PERIODONTAL

LIGAMENT

Dept. Of Oral and Maxillofacial Pathology

INTRODUCTION
STRUCTURE
CELLS
FIBRES
GROUND SUBSTANCE
BLOOD SUPPLY
NERVE SUPPLY
FUNCTIONS
CLINICAL CONSIDERATIONS
AGE CHANGES
 Periodontium

Attachment apparatus of the tooth

Consists of:
2 mineralised tissues – Cementum

Alveolar Bone

2 soft tissues – Periodontal ligament

Gingiva
 Gingiva

Cementum

PDL

Bone
Synonyms:
Desmodont
Gomphosis
Dental Periosteum
Pericementum
Alveodental ligament
Periodontal membrane
Most accepted: Periodontal Ligament
Attaches 2 hard tissues- Bone & cementum
Fibrous tissue- high collagen content
Definition:

“Defined as dense fibrous

connective tisssue between
root surface of the tooth &
Alveolar bone”

“It is the connective tissue

that surrounds the root &
connects it with the bone
 Periodontal space

Gap betn. Cementum and alveolar bone

Shape --- Hourglass
Volume ---
Single rooted teeth – 30-100mm3
Multirooted teeth – 65-150mm3
Width--- Avg –0.2mm (range-0.15-0.38mm)
Age – progressive decrease with age
Functional status
Type of dentition
Functions:
 Major supporting apparatus – withstand masticatory stresses
 Nutrition
 Synthesis & resorption
 Proprioception

Fibrous CT
Cellular
Vascular
 Structure

Fibres
Cells Extracellular matrix
Ground
substance
Blood vessels

Nerves

Lymphatics
 CELLS
Synthetic Cells : Fibroblasts

Cementoblasts

Osteoblasts

Resorptive Cells: Fibroclasts

Cementoclasts

Osteoclasts
Progenitor Cells – Undifferentiated Mesenchymal
Cells

Epithelial cells - Cell Rests of Malassez

Defense Cells – Mast Cells

Macrophages

Neutrophils

Lymphocytes
 I .Synthetic Cells
Fibroblast

Major population
Heterogeneous – Active/Resting
surrounded – Fibers & Ground subs.
High rate of turnover of collagen
 Distinct characterstics
Large cells, extensive cytoplasm,abundant
organelles
Extensive cytoplasmic processes
Well developed Cytoskeleton – Contractile
proteins- Actin- Change of shape&
migration
Cell-Cell contacts & intracellular adhesions
Fibronexus – Intracellular filaments
Extracellular filaments
Sticky glycoprotein- fibronectin
Cilia
Arrangement/Location
Parallel to fibres

Dual role – Single cell

Synthesis – All organelles- RER, Mitochondria,
ribosomes,golgi apparatus
Degradation – Lysosomes- Phagocytic debris –
Enzyme hydrolysis

Fibroclasts
 Osteoblast
Line the bone surface
Types- active& Resting
No continous arrangement
Uneven distribution
Seperated from bone –thin rim of osteoid

Modified Endosteum

PDL fibres
 Cementoblast
Line the tooth/ cementum surface
Cells forming Cementum
Origin: UDMC of PDL
Dental follicle
Location – Lining the precementum/cementoid
Shape- Cuboidal/round
Large nucleus, prominent nucleoli, organelles
Cytoplasmic process- Directed to PDL
 Active
 Resting
Diameter-8-12ú
Function- Lay down matrix of Cm
Mineralisation
 II. Resorptive Cells
Osteoclast
Cells that resorb bone
Multinucleated cells (2-10) , can be mononucleated
Origin: Fusion of Circulating monocytes
Location: Howships lacunae- bay like recesses
Arrangement –usually in clusters
Content: Abundant golgi, mitochondria, lysosomes but
little RER.
Acid phosphatase
Function – resorb bone
 Morphologic Characteristics

Ruffled/ Striated border

Clear zone
 Electron Microscopy

Sequence of events;
 Removal of mineral/inorganic Matrix
 Degradation of org. matrix
 Cementoclasts

Occasionally found

Resemble osteoclasts

Origin- unknown

No resorption- Continous deposition

Progenitor cells/undifferentiated mesenchymal cells

Mitotic division

Appearance :

small close faced nucleus, little cytoplasm

More differentiated cell

Location – Perivascular- 5um of BV

 Epithelial cell Rests of Malassez
Malassez – 1884
Origin - HERS
Development
Appearance
 Easy to recognize
 Squamoid
 Closed face nuclues
 Stain deeply
 exhibit desmozomal attachments
 Close towards CM
 Basal lamina
Function – Not known
Density and arrangement – Varies with age
Young age – Plate with slight perforation
Middle age – Sieve like pattern/Network
Elder age – Nests or clumps
 Decrease with age
 Parallel to long axis
 Closer to cementum
 Cervical 3rd-old
 Apical 3rd-young

C/C
- Cysts & Tumours
- Cementicles
 Defense Cells

Mast Cells :
Small round/ovoid cell , round central nucleus
Diameter-12-15um
Ch Feature: cytoplasmic granules – heparin &
histamine
Stain – basic dyes/Metachromatic dyes(toluidine blue)
Function : Inflammation
Degranulate – ag-ab response
Eosinophils- seen occasionally

Macrophages –
Origin- blood monocytes
Large cell, horseshoe/kidney shaped nucleus
Rare nucleoli
E/M : free ribosomes, RER, Golgi, microvilli
Stains- trypan blue
Function: Phagocytosis
Fibres Of Periodontal ligament

Collagen fibres
Elastic fibres
Reticulin fibres
Oytalan fibres
Elaunin
 Collagen fibres

Majority- 90%

Gathered in bundles –

Principal fibers

Mixture of Type I&II

Avg diameter- 55nm

 Alveolar crest group
Horizontal group
Oblique group
Apical group

CM Interradicular group
bone
Bone Cm
 Alveolar Crest group

• Below CEJ
• Downwards

Function:
• Resist lateral movement
• Prevent extrusion of tooth
 Horizontal group

• Rt angles to long axis

• apical to alv.crest
fibres

Fn: Resist dipping & rotating movements

 Oblique group

• Run obliquely
• Most numerous
• attachment to cm
is apical
• 2/3rd of root

Fn: Major attachment

Suspensory ligament & support teeth
 Apical group

• Irregularly arranged
•Radiate from apex
•Not seen –
incomplete root

Fn: Acts as cushion –support apical vessels

Resist lateral & intrusive movement
 Interradicular Fibers

•betn roots –
multirooted teeth
•radiate – Cm --
interradicular septa

Fn: Prevent tipping

Resist movement – interradicular area
 Sharpey’s fibres

Alv.C

Bone CM

BV

• embedded portions – principal

fibres
• Near alv crest – Insertions
• Deeper- end in BV
 Transeptal fibres

 Cross interdental septa

 Cm to Cm = above alv. Crest & below DGJ
 Fn: Unite all teeth in arch, maintain integrity –

interdental ligament
Resist seepage –toxins , extn of Inflammation-
gingiva
 C/S : Post retention relapse
 Gingival fibres
 Found in lamina propria of gingiva
 Gingival ligament

Dentogingival

Alveogingival

 Circular
 Dentoperiosteal
 Transseptal
 Oxytalan fibres

Immature elastic fibres

Start from CM & end in the wall of BV
Width- 0.5-3.5cm
Orientation- parallel to long axis of tooth
Location- numerous & dense- cervical region
Function:
Regulate the blood flow - elastin
 Elaunin fibres
immature elastic fibres
bundles of microfibrils- elastin

Reticulin fibres
Type III collagen
Basement membrane- BV

Indifferent Fiber plexus

Fibers run in all directions
Intermediate Plexus

 Wavy course- Crimping

 Intermingle in centre-
lattice like network
 Seen in L.S.
 Theories:
 Site of rapid remodeling
 Artefact
 Ground substance
Present betn. Cells, fibers, BV & nerves
Contents:
Water-70% ( withstand stress)
Proteoglycans – Dermatan sulphate
Glycoproteins – tenascin & fibronectin
Structureless
Functions:
• Support BV & nerves
• Shock absorber
• Fibrillogenesis & fiber orientation
• Link all contents of PDL
• Ion and water binding capacity
Blood Supply

Well Vascularised
3 sources
• Apical vessels
• Intraalveolar vessels
• Gingival vessels
Lie in Interstial area
Rich plexus- apex& cervical
region
Venous drainage
 Lymphatics

Follow venous drainage

Flow PDL

Alveolar bone PDL vasculature

Submandibular
Submental LN
 Nerve Supply
Extensive nerve supply
2 functions

Sensory Autonomic
Pain Regulation of BF
Pressure

Myelinated -thick
2 types of nerve fibers
Unmyelinated- thin
Patterns of Innervation

2 sources
• Root apex
• Alveolar Bone

2 branches
• Apically
• Gingivally
 Cementicles

Calcified masses
lamellar structures with central nidus
Concentric depo. Of Ca+
Origin: Not established
Can be:
 Calcified Epithelial rests
 Traumatically displaced CM?Bone
 Calcified Sharpey’s fibres
Calcified thrombosed vessels
 Types

 Free cementicle
 attached to wall of cementum-
Interstial Cementicle
 Embedded in cementum
 Excementosis- Knob like projection
Functions Of Periodontal Ligament

Supportive

Sensory

Nutritive

Homeostasis

Tooth eruption
 Support

Medium for attachment

Soft tissue casing- Protects the nerve and BV
Shock absorber- Resist and transmit – occlusal
forces to bone
 Sensory function

Tactile, pain and presusre

Nutritive Function
Cm, bone and Gingiva
BV and lymphatic drainage

Homeostasis
formation and resorption – Bone, Cm, and PDL
•Physiologic tooth movt
•Repair of injuries
•Accomdation of occlusal forces
 Clinical considerations
Thickness varies – functional state of tooth – support
Restorative Dentistry- abutment, anchorage
Accessory, apical foramen – Spread inf– Pulp –PL
PL in periapical area- site of pathology
Epi cell rests- cysts& Tumors
Malignant tumor – gingiva extend-PL
Periodontal disease
Orthodontic therapy
Trauma to P.L.
Dept. Of Oral and Maxillofacial Pathology