CONSISTS of investing and supporting tissues

Gingiva

Supporting structures:
PDL
Cementum
Alveolar
process
 CEMENTOGENESIS
• IS divided into two stages
• A) Prefunctional stage= occurs through out
root formation
• B)Functional stage =starts when tooth is in
occlusion
– disintegration of Hertwig’s root sheath is
followed by cementogenesis
– allows direct contact of the cells of the dental
sac with the root dentin – cementoblast
differentiation results (cementoblasts)
– the differentiating cementoblasts disperse to
cover the root and undergo cementogenesis
– results in the formation of unmineralized
cementoid
– many CBs become entrapped in the
mineralizing cementoid = cementocytes
– once the cementoid reaches full thickness it begins
to mineralize – initially around the cementocytes –
• now called cementum
– the cementocytes are located in lacunae – similar
to bone
– connected by canaliculi – unlike bone they do not
contain nerves/vessels
• also they do NOT radiate out but are directed toward
the PDL
• the cellular processes of the cementocytes take up
nutrients that have diffused from the PDL into the
cementum
• HERS cells may participate in maintanance
and regeneration of periodontal tissues
• Enamel pearls
 CLASSIFICATION
•  Acellular Afibrillar 1-15micro Coronal
•  Acellular Ext fiber 30-230 1/3 coronal
•  Cellular Mixed fiber 100-1000 apical/furc
•  Cellular Int fiber Resorptive area
•  Intermediate CDJ
 CLASSIFICATION
• Acellular
–first layers that are laid at the DCJ
–formed at a slow rate
–no embedded cementocytes seen
–once continuous layer covers the root
–many layers are found covering the
cervical 1/3rd of the tooth near the
CEJ
• Cellular
– or secondary cementum
– last layers deposited – over the acellular layers
– mainly at the apical 1/3rd of the tooth
– deposited at a faster rate – therefore the presence
of many cementocytes
– at the periphery are CBs - found within the PDL
• allow for the future production of more secondary
cementum
• therefore the width of these layers changes with the life
span of each tooth
• especially at the apex
 Microscopic appearance

• Made of a matrix + cells

• matrix
– consists of Sharpey’s fibers – portion of
collagen fibers from the PDL that partially
insert into the outer part of the
cementum at a 90 angle and into the
alveolar bone
– these function as a ligament between the
tooth and
• fibers
– collage fibers made by the
cementoblasts
– non-organized
– but they do run parallel to the DCJ
• cells
– cementoblasts
– located in lacunae and connected by
canaliculi
 Cementoenamel Junction (CEJ)
• 3 patterns may be present
– 1) 60% show cementum overlapping the enamel at
the CEJ
– 2) 30% show an end-on-end meeting of cementum
and enamel
– 3) 10% show a definitive gap between the
cementum and enamel
• can result in dental hypersensitivity as the gingiva
recedes exposing the underlying root dentin
• “new study” – 1993 – 76% edge to edge, 14% overlap
and 10% gap with no exposed dentin
PERIODONTAL LIGAMENT
 INTRODUCTION
• Part of the periodontium that provides for
the attachment of the teeth to the
surrounding alveolar bone by way of the
cementum
• PDL appears in the periodontal space (0.4 to
0.5mm) in radiographs – between the
lamina dura of the ABP and the cementum
• Physically small but functionally important
• Fibrous connective tissue
• Transmits occlusal forces from the teeth
to the bone – allowing for a small
amount of movement
• Wider at the apex and cervical portion
narrows between these two points
 Embryogenesis

The PDL forms from the dental

follicle
roostartSSrootdevelopment
begins
 COMPONENTS
– Made of matrix containing cells and fibers
– Also a vascular supply, lymphatics and nervous
innervation – enter the apical foramen to supply
the pulp
• vascular supply is for the supply of nutrition for the
cells of the PDL and surrounding cementum and
alveolar bone
• the nerve supply provides an efficient propriception
mechanism – allows the sensation of even the most
delicate forces applied to the teeth
• afferent and autonomic sympathetic (regulates blood
vessel diameter)
• afferent fibers transmit pain, touch, pressure and
temperature
• Principle fiber
Sharpey fiber
Collagen 1
Collagen III
Collagen IV
• ELASTIC FIBRES
Immature elastin( oxytalan)
ELAUNIN
Elastin
• 1) Principle fibers
Alveolar crest
Horizontal
Oblique
Apical
Interradicular
2)Gingival ligament fibers
 CELLS
• a) Osteoblasts
• b) Osteoclasts (critical for periodontal disease and
tooth movement)
• c) Fibroblasts (Most abundant)
• d) Epithelial cells (remnants of Hertwig’s epithelial
root sheath-epithelial cell rests of Malassez)
• e) Macrophages (important defense cells)
• f) Undifferentiated cells (perivascular location)
h) Cementoblasts
• i) Cementoclasts (only in pathologic conditions)
 CELLS
• Participate in the formation and resorption of the hard
tissues of the periodontium
• Most common cell is the fibroblast – similar to other
fibrous connective tissues
• Also has cementoblasts along the cemental surface and
osteocytes at the periphery of the ABP
• Also has odontoclasts and osteoclasts for resorption of
cementum and bone
• Balance between the “clasts” and “blasts” maintain a
certain level of AB and cementum – depending on the
need and environment adjacent to the PDL
• Also has epithelial rests of Malassez
– disintegration of Hertwig’s root sheath during tooth formation
 FIBROBLAST
• Principle cell of PDL
• Hetrogenous types, have high rate of turnover
• Large cell with extensive organelles
• Also have well developed cytoskeleton ,Have
cell contacts have extensive processes that
wrap around the bundles
• Duel function
• CLINICAL IMPORTANCE:
Because of exceptionally high turnover rate of
collagen in the ligament , any interferance
with fibroblast function by disease results in
rapid loss of supporting tissues of the tooth
 EPITHELIAL CELLS
• In the PDL are remanents of H.E.R.S known as
epithelial rest of malassesz
• CLINICAL IMPORTANCE
Occasionaly develops eruption cyst and may
participate in maintenance and regeneration
of periodontal tissues
 Ground Substance
• GAG
• GP
• Water
• Cementicle
 GROUND SUBSTANCE
•Amorphous background material that binds tissues and fluids

•A major constituent of the PDL

•Similar to most connective tissue ground substance

•Dermatan sulfate is the major glycosaminoglycan

•70% water; critical for withstanding forces

•When function is increased PDL is increased in size and fiber thickens

•Bone trabeculae also increase in number and thicker

•However, in reduction of function, PDL narrows and fiber bundles

•decreases in number and thickness (this reduction in PDL is primarily due
•to increased cementum deposition)
 PDL Fibers
• principal fibers – organized into groups or
bundles
• designed to resist the forces generated during
mastication - because the PDL fibers are
anchored in both the cementum and AB
 PDL FIBRES

-Collagen fibers: I, III and XII. Groups of fibers that are

continually remodeled. (Principal fiber bundles of the PDL).
The average diameter of individual fibers are smaller than
other areas of the body, due to the shorter half-life of PDL
fibers (so they have less time for fibrillar assembly)

•- Oxytalan fibers: variant of elastic fibers, perpendicular to

teeth, adjacent to capillaries

•- Eluanin: variant of elastic fibers

 Principal Fibers
Run between tooth and bone. Can be
classified as dentoalveolar
and gingival group
Dentoalveolar group
a. Alveolar crest group (ACG): below CE
junction, downward, outward
b. Horizontal group: apical to ACG, right
angle to the root surface
c. Oblique group: most numerous, oblique
direction and attaches coronally to bone
d. Apical group: around the apex, base
of socket
e. Interradicular group: multirooted teeth
Runs from cementum and bone , forming
the crest of the interradicular septum

At each end, fibers embedded in bone

and cementum: Sharpey’s fiber
Gingival ligament fibers: the principal
fibers in the gingival area are referred
to as gingival fibers. Not strictly related
to periodontium. Present in the lamina
propria of the gingiva

a. Dentogingival: most numerous;

cervical cementum to f/a gingiva
b. Alveologingival: bone of the alveolar
crest to f/a gingiva
c. Circular: around neck of teeth, free
gingiva
d. Dentoperiosteal: runs apically from
the cementum over the outer cortical
plate to aiveolar process or vestibule
(muscle) or floor of mouth
e. Transseptal: cementum between
adjacent teeth, over the alveolar crest
 Oxytalan Fibers
Type of elastic fibers present as
bundes of microfibrils that run oblique
from the cementum surface to the
blood vessels. Associated with neural
elements. Most numerous in the
cervical area.
Function: Regulate vascular flow in
relation to tooth function
The PDL gets its blood supply from
perforating arteries (from the cribriform plate
of the bundle bone).

The small capillaries derive from the superior

& inferior alveolar arteries.

The blood supply is rich because the PDL

has a very high turnover as a tissue.

The posterior supply is more prominent than

the anterior. The mandibular is more
prominent than the maxillary.
 Nerve supply

The nerve supply originates from the

inferior or the superior alveolar nerves.

The fibers enter from the apical region and

lateral socket walls.

The apical region contains more nerve

endings (except Upper Incisors)
 Interstitial Space
Present between each bundle of
ligament fibers
Contains blood vessels and nerves
Designed to withstand the impact of
masticatory forces