PERIODONTAL LIGAMENT

SYNONYMS:

-Peridontal Membrane
-Alveolo-dental Ligament
-Desmodont
-Pericementum
-Dental Periosteum
-Gomphosis
DEFINITION:

-The periodontal ligament is a complex vascular and highly cellular

connective tissue that surrounds the root and connects it to the inner wall
of alveolar bone. It is continuous with the connective tissue of the gingiva
and communicates with the marrow spaces through vascular channels in
the bone.(Carranza)

-It occupies the periodontal space, which is located between the

cementum and the periodontal surface of bone and extends coronally to
the most apical part of the lamina propria of the gingiva.(Orban’s)
SHAPE AND EXTENT:

-It is the thinnest around the middle third of root, hourglass

appearance.

-It ranges in width from 0.15-0.38mm.(Ten cate)

-It appears as a radiolucent area of 0.4-1.5mm between the

radiopaque lamina dura of the bone and cementum.(Orban’s)
Radiograph of a mandibular pre-molar region
showing 2 types of alveolar bone: Part of alveolar
bone covering alveolus  LAMINA DURA (arrows)
Portion of alveolar bone having appearance of a
meshwork  SPONGY BONE
WIDTH OF PDL = 0.25 mm (Range 0.2 to 0.4 mm)
 TOOTH TISSUES: Cell Sources

DENTAL LAMINA TOOTH

DENTAL ORGAN ENAMEL

Ameloblasts

DENTAL PAPILLA DENTINE

Odontoblasts
PULP
CT cells
DENTAL SAC/FOLLICLE CEMENTUM
Cementoblasts
PDL
Fibroblasts
ALVEOLAR BONE
A BONE
Osteoblasts & ‘clasts
Crest
 DEVELOPMENT:
•Crown approaches the oral mucosa during tooth eruption
•Fibroblasts become active and produces fibrils.
•Initially lack orientation, but they soon acquire an orientation oblique
to the tooth.
•The first collagen bundles appear apical to the CEJ (gingivodental
fiber groups)
groups
•As tooth eruption progresses, additional oblique fibers appear and
become attached to bone & cementum.
•Trans septal and alveolar crest fibers develop when the tooth erupts
• Alveolar bone deposition occurs simultaneously with periodontal
ligament organization.

Grant D, Bernick S: Formation of the periodontal ligament, J Periodontol 43:17, 1972

The collagen fibers produced by the The true PDL fibres (Principal fibers)
fibroblasts embedded into the newly develop in conjunction with tooth
formed cementum immediately apical eruption.
to the CEJn.
First, small, fine, brush- Later the number and The fibers originating
like fibrils are detected thickness of fibers from the cementum
and the surface of the entering the bone subsequently fuse in
bone is covered by increase which the periodontal
osteoblasts. gradually become ligament space with the
longer. fibers originating from
the alveolar bone.
Later, more apically positioned The orientation of the collagen fiber
bundles of oriented collagen fibres bundles gets altered continously
are seen. during tooth eruption and stabilises
once the tooth reaches in occlusion.
PERIODONTAL FIBERS:
-Sharpey’s fibers-The collagen bundles of the
periodontal ligament embedded into cementum and
alveolar bone.

-Principal fibers(Holmstrup et al 1996)-These are

collagenous fibers that follow wavy pattern when viewed
in longitudinal section.
 Principal fibers of the periodontal ligament follow
a wavy course when sectioned longitudinally.
Ciancio SC, Neiders ME, Hazen SP: The principal fibers of the periodontal ligament,
Periodontics 5:76, 1967
Collagen is a protein composed of different amino acids, the
most important of which are glycine, proline, hydroxylysine, and
hydroxyproline. The amount of collagen in a tissue can be
determined by its hydroxy­proline content.
Collagen biosynthesis occurs inside the fibroblasts to form
tropocollagen molecules. These aggregate into microfibrils that are
packed together to form fibrils.
Collagen fibrils have a transverse striation with a characteristic
periodicity of 64 nm; this striation is caused by the overlapping
arrangement of the tropocollagen molecules.
In collagen types I and III, these fibrils associate to form fibers,
and in collagen type I the fibers associate to form bundles.

Romaniuk K: Some observations of the fine structure of human cementum, J Dent Res
46:152, 1967.
Collagen microfibrils, fibrils, fibers, and bundles
 Collagen is synthesized mainly by fibroblasts, chondroblasts,
osteoblasts and odontoblasts. The several types of collagen are all
distinguishable by their chemical composition, distribution,
function, and morphology.
morphology
The principal fibers are composed mainly of collagen type I,
whereas reticular fibers are composed of collagen type III.
Collagen type IV is found in the basal lamina.
The molecular configuration of collagen fibers confers to them a
tensile strength greater than that of steel. Consequently, collagen
imparts a unique combination of flexibility and strength to the
tissues wherein it lies.

Romanos G, Schroter-Kermani C, Hinz N, et al: Immunohistochemical distribution of the

collagen types IV, V and VI and glycoprotein laminin in the healthy rat, marmoset and
human gingivae, Matrix 11:125, 1991
The principal fibers of the periodontal ligament are arranged in six
groups that develop sequentially in the developing root:

1. Transseptal group: It extends interproximally over the alveolar bone

crest and are embedded in the cementum of adjacent teeth.

2. Alveolar crest group: It extends obliquely from the cementum just

beneath the junctional epithelium to the alveolar crest which prevent
the extrusion of the tooth and resist lateral tooth movements.

3. Horizontal group: Horizontal fibers extend at right angles to the long

axis of the tooth from the cementum to the alveolar bone.
4. Oblique group: ( largest group)
It extends from the cementum in a coronal direction obliquely to
the bone. They bear the brunt of vertical masticatory stresses and
transform them into tension on the alveolar bone.

5. Apical group: This radiate in a rather irregular fashion from

the cementum to the bone at the apical region of the socket.

6. lnterradicular fibers: The interradicular fibers fan out from

the cementum to the tooth in the furcation areas of multirooted
teeth.
Principal fibers of PDL
 IMMATURE FIBERS:
OXYTALAN & ELAUNIN:
Although the periodontal ligament does not contain mature
elastin, two immature forms are found  oxytalan and eluanin.
eluanin
The so called oxytalan fibers run parallel to the root surface in a
vertical direction and bend to attach to cementum in the cervical
third of the root. They are thought to regulate vascular flow.

Goggins JF: The distribution of oxytalan connective tissue fibers in periodontal

ligaments of deciduous teeth, Periodontics 4:182, 1966.
INDIFFERENT FIBER PLEXUS:

In addition to these fiber types, small collagen fibers

associated with the larger principal collagen fibers have
been described. These fibers run in all directions, forming a
plexus called the indifferent fiber plexus.
plexus
Cellular Elements
(connective tissue cells, epithelial rest cells, immune system cells,
and cells associated with neurovas­cular elements)
-Connective tissue cells include fibroblasts, cementoblasts, and
osteoblasts.
-Fibroblasts are the most common cells in the periodontal ligament
and appear as ovoid or elongated cells oriented along the principal
fibers and exhibiting pseudopodia like processes.
-These cells synthesize collagen and also possess the capacity to
phagocytose "old" collagen fibers and degrade them by enzyme
hydrolysis. Thus collagen turnover appears to be regulated by
fibroblasts in a process of intracellular degradation of collagen not
involving the action of collagenase.
-Osteoblasts and cementblasts, as well as osteoclasts and
odontoclasts, also are seen in the cemental and osseous surfaces of
the periodontal ligament.

-The epithelial rests of Malassez form a latticework in the

periodontal ligament and appear as either isolated clusters of cells
or interlacing strands, depending on the plane in which the
microscopic section is cut.
-The epithelial rests are considered remnants of Hertwig's root
sheath,
sheath which disintegrates during root development.
Fig. shows the presence of clusters of epithelial cells (ER) in the periodontal
ligament. These cells, called the epithelial cell rests of Mallassez,
Mallassez represent
remnants of the Hertwig's epithelial root sheath.
sheath The epithelial cell rests are
situated in the periodontal ligament at a distance of 15-75 μm from the cementum
(C) on the root surface. A group of such epithelial cell rests is seen in a higher
magnification.
 Clinical significance:

• The epithelial cell rests of Malassez (ERM) are odontogenic epithelial

cells located within the periodontal ligament matrix.

• While their function is unknown, they may support tissue homeostasis

and maintain periodontal ligament space or even contribute to
periodontal regeneration.

• ERM contain a subpopulation of stem cells that could undergo

epithelial–mesenchymal transition and differentiateinto mesenchymal
stem-like cells with multilineage potential.

Reeve CM, Wentz FM: The prevalence, morphology and distribution of epithelial
rests in the human periodontal ligament, Oral Surg Oral Med Oral Pathol 15:785,
1962
-Cementicles may develop from calcified epithelial rests; around
small spicules of cementum or alveolar bone traumatically
displaced into the periodontal ligament; from calcified Sharpey's
fibers;
fibers and from calcified, thrombosed vessels within the
periodontal ligament.
-Epithelial rests are distributed close to the cementum throughout
the periodontal ligament.
- They diminish in number with age by degenerating and
disappearing or undergoing calcification to become cementicles.
-The defense cells include neutrophils, lymphocytes,
macrophages, mast cells, and eosinophils.
GROUND SUBSTANCE

1. Glycosaminoglycans,
Glycosaminoglycans such as hyaluronic acid and
proteoglycans.

2. Glycoproteins such as fibronectin and laminin. It also has a

high water content (70%).The periodontal ligament also may
contain calcified masses called cementicles,
cementicles which are
adherent to or detached from the root surfaces
PDL: Intermediate plexus Non-embedded
ends of PDL fibers
meet & attach in
D INTERMEDIATE
E PULP PLEXUS
N

{
T
I
N
E
This arrangement
provides for greater
ease of remodelling &
readjustment of the
plexus for growth &
altered function. But
remodelling occurs
throughout the PDL
 Early investigators had suggested that the individual fibers,
rather than being continuous, consisted of two separate parts
spliced together midway between the cementum and the bone in a
zone that is called the inter­mediate plexus.
Rearrangement of the fiber ends in the plexus is supposed to
accommodate tooth eruption without necessitating the embedding
of new fibers into the tooth and the bone.
FUNCTIONS:
The functions of the periodontal ligament are physical, formative and
remodeling, nutritional, and sensory.
Physical Function: The physical functions of the periodontal ligament
entail the following:
1. Provision of a soft tissue "casing" to protect the vessels and nerves
from injury by mechanical forces
2. Transmission of occlusal forces to the bone
3. Attachment of the teeth to the bone
4. Maintenance of the gingival tissues in their proper relationship to the
teeth
5. Resistance to the impact of occlusal forces (shock absorption)
RESISTANCE TO THE IMPACT OF OCCLUSAL FORCES
Two theories relative to the mechanism of tooth support have been
considered: the tensional and viscoelastic system theories.
theories
TRANSMISSION OF OCCLUSAL FORCES TO THE BONE
The arrangement of the principal fibers is similar to a suspension
bridge or hammock.
hammock
When an axial force is applied to a tooth, a tendency toward
displacement of the root into the alveolus occurs. The oblique fibers alter
their wavy, untensed pattern;
pattern assume their full length; and sustain the
major part of the axial force.
2 PHASES- The first is within the confines of the periodontal ligament,
and the second produces a displacement of the facial and lingual bony
plates. The tooth rotates about an axis that may change as the force is
increased.
 The apical portion of the root moves in a direction opposite to the
coronal portion.
In areas of pressure, the fibers are compressed, the tooth is displaced,
and a corresponding distortion of bone exists in the direction of root
movement. In single-rooted teeth, the axis of rotation is located in the
area between the apical third and the middle third of the root.
The root apex and the coronal half of the clinical root have been
suggested as other locations of the axis of rotation.
In compliance with the physiologic mesial migration of the teeth, the
periodontal ligament is thinner on the mesial root surface than on the
distal surface.

Boyle PE: Tooth suspension: a comparative study of the paradental tissues of man and
of the guinea pig, J Dent Res 17:37, 1938
 Distribution of faciolingual forces (arrow) around the axis of
rotation (black circle on root) in a mandibular premolar. The
periodontal ligament fibers are compressed in areas of pressure
and tension. Left, The same tooth in a resting state.
Formative and Remodeling Function
•Cells of the periodontal ligament participate in the formation and
resorption of cementum and bone, which occur in physiologic tooth
movement; in the accommodation of the periodontium to occlusal forces;
and in the repair of injuries.
• Variations in cellular enzyme activity are correlated with the
remodeling process. Cartilage formation in the periodontal ligament,
although unusual, may represent a metaplastic phenomenon in the repair
of this ligament after injury.
•The periodontal ligament is constantly undergoing re­modeling. Old
cells and fibers are broken down and replaced by new ones, and mitotic
activity can be observed in the fibroblasts and endothelial cells.
Tooth drifts mesially TOOTH MOVEMENT
by combined actions
of osteoclasts &
osteoblasts moving
bone, taking tooth
with it

Osteoblasts
laying down
bundle bone

Plus PDL
reorganization

Osteoclasts
resorbing bone
NUTRITIONAL AND SENSORY :
•The periodontal ligament supplies nutrients to the cementum, bone,
and gingiva by way of the blood vessels and provides lymphatic
drainage.
•The periodontal ligament is abundantly supplied with sensory nerve
fibers capable of transmitting tactile, pressure, and pain sensations by
the trigeminal path­ways.
•Nerve bundles pass into the periodontal ligament from the periapical
area and through channels from the alveolar bone that follow the
course of the blood vessels.
 PDL Vessels DENTINE

PULP

Enter via cribriform

(sieve) walls of the
alveolus & at the
base

Lymphatic drainage
Blood Supply:
Derived from the inferior and superior alveolar arteries to the mandible and
maxilla and reaches the PDL from 3 sources:
sources
1. Apical vessels.
2. Penetrating vessels from the alveolar bone
3. Anastomosing vessels from the gingiva.
• The trans alveolar vessels are branches of the intraseptal vessels that
perforate the lamina dura and enter the ligament.
• The intra septal vessels continue to vascularize the gingiva; these
gingival vessels in turn anastomose with the periodontal ligament
vessels of the cervical region.
• The blood supply increases from the incisors to the molars;
molars is great­
est in the gingival third ; and also in mesial side than distal side.
• The venous drainage of the periodontal ligament accompanies the
arterial supply. Venules receive the blood through the abundant
capillary network; also, arteriovenous anastomoses bypass the
capillaries( apical and interradicular)
• Lymphatics supplement the venous drainage system. Those draining
the region just beneath the junctional epithelium pass into the
periodontal ligament. From there they pass through the alveolar bone
to the inferior dental canal in the mandible or the infraorbital canal in
the maxilla and then to the submaxillary lymph nodes.
 PERIODONTAL LIGAMENT INNERVATION
Sup Cervical
Sympathetic Ganglion

Free ending V Ganglion CNS

Mesencephalic
“Ruffini” receptors nucleus of V
Mechanoreceptors for stretch

Modalities: PROPRIOCEPTION & pain

 -They divide into single myelinated fibers, which ultimately lose their
myelin sheaths and end in one of four types of neural termination:

• Free endings,
endings which have a treelike configuration and carry pain
sensation;
• Ruffini-like mechanoreceptors,
mechanoreceptors located primarily in the apical area;
• Coiled Meissner's corpuscles,
corpuscles also mechanoreceptors, found mainly
in the midroot region;
• Spindle like pressure and vibration endings,
endings which are surrounded by
a fibrous capsule and located mainly in the apex.
Wider on bone- PDL in Cross-section
Interstitial Area
depository side

Bundle

DENTINE
CEMENTUM
P
D PULP
L

BONE
Narrow on bone-
resorptive side
Loss of Periodontal reactions to disuse
alveolar bone Reduction in
number & size of
principal
fibers
Mild bone Bundle
deposition definition
on wall DENTINE
lost
CEMENTUM
P thickens
D PULP
L
PDL CEMENTUM
narrower all loses
around Sharpey’s
BONE fibers
AGE CHANGES IN THE PERIODONTAL LIGAMENT:

Changes in PDL ligament with aging include decreased no. of

fibroblasts and a more irregular structure (Mackenzie, Holm –
Pederesen,Karring)

Decreased organic cell matrix production and increased amount of

elastic fiber (Vander velden)

Impairment of periodontal ligament repair with aging is due to the

decrease in proliferative ability in HPL cells with aging (Shiba et al)

The decrease in secreted protein acidic and rich in cysteine (SPARC)

with aging may be related to changes in metabolism of periodontal
ligament that occur with aging.
WIDTH OF PDL SPACE:

According to Klein & Kronfeld the width of the Pdl space increases
with age because with age there is less number of remaining natural
teeth and the masticatory load is distributed through the natural teeth.
Hence there is increase in the PDL space as an adaptation to function.

According to Helkins & Herring the masticatory force by itself

decreases with age and there is a decrease in PDL space due to disuse
atrophy.

Moreover Ive et al reported a decrease in PDL space due to the fact

that both the cementum and bone undergoes remodelling with age. This
occurs at the expense of the pdl space.
PERIODONTITIS:
Periodontal pocket
 Soft Tissue Wall

A, Lateral wall of periodontal pocket showing epithelial proliferative

and atrophic changes and marked inflammatory infiltrate and
destruction of collagen fibers. B, Slightly apical view of the same case
showing the shortened junctional epithelium.
 Microtopography of Gingival Wall

1. Areas of relative quiescence- flat surface with minor depressions and

mounds and occasional shedding of cells.
2. Areas of bacterial accumulation,bacteria are mainly cocci, rods, and
filaments, with a few spirochetes .
3. Areas of emergence of leukocytes, where leukocytes appear in the
pocket wall through holes located in the intercellular spaces
4. Areas of leukocyte-bacteria interaction, where numerous leukocytes are
present and
covered with bacteria in an apparent process of phagocytosis.
5. Areas of intense epithelial desquamation, which consist of semi attached
and folded epithelial squamous.
6. Areas of ulceration, with exposed connective tissue.
7. Areas of hemorrhage, with numerous erythrocytes.
POCKET CONTENTS:

•Debris consisting of micro organism and their

products.

•Gingival fluid, food remnants.

•Desquamated epithelial cells.

•Leucocytes.

•Plaque covered calculus.

ROOT SURFACE WALL
RELATIONSHIP OF ATTACHMENT LOSS AND BONE LOSS TO
POCKET DEPTH
PERIODONTAL ABCESS

PERIODONTAL CYST
HEALING AFTER PERIODONTAL THERAPY:
Guided tissue regeneration:
RECENT ADVANCES:
REFERENCES:

-carranza 10th edition.

-lindhe 8th edition.
Boyle PE: Tooth suspension: a comparative study of the paradental tissues of man and of
the guinea pig, J Dent Res 17:37, 1938.
-Carneiro J, Fava de Moraes F: Radioautographic visualization of collagen metabolism
in the periodontal tissues of the mouse, Arch Oral Biol 10:833, 1955.
-Rao LG, Wang HM, Kalliecharan R, et al: Specific immunohistochemical
localization of type I collagen in porcine periodontal tissues using the peroxidase-
labelled antibody technique, Histochem J 11:73, 1979.
-Reeve CM, Wentz FM: The prevalence, morphology and distribution of
epithelial rests in the human periodontal ligament, Oral Surg Oral Med Oral
Pathol 15:785, 1962.
-Rippin JW: Collagen turnover in the periodontal ligament under normal and
altered functional forces. II. Adult rat molars, J Periodontal Res 13:149, 1978.
Thank
you!!!