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Tissues of the Periodontium (Gingivia (Texture (stippling, edematous,…
Tissues of the Periodontium
PDL
Functions to...
Shock absorbers for nerves and vessels
resist impact of occlusal forces
Maintain position of gingival
transmit touch/pain/pressure sensation
supplies nutrients to periodontal structures
transmits occlusal forces to bone
attaches teeth to bone
Principal FIbers
Oblique Fibers
Largest and most significant, can withstand masticatory stress in a vertical direction
Horizontal Fibers
Alveolar Crest Fibers
Transseptal Fibers
Adjusted during ortho
Apical Fibers
Inter-radicular
Cells of PDL
Osteoblasts and Osteoclasts
Cementoblasts
Fibroblasts
Cementum
What is it?
Calcified or mineralized tissue layer covering the roots of the teeth
It's thickness varies at different levels of the tooth
Thickest at apex of the root, between multicoated teeth. Thinnest at CEJ
What Types?
Cellular
Present apically, contains cells called Cementocytes
Acellular
Found at coronal half, has no cells
Function?
Provides attachment to collagen fibers in PDL
Maintains integrity of root and position within alveolar socket
Alveolar Bone
Alveolar Process
part of the maxilla and mandible that forms and supports the sockets (
alveoli
) of the teeth
2 Parts of the Alveolar Process
Alveolar Bone Proper
Cribiform plate, the hard compact bone that lines the socket, which is contained within the alveolar process
referred radiographically as the
lamina dura
The
cribriform plate
are thin plates of bone that is perforated by numerous openings to carry blood, nerves, and lymphatics from bone to the PDL
The bone where Sharpey's fibers terminate is called
bundle bone
Alveolar crest
: coronal rim of alveolar bone
Supporting Bone
Composed of 2 Parts
Compact Bone (Cortical Plate)
Cancellous Bone
Radiographically
Normal Bone Patterns
Contour follows CEJ contour
Intact lamina dura
Alveolar crest 1-2mm apical to CEJ
Visible and uniform PDL space
Bony Destruction
Change in furcation involvement
less distinct lamina dura
Vertical (angular) bone loss more than 2mm
Supra-bony: base of pocket is
coronal
to the crest of alveolar bone
Horizontal bone loss: more than 2mm
Intra-bony: base of pocket is
apical
to crest of alveolar bone "within the bone"
Gingivia
Color
(erythema, cyanosis, pallor, melanin)
cyanosis is often from vascularity (seen around crowns); pallor is lighter than normal color in response to fibrosis, anemia, or leukemia; melanin is a dark pigmentation
Contour
(bublous, McCall's Festoon, receded, hyperplastic, blunted)
rolled is more chronic and slightly receded; rounded is more acute and swollen above the gingival margin
Distribution
(marginal, papillary, facial, lingual)
Texture
(stippling, edematous, spongy, shiny)
the obvious result of vasodilation of the peripheral circulation is edema
Fibrosis is the hallmark sign of chronic inflammation: surface texture is highly stippled due to the increase in cellular and fibrous components
Extent
(localized or generalized)
Inflammation
Acute
(vascular)
Heat "calor"
Swelling "tumor"
Redness "rubor"
Pain "dolor"
Loss of Function "functio laesa"
Pain and bleeding
Mushy/spongy and red
obvious inflammation
Chronic
(cellular)
may appear normal "stippled"
May not cause pain
Slow development
Patients can be in denial about pain
rapid development
Disease and Classifications
Gingivitis
Gingivitis Associated with dental plaque only
Gingival Disease Modified by Systemic Factors
Puberty
Menstrual Cycle
Pregnancy
Diabetes
Leukemia
Mal-nutrition
Medications
Dental Plaque Induced
Non-plaque induced Gingival Lesions
Viral
Fungal
Bacterial
Genetic
specific causes of gingival inflammation can include open contacts (as sub gingival margin restorations or diastema)
Fiber Bundles: Collagenous fibers that attach to bone "Sharpey's Fibers"