Tissues surrounding teeth

 PERIODONTIUM
Includes structures and tissues that surround
and support the teeth
 Alveolar Process

 Gingiva

 Periodontal Ligament/Membrane

 Cementum
Cementum
 Characteristics:
 Covers root of tooth – forms a thin layer
around the root
 Has same density as bone

 55% inorganic

 Contains fibers that attach tooth to the

alveolar bone
Cementum
 Cementum is a tissue of the tooth and an
important part of the supporting structure
 Function: attachment of the tooth in its
socket
Cementum
 Clinical concerns:
 May be exposed with recession of gingiva
 Removal of some of cementum could expose
dentin
 Extreme sensitivity is experienced by patients
with exposed cementum and dentin
Cementum
 Clinical concerns:
 Cemental spurs may form at C E J
• Calculus is easy to remove, spurs are not
 Hypercementosis – occurs at apex in
response to trauma
Alveolar Bone
 Structure:
 Bones in the maxilla and mandible are
formed byosteoblasts
 Extended areas of bone that hold the teeth
are referred to as thealveolar process
Alveolar bone/process
 Lamina dura – outside layer of bone
surrounding the periodontal ligament
 Lamina dura – ‘hard layer’ (like the crust
of bread)
 Cortical bone – compact or dense layer of
bone
Alveolar bone/process
 Cancellous bone – inner or central part of
alveolar bone
 Cancellous bones is also referred to as
trabecular bone
 Spongy or porous in appearance
Alveolar bone/process
 Function:

 Supports the tooth

 Stabilizes the root

Alveolar bone
 Clinical concerns:
 Periodontal disease can cause loss of bone
 Bone is stimulated from chewing and speech
– if teeth are removed this stimulation is lost
and bone resorbs
Alveolar Process

Lamina dura,
cortical, spongy
Periodontal Ligament
 Surrounds the root of the tooth
 Composed of fibers, or ligaments, that
support and suspend the tooth in the
socket
 Fibers are arranged in bundles
 Forms a ‘shock-absorber’ for the tooth in
the socket
Periodontal ligament
 Contains fibers for attachment
 Contains nerves, blood vessels and
lymph vessels
Periodontal ligament
 FUNCTIONS:
 Supportive – maintains tooth in socket
 Sensory – nerves supply ‘sense of touch
 Formative – fibroblasts, cementoblasts
 Protective- cushion-like action from shock
 Nutritive– blood vessels provide nutrients
Periodontal fiber groups
 Alveolar crest fibers-extend from cervical area
of tooth to alveolar crest
 Horizontal group – run at right angles
 Oblique group – slants into alveolar bone
 Apical group – extend from apex
 Interradicular –only in multi-rooted teeth
 Transseptal – from one tooth to another
PDL Fibers
Periodontal fiber groups
 Most important fibers:
 Oblique – largest group – resist vertical (up
and down) force
• Work like shock absorbers
 Transseptal or interdental – support
interdental gingiva
Gingival fiber group
 Found above the alveolar bone crest and
below the epithelium
 Dentogingival fibers
 Circular ligament fibers

 Alveologingival fibers

 Dentoperiosteal fibers
Periodontal ligament
 Clinical considerations:
 Occlusal trauma does not cause periodontal
disease but can accelerate an existing
condition
 Chronic periodontal disease causes the fiber
groups to become disorganized and lose
attachment due to resorption
Gingiva
 Only portion of periodontium visible in
oral cavity
 Made up of epithelial tissue covered with
mucosa
 Surrounds cervix of tooth
 Fills interproximal spaces
Gingiva
 Free Gingiva – movable – fits snugly
around the crown just above the cervix of
tooth
 Attached Gingiva – non-movable –
extends from the base of the sulcus to
the mucogingival junction
 Attached directly to the cementum and
alveolar process
Gingiva
Gingiva
 Characteristics of normal tissue:
 1) adapts tightly to tooth and bone
 2) firm and resistant

 3) surrounds tooth in collar-like fashion

 4) color varies from pink to coral

 5) surface isstippled
• Stippling – like surface of an orange
Gingiva
 Alveolar mucosa – appears thin and loosely
attached
 Attached gingiva – part that is stippled
 Gingival sulcus – space between the
unattached gingiva and the tooth
 Normal depth is about 2 mm
 Gingival papilla – interdental extension of free
gingiva (between teeth)
Mucosa -- differences
 Masticatory mucosa – dense covering in the
mouth
 Withstands activity of mastication (chewing)
 Covers gingiva and hard palate
 Lining mucosa – covers the oral soft tissues
that are not covered by masticatory mucosa
 Covers insides of cheeks, soft palate, floor of mouth;
tears and injures easily
Gingiva
 Clinical considerations:
 Certain drugs can affect the gingiva and
causegingival hyperplasia, (over growth of
tissue)
 Tissue can become inflamed to fight
infection – appearing swollen and red, bleeds
easily, and looses its stippling
Gingival description
 Healthy gingiva is pink and stippled on
the attached portion.
 Normal gingiva is firm and resilient; it
follows the contour of the bone and fills
the interproximal spaces, forming a sharp,
knifelike triangular point at the contact
area.
Gingival description
 Attached gingiva adheres tightly to the
bone and is pale, compared to the smooth
shiny alveolar mucosa, which contains
many blood vessels and thus appears
more red in color.
Review:
 Periodontium – supporting structure of
the tooth
 – composed of:
 Cementum
 Periodontal ligament

 Gingiva

 Alveolar process
Review:
 Healthy gingiva:
 Fits tightly around tooth and bone
 Surrounds like a collar
 Color varies with ethnicity
 Surface is stippled
Review:
 Two types of gingiva:
 Free gingiva
 Attached gingiva
Review:
 Function of periodontal ligament
 Most important function is supportive –
maintains the tooth in the socket by fiber
attachment
Trick or Treat