PERIODONTAL LIGAMENT

NUSREEN JAMAL.T.P
JUNIOR RESIDENT
 Introduction
 The normal periodontium is a unique and a
complex dynamic structure; each of its
components having distinct functions that are
capable of adaptation during the life of the
structure.

 Periodontal ligament is the soft, richly

vascular and cellular connective tissue which
surrounds the roots of teeth and joins the root
cementum with the socket wall.
 Definition
 According to CARRANZA,
The periodontal ligament is composed of a complex vascular and
highly cellular connective tissue that surrounds the tooth root and
connects it to the inner wall of the alveolar bone. It is continuous with
the connective tissue of the gingiva, and it communicates with the
marrow spaces through vascular channels in the bone.

 According to BERKOVITZ:
“Itis the dense fibrous connective tissue that occupies the periodontal
ligament space between the roots of teeth and alveolus. It is derived
from the dental follicle above alveolar crest and is continuous with
connective tissue of gingiva and the apical foramen which is further
continuation with dental pulp.
 Soft, richly vascular and cellular connective tissue which
surrounds the roots of the teeth and joins the root cementum
with the socket wall. (Jan Lindhe 6th ed)

 The periodontal ligament occupies the periodontal space,which

is located between the cementum and the periodontal surface
of alveolar bone and extends coronally to the most apical part
of the lamina propria of the gingiva. (Orban’s)
 synonyms

 Periodontal membrane

 Alveolodental ligament

 Desmodont

 Dental –periosteum

 Pericementum

 Gomphosis,
 Extent
 In the coronal direction it is continuous
with lamina propria of gingiva & is
demarcated by the alveolar crest fibers.

 At the root apex it merges with the dental

pulp.

 It ranges in width from 0.15-0.38mm.

(A.R Tencate)
 shape
 Thinnest around the middle third of the root & widens both
apically and near the crest with an hour glass appearance.

 The ligament appears as a radiolucent area of 0.4 -1.5 mm

between the radioopaque lamina dura of the alveolar bone
and cementum.(Orbans)
 Devolopment
 The periodontal tissues are derived from dental follicle.
 It has also been proposed that the mesenchyme deriving
periodontium may have two differentiation
compartments(Osborn 1984)
a. Alveolar clade --- Fibroblasts & osteoblasts
b. Cementum clade --- fibroblasts & cementoblasts
 Development of periodontal
ligament begins with root formation,
prior to the tooth eruption.
Continuous proliferation of internal
and external epithelium forms
cervical loop of tooth bud.
 Sheath of epithelial cells grows
apically in form of HERTWIG’S
ROOT SHEATH between the dental
papilla and the dental follicle.
 Sheath forms a circumferential structure
enclosing dental papilla separating it from
the dental follicle cells.
 composed of TWO SUBPOPULATIONS:
 A. mesenchymal cells of dental follicle
proper
 B. perifollicular mesenchyme

 Mesenchymal cells of perifollicular

mesenchyme bounded by dental follicle
proper & developing alveolar bone are
stellate shaped.
 Cells are widely separated & contain
euchromatic nucleus, very little cytoplasm,
short cisternae of rough endoplasmic
reticulum, mitochondria, free ribosomes& an
inactive Golgi area.
 As the root formation continues, cells in perifollicular area gain
their polarity and cellular volume & synthetic activity increase.
These cells become elongated & contain increased amount of
ROUGH ENDOPLASMIC RETICULUM, mitochondria &
active Golgi complex.
 As a result, actively synthesize and deposit collagen fibrils and
glycoproteins in the developing periodontal ligament.
 As the root formation continues,cells in the perifollicular
mesenchyme gain their polarity,cellular volume &synthetic
activity increases

Actively synthesize &deposit collagen fibrils in developing PDL

Type 1 collagen is secreted

Assemble as collagen bundles on the bone and cementum surface

Establish continuity across ligament space

 Development of principal fibers
 Closely related to root formation
Organization of pdl

•The tooth bud is formed in a crypt of the bone.

•Collagen fibers produced by the fibroblast around the tooth bud
are embedded immediately apical to the cementoenamel junction
(CEJ).
•Oriented towards the coronal portion of the bone crypt will later
form the dentogingival fiber group, the dentoperiosteal fiber
group, and the trans‐septal fiber group
The true periodontal ligament
fibers,the principal fibers, develop in
conjunction with the eruption of the
tooth. First, fibers can be identified
entering the most marginal portion of
the alveolar bone.
Later, more apically positioned
bundles of oriented collagen fibers
are seen.
The orientation of the collagen fiber bundles
alters continuously during the phase of tooth
eruption.
First, when the tooth has reached contact in
occlusion and is functioning properly, the
fibers of the periodontal ligament associate
into groups of well‐oriented dentoalveolar
collagen fibers.
These collagen structures undergo constant
remodeling (i.e. resorption of old fibers and
formation of new ones).
 Mature PDL can be subdivided into 3 regions.
COMPOSITION OF PDL
 Synthetic cells
1)Fibroblasts

 Predominant cells in PDL

 Origin:
Cementum surface: ectomesenchyme of investing layer of
dental papilla and the dental follicle.
Alveolar bone: perivascular mesenchyme
 They appear as ovoid or elongated cells
and they exhibit pseudopodia like
processes
 Oriented with their long axis parallel to
the direction of collagen fibers.
 Aligned along and between collagen
fibers.

.
Synthetic activity and interaction with surrounding
extracellular matrix determines the shape of the fibroblast
Most of them are highly active
Extensive, elongated, polarized cytoplasm
Progenitor cells are smaller and less polarized
Areas of extensive contact with collagen fibers
Less active cells are found around blood vessels and near
cementum surface.
Cytoplasm
 Abundance of RER and well developed Golgi complexes
 A cytoskeleton with prominent actin network
 Smooth muscle actin and myosin which help in forming
stress fibers
 Stress fibers
 Oriented parallel to the long axis of the cell
 Terminates at the cell surface at special attachment plaques
 It endows contractility
 It allows to exert forces on extracellular matrix.
 Mitochondria distributed throughout the cell

 Lysosomes are fewer in number when compared to phagocytic

cells(neutrophils)

 PDL fibroblasts contain small amounts of fragments of

collagen fibrils within membrane bound vesicles (Tencate
1972,Listgarten 1973)

 They help in intracellular collagen degradation(Tencate et al

1976)
Vimentin type intermediate filaments are present (type III)

Cell contacts:
 Numerous intercellular contacts are present
 Usually not seen in fibroblasts of other tissues.
 2 types of contacts are seen; gap junctions and simplified
desmosomes (macula adherens)
 Gap junctions- 0.1-0.5µ
 Maculae adherens are smaller 0.1-0.4µ
 This high number of contacts are related with the generation of
eruptive forces
 They may also be related to the high turnover of the matrix
Nucleus
 Prominent, has single distinct nucleolus

 Internal dense lamina characteristic of connective tissues

 Nucleus is flattened, disc shape(10µ)

 Occupies up to 30% of the cell

 At the narrow end of the triangular cell

 Fibroblast Contractility
 Fibroblasts exhibit features of smooth muscle cells with many
intracellular microfilaments and expression of α- smooth
muscle actin
 They are called myofibroblasts
 Make connection with extracellular matrix through fibronexi
 Present in many tissues- spleen, adrenal glands,
tendons,ligaments, etc.
 Myofibroblasts are responsible for contraction of wounds

 They are also associated with the stroma of many carcinomas

 Such fibroblasts are common in PDL

 They are supposed to be responsible for generation of eruptive

forces
 It is also significant in post eruptive movements like those
during mastication, growth of jaws, and compensation for
occlusal wear.
 Fibroblasts respond to changes in the matrix
 Integrins help in transmitting mechanical stimuli into the cell
 This leads to contraction
 Fibroblasts align parallel to direction of principal strain
 Functions of fibroblasts
1. Synthesize Collagen(Esterl 1961)
2. Synthesize fibrils(Stallard 1963)
3. Organize fibrous network &generate force for tooth eruption.
4. Produce extracellular matrix of PDL(Sodek 1977)
5. Have capacity to give rise cementoblasts and osteoblasts.
6. Maintain normal width of PDL.
7. Synthesize and shape the proteins of ECM in which collagen
fibrils form bundles and insert as Sharpey’s fibers.
8. Regulate collagen turnover by PHAGOCYTOSING old
collagen fibers via enzyme hydrolysis.30 minutes are taken
for the intercellular degradation of collagen.
 Difference b/w periodontal and gingival
fibroblasts
 Periodontal ligament fibroblasts are ectomesenchymal
in origin whereas gingival fibroblasts are mesodermal
in origin.
 Expression of alkaline phosphatase & cyclic AMP is
more in periodontal ligament fibroblasts. Gingival
fibroblasts are less proliferative.
 Periodontal ligament fibroblasts can generate force for
tooth eruption as they are motile and contractile
 Fibroblasts of pdl are capable of collagen degradation.
(Orban’s textbook of histology 14 th edition)
 2)osteoblasts
 These cells covers the periodontal
surface of the alveolar bone.
 Line the tooth socket and are
cuboidal in shape with a prominent
round nucleus at the basal end of the
cell.
 RER , mitochondria , and vesicles
are abundant in active cells.
 Microfilaments are prominent
beneath the cell membrane at
secreting surface,
 •The cells contact one another
through desmosomes and tight
junctions.
3) cementoblasts

 Its distribution is similar to that of osteoblasts on the bone

surface . These cells line the surface of cementum.

 They are cuboidal with a large vesicular nucleus , with one ore
more nucleoli and abundant cytoplasm.

 All the organelles are required for protein synthesis and secretion
are present . Cells actively depositing cellular cementum exhibit
abundant basophilic cytoplasm and cytoplasmic processes
 RESORPTIVE CELLS

Fibroblasts as resorptive cell

• Lysosomes are present in these fibroblasts .
• They are present in the form of large membrane bound
vesicles .
• Many reports have cited that the fibroblasts contain small
fragments of collagen fibrils with membrane bound vesicles
(ten cate 1972,listergarden1973,beersteen 1974,shore and
berkovitz 1979 ).
• They are called as “intracellular collagen profiles”.
 Three broad categories are seen within
1. A normal banded fibril within an electron lucent vacoule.
2. A normally banded fibril within an electron dense
vacoule.
3. A fibril where characterstic banding is lost.
 These 3 types are thought to constitute the temporal
sequence of intracellular degradation of collagen.
Osteoclasts
• These resorb bone and tend to be large
and multinucleated but can also be
small and mononuclear .
• Multinucleated Osteoclasts are formed
by fusion of precursor cells similar
to circulating monocytes.
• The part of plasma membrane lying
adjacent to bone that is being
resorbed is raised in characteristic
folds and is termed the Ruffled or
Striated border.
• Are found against the bony surface
occupying shallow depression called
Howship’s lacunae.
 • The ruffled border is separated from the rest of plasma
membrane by a zone of specialized membrane that is
closely applied to the bone, the underlying cytoplasm of
which tends to be devoid of organelles and has been called
The Clear Zone.
Cementoclasts

• As cementum does not remodel, Cementoclasts are not

usually found in the ligament.
• These cells only occur in certain pathologic conditions,
during resorption of deciduous teeth and when regressive
forces are applied on a tooth such as orthodontic therapy.
• These Cementoclasts resembles Osteoclasts and are located
in depressions in cementum resembling Howship’s lacuna.
• These cells not only resorb cementum, they can destroy
dentin and enamel as well thus they are also called
Odontoclasts.
 3.PROGENITOR CELLS
• All connective tissues including PDL
contain progenitors cells that have the
capacity to undergo mitotic division .
• Are the undifferentiated mesenchymal
cells that have a perivascular location
within 5 micrometres of blood vessels.
• When stimulated appropriately, these
cells undergo mitotic division and can
differentiate into fibroblast, osteoblast or
cementoblast.
4.EPITHELIAL CELL REST OF
MALASSEZ

• These were first described by Malassez in 1884 and are the

remnants of the epithelium of Hertwig’s epithelial root
sheath.
• The PDL contains epithelial cells that lie about 25 mm from
the cementum surface.
• At the time of cementum formation, the continuous layer of
epithelium that covers the surface of the newly formed
dentin breaks into lacelike strands.
• They persist as networks, strands, islands or tubule-like
structures near and parallel to the surface of the root.
•Most numerous in the apical area & cervical area. (Xiong J,
Gronthos S, Bartold PM )
• Presence: children – more numerous old individuals – less
Dimnishes with age (Simpson HE)
•These cells may proliferate to form cysts and tumors.
•These cells may undergo calcification to become
CEMENTICLES.
Functions of Epithelial rests of malassez

 Putative roles of the epithelial cell rests of Malassez in adult

periodontal ligament include
1. maintaining periodontal ligament homeostasis
2 .to prevent ankylosis
3 .maintain periodontal ligament space
4. to prevent root resorption
5 .to serve as a target during periodontal ligament
innervation and
6 .to contribute to cementum repair.
(Role of the epithelial cell rests of Malassez in the development,
maintenance and regeneration of periodontal ligament tissues JIMIN
XIONG, STAN GRONTHOS & P. MARK BARTOLD
Periodontology 2000, Vol. 63, 2013, 217–233)
 5.DEFENCE CELLS
EOSINOPHILS

MACROPHAGES
1.Mast cells
 Relatively round or oval cell having a diameter of about 12 to
15µm. Mast cells are often associated with blood vessels.
 The cells are characterised by numerous cytoplasmic
granules, which frequently obscure the small, round nucleus.
 The granules stain with basic dyes but most commonly
stained with metachromatic dyes such as azure A, also
positively stained by periodic acid Schiff reaction.
 The granules are dense, membrane bound vesicles
approximately 0.5 to 1µm in diameter.
 When the cell is stimulated it degranulates.
 The granules contain heparin, histamine and in some animals
serotonin.
 Electron microscopy shows the mast cell cytoplasm
contains free ribosomes, short profiles of granular
endoplasmic reticulum, few round mitochondria, and a
prominent golgi apparatus.
 Occasional mast cell may be seen in the healthy pdl. The
release of histamine into the extracellular environment
causes proliferation of endothelial cells
2.Macrophages
 In the pdl predominantly located adjacent to blood vessels
 Are derived from monocytes and phagocytose particulate
matter and invading microorganism.
 Resting macrophages can be distinguished from fibroblast in
the electron microscope by the presence of numerous
microvilli, lysosomes and their membrane bound vesicles of
varying density and paucity of RER and golgi complex.
 The wandering type of macrophage has a nucleus, generally of
regular contour, which may be horseshoe or kidney shaped and
which exhibits a dense uneven layer of peripheral chromatin.
Nucleoli are rarely seen.
 In the pdl macrophages may play a dual role
1. Phagocytosing dead cell
2. Secreting growth factors that regulate the proliferation of
adjacent fibroblasts. Also synthesize interferon,
prostaglandins and factors that enhance the growth of
fibroblasts and endothelial cells.
Eosinophils

Occasionaly seen in pdl.

They posses granules that consists of one or more
crystalloid structures.
The cells are capable of phagocytosis.
 Periodontal Fibers
COLLAGEN
• The main types of collagen in the PDL are TYPE I and
TYPE III.
• More than 70 % of PDL is Type I .
• Type I is uniformly distributed in the ligament .
• Type III collagen accounts for about 20 % of collagen fibers,
found in periphery of Sharpey’s fiber attachments into
alveolar bone.
• Type IV and VII are associated with epithelial cell rests and
blood vessels.
• Type XIII collagen is believed to occur within the PDL only
when ligament is fully functional .
• The collagen is gathered to form bundles approximately 5
um in diameter. These bundles are termed as PRINCIPAL
FIBERS.
• Within each collagen bundle , subunits are present called
collagen fibrils.
 Turnover Rate of the Collagen
• The rate of turnover of collagen within the PDL is faster than all
other connective tissues.
• Sodek (1977) found collagen synthesis in PDL of adult rat to be 2
fold greater than that of gingiva ,4 fold greater than that of skin,
6 fold greater than that of bone.
• The rate appears to be highest towards the root apex.
• The collagen on the tooth side has low turnover rate than that on
the bone side where it shows high turnover rate.
 PRINCIPAL PDL FIBERS

• The principal fibres of Periodontal ligament (Holmstrup 1996).

• These are collagenous and follow a wavy pattern when viewed in

longitudinal section .

• They are thought to contribute to the regulation of mineralization and to

tissue cohesion at sites of increased biomechanical strain. (Mc Kee MD,
Zalzal S, Nanci A 1996)

• The adult human PDL fibers : 54- 59 nm in diameter.

 SHARPEYS FIBERS
• The collagen bundles of the periodontal
ligament embedded into cementum and
alveolar bone – are called as Sharpey’s
fibers.
• Orientation is similar to that of adjacent
periodontal ligament bundles.
• Are more numerous but smaller at their
attachment into cementum than alveolar
bone.
• Sharpey’s fibers in Acellular cementum-
fully mineralized. Cellular cementum &
AB – partially mineralized.
• Few Sharpey’s fibers pass uninterruptedly
through bone of alveolar process –
Transalveolar fibers.
 INTERMEDIATE PLEXUS
 Earlier it was believed that principal fibers follow a wavy course from
cementum to bone and are joined in the mid region of the periodontal space
giving rise to a zone of distinct appearance i.e the Intermediate plexus .

 Research over past yrs suggests that cemental fibers meet and fuse with
osseous fibers, no such plexus remains and the entire PDL is metabolically
active , not just the middle or intermediate zone (Thomas M. Hassel).

 The recent concept is that, fibers cross the entire width of periodontal space
but branch en route and join neighboring fibers to from a complex three
dimensional network .
 In addition to these fiber types, small collagen fibers associated
with larger principal fibers have been called as “Indifferent fiber
plexus of Shefforfold”
 ELASTIC FIBERS
• There are three types of elastic fibers which are histochemically and
ultrastructurally different.
• Mature Elastic fibers , Elaunin fibers and the Oxytalan fibers .

• Eluanin fibers and Oxytalan fibers have been described as immature elastic
fibers.

MATURE ELASTIC FIBERS

• Consist of microfibrillar component surrounding an amorphous core of
elastin protein .
• Restricted to walls of blood vessels in humans
• PDL fibers do not contain mature elastin but two immature forms are found
oxytalan and elaunin
.
OXYTALAN FIBERS
• Are micro fibrils
• Run in apico-coronal direction to bend and attach at cervical third of root
(Fulmer et al. 1974)
• Diameter – 0.5-2.5um
• Volume – 3%
• Function is unknown but they may play a role in
- supporting blood vessels of PDL.
- tooth support(They are thicker and more numerous in teeth that are
subjected to high loads, as in abutment teeth for bridges and teeth that are
moved orthodontically. )
ELAUNIN FIBERS
• Are bundles of microfibrils embedded in a small amount of amorphous
elastin.

• An elastic meshwork has been described in the PDL as being composed of

many elastin lamellae with peripheral oxytalan & elaunin fibers

• Functions
- Regulate vascular flow
- Role in tooth support
- Facilitate fibroblast attachment and migration
RETICULAR FIBERS
• These are immature collagen fibers with argyrophilic staining properties and
are related to basement membrane of blood vessels and epithelial cells
which lie within the periodontal ligament.

SECONDARY FIBERS
• Represent the newly formed collagenous elements, not yet incorporated into
principal fiber bundle.
• Located between and among the principal fibers.
• These are relatively non-directional and randomly oriented.
• Appear to transverse the periodontal ligament space corono-apically and are
often associated with path of vasculature and nervous elements.
GROUND SUBSTANCE
• The ground substance is the gel like matrix synthesized by the fibroblast
family & fills the space between the fibers and cells.
COMPOSITION
• Consists of a biochemically complex, highly hydrated, semisolid gel.
• Water content of 70%
• Glycosaminoglycan's – hyaluronic acid,
• Proteoglycans( versican , decorin )
• Glycoproteins -fibronectin , laminin, vibronectin , tenascin
 Glycosaminoglycan's

• With the exception of hyaluronic acid, all other glycosamino glycans are
sulphated and covalently attached to the core proteins at the reducing
terminus of proteoglycans.
• The major GAGs are:
1. Chondroitin Sulphate
2. Dermatan Sulphate
3. Heparin Sulphate
4. Hyaluronic Acid
5. Keratan Sulphate
 PROTEOGLYCANS
• Large group of anionic macromolecules that consists of a protein core to
which are attached hexose amine containing polysaccharides called
GAG chains.
1. Decorin – regulates growth of collagen fibrils.
2. Versican – binds cell surface glycoproteins to ECM.
3. Prelecan - binds to fibronectin & helps anchor fibroblast to ECM.
4. Syndecan - binds to collagen & other glycoproteins.
 GLYCOPROTEINS
• Three distinctly related glycoprotiens of the extra cellular matrix have
been localized in the decalcified sections of human periodontal
ligament, namely:

1. FIBRONECTIN
• It promotes the attachment of cells to the substaratum especially to
collagen.
• It is expressed strongly along attachment sites of the PDL collagen
fibers to cementum but not bone.
• In addition to its function as an adhesion protein it is also involved in
blood coagulation, wound healing and chemotaxis.
2. TENASCIN :

• Also known as cytotactin

• It is the other glycoprotein identified in the PDL .
• It is found mostly in healing wounds.
• Unlike fibronectin it is not uniformly distributed through out the PDL.
• But is concentrated in between the less densely packed collagen fibrils
near cementum and alveolar bone.
• Present in the glycoproteins of periodontal ligament with a smaller role in
cell attachment and organization of basement membrane.
3. LAMININ :
• Major glycoprotein component of basement membrane of Epithelial cell
rests of Mallassez..
• Implicated in variety of functions including.
 Cell adhesion
 Migration
 Differentiation
• Other glycoproteins like
Entactin (Nidogen ) – dumb bell shaped glycoprotiens
Vitronectin
Thrombospondin
May also be present
 BLOOD SUPPLY
Blood supply is derived mainly from :
Inferior and superior alveolar arteries to mand. &
max respectively from 3 sources:
1. Apical vessels (Dental artery) – supply dental
pulp
2. Transalveolar vessels (rami perforantes-
penetrating vessels from alveolar bone)
3. Intraseptal vessels (anastomosing vessels from the
gingiva)
• Ramify and form a rich network of arcades more
evident adjacent to bone than cementum..
• Blood Supply: Posterior teeth > Anterior teeth
 NERVE SUPPLY
The nerve fibres supplying the PDL – 2 types
sensory
autonomic.
• The nerve follow almost the same course as the blood vessels.
• Nerve bundle divide → myelinated fibers → lose their myelin sheath → end
in one of the 4 types of neural terminations :
Free endings with tree like ramifications :
• terminal branching of myelinated fibers
• 0.2-1 um in diameter
. •Located at regular intervals along the length of the root.
Ruffini’s endings :
• Found around the root apex.
• Appear dendritic and end in terminal expansions among the
PDL fiber bundles.
• Are mechanoreceptors.

Meissner's corpuscles : mid-root, for tactile perception

Encapsulated spindle type : temperature receptor, associated

with root apex.
Lymphatic system of the periodontium….
 The lymph from the periodontal tissues drains to the
lymph nodes of the head and the neck.
 The labial and lingual gingiva of the mandibular
incisor region is drained to the submental lymph nodes
(sme).
 The palatal gingiva of the maxilla is drained to the
deep cervical lymph nodes (cp). The buccal gingiva of
the maxilla and the buccal and lingual gingiva in the
mandibular premolar–molar region are drained to
submandibular lymph nodes(sma).
 Except for the third molars and mandibular incisors,
all teeth with their adjacent periodontal tissues are
drained to the submandibular lymph nodes (sma).
 The third molars are drained to the jugulodigastric
lymph node (jd) and the mandibular incisors to the
submental lymph nodes (sme).
 Functions of pdl
I. PHYSICAL FUNCTION :
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) Maintainence of the gingival tissues in their proper relationship to the
teeth.
5) Resistance to the impact of occlusal forces (Shock absorption).
+
Transmission of Occlusal Forces to Bone

 The arrangement of the principal fibers is similar to that of a

suspension bridge or a 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, assume
their full length, and sustain the major part of the axial force.
 When a horizontal or tipping force is applied, two phases of
tooth movement occur. 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 that is
opposite to the coronal portion.
 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 .
 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.
II. FORMATIVE AND REMODELING FUNCTION :
• Cells of the PDL participate in the formation and resorption of cementum
and bone, which occur in
- physiologic tooth movement,
- accommodation of the periodontium to occlusal forces
- in the repair of injures.
• Remodeling : The 3-D organization of the fiber meshwork is adapted to
accommodate for positional changes of the tooth in its socket or changes in
functional state (such as hypofunction).
• It relates to adaptability of PDL tissues.
• Both these processes can occur simultaneously and may therefore be
indistinguishable.
• The PDL is constantly undergoing remodeling. Old cells & fibers are
broken down & replaced by new ones, & mitotic activity can be
observed in the fibroblasts & endothelial cells (Muhlemann; 1954)

• Sodek (1977) has demonstrated that the periodontal ligament

incorporates proline at least 5 times faster than gingiva or alveolar bone
and that the biological half-life of mature collagen was 20% and 17%
less than found in gingiva and alveolar bone, respectively.
III. NUTRITIONAL:
• PDL supplies nutrients to the cementum , bone, and gingiva by
way of blood vessels and provides lymphatic drainage.
• The PDL contains blood vessels, which provide anabolites and
other substance to the cementum, bone and gingiva. & removes
catabolites.
4.HOMEOSTATIC FUNCTION
 PDL has the capacity to maintain its width overtime despite the fact
that its squeezed in between 2 hard tissues.
 Studies indicate that cells of PDL, both during development and
regeneration secrete molecules which regulate mineralization and
prevent ankylosis.
 Various molecules proposed:
1. PDL cells inhibit mineralized bone nodule formation by
bone stromal cells – dependent on prostaglandin
production.
2. Msx2 prevents osteogenic differentiation of PDL
fibroblasts by repressing transcriptional activity of Runx2
3. Matrix Gla Protein – inhibitor of mineralization.
4. GAGs – maintain unmineralised state of PDL.
5. Balance b/w activities of bone sialoproteins
and osteopontin – maintains unmineralized
PDL region.
PDL has capacity to adapt to functional changes:
V. SENSORY FUNCTION

• The PDL is abundantly supplied with sensory nerve fibers capable

of the repair of transmitting tactile, pressure and pain sensations by
the trigeminal pathway.
• The PDL provides a most efficient proprioceptive mechanism.
• 4 types of neural terminations are seen
1. Free nerve endings –pain(at regular intervals along the length
of the root.
2. Ruffini like mechanoreceptors (apical area)
3. Meissner’s corpuscles - mechanoreceptors (middle 3rd)
4. Spindle like pressure and vibration endings (apex)
 aGE CHANGES IN PDL
• Increase in the collagen fibrosis & decrease in cellularity (Grant & Bernick
1972).
• Areas of hyalinization are present.
• Sporadic mineralization of the fibers also occurs.
• Decrease in the no of periodontal fibers (Grant et al 1973).
• Decrease in the cellularity & the formation of multinucleated fibroblasts.
• Decrease in collagen synthesis (Johnson et al 1986).
• The surfaces of the periodontal alveolar bone are jagged & uneven & an
irregular insertion of fibers is seen.
• Replacement of some of the PDL space by interstitial areas & fat cells. •
Structural organization of the ligament degenerates with age.
WIDTH OF THE PERIODONTAL LIGAMENT SPACE

• The width of the periodontal ligament space of nonfunctioning teeth is

narrower than that of functioning teeth (Klein 1928, Kronfeld 1931).
• If, with increasing age, less teeth are present, the force acting on the
remaining teeth may increase and an increasing width of the
periodontal ligament space with age.
• On the other hand, it has also been noted that the masticatory forces
decrease with age (Helkins et al 1977, Herring 1977).
This could explain decrease in the periodontal ligament space with age.
Clinical considerations….
Orthodontic forces and pdl
Orthodontic tooth movement depends on resorption
and formation of tooth bone and periodontal ligament.
These activities can be stimulated by properly
regulated pressure and tension.
If the movement of teeth is within phsysiologic limits
the initial compression of PDL on the pressure side is
compensated for by bone resorption whereas on the
tension side bone apposition is seen.
Clinical considerations….
 Application of large forces results in necrosis of PDL
and alveolar bone on the pressure side and movement
of the tooth will occur after the necrotic bone has been
resorbed by osteoclasts located on its endosteal
surface.
Clinical considerations….

Inflammation from pulp to pdl

Inflammatory diseases of the pulp progress to the
apical periodontal ligament and replace its fiber
bundles with granulation tissue .This lesion is called a
periapical granuloma may contain epithelial cells that
undergo proliferation and produce a cyst .
 Clinical considerations….
Periodontitis
Chronic inflammatory disease is common pathology
related to PDL .
The toxins released from the bacteria in the dental plaque
and metabolites of the host’s defense mechanism destroy
the PDL and the adjacent bone very frequently .
This leads to tooth mobility and further loss of tooth.
To repair the existing destruction of PDL can be quite
challenging . It involves limiting the disease process and
to regenerate the host tissues to their original form in such
a way that reattachment of PDL to bone becomes possible.
 Clinical considerations….
Ankylosis
Fusion of alveolar bone and cementum with obliteration
of the periodontal ligament is termed Ankylosis.
Occurs in teeth with cemental resorption which suggests
that it may represent a form of abnormal repair.
May also develop after chronic periapical inflammation,
tooth implantation and occlusal trauma and around
embedded teeth.
Clinically ankylosed tooth sounds DULL or WOODY on
percussion. Before extraction such tooth require X-ray to
facilitate surgical extraction.
Clinical considerations….
External forces & PDL
Within physiologic limits, the PDL can accommodate
increased function with - an increase in width, - a
thickening of its fiber bundles, and - an increase in diameter
& number of Sharpey’s fibers
Forces that exceed the adaptive capacity of the
periodontium produce injury called trauma from occlusion.
Slight excessive pressure: resorption of bone, widening of
PDL space.
Slight excessive tension: elongation of PDL fibers &
apposition of bone
Clinical considerations….
Acute trauma to the periodontal ligament, accidental
blows or rapid mechanical destruction may produce
pathologic changes such as fractures or resorption of
the cementum tears of fiber bundles , hemorrhage and
necrosis .
Clinical considerations….
Replantation & transplantation
To have any chance of success , it is essential to
maintain the viability of PDL .
Avoid dehydration of PDL.
Avoid loss of viability of its cell rests.
Transplantation : Best results when unerupted tooth
with partially formed roots as there is less damage to
PDL.
Dysplasias associated with pdl
The cemento-osseous dysplasias of periodontal ligament
origin are the most common fibro-osseous lesions
encountered clinically.
1.Periapical cemento-osseous dysplasia (PCD) – young-
middle age, black female, apical area of anterior
mandibular teeth.
2. Focal cemento-osseous dysplasia – women predilection,
posterior mandible.
3. Florid cemento-osseous dysplasia – Middle-elderly
black women.
Neoplasms arising from PDL
Cemento-ossifying fibroma
 The cemento-ossifymg fibroma is a benign neoplasm,
speculated to be of periodontal ligament origin.
 the mean age was 29.9, 67% affected women and 71% were in
the mandible.
 Most patients are asymptomatic but bony expansion does occur.
 They are well circumscribedand often associated with the roots
of teeth.
 Lesions range from completely lucent, to mixed, to
predominantly opaque. (Summerlin DJ, Tomich CE. Focal
cemento-osseous dysplasia: A clinicopathologic study of 221
cases. Oral Surg Oral Med Oral Path01 Oral Radiol Endod
1994: 78: 611-620)
Soft Connective Tissue disorders & PDL
Progressive Systemic Sclerosis
Radio graphically ---- PDL widening up to 3mm
thickening.
Collagen ---- dense, mature & more hyalinized than
normal.
Oxytalan fibers increased.
 Soft CT disorders & PDL….
LATHYRISM
Condition caused by drugs that inhibit cross linking in
collagen & elastin (cystamine)
Fragile collagen fibers
Retard eruption

DISUSE ATROPHY
Narrowing of PDL & reduction in no. of principal fibers.
Fibers oriented parallel to the long axis of root & PDL
shows reduced rate of collagen turn over.
 CONCLUSION
• The periodontal ligament is a fibrous connective tissue forming
important part of the Periodontium.
• The PDL is a physically small, but functionally important tissue in tooth
support, proprioception and regulation of alveolar bone volume.
• The PDL is an absolute requirement for rapid remodeling of alveolar
bone when forces are applied to teeth.
• Cell of the periodontal ligament are Pluri-potent and helps in the
regeneration of all the components of Periodontium lost in the
periodontal disease process.
• A better understanding of cell and molecular biology of developing and
regenerating periodontium offers newer avenues to regenerate the PDL.
• Yet safeguarding the integrity of the PDL and alveolar bone is still one
of the most important challenge
 REFERENCES
1. Clinical Periodontology 13th edition. F.A. Carranza, M.G. Newman .
2. Clinical Periodontology and Implant Dentistry, 6th edition. Jan Lindhe,
Thorkild Karring, Niklaus P. Lang.
3. Tencate’s Oral histology, Development, Structure and function. 4th
edition.
4. Orbans Oral Histology And Embryology. 14th Edition
5. Dental embrology, histology and anatomy. Mary Bath- Balogh, Margret J
Ferhrenbach. 2nd edition.
6. Bartold PM, Walsh LJ, Sampath Narayan A. Molecular and cell biology
of gingiva. Periodontol 2000, Vol. 24, 2000, 28–55.
7. Cho MI, Garant PR. Development and general structure of the
periodontium, Periodontol 2000, Vol. 24, 2000, 9–27.
8. Ertsenc W, Mcculloc HG , Sodek HJ. The periodontal ligament a unique,
multifunctional connective tissue. Periodontol 2000. Vol. 13, 1997, 20-40.