Development of

Periodontium
(a largely ectomesenchymally derived unit )
Contents :
•Introduction

•Development of teeth

•Stages of tooth growth

•Hertwig’s epithelial root sheath & root formation

•Development of cementum/ cementogenesis

•Development of PDL

•Development of alveolar bone

•Development of dentogingival unit

•conclusion

Dr.Jignesh
 Introduction
 The periodontium is simply defined as the tissues supporting

and investing the tooth - consists of cementum, PDL, bone

lining the alveolus & that part of the gingiva facing the tooth.

 The tissues supporting the tooth are developmentally derived

from the dental follicle proper, whereas those investing the

tooth, that is the gingiva, are an adaptation of the oral

mucosa.

- Richard Ten Cate

Dr.Jignesh
 The widespread occurrence of periodontal diseases & the realization that
periodontal tissues lost to the disease can be repaired has resulted in
considerable effort to understand the factors & cells regulating the formation,
maintenance, & regeneration of the periodontium.
- Ten Cate et al Periodontology 2000, Vol. 13

Dr.Jignesh
Reciprocal induction

Dr.Jignesh
 Tooth germ
 Ectodermal cells of dental lamina divide more rapidly & form little knobs
that grow into underlying mesenchyme.

 These little down growths from the dental lamina represents the beginning
of enamel organ of the tooth bud.

Dr.Jignesh
As cell proliferation continues...

 Each enamel organ increase in size & sink deeper into the
ectomesenchyme, & due to differential growth shape also changes.

First it takes a shape that resembles a Cap, with an outer convex facing
the oral cavity & inner concavity.

Dr.Jignesh
Three basic parts of Tooth germ

◦ Enamel organ (ectodermal component)

◦ Dental papiila Ectomesenchymal

component
◦ Dental sac or dental follicle

Enamel Dental Dental

organ papilla follicle
• Enamel • dentin • Cementum
• pulp • PDL
• Alveolar bone

Dr.Jignesh
 Hertwig’s epithelial root sheath (HERS)
& root formation

 Schour & Massler suggested that the major function of the

Hertwig’s epithelial root sheath is to induce and regulate root
formation, including the size, shape and number of roots

 Characteristics of HERS:

1. HERS consists of inner & outer enamel epithelia only.

2. Cells of inner layer remain short in size and induce the

differentiation of radicular dental papilla cells into
odontoblast which lays down first layer of radicular dentin.

Dr.Jignesh
3. Some outer layer cells in coronal root region induce cells of dental follicle to
differentiate into cementoblasts similar to osteoblasts which give rise to acellular
cementum.

4. Slavkin suggests, since the epithelial cells of the inner layer of Hertwig’s epithelial root
sheath are analogous to the preameloblasts, it is suggested that they might secrete
enamel matrix proteins over the newly deposited root dentin.

5. In addition to these matrix proteins there are also the components of the epithelial
basement membrane, such as laminin and collagen type IV are sectreted by root sheath.

Dr.Jignesh
Dental Cementum
The dynamic tissue
covering the root

Dr.Jignesh
 Development of cementum

 Process of cementum development is called as “cementogenesis”.

 Cementum is calcified, avascular mesenchymal tissue that forms outer coverings of the
anatomic root.

 It was first demonstrated microscopically in 1835 by two pupils of purkinje.

 It is a specialized connective tissue that shares some physical, chemical & structural
characteristics with compact bone.

Dr.Jignesh
asd
t&
el
ian
o
op
ltn Cementogenesis (Briefly)
n
roig
,on
tg
w
eth
h
ote
igh
clei
h
yon
n
cem
saxe
u
tr
n
b
sei
srn
a
ew
s
n
q
acp
h
u
iloe
ecn
n
st
h
tu
a
lfrco
yoft
ra
m
H
cw
iseE
n
tR Dr.Jignesh
etoh
S
rh
f
[Hertwig’s epithelial root sheath is broken up &
separated from root, and differentiation of
cementoblasts lead to formation of cementum] Dr.Jignesh
 Varieties of cementum

 Two basic types of cementum, hence they are usually classified on the basis of presence of
cementocyte (cellular cementum) or absence of it (acellular cementum).

 It can also be classified on the basis of the types of fibers (extrinsic/intrinsic) presence or
their absence (afibrillar cementum).

 acellular extrinsic fiber cementum is regarded as Primary cementum as it forms first.

Cellular cementum is regarded as secondary cementum because it forms later than
primary cementum.

Dr.Jignesh
Growth factor families involved in the differentiation of
cemetoblasts from dental follicle

TGFβ 1-5
BMP2-8

EGF & IGF

PGE2 & PGF2α enhance differentiation

by activating protein kinase cell
signalling pathway

Fibroblast growth factor promotes

proliferation, migration & angiogenesis

CAP, BSP and osteopontine helps in

attachment of differentiated cells to newly
forming tissue

Dr.Jignesh
Development of acellular cementum
 Development of acellular cementum is associated with secretion of
enamel matrix protein (EMP) by HERS after mineralization of first
layer of dentin adjacent to the root.

 Enamel proteins including amelogenin & certain basement membrane

constituents are reported to be involved in epithelial-mesenchymal
reaction.

 HERS also secrete cementum related proteins like Bone sialoprotein

(BSP), osteopontin & fibrillar collagen.

Dr.Jignesh
 At the same time fibroblast precursors cells from dental follicle come in contact with
predentine matrix and start depositing bundle of collagen fibrils to form a thin layer of
perpendicularly oriented “Sharpey’s fibers” or “fringe fibers”.

 Sharpey’s fibers interdigitate with unmineralized dentin at one end and into extracellular
compartment of acellular cementum at another end.

 As the mineralization front advances, it contacts the sharpey’s fibers and they undergo slow
mineralization to complete the process of acellular extrinsic fiber cementum formation.

Dr.Jignesh
 Development of cellular cementum
(a more rapidly formed & less mineralized variety of cementum)
 Formation occurs after at least half the root is formed.

 Development can be divided into 2 stages:

 An early stage in which extrinsic sharpey’s fibers produced by fibroblasts are few &
traces of intrinsic fibers produced by cementoblasts are randomly arranged

 Later stage of cementogenesis- it closely resembles bone formation. Cementoblasts and

cementocytes are involved in the secretion of intrinsic fibers.

Dr.Jignesh
 Rapid and multipolar mode of mineralization
takes place

 Entrapped cementoblasts are called as –

cementocytes

 Cementcytes have processes that lodge in

canaliculi that communicate but do not form a
syncitium that extends all the way to the surface,
as is the case with in the bone.

Dr.Jignesh
 Cementoid tissue & calcification of matrix
 The uncalcified matrix is called as cementoid.

 the growth of cellular cementum is a rhythmic process, and as a new layer of cementoid is
formed, the old calcifies.

 Gla proteins – osteocalcin & osteonectin acts as neucleators for mineralization due to their
strong affinity for calcium & BSP.

 Alkaline phosphatase promotes mineralization.

 Osteopontine regulates growth of apatite crystals.

 Major proteoglycan located in non-mineralized cementum is keratan sulfates- lumican &

fibromodulin.

Dr.Jignesh
 “Periodontal ligament”
Soft-tissue
continuity
Between the mineralized

Tissues of
Dr.Jignesh
 The periodontal ligamment (PDL) is composed of a complex
vascular & highly cellular connective tissue that surrounds the tooth
root & connects it to the inner wall of the alveolar bone.

 Over the years it has been described by number of terms:

• Desmodont
• Gomphosis
• Pericementum
• Dental periosteum
• Alveodental ligament
• Periodontal membrane

Dr.Jignesh
 Development

 Development of PDL begins with root formation, prior to tooth eruption.

 The dental follicle cells located between the alveolar bone & HERS are composed of two
subpopulations:

 Mesenchymal cells of dental follicle proper

 Perifollicular mesenchyme

 Perifollicular mesenchymal cells bounded by mesenchymal cells of dental follicle proper.

Dr.Jignesh
 As the root formation continues, cells in the perifollicular region and follicle proper are gain their
polarity & the cellular volume & synthetic activity increases.

 These cells obtain long & thin, elongated cytoplasm with increased amount of mitochondria, RER
& active Golgi complex.

 As a result, these cells actively synthesize & deposits collagen fibrils & glycoprotein in the
developing periodontal ligament.

 progenitors for periodontal ligament, osteoblast and cementoblast cells adopt a paravascular
location in the periodontal ligament, and these cells, which exhibit some features of stem cells,
can regenerate functional tissues when the need arises.

Dr.Jignesh
 Developmet of principal fibers

 Immediately before tooth eruption & for sometimes there

after, active fibroblasts adjacent to the cementum of the
coronal 1/3 of the root, aligne in oblique direction to the
long axis of the tooth.

 Soon, thereafter, first collagen fiber bundles of the ligament

become discernible. These are the precursors of the
alveolar crest fiber bundle group.

 Later, similar fibers are observed on the adjacent osseous

surface of the developing alveolar bone.

Dr.Jignesh
 Both set of fibers, alveolar & cemental, continue to elongate toward each other, ultimately to meet,
intertwine & fuse, & cross linking of individual collagen molecules occur.

 By the time of first occlusal contact of the tooth with its antagonist, the principle fibers around the
coronal 1/3 of the root, the horizontal group are almost completely developed

 Oblique fibers in middle third of the root are still being formed.

 After complete root apex is formed, apical group of fibers are developed.

Dr.Jignesh
 l f
a• fI
e
n
p he
r
PDL homeostasis
r in
o bt
t i
 A remarkable capacity of PDL is that it maintains its width more or less, despite the fact, it is
eB at
squeezed
io t in between two hard tissues.
nn im o
 Various se inmolecules have been proposed, which play a role in maintaining an unmineralized PDL.
(• on
I seo
sn ftr
ih ea Prostaglandins
MP
ai ol
s D
bl piL
xi oz
o
2t nef
p
or tdi
r ib
os rnb
t oo
eo bn
l
if ea
n s
m t
i si
n s Dr.Jignesh
b
e s
y
r u
 Cell biology of normal PDL

Resorport Progenito Epithelial Defense

ive cells r cells cells cells

Fibrobla Fibrobla Mast

Epitheli
sts sts cells
Undiffere al cell
Osteobla Osteocla Macrop
ntiated rests of
sts sts stem cells hages
malasse
cemento cemento eiosinop
z
blasts clasts hils

Dr.Jignesh
 Epithelial cell rests of malassez
 Roles attributed to the Epithelial Rest of Malassez cells
range from bad to good.

 Bad Role

 Malassez cells are held responsible for the formation of

periodontal cysts and tumours as a result of peri-apical
inflammation associated with pulpal necrosis.

 Epithelial Rest of Malassez cells contribute to the

formation of the periodontal pocket because of their
continuum with the junctional epithelium.
-Ohshima M, Nishiyama T, Tokunaga K, Sato S, Maeno M, Otsuka K.

Dr.Jignesh
  Good Role

 The cells of the Epithelial Rest of Malassez may protect the root from resorption
- Wallace JA, Vergona K.

 Epithelial cells Rest of Malassez secrete hyaluronic acid, which contributes to the formation
of the loose connective tissue characteristics of the periodontal ligament & react to
mechanical stress, like that associated with orthodontic tooth movement, by increasing their
proliferation rate and cell size. - Brunette DM & Merrilees MJ, Sodek J, Aubin JE

 Epithelial Rest of Malassez - help in cementum repair because of their ability to activate
matrix proteins, such as amelogenin, which are also expressed during tooth development -

Hamamoto Y, Nakajima T, Ozawa H, Uchida T.

Dr.Jignesh
Dr.Jignesh
 The alveolar process is the portion of the maxilla & mandible that forms & supports the tooth
sockets.

 It forms when the tooth erupts to provide the osseous attachment to the forming PDL & it
disappears gradually after the tooth is lost.

Dr.Jignesh
 Bone formation

Intramembranous ossification

Formation of bone matrix

Formation of woven bone

Appositional growth & formation of harvesian

system (osteon)

Endochondral bone formation

Formation of cartiagenous model

Dr.Jignesh
 Development of alveolar process

 An alveolar bone in the strict sense of words develops only during the eruption of the teeth.

 As the root & its covering of primary cementum form, new bone is deposited against the
crypt wall.

Dr.Jignesh
 Crystal form coalescing bone nodules with fast growing,

non oriented collagen fibers- is the substructure of

woven bone, first bone formed in the alveolus.

 Later, through bone deposition, remodelling & secretion

of oriented collagen fibers in sheets, mature lamellar

bone is formed.

 Subsequently, a tissue may develop at alveolar crest that

combines characteristics of cartilage & bone.

 It is called as chondroid bone.

Dr.Jignesh
 Structure of alveolar bone
Alveolar bone proper
(a thin lamella of the bone that surrounds the root of the tooth & gives attachment to the
principle fibers of the PDL)

• Inner socket wall of thin compact bone

• Bundle bone
• Cribriform plate
• Lamina Dura (radiographically)

supporting alveolar bone

(the bone that surrounds the alveolar bone proper
& gives support to the socket)

• External plate of cortical bone

• Spongy bone/ cancellous trabeculae Dr.Jignesh
 Bone remodeling
 Bone is a highly dynamic connective tissue with continuous remodeling.

 Process of bone formation & bone breakdown go on simultaneously, thus the bone represents
the net results of a balance between the two processes

 This phenomena is called as coupling of bone resorption & bone formation.

 The main function of the remodeling are to prevent the accumulation of damaged & fatigued
bone by regenerating new bone & to facilitate mineral homeostasis.

Dr.Jignesh
 Mediators of bone remodeling

 Mechanical factors : when stress is applied on the alveolar bone, two sites are formed, bone is
resorbed at compression site & bone is deposited at tension site.

 Parathyroid hormone

 Vita. D metabolites

 Growth factors

 Bacterial products

Dr.Jignesh
 Markers of bone turnover

Markers of bone • Alkaline phosphatase

formation • osteocalcin
(serum markers) • Procollagen I extension peptide

• Urine calcium
• Urine hydroxyproline
Markers of bone • Collagen crosslink fragments
resorption • Urine N-telopeptides
(urinary markers) • Urine C-telopeptides
• Urine pyridinoline
• Urine free deoxypyridinoline

Dr.Jignesh
Gingiva
The First
Responder

Dr.Jignesh
 Gingiva is an adaptation of oral epithelium in areas involved in mastication of food

 The gingiva is a part of the oral mucosa that covers the alveolar processes of the jaws &
surrounds the neck of the teeth.- McCall

Dr.Jignesh
Clinical features of gingiva

Dr.Jignesh
 Dentogingival junction
(junctional epithelium)
 The epithelium of the gingiva which gets
attached to the tooth is called as junctional or
attachment epithelium.

 It consists of collar like band of stratified

squamous non keratinizing epithelium, located at
CEJ in healthy tissue

Dr.Jignesh
 JE resembles reduced enamel epithelium (RER) in its structure in that they have a basal layer
& few layers of flattened cells & express CK 5, 14, 19, which is typical of nondifferentiating
tissue like RER.

 Highest turnover rate of 5-6 days

 JE is highly permeable & it has large intracellular spaces, so that neutrophils can easily pass
in & out of the epithelium.

 Permits easy flow of GCF

Dr.Jignesh
 Development of dentoginval junction &
gingival sulcus
G
i
n
g
i
v
a
l

s
u
l
c
u
s

d
e
e
p
e
n
s

a
s

r
e
s
u
l
t

o
f

s
e
p
a
r
a
t
i
o
n

o
f

t
h
e

R
E
E

f
r
o
m

a
c
t
i
v
e
l
y

e
r
u
p
t
i
n
g

t
o
o
t
h

&

J
E

a
t
t
a
i
n
s

i
t
s

p
o
s
i
t
i
o
n

a
t

C
E
J

o
f

f
u
l
l
y

e
r
u
p
t
e
d

t
o
o
t

Dr.Jignesh
h
Formation of JE & Gingival sulcus
Dr.Jignesh
 Shift of dentogingival junction

A. The actual movement of crown towards the occlusal plane is called as a active eruption

B. The separation of primary attachment epithelium from the enamel is termed as passive
eruption

crown exposure involving passive eruption & further recession has been described
in four stages

firsr two stages may be physiologic but last two are probably pathologic.

Dr.Jignesh
Stage 1 stage 2 stage 3 stage 4

Shift of dentogingival junction

Dr.Jignesh
Dr.Jignesh
 Reciprocal induction between oral ectoderm & mesenchymal cells derived from neural crest

cells form the major pathway for the development of periodontal tissues.

 Various histochemical molecules favours the differentiation of fibroblasts, cementoblasts &

osteoblasts from the inner cells of the dental sac, which are also secreted at the time of
periodontal regeneration or repair by PDL

 PDL contains both formative & resorptive cells for cementum, A.bone & PDL itself.

Dr.Jignesh
 Based on the information presented, it appears that the developed or adult
periodontium retains its potential for repair/regeneration in the form of
cells of the Epithelial Rest of Malassez, progenitor cells and stem cells,
which can be induced to differentiate into cementoblast, osteoblast or
periodontal ligament cells to regenerate periodontal tissues.

Dr.Jignesh
References:
1. Textbook of Orban’s Oral histology & Embryology, 12 th Ed.
2. Textbook of TenCate’s Oral histolgy & Embryology, 8 th Ed.
3. Margarita zeichner-david, Regeneration of periodontal tissues: cementogenesis revisited, Periodontology
2000, Vol. 41, 2006, 196–217.

4. A. Richard ten cate, The development of the periodontium - a largely ectomesenchymally derived unit,
Periodontology 2000, Vol. 13, 1997, 9-19.

5. Thomas HF, Kollar EJ. Differentiation of odontoblasts in grafted recombinants of murine epithelial root
sheath and dental mesenchyme. Arch Oral Biol 1989; 34: 27-35.

6. Textbook of clinical periodontology, F.A.Carranza, 10 th Ed.

Dr.Jignesh