sulcus.

Epithelial cells move/migrate in the coronal direction along the tooth surface and are
replaced by basal cells migrating round the apical termination of JE.

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 Gingival crevicular fluid

FUNCTIONS OF GCF

• Lubrication of foreign material facilitate its expulsion

• Antibacterial enzymes +antibodies against bacteria

• Contain plasma protein to improve epithelial adhesion to the tooth

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 • Wash out irritant & prevent bacterial pentration

GINGIVAL CONNECTIVE TISSUE (LAMINA PROPRIA)

• PAPILLARY LAYER: Subjacent to epithelium Consists of papillary projections

between epithelial rete pegs

• RETICULAR LAYER: Contiguous with periosteum of alveolar bone

•
• The major components of the
gingival connective tissue are collagen fibers (about 60% by volume), fibroblasts
(5%), vessels, nerves, and matrix (about 35%)

The ground substance fills the space between fibers and cells; It is composed of

• proteoglycans (mainly hyaluronic acid and chondroitin sulfate)

• glycoproteins (mainly fibronectin).

• Fibronectin binds fibroblasts to the fibers and many other components of the
intercellular matrix, thereby helping to mediate cell adhesion and migration.

• Laminin, which is another glycoprotein found in the basal lamina, serves to attach
it to epithelial cells

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 • FIBROBLAST: Predominant connective tissue cells(65%) Spindle or stellate
shaped with oval nucleus containing one or more nucleoli

• Function- maintains structural integrity of connective tissue by secreting

extracellular matrix. And collagen fibers play a role in collagen turn over

• MAST CELLS:

• Large spherical or elliptical mononuclear cell

• Present in relation to blood vessels so they play a role in maintaining normal

tissue stability and vascular homeostasis

MACROPHAGES:

• Well developed nucleus,golgi apparatus

• Numerous vesicles

• Scarse granular endoplamic

INFLAMMATORY CELLS

• Includes , Neutrophils,Lymphocytes,Plasma cells

GINGIVAL FIBRES

 CONNECTIVE TISSUE OF MARGINAL GINGIVA IS DENSELY

COLLAGENOUS CONTAINING A PROMINENT SYSTEM OF COLLAGEN
FIBRE BUNDLE

CONSIST MAINLY OF TYPE1 COLLAGEN

FUNCTIONS OF GINGIVAL FIBRES

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 •

GINGIVAL FIBRES

PRINCIPAL FIBRES

DENTOGINGIVAL FIBRES

 EXTENT: Facial, lingual & interproximal surfaces

 Originate at cementum Fanlike conformation

 Interproximally : Extend towards , crest of the interdental gingiva

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  FUNCTION: Provide gingival support

DENTOPERIOSTEAL FIBRES

EXTENT: Arise in cementum

INSERTION: Crest of alveolar process Lateral aspect of cortical plate

FUNCTION: Anchor tooth to bone Protect PDL

CIRCULAR FIBRES

EXTENT: Running within Marginal & Interdental gingival CT, Encircle each tooth,
Cuff /Ring like fashion

FUNCTION: Maintain contour & position of free marginal gingiva

TRANSEPTAL FIBRE:

EXTENT: Interproximally, Horizontal bundles between epithelium at base of crest of

gingival sulcus and interdental bone

FUNCTION

 support interdental gingiva, protect interproximal bone & secure position of

adjacent teeth

dentogingival unite (gingival fibers+ JE)

RETICULIN: FIBRESArgyrophilic staining properties

 Numerous in tissue adjacent to basement membrane

 Occur in large no. in loose connective tissue

 Present at epithelium-connective tissue interface

ELASTIC FIBRES Only present in assosciation with blood vessels of gingiva and
PDL.

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  Gingiva coronal to mucogingival junction (MGJ) does not contain elastic fibres
except in association with blood vessels.

OXYTALAN FIBRES

 Scarse in gingiva but numerous in PDL

 Composed of long thin fibrils with diameter of approx. 150 A

Periodontal ligament

The periodontal ligament is the connective tissue (complex vascular highly cellular)that
surrounds the root and connects it with the bone. It is continuous with the connective
tissue of the gingiva and communicates with the marrow spaces through vascular
channels in the bone.

the average width is about 0.2 mm

The fibers of the periodontal ligament are mainly collagen. (Type I)

They are divided into:

• A) The principal fibers. (The most important components of PL are the principle
fibers which are collagenous and arranged in bundels)

B) The accessory fibers.

C) The oxytalan ( elastic ) fibers.

Principle fibers

1-Alveolar crest group:

radiate from the crest of the alveolar process and attach to the cervical part of the
cementum. It prevent the extrusion of the tooth and resist lateral tooth movements.

2-Horizontal group:

The fiber bundles run from the cementum to the bone at right angle to the long axis of
the tooth

3- Oblique group:

The fiber bundles run obliquely.

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Their attachment in the bone is somewhat coronal than the attachment in the cementum.

It is the greatest number of fiber bundles found in this group.

They perform the main support of the tooth against masticatory force.

They bear the brunt of vertical masticatory stresses and transform them into tension on
the alveolar bone.

4- Apical group:

The bundles radiate from the apical region of the root to the surrounding bone.

5- Interradicular group:

The bundles radiate from the interradicular septum to the furcation of the multirooted
tooth.

Sharpey fibers

The terminal portions of the principle fibers that are inserted into cementum and bone
are termed sharpey fibers embeded in alveolar bone or tooth and calcify to a
considerable degree

Accessory fibers:

It is collagenous in nature and run from bone to cementum in different planes, more
tangentially to prevent rotation of the tooth and found in the region of the horizontal
group.

Oxytalan fibers

 Oxytalan fibers run parallel to the roots and bend to attach to cementum in
cervical 1/3 it regulate vascular flow

 Immature form of elastic fibers.

 Run in axial or oblique direction.

 One end being embedded in cementum or bone and the other end in the wall of
b.v.

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  they play a part in supporting the blood vessels of the periodontal ligament during
mastication i.e., it prevents the sudden closure of the blood vessels under
masticatory forces.

Function of periodontal ligament

Physical: Soft tissue casing protecting B.V and nerve from injury of mech. Force,
transmission of occl. force to bone, Attachement of tooth to bone, Resistance to the
impact of occlusal force (shock absorption),

Sensory: The periodontal ligament having the mechanoreceptor contributes to the

sensation of touch and pressure on the teeth.

Nutritive: The blood vessels in the periodontal ligament provide nutrient supply
required by the cells of the ligament and to the cementocytes and the most superficial
osteocytes.

Formative: The fibroblasts are responsible for the formation of new periodontal
ligament fibers and dissolution of the old fibers ( remodeling :Old cells and fibers are
broken down and replaced by new ones)

Cementoblasts and osteoblasts are essential in building up cementum and bone.

Protective

The principal fibers:

The arrangement of the fiber bundles in the different groups is well adapted to fulfill the
functions of the periodontal ligament.

The alveolodental ligament transforms the masticatory pressure exerted on the tooth
into tension or traction on the cementum and bone.

If the exerted force on a tooth is transmitted as pressure this will lead to differentiation
of osteoclasts in the pressure area and resorption of bone.

Thickness of Periodontal Ligament

Age, location of the tooth, and degree of stress to which the tooth was subjected

􀂆The mesial side is thinner than distal side

􀂆A tooth that is not in function has a thin periodontal ligament

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􀂆A tooth in functional occlusion has a periodontal ligament space of approximately
0.25 mm, plus or minus 0.10 mm

􀂆A tooth subjected to abnormal stress has a considerably thicker periodontal space.

Histological structure
The periodontal ligament is formed of : cells(Synthetic, Resorptive , Progenitor,
Defensive )

Extracellular substances (Fibers, ground substances, blood vessels,nerves &

lymphatics.)

The cells Synthetic cells: Fibroblasts(synth. Collagen, extracellular components,

possess the capacity to phagocytose "old" collagen fibers and degrade them by enzyme
hydrolysis.) osteoblasts cementoblasts

Resorptive cells: cementoclasts , osteoclasts fibroclasts. N.B resorptive and synthetic

cells responsible for remodelling of the principle fibers to adapt to phtsiologic needs.

Progenitor cells: undifferentiated mesenchymal cells

Defensive cells: macrophage, lymphocytes and mast cells

epithelial cells Epith. Rest of malassez : remnants of the epithelial root sheath of
Hertwig appear isolated cluster of cells or interlacing strand close to cementum May
contain KGF (keratinocyte growth factor)

Extracellular substances: ground substances(Proteoglycan and glycoprotein

(fibronectine & laminin)

Important for cell adhesion cell-cell adhesion , cell- matrix interaction, binding various
GF)

Cementum: Definition:

Cementum is a calcified avascular tissue that forms the outer covering of the
anatomic tooth.

 Types of cementum

-Primary (accelular) cementum

-Secondary (cellular) cementum

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Physical Characteristics

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Afibrillar Cementum: Before tooth eruption, the enamel at the cervical area lose its
REE covering.

The connective tissue of the dental sac lay down cementum on the exposed enamel
(neithr cells nor collagen fibers ex&intr)

Relation to CEJ
60% cementum overlaps E (afibrillar cementum)

30% cementum meets the enamel in a sharp line (edge to edge)

10% cementum and enamel don’t meet because of delayed separation of epith root
sheath of Hertwig (area of dentin not covered by C).

Thickness of Cementum

􀂆Cementum deposition is a continuous process, most rapid in the apical

􀂆the thickness of a hair

􀂆thicker in distal

􀂆Hypercementosis is a prominent thickening

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Alveolar bone

Alveolar process is the portion of maxilla and mandible that forms and supports the
tooth sockets.

It consists of,

-External buccal and lingual cortical plate.

-Inner socket wall of compact bone called Alveolar bone proper ,seen as lamina
dura in radiographs.

-Cancellous trabeculae between these two layers, which act as a supporting

alveolar bone.

Composition:67% inorganic HA, 33% organic (28% collagen, 5% noncollagenous

protein)

Composition; alveolar bone proper( lamellated bone, bundle bone)

Supporting alveolar bone (cortical plate, spongy bone)

Cribriform plate Vs Lamina dura

( socket wall) alveolar bone proper formed of dense lamellated bone lining of the tooth
socket or alveolus , is also called the cribriform plate because of the many holes through
which Volkmann’s canals pass (from the alveolar bone into the PDL) .

• Bundele bone characterized by thin lamellae arranged parallel to roots. also

called bundle bone because Sharpey’s fibers insert into this bone (Sharpey’s
fibers = portion of the fibers of the PDL) these fibers are inserted at a 90 angle
into the ABP varies in thickness from 0.1 to 0.5mm

• b. supporting alveolar bone:

• Cancellous trabeculea between those component of compact layer of alveolar

bone (interdental septum)

• Basal bone that part of jaw unrelated to teeth

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 • Isolated areas in which the root is denuded of bone and the root surface is
covered only by periosteum and overlying gingiva are termed fenestrations.

• In these areas, the marginal bone is intact. When the denuded areas extend
through the marginal bone, the defect is called a dehiscence

• Periosteum and endosteum: Periosteum“: Layers of differentiated osteogenic

connective tissue cover all of the bone surfaces.

The periosteum consists of an

inner layer composed of osteoblasts surrounded by osteoprogenitor cells, which have

the potential to differentiate into osteoblasts,

outer layer rich in blood vessels and nerves and composed of collagen fibers and
fibroblasts. The inner layer is the osteogenic layer, and the outer layer is the fibrous
layer
endosteum whereas the tissue that lines the internal bone cavities composed of a single
layer of osteoblasts and sometimes a small amount of connective tissue..

Alveolar bone is formed during fetal growth by intramembranous ossification, and it

consists of a calcified matrix with osteocytes enclosed within spaces called lacunae. The
osteocytes extend processes into canaliculi that radiate from the lacunae. The canaliculi
form an anastomosing system through the intercellular matrix of the bone, which brings
oxygen and nutrients to the osteocytes through the blood and removes metabolic waste
products. Blood vessels branch extensively and travel through the periosteum.
Haversian systems (i.e., osteons) are the internal mechanisms that bring a vascular
supply to bones that are too thick to be supplied only by surface vessels. These are found
primarily in the outer cortical plates and the alveolar bone proper.

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