PERIODONTAL

LIGAMENT IN
HEALTH AND DISEASE

PRESENTED BY –
DR SHRUTI LENDHEY
 INDEX
 Introduction
 Definition
 Development
 Content
 Functions of pdl
 Clinical considerations
 Periodontal ligament in disease
 Regenerative potential of pdl
 Summary
 References
 INTRODUCTION

 The periodontal ligament

is situated in the
space between the roots
of the teeth and the lamina
dura or the alveolar bone
proper.

 The width of PDL

is approximately
0.25mm (range 0.2 to
0.4mm)
 In the coronal direction, the periodontal ligament
is continuous with the lamina propria of the
gingiva and is demarcated from the gingiva by the
collagen fiber bundles which connect the alveolar
bone crest with the root.

 The periodontal ligament space has the shape of

an hourglass and is narrowest at the mid root level
 DEFINITION
 The periodontal ligament is a complex cellular and
highly vascular connective tissue structure that surrounds
the tooth root and connects it to the inner wall of the alveolar
bone. It is continuous with the connective tissues of the
gingiva and communicates with the marrow spaces
through vascular channels in the bone
- Carranza

 The periodontal ligament is the soft, richly vascular and cellular

connective tissue which surrounds the roots of the teeth
and joins the root cementum with the socket wall.
- Lindhe
 DEVELOPMENT
 The periodontal fibroblast have
their origin in the dental follicle
and begins to differentiate
during root development.
(Ten Cate et al 1971)
 With continuing
apical development of the root, the
cells of dental follicle
differentiate into cementoblast to
form cementum lining the root
surface, and this subsequently
leads to the appearance of
periodontal ligament fibroblasts
and formation of periodontal
ligament.
 All of these development processes occur prior to eruption of
teeth (Grant and Bernick 1972)

 Fiber formation and deposition occur sequentially from the

newly forming CEJ to the apex of the tooth root.

 The first fibers to develop ultimately become the dentogingival

and Transeptal fibers of the gingiva while those that develop
apical to CEJ ultimately form fibers of periodontal ligament.

 As the teeth begins to erupt, the orientation of the ligament

fibers changes according to the stage of eruption.
(Grant and Bernick 1972)
Stages of organisation of PDL
 Development of principal fibres of PDL

 I l lustration of the development of the

principle f ibers of the
periodontal l igament.
 HISTOLOGICAL STRUCTURE

CELLS EXTRACELLULAR
COMPONENTS

CONNECTIVE
TISSUE CELLS FIBERS

EPITHELIAL REST GROUND

CELLS SUBSTANCE

CELLS ASSOC. WITH

NEUROVASCULAR
ELEMENTS
BLOOD SUPPLY,
NERVE SUPPLY
AND LYMPHATICS
DEFENCE CELLS
 Extracellular components

 FIBERS:
Principal fibers
Oxytalan fibres
Indifferent fiber plexus

 GROUND
SUBSTANCE:
Proteoglycans
Glycoproteins
 PERIODONTAL FIBERS

 The most important element

of the periodontal ligament
are the principal fibers.

 These are collagenous

in nature and are arranged
in bundles. They follow a
wavy course.

 The terminal portion of these

fibers are inserted in
the cementum and
bone and called as
Sharpey’s fibers.
 Sicher (1923) postulated the existence of an intermediate
zone, located midway between the bone and the cementum
in which fibres intermesh. It was presumed to an area
of high metabolic activity where the fibres could
be sliced and unsliced with ease.
 Sicher (1942) stated that human PDL consists of
 alveolar fibres
 dental fibres
 an intermediate plexus
 Berkovitz et al(1980) demonstrated a “zone of shear” – a site
of remodeling during eruption.
 However, its location is in dispute ie if it lies near the tooth
surface or in the centre.
 COLLAGEN
 Collagen is the predominant protein of the
periodontal tissues.
 Composed of different amino acids, the most important of
which are Proline, glycine,hydroxyproline,
hydroxylysine .
(Carneiro J).
 The amount of collagen can be determined by
its hydroxyproline content.

 Collagen fibrils have transverse striation with a characteristic

periodicity of 64nm; this striation is caused by
the overlapping of tropocollagen molecules.
 The molecular configuration of collagen give them
tensile strength greater than that of steel

 Sodek (1977) found collagen synthesis in PDL of adult rat

to be
 2 fold greater than that of gingiva
 4 fold….. than skin
 6 fold …...than that of bone.
 STAGES IN THE FORMATION OF
COLLAGEN

TROPOCOLLAG MICRO
EN
MOLECULES FIBRILS

COLLAGEN COLLAGEN
FIBER FIBRILS
 In collagen types I and III these fibrils associate to
form fibers, and in collagen type I the fibers
associate to form bundles.

Collagen microfibrils, fibrils, fibers, and bundles

 PRINCIPAL FIBERS

 The principal fibers of the periodontal ligament are

arranged in six groups that develops sequentially
.

1. TRANSSEPTAL GROUP
2. ALVEOLAR CREST GROUP
3. HORIZONTAL GROUP
4. OBLIQUE GROUP
5. APICAL GROUP
6. INTERRADICULAR FIBER
 TRANSEPTAL GROUP

 EXTENT: Interproximally
over the alveolar bone crest
and are embedded in the
cementum of adjacent teeth.

 FEATURES:
 They are reconstructed even
after the destruction
of alveolar bone.
 These fibers may be
considered as belonging
to the gingiva as they don’t TRANSSEPTAL FIBERS
have any osseous attachment
 ALVEOLAR CREST GROUP
 EXTENT: These fibers run
obliquely from the
cementum just beneath
the junctional
epithelium to the alveolar crest

 FEATURES:
1. Prevent the extrusion of the
tooth and resist lateral tooth
2. movement
Incision of these fibres
during surgery does not
increase mobility unless
significant attachment loss
has occured. (Gillespie BR) (1979)
 HORIZONTAL GROUP

 EXTENT: In horizontal
direction at right angles to the
long axis of the tooth from the
cementum to the alveolar bone.

 FEATURES:
Restrain lateral tooth
movements
 OBLIQUE GROUP
 EXTENT: They extend from
the
cementum in a coronal direction
obliquely to the bone,

 attached superiorly to the alveolar

bone and inferiorly to
cementum

 FEATURES:

1. Largest group of fibres.

2. Bear the brunt of the vertical

masticatory stresses and
 APICAL GROUP

 EXTENT: They radiate in a

rather irregular fashion from
the cementum to the bone
at the apical region of
the socket.

 FEATURES:

1. They do not occur on

incompletely formed roots

2. Prevent tipping and resist

 INTERRADICULAR GROUP

 EXTENT:
They fan out from the
cementum to the tooth in the
furcation areas of multirooted
teeth.

 FEATURES:
It resist and also
luxation tipping and
torquing
 OXYTALAN FIBERS

 Describe by Fullmer (1974).

 Two immature elastins are oxytalan
and eluanin are seen.
 The oxytalan fibers run parallel to the
root surface in a vertical direction
and bend to attach to the
cementum in the cervical third
of the root.
 They are thought to regulate the
vascular flow.
OXYTALAN FIBRES
 INDIFFERENT FIBER PLEXUS

 In addition there are small collagen fibers

associated with the larger principal
collagen fibers.

 These fibers run in all directions forming a

plexus- called the indifferent fiber plexus
 CELLULAR ELEMENTS
C e l l so f t h e P D L i s c a t e g o r i z e d a
s 1) S: y- n t h e t i c

cells-
Fibrobla
st
Osteoblast
Cementoblas
t
2) Resorptive c
ells- Fibroblas
t
of Malass
Osteoclast ez
Defence cells - m a s tc e l l s and
C e m e nmt ao c rl oa sp th a g e s
3) Progenitor ce
 FIBROBLASTS

 Periodontal fibroblasts are the most common cells in

the
periodontal ligament

 Responsible for metabolism of extracellular matrix

components

 Appear as ovoid or elongated cells oriented along the

principal fibers and exhibit pseudopodia like processes.

 These cells synthesize collagen and also possess the capacity to

phagocytose "old" collagen fibers and degrade them
via enzymes hydrolysis.
 The collagen turnover appears to be regulated by fibroblasts in a
process of intracellular degradation of collagen not involving
the action of collagenase

 The fibroblasts in the ligament are oriented more or less parallel

to the collagen fibers, whereas in cross-sections they may
exhibit a stellate appearance, with cytoplasmic
processes segregating individual bundles of collagen
fibers.

FIBROBLAST
 The fibroblasts of the periodontal ligament
are interconnected by numerous junctions which
can be categorized as gap and adherence type
junctions.

(Beertsen)

Gap junction Adherence type of junction

 FUNCTION OF FIBROBLASTS

 The main function of fibroblast is the production of various type

of fibers and synthesis of connective tissue matrix.

 They produce;
Collagen
fibers Reticulin
fibers Oxytalan
fibers Elastin
fibers
 The periodontal ligament is known to have two main lineages
of fibroblasts-the common connective tissue fibroblast and
the osteoblast-like fibroblasts, rich in alkaline phosphatase.

 These cells have the capacity to give rise to bone cells

and cementoblasts. They are also responsible for the
production of acellular extrinsic fiber cementum in the
mature periodontal ligament.

 Periodontal ligament fibroblasts are also needed to maintain

the normal width of the periodontal ligament by preventing
the encroachment of bone and cementum into the
periodontal ligament space.
 CEMENTOBLAST

 Cementoblast are cementum forming cells

lining the surface of cementum.

 Cementoblast are not as elongated as the

fibroblast, being cuboidal cells. They
are rich in cytoplasm and contain large
nuclei.

 They have all the intercellular substance

necessary for protein synthesis
and secretion.
CEMENTOBLAST
 OSTEOCLAST

 The surface of alveolar bone shows a

number of resorption
termed concavities as
which osteoclast
howship’s
lies. lacunae in
 Osteoclast shows
considerable
change in size and shape ranging
from small mononuclear to
large multinucleated.
OSTEOCLAST
 The cell which lie close to the
bone often has brush border.
 CEMENTOCLAST

 Cementoclast are the cells which are found close to

the cementum being desorbed.

 These cells are actively involved in the resorption

process of the cementum.

 Cementoclast has the same cytoplasmic feature as that

of osteoclast, and they are supposed to be
derived from the blood cell of the macrophage
type.
 PROGENITOR CELLS

 An important constituent of the periodontal

ligament is undifferentiated mesechymal cells
or progenitor cells.

 These have a location of within 5 micron of the

blood vessels.

 However it has been demonstrated that these cells

are the source of cells in the periodontal ligament
 EPITHELIAL REST CELLS

 The cell rests of Malassez form a

latticework in the periodontal
ligament and appear as
isolated clusters of either
cells or
interlacing strands.
 The epithelial rests are considered
remnants of Hertwig's root
sheath
which disintegrates during
root development.
 The epithelial cell rests are situated
in the periodontal ligament at a
distance of 15–75 μm from the
cementum(C) on the root EPITHELIAL REST
surface. CELL OF MALASSEZ
 During the 1st and 2nd decade of life
they are most numerous near the
apical end of root and in the last
decade they are more prevalent in
the cervical area. EPITHELIAL REST
CELL OF MALASSEZ

 They diminish in number with age by

degenerating and disappearing or
undergoing calcification to become
cementicles.

 Play a role in tissue homeostasis as

well as tissue regeneration.
DEFENCE CELLS

NEUTROPHILS

LYMPHOCYTES

MACROPHAGES

MAST CELLS

EOSINOPHILS
 MAST CELLS
 Mast cells are often associated with blood vessels. They
show a large number of intracytoplasmic granules.

 When the cell is stimulated it degranulates and is also

involved in production of histamine, heparin and
other factors associated with anaphylaxis

MAST CELLS
 MACROPHAGES

 Macrophages are responsible for

phagocytosing particulate
matter and invading the
microorganisms

molecules
 They with
also synthesize important
a range
function such
of interferon,
as prostaglandin factors that MACROPHAGES
stimulates
and the fibroblast and
endothelial cells.
 GROUND SUBSTANCE

The periodontal ligament also contains a large

proportion of ground substance filling the spaces
between fibers and cells. It consists of two main
components:

 Glycosaminoglycans such as hyaluronic

acid proteoglycans

 Glycoproteins such as fibronectin and

laminin.
 PROTEOGLYCANS

 The Proteoglycans are compounds containing anionic

polysaccharides (glycosoaminoglycans) which are
covalently attached to protein coat.

 Two proteoglycans been isolated (Gibson 1992)

have Dermatan
sulphate
Chondroitin sulphate
 The chondroitin sulfate rich proteoglycans play a role in
absorbing compressive shocks and thereby protect the cells
of the ligament from damage during occlusal contact
 GLYCOPROTEIN

 The complex glycoprotein are called as fibronectin. The

fibronectin is widely distributed between cross
striated collagen fibrils, surrounding these fibrils in
the microfibrillar network.

 These proteins are thought to promote attachment of cells

specially to collagen fibrils.

 As cells preferentially attach to fibronectin they are also

helpful in the orientation and migration of cells.
 Like fibronectin, PDL also contain tenascin that is
more like a fetal connective tissue. Tenascin is
not present uniformly in the PDL but it is
more concentrated near the alveolar
bone and cementum.

 Inaddition PDL also contain osteonectin,

vitronectin and osteopoetin. The osteopoetin is
produced during alveolar bone regeneration.
(Lekic et al 1996)
 CEMENTICLES

 These are calcified masses which are

adherent to or detached from the
root surfaces.
 They may develop from :
 Calcified epithelial rests
 Around small spicules of cementum
or alveolar bone
traumatically displaced into the PDL.
 From calcified Sharpey’s fibers
 From calcified thrombosed vessels in
the ligament
 BLOOD SUPPLY

Derived from the inferior and superior

alveolar arteries to the mandible and
maxilla and reaches the PDL from 3
main sources :-
 Apical group of arteries: These are
branches of vessels supplying the
tooth pulp.
 Alveolar group of arteries: These arteries
enter the PDL space from the
alveolar bone. These are also
referred to as perforating arteries..
 Gingival group of arteries: These
are derived from the gingival blood
supply. These enter the PDL from the
crestal region and anastomoses
with the vascular network of PDL.
 NERVE SUPPLY

 The nerve supply of the PDL comes from either

the inferior or superior dental nerves.
1. Bundles of nerve fibers run from the apical region of
the tooth to the gingival margin.
2. Nerves enter the ligament horizontally
through multiple foramina in the bone.

 Theperiodontal ligament is capable of

transmitting tactile ,pressure and pain sensations by
trigeminal pathways.
 FUNCTIONS OF
PERIODONTAL LIGAMENT
 FORMATIVE AND
PHYSICAL
REMODELLING
FUNCTIONS
FUNCTION

FUNCTIONS

REGULATION OF
NUTRITIONAL AND
PERIODONTAL
SENSORY FUNCTIONS
LIGAMENT WIDTH
 PHYSICAL FUNCTIONS
 The physical functions 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 in their proper

tissues relationship to the teeth

5. Resistance to the impact of occlusal

forces (shock absorption)
 Resistance To Impact to occlusal forces :-
Acts as shock absorber to the occlusal
forces, there are two theories have been
1. considered ; theory
Tensional
2. Viscoelastic theory (Bien SM 1966)

 Transmission of occlusal forces to bone:-

-The arrangement of principle fiber is like a suspension
bridge.
-The apical portion of root moves in a direction opposite
to the coronal portion.
(Picton DC)
 In areas of tension, the principal fiber bundles are
taut rather than wavy. 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.

 In multi-rooted teeth, the axis of rotation is located in

the bone between the roots.
The periodontal ligament has an hourglass shape, and is
narrowest at the axis of rotation.
(Coolidge ED)
The PDL is thinner at the mesial root surface than on
the distal surface.

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 distension in
areas of tension.
Left, The same tooth in a
resting state.
 PROPRIOCEPTION

 One of the main functions of the PDL in the masticatory cycle

is to provide sensory feedback during chewing.

 Humans are capable of detecting the presence of very small

particles between the occlusal surfaces of teeth. The teeth
also can serve as an excellent judge of material properties.

 There are proprioceptive sensors in the PDL that provide

sensory information about how fast and how hard to bite
(Hannam 1982).
 Lund and Lamarre (1973) anesthetized patient’s teeth and
found a 40% reduction in bite force applied, indicating
that PDL proprioceptors are important in the control of
bite force
 FORMATIVE AND REMODELING
FUNCTION

 Cells of the PDL participate in the formation and remodeling

of the cementum and the bone, which occurs during the
tooth movement.

 Variation in the cellular enzyme activity is related with the

remodeling.
(Gibson W)
 Cartilage formation in the periodontal ligament is a
metaplastic phenomenon which may be due to the repair
from injury.
(Bauer WH)
 The PDL is constantly undergoing remodeling.
(Muhlemann)

 Studies by the use of radioactive

element suggest that the turnover rate of
collagen is twice as that of gingiva and four
times as that of skin ,as established in
rat molar (Sodek J)
 NUTRITIONAL FUNCTIONS

 The periodontal ligament supplies nutrients to the

cementum, bone and gingiva by way of the blood
vessels and also provides lymphatic drainage.

 PDL is highly vascularized tissue and this may provide

hydrodynamic damping to applied forces, as well as
high perfusion rates to the periodontal ligament.
 SENSORY FUNCTIONS

NEURAL TERMINATIONS

COILED SPINDLE
FREE RUFFINI MEISSNER’S LIKE
ENDINGS MECHANO CORPUSCLE
RECEPTORS ENDINGS
-primarily
-pain -primarily in in midroot
-pressure and
sensation apical areas vibration
region mainly in apex
 REGULATION OF PERIODONTAL LIGAMENT
WIDTH

 The cells, vascular elements and extracellular matrix

proteins of the periodontal ligament
function collectively to enable the teeth to adjust
their position while remaining firmly attached to
the bony socket.

 Cytokines and growth factors are important locally

acting regulators of cell function and
periodontal ligament cells are capable of synthesizing
and secreting some of these factors.
 Protein S100A4- a member of the S100 calcium
binding protein family, suppresses the expression
of osteoblastic genes in the
PDL cells and thus inhibit mineralization
in PDL .
( Kato et al 2005)

 Prostaglandins PGE2 & PGF2 which are also

produced by periodontal ligament cells, can inhibit
mineralized bone nodule formation and prevent
mineralization by periodontal ligament cells in vitro.
 As prostaglandins and interleukin-1 can strongly
induce
matrix degradation, there is evidently an important
relationship between mechanical forces, cytokine
production and regulation of the periodontal ligament space

 The appropriate regulation of these signaling systems is

clinically important since the failure of
homeostatic mechanisms to regulate periodontal
ligament width may lead to tooth ankylosis and/or root
resorption.
 CLINICAL
CONSIDERATIONS
 AGING AND ITS EFFECT ON
PDL
 Aging of the periodontal ligament fiber:
Qualitative studies of the aged human periodontal ligament
have suggested that the main change with age is increased
collagen fibrosis and decreased cellularity.
(Grant and Bernick 1972)

 Aging results in greater number of elastic fibres, decrease

in vascularity, mitotic activity ,collagen fibres
and mucopolysaccharides .
 Both an increase and a decrease in the width of the
ligament is seen with aging.

 A reduction in width may be accounted for by a lower

functional demand owing to decrease in strength of the
masticatory musculature..

 Decreased width may also result from encroachment of the

ligament by continuous deposition of cementum and bone.

 An increase in width may be due to availability of fewer

teeth to support the entire functional load
 Periodontal Ligament becomes thinner as age advances

11 – 16 years - 0.21 mm,

32 – 52 yrs - 0.18mm,
51 – 67 yrs - 0.15mm.

 PDL is thinner in functionless teeth or teeth without

antagonists and thick and wide in teeth subjected to
excessive occlusal stress.
 PHYSIOLOGIC DRIFT

 Tooth movement does not end when active eruption is

completed and the tooth is in functional occlusion. With
time and wear, the proximal contact areas of the teeth are
flattened and the teeth tend to move mesially.This is
referred to as “Physiologic mesial migration”.

 The width of periodontal ligament is greater on mesial

than on the distal side owing to physiologic mesial
migration. By the age 40 it results in reduction of about
0.5cm in the length of the dental arch from the midline to the
third molars.
 ORTHODONTIC CONSIDERATIONS

 During orthodontic correction, due to force applied in a labio-

lingual direction, the principal fibres lose their wavy nature ,
are stretched on the labial side and are compressed on the
lingual aspect and hence, teeth are brought into the
desired position.

 Once the treatment is completed, it is advisable to give a

retentive appliance. This is because, the teeth have a
tendency to move back to its original position due to
the rheologic property of the periodontal fibres (elastic
memory)

 Supracrestal fibrotomy is usually done after derotation to

prevent relapse.
 RECESSION

 Some of the inter-radicular fibres

may be lost if age related
gingival recession exposes
the furcation area.
 Total loss of the fibres occurs
in case of inflammatory
periodontal disease involving
the furcation area.
 ANKYLOSIS
 Ankylosis of a tooth is defined as an anatomical fusion
of alveolar bone with cementum and can occur
either before or after the tooth erupts into the oral
cavity.

 Essentially, the periodontal ligament is obliterated by a

'bony bridge' and the root becomes fused to the alveolar
bone.

 The most common theory that is known to cause

ankylosis is traumatic injury of the
periodontal ligament
(Kracke: 1975,Andreasen: 1981).
 Risk of ankylosis
is highest for
teeth with
subluxation or
avulsion
injuries because
of the nature
and severity of
damage to the
periodontal
ligament
PERIODONTAL LIGAMENT
IN DISEASE
 LOCALIZED AGGRESSIVE PERIODONTITIS

 The alveolar attachment of

the periodontal
ligament fibers is lost
initially.
wideningis offollowed
 This periodontal
by
ligament space
bone resorption.
owingto
 Remaining Periodontal
ligament fibers run
parallel to the root
surface.
 PAPILLON –LEFEVRE SYNDROME
 Reduced density of Periodontal
ligament fiber attachment
produced by defective
Periodontal ligament

 With advancing disease, there is

deep penetration of
inflammatory cells into
periodontal ligament resulting
in deep periodontal pockets.

 Early loss of both

deciduous and permanent
teeth .
 NON- SUPPURATIVE PERIODONTITIS
 The granuloma itself constitutes
mainly of chronic
inflammatory granulation tissue
composed mainly of plasma
cells, lymphocytes,
fibroblasts and a varying density of
collagen bundles

 Widening of Periodontal ligament

space, with breaks in continuity
of the lamina dura.

 The ligament seems to be more

resistant to the spread of
periapical inflammation than
 SUPPURATIVE APICAL PERIODONTITIS

 The periapical suppurative

lesions are composed of a focus
of infection around the apical
foramen, which with the
accumulation of
Polymorphonuclear neutrophils,
results in pus formation.

 Pus may accumulate in the

adjacent marrow spaces as
well as the periodontal
ligament space.
 NECROTIZING ULCERATIVE
PERIODONTITIS

 Spread to involve
the
periodontal ligament.

 There is loss of crestal bone,

and the ligament is
affected by
marked vasodilatation
and thrombosis, resulting
in
localized
 TUBERCULOSIS

 The oral lesion is crateriform,

painless ulcer with a
caseated base, which
may rarely extend to the
Periodontal Ligament and
cause tooth loss.

 In general, periodontal lesions

are secondary to
pulmonary tuberculosis.
 LEPROSY
 Gingival ulceration in
lepromatous leprosy may
spread to cause severe
periodontal ligament
destruction.

 It causes both,
widening
of lamina dura
periodontal and
space. ligament
 SCLERODERMA
 Systemic Connective
tissue disease
characterized by
vasomotor disturbances,
fibrosis, subsequent atrophy
of the skin, subcutaneous
tissue ,muscles and assoc
immunologic disturbances.

 Extreme
generalised
widening of the periodontal
ligament two to three
 OSTEOSARCOMA

 Localized
symmetric
widening of the PDL space

 The medullary bone adjacent

to widened ligament
space shows a ragged
moth eaten pattern.

 Male prediliction.
 PAGET’S DISEASE
 Enlargement of jaws may cause
spaces to appear between
teeth or dentures to lose
their proper fit; serum
alkaline phosphatase levels
are elevated in active
disease

 Classic finding is a patchy

mixed
radiolucency/radiopacity
with a cotton wool appearance,
may see hypercemntosis
of tooth roots, loss of
lamina dura, obliteration of
 REGENERATIVE POTENTIAL
 The objective of regenerative potential is to restore the
destroyed connective tissue, form new cementum and bone
and induce attachment of new connective tissue fibers.
(Egelberg J)
 Many reports indicate that restoration of destroyed periodontal
ligament is at least possible, although their effectiveness
is unclear and success is unpredictable.
(Lynch SE)
 In regenerating periodontal ligament, the fibroblast population
must first produce oriented collagen bundles and then
maintain the orientation of these fibers during the
development of normal function.
 Cell kinetic experiments in mice and rats have shown that
periodontal ligament fibroblast populations are a renewal
cell system in steady
state: the number of new cells generated by mitosis is
equal to the number of cells lost through apoptosis and
migration. (Mc Culloch CAG)

 In other renewal systems, the most primitive cell is classified as a

stem cell, characterized by extensive self-renewal,
responsiveness to regulatory factors, generation of
multiple types of different specialized cells. Consequently,
periodontal ligament fibroblast populations are renewal cell
systems like stem cells.

 Short-term application of platelet-derived and insulin-like growth

factors can enhance new attachment procedures in
 CONCLUSION

Over the past decade, insight into the physiology of the

periodontal ligament and the properties of its cells has
increased. This insight has come from the synthesis of
research results from sources as varied as in vivo rodent
models, in vitro studies of cells and tissues and protein
biochemistry. Based on these studies, we conclude that the
periodontal ligament is a unique connective tissue: it cannot
be readily replaced by cell populations other than those that
have their origin in the ligament itself.
 REFERENCES

 CLINICAL PERIODONTOLOGY
CARRANZA 10TH EDITION
 ORBANS TEXTBOOK
OFORAL HISTOLOGY
 PERIODONTICS MEDICINE,
SURGERY, IMPLANT
LOUIS.F.ROSE
 CLINICAL PERIODONTOLOGY AND
IMPLANT DENTISTRY
JAN LINDHE 5TH EDITION
 PERIODONOLOGY 2000
THANK YOU