1. Anatomy of the PeriodontiumAnatomy of the Periodontium
PeriodontiumPeriodontium
The tissues that surround and support theThe tissues that surround and support the
teeth are known as the periodontium.teeth are known as the periodontium.
It includes:It includes:
1. Gingiva1. Gingiva
2. Periodontal ligament2. Periodontal ligament
3. Alveolarbone3. Alveolarbone
4. Cementum4. Cementum
Periodontium: peri = around . odontous =Periodontium: peri = around . odontous =
toothtooth
Periodontics: the art and science ofPeriodontics: the art and science of
studying the periodontium.studying the periodontium.
Periodontist: specialist in periodonticsPeriodontist: specialist in periodontics
3. Gingiva:Gingiva:
The fibrous investing tissue coveredThe fibrous investing tissue covered
byby keratinized epithelium. The gingiva is onekeratinized epithelium. The gingiva is one
ofof the soft tissues that line the oral cavity.the soft tissues that line the oral cavity.
All the soft tissue in the mouth are KnownAll the soft tissue in the mouth are Known
as theas the
the oral mucosa, it isthe oral mucosa, it is
divided into three different types:divided into three different types:
4. Types of gingiva:Types of gingiva:
1.1. Marginal gingiva (free orMarginal gingiva (free or
unattached)unattached)
2.2. Attached gingiva (firmlyAttached gingiva (firmly
attached to underlying toothattached to underlying tooth
and bone)and bone)
3.3. Inter-dental gingiva( locatedInter-dental gingiva( located
between adjacent teeth.between adjacent teeth.
4.4. Gingival sulcusGingival sulcus
7. • 1:Enamel.1:Enamel.
• 2:gingival margin.2:gingival margin.
• 3:gingival sulcus.3:gingival sulcus.
• 4:free gingival groove.4:free gingival groove.
• 5:lveolar bone.5:lveolar bone.
• 6:CEJ6:CEJ
• 7Cementum7Cementum
• 8:PDL8:PDL
• Between 2 and 4 is free gingivaBetween 2 and 4 is free gingiva
8. Gingival sulcus:Gingival sulcus:
** It isashallow fissureIt isashallow fissure
betweenbetween marginal gingival andmarginal gingival and
theenamel or cementum.theenamel or cementum.
** Clinical normalClinical normal
gingivalgingival sulcusdepth = 2-3 mmsulcusdepth = 2-3 mm
measured with periodontalmeasured with periodontal
probe.probe.
9. Interdental gingiva:Interdental gingiva:
• Its that part of the gingiva that occupy theIts that part of the gingiva that occupy the
inter-proximal space, created by adjacent teethinter-proximal space, created by adjacent teeth
in contact. Therefore, shape determined byin contact. Therefore, shape determined by
contact relationship with teeth, and width ofcontact relationship with teeth, and width of
proximal surfaces.proximal surfaces.
• If the contours are flat, interproximalIf the contours are flat, interproximal
contacts, the gingiva will be narrow andcontacts, the gingiva will be narrow and
short. If the proximal contours are moreshort. If the proximal contours are more
convex with a small coronally positionedconvex with a small coronally positioned
contact area, the interdental gingiva will becontact area, the interdental gingiva will be
broad and high.broad and high.
10.
11. The interdental gingiva can beThe interdental gingiva can be
pyramidal and have col shape.pyramidal and have col shape.
Buccolingual dimension the inter-Buccolingual dimension the inter-
dental gingival terminates coronally withdental gingival terminates coronally with
separate buccal and lingual peaks ofseparate buccal and lingual peaks of
tissueasthegingival col.tissueasthegingival col.
12. Gingival Groove (4):Gingival Groove (4):
It is a shallow, v-shaped orIt is a shallow, v-shaped or
indentation that is closely associatedindentation that is closely associated
with apical extent of freegingiva.with apical extent of freegingiva.
13. The understanding of clinical features ofThe understanding of clinical features of
periodontium is enhanced by a knowledgeperiodontium is enhanced by a knowledge
of histological component of tissue.of histological component of tissue.
18. SulcularEpithelium:SulcularEpithelium:
It lines the gingival sulcus facingIt lines the gingival sulcus facing
the tooth similar to oral epitheliumthe tooth similar to oral epithelium
except the 2except the 2ndnd
layer (it lacks granularlayer (it lacks granular
cell layer)cell layer)
It acts as semipermeable membrane fromIt acts as semipermeable membrane from
the bacteria and tissue fluid from thethe bacteria and tissue fluid from the
gingivaseepsinto thesulcus.gingivaseepsinto thesulcus.
19. Junctional Epithelium:Junctional Epithelium:
Forms the core of epithelium. It isForms the core of epithelium. It is
thickest in coronal part. Is single or multiplethickest in coronal part. Is single or multiple
layer of non-keratinized cells adhering to toothlayer of non-keratinized cells adhering to tooth
surface and face the gingiva by means of basalsurface and face the gingiva by means of basal
lamina.lamina.
• Basal Laminaconsist of:Basal Laminaconsist of:
LaminalucidaLaminalucida
LaminadensalLaminadensal
20. Details of the sulcular junctional epithelium areasDetails of the sulcular junctional epithelium areas
21. Connective Tissue:Connective Tissue:
Is known as the lamina propria. DividedIs known as the lamina propria. Divided
into two layers: (1) the papillary layerinto two layers: (1) the papillary layer
adjacent to epithelium, (2) reticular layer,adjacent to epithelium, (2) reticular layer,
contiguouswith theperiosteum.contiguouswith theperiosteum.
– Lamina propria consist of:Lamina propria consist of:
• Collagen fibersCollagen fibers
• Intercellular ground substanceIntercellular ground substance
• CellsCells
• Blood vesselsBlood vessels
• NervesNerves
23. Histological charecterstics of the gingiva(FaciolingualHistological charecterstics of the gingiva(Faciolingual
section of the periodontium)section of the periodontium)
24. The collagen fibers help to hold the marginal gingivaThe collagen fibers help to hold the marginal gingiva
tightly against the tooth and provide a firm junction oftightly against the tooth and provide a firm junction of
the attached gingiva to the underlying tooth root andthe attached gingiva to the underlying tooth root and
alveolar bone.alveolar bone.
Thefibersaregrouped:Thefibersaregrouped:
1. Gingivodental1. Gingivodental
2. Circular2. Circular
3. Transeptal3. Transeptal
4. Alveolo gingival4. Alveolo gingival
5. Inter-radicular fibers5. Inter-radicular fibers
6. Intra-papillary fibers6. Intra-papillary fibers
25. The most prominent cells found in theThe most prominent cells found in the
gingival connective tissue:gingival connective tissue:
1. Plasmacells1. Plasmacells
2. Fibroblasts2. Fibroblasts
3. Mast cells3. Mast cells
4. Lymphocytes4. Lymphocytes
26. VascularSupply:VascularSupply:
It’s derived from the branches of theIt’s derived from the branches of the
superiorand inferioralveolararteries:superiorand inferioralveolararteries:
1. Greater palatineartery1. Greater palatineartery
2. Buccal artery2. Buccal artery
3. Sublingual artery3. Sublingual artery
4. Mental artery4. Mental artery
27. The lymphatic drainage usuallyThe lymphatic drainage usually
follows the blood supply, the majorfollows the blood supply, the major
portion of the lymph drainage from theportion of the lymph drainage from the
gingiva going to the submandibulargingiva going to the submandibular
lymph nodes.lymph nodes.
28. Gingival Fluid:Gingival Fluid:
The gingival (crevicular) fluid isThe gingival (crevicular) fluid is
continually secreted from the gingivalcontinually secreted from the gingival
connective tissues into the sulcus throughconnective tissues into the sulcus through
thesulcular epithelial wall.thesulcular epithelial wall.
This fluid helps to mechanically cleanThis fluid helps to mechanically clean
the sulcus and in addition, possess anti-the sulcus and in addition, possess anti-
microbial properties and antibodies thatmicrobial properties and antibodies that
enhance the resistance of the gingiva toenhance the resistance of the gingiva to
gingivitis.gingivitis.
31. Gingival contour:Gingival contour:
The inter-dental gingiva is generallyThe inter-dental gingiva is generally
pointed. However, the contours of thepointed. However, the contours of the
gingiva vary depending upon the shape ofgingiva vary depending upon the shape of thethe
teeth, the buccolingual position of theteeth, the buccolingual position of the
teeth in the arch, and the size of the inter-teeth in the arch, and the size of the inter-
proximal embrasurespace.proximal embrasurespace.
32. Gingival Consistency:Gingival Consistency:
Usually resilient and firm because of theUsually resilient and firm because of the
dense collagenous nature of the gingivaldense collagenous nature of the gingival
connectivetissue.connectivetissue.
Gingival Surface Texture:Gingival Surface Texture:
Being stippled like an orange peel orBeing stippled like an orange peel or
smooth and shiny. Degree of stipplingsmooth and shiny. Degree of stippling
varies considerably among patients and invaries considerably among patients and in
different partsof thesamemouth.different partsof thesamemouth.
33. Nerve Supply:Nerve Supply:
Derived from maxillary and mandibularDerived from maxillary and mandibular
branchesof thetrigeminal nerve.branchesof thetrigeminal nerve.
35. Periodontal ligamentPeriodontal ligament
• Connective tissue around and attach teethConnective tissue around and attach teeth
to the alveolar bone.to the alveolar bone.
• Consist of bundles of fibers, according toConsist of bundles of fibers, according to
their directions:their directions:
1)Alveolar crest group1)Alveolar crest group
2)Horizontal group2)Horizontal group
3)Oblique group.3)Oblique group.
4)Apical fibers.4)Apical fibers.
36.
37. • The ends of the princible fibers areThe ends of the princible fibers are
embeded in cementum on the tooth sideembeded in cementum on the tooth side
and in the alveolar bone proper on theand in the alveolar bone proper on the
opposite side. The embeded portions ofopposite side. The embeded portions of
the princible fibers are the Sharpey’sthe princible fibers are the Sharpey’s
fibersfibers
40. The physical functions of pdlThe physical functions of pdl
• Transmission of occlusal forces to the bone.Transmission of occlusal forces to the bone.
• Attachment of the teeth to the bone.Attachment of the teeth to the bone.
• Maintainance of the gingival tissues in theirMaintainance of the gingival tissues in their
relationship to the teeth.relationship to the teeth.
• Resistence to the impact of occlusalResistence to the impact of occlusal
forces(shock obsorption).forces(shock obsorption).
• Provision of a soft tissue casing(to protectProvision of a soft tissue casing(to protect
vessels and nerves from injury by mechanicalvessels and nerves from injury by mechanical
forces).forces).
43. Cementum:Cementum:
Calcified tissue covers the root of the teethCalcified tissue covers the root of the teeth
and provide attachment to the periodontaland provide attachment to the periodontal
ligament.ligament.
Consist of collagen fibers in a groundConsist of collagen fibers in a ground
substance consist of 45-50% inorganicsubstance consist of 45-50% inorganic
materials. 50-55% organic materialsmaterials. 50-55% organic materials
44. Width vary from 60-68 microns in coronalWidth vary from 60-68 microns in coronal
third 150-200 micronsin apical third.third 150-200 micronsin apical third.
Width increase with age. 95 microns atWidth increase with age. 95 microns at
ageage 20. 215 micronsat age6020. 215 micronsat age60
Two types of cementum a cellular (coronalTwo types of cementum a cellular (coronal
portion of the root) Cellular apical portionportion of the root) Cellular apical portion
of root and in furcation areas of multi-of root and in furcation areas of multi-
rootedrooted teeth.teeth.
45. Cemento Enamel JunctionCemento Enamel Junction::
The area where cementum and enamelThe area where cementum and enamel
meet (cervical area).meet (cervical area).
Threedifferent relationship:Threedifferent relationship:
60-50%60-50% cementum overlapsenamelcementum overlapsenamel
30%30% edgeto edgeedgeto edge
5%-10%5%-10% cementum fail to meetcementum fail to meet
enamel resulting in exposedenamel resulting in exposed
dentinedentine
