PDL considerations by DR JAMEEL KIFAYATULLAH

3. Clinical considerations of
periodontal ligament
Dr jameel Kifayatullah

4. Clinical considerations
• 1) Restorative dentistry
The supporting tissues of a
tooth long out of function are
poorly adapted to carry the
load suddenly placed on a
tooth by restoration
e.g bridge abutments,teeth
opposing
bridges/dentures,teeth used as
anchorage for removable
bridges

6. Clincial considerations
Restorative dentistry
• Therefore the patient cannot use the tooth
immediately
• After restoration supporting tissues take some
time to adapt to new functional
demands.Therefore after restoration an
adjustment period should be allowed
• Gradually use the tooth first for soft food before
the tooth is put to full use to bite hard food.

7. Orthodontic therapy
• Orthodontic therapy also affects PDL similar to alveolar
process
• On the side under tension,the PDL space will become
wider
• With the side under pressure it will become narrower
• Inerdental ligament responsible for memory of a tooth
positioning within each dental arch
• There fore a prolonged retention period must be
allowed to reattach the interdental ligament fully to its
new position ensure maintenance of clinical stability
of tooth position
• Retainers used to maintain this desirable alignment

10. Retainers after braces

11. Periapical granuloma and cyst
• PDL in the periapical area of tooth often site of a
pathologic lesion
• Inflammatory disease of pulp(pulpitis) progresses
to the apical periodontal ligament and replace its
fiber bundles with granulation tissue.This lesion is
called periapical granuloma
• The periapical granuloma contain epithelial cells
which undergo proliferation and produce a cyst

12. Periapical granuloma

14. Chronic inflammatory periodontal
disease

15. Chronic inflammatory periodontal
disease
• Commonest pathology related to periodontal
disease
• Dental plaque –toxins released from bacteria in
plaque and metabolites of host defense
mechanisms destroy PDL and adjacent bone very
frequently-tooth mobility and loss of tooth
• Repair of destroyed PDL challenging
• Involves limiting the disease process and to
regenerate host tissues (pdl and bone to their
original form so that reattachment of pdl to bone
becomes possible

16. Guided tissue regeneration
• The periodontal ligament is unique among the
periodontal tissues, in that it contains precursor
cells for the production of the entire attachment
apparatus of the tooth, i.e. cementum,
periodontal ligament and bone. By using
biologically compatible barriers, the therapist is
able to promote the ingrowth of these cells into
damaged sites where a new periodontal
attachment is needed. This therapeutic principle
is known as guided tissue regeneration.

17. GTR
• The biological principle
of Guided Tissue
Regeneration describes a race
among four tissue types
during healing:
• Epithelium (outer gum tissue
drawn in red)
• Connective tissue (under the
epithelium drawn in pink)
• Bone that surrounds the tooth
(yellow)
• Periodontal ligament
(connects the gum and the
bone to the root-thin black
lines)

18. Guided tissue regeneration
• These four tissues compete for the space next to
the tooth root following surgery. Without
interference, epithelium usually wins the race
and stops the bone healing.
• Some regenerative materials are designed to act
as barriers to block the gum tissue. They are
placed in order to isolate the space next to the
root, so that the epithelium and connective tissue
are kept away, thus allowing the slower growing
ligament and bone cells to fill the space