Preclinical Preclinical periodontologyperiodontology
PeriodontologyPeriodontologyBranch of Dentistry deals with the Branch of Dentistry deals with the
diseases & treatment of diseases & treatment of PeriodontiumPeriodontium
PeriodontiumPeriodontiumsupporting tissues supporting tissues
supporting teeth in the supporting teeth in the archesarches
Periodontium composed Periodontium composed from four partsfrom four parts
GingivaGingivaPeriodontal ligamentPeriodontal ligament
Cementum Cementum Alveolar boneAlveolar bone
Periodontal diseases have Periodontal diseases have afflicted humans since the afflicted humans since the dawn of history & studies dawn of history & studies showed that destructive showed that destructive periodontal diseases as periodontal diseases as evidenced by bone loss evidenced by bone loss affected ancient egyptaffected ancient egypt
Oral hygiene was practiced by Oral hygiene was practiced by sumerians as seen gold toothpicks sumerians as seen gold toothpicks
found in excavations atfound in excavations at OROR
babylonians & assyrians suffered babylonians & assyrians suffered from periodontal problems & they from periodontal problems & they
were treating them by Gingival were treating them by Gingival massage combined with various massage combined with various
herbal medicationsherbal medications
Later on, during golden age Later on, during golden age of arabic science & medicine, of arabic science & medicine,
Ibn Sina was greatest Ibn Sina was greatest physicians with his text the physicians with his text the Canon that involve Gingival Canon that involve Gingival disease as bleeding gum, disease as bleeding gum,
ulcers ,recession & ulcers ,recession & separation of gum & epulisseparation of gum & epulis
Abul Qasim described Abul Qasim described role of calculus deposit role of calculus deposit
in etiology of periodontal in etiology of periodontal disease & technique of disease & technique of
scaling the teeth using a scaling the teeth using a set of instruments that set of instruments that
he developed,he developed,he also wrote in details he also wrote in details splinting loose teeth splinting loose teeth
with gold wirewith gold wire
Histology & Anatomy of periodontium
Histology & Anatomy of periodontiumGingiva
Together with hard palate form masticatory mucosa
its part of oral mucosa that covers Alveolar process & surround the neck
of teeth
Gingiva is of three parts
attached Marginal
Interdental papillae
Marginal(Free,unattached)
terminal edge of Gingiva surrounding teeth in a collar-
like fashion
Marginal(Free,unattached)
its demarcated from Attached Gingiva by shallow linear depression known as free Gingiva groove in about 50% of
people, its positioned at a level corresponding to
level of CEJ
Pink in colorPink in color firm in consistency firm in consistency scalloped outline scalloped outline
free Gingiva rounded in free Gingiva rounded in such away that small such away that small
sulcus is formedsulcus is formed
its of 1.5-2mm in depthits of 1.5-2mm in depth& about 1mm in & about 1mm in widthwidth
InterDental InterDental papillaepapillae
its shape determine by contact its shape determine by contact relationship, relationship,
in anterior region is pyramidal in anterior region is pyramidal in molar its more flattened in BL in molar its more flattened in BL
direction & consist of 2 papillae & col direction & consist of 2 papillae & col shape( valley like depression ) connect shape( valley like depression ) connect them & conform to shape of the above them & conform to shape of the above
contact areacontact area
in absence of proximal tooth contactin absence of proximal tooth contactGingiva is firmly bound over InterdentalGingiva is firmly bound over Interdental
bonebone& & form smooth rounded surfaceform smooth rounded surface
firm & tightly bound to firm & tightly bound to underlying periosteum & underlying periosteum &
extend to movable & loose extend to movable & loose oral mucosa where its oral mucosa where its separated from it by separated from it by
Mucogingival junctionMucogingival junction
Attached GingivaAttached Gingiva
Its pink in color with Its pink in color with stippling (orange peel) in stippling (orange peel) in
40% of people due to 40% of people due to presence of minute presence of minute depression in oral depression in oral
epithelium at the collection epithelium at the collection of retepegeof retepege
Attached GingivaAttached Gingiva
Its width range between 1-9mmIts width range between 1-9mm& & gradually increase with agegradually increase with age
due to occlusal weardue to occlusal wear so teeth is slowly eruptso teeth is slowly erupt
MoreMore in maxilla in maxilla than mandible with least than mandible with least
width width in the 1in the 1stst premolar region premolar region
palatal surface in maxilla palatal surface in maxilla blends imperceptibly with blends imperceptibly with
equally firm, resilient palatal equally firm, resilient palatal mucosamucosa
Gingival contourGingival contour
marginal Gingiva envelops teeth in marginal Gingiva envelops teeth in collar like fashion & follows a collar like fashion & follows a
scalloped outline on Facial & oral scalloped outline on Facial & oral surfacessurfaces
It form a straight line along teeth It form a straight line along teeth with flat surfaceswith flat surfaces
on teeth with labial version on teeth with labial version as upper canine, the normal as upper canine, the normal
contour is accentuated & contour is accentuated & Gingiva located farther Gingiva located farther
apicallyapically
teeth with lingual version, teeth with lingual version, Gingiva becomes horizontal Gingiva becomes horizontal & thickened shelf-like that & thickened shelf-like that
its aggravated by local its aggravated by local irritation of Dental Plaqueirritation of Dental Plaque
Microscopical Microscopical AnatomyAnatomy
Epithelium covers Free Epithelium covers Free Gingiva is differentiated intoGingiva is differentiated into Oral Epithelium facing oral Oral Epithelium facing oral
cavity & covers free & cavity & covers free & Attached Gingiva,Attached Gingiva,
sulcular epithelium lining sulcular epithelium lining the sulcus & the sulcus &
Junctional Epithelium Junctional Epithelium bringing Gingiva in contact bringing Gingiva in contact
with toothwith tooth
Oral Epithelium are Oral Epithelium are keratinized stratified keratinized stratified squamous cells with squamous cells with
retepeges while Sulcular & retepeges while Sulcular & Junctional are not Junctional are not
keratinized ,keratinized ,only Sulcular one of them only Sulcular one of them
has retepegeshas retepeges
Epithelium composed Epithelium composed ofof
1- basal cells layer faces 1- basal cells layer faces basement membrane & its basement membrane & its
mitotic activity induces new cells mitotic activity induces new cells that migrate to surfacethat migrate to surface2- spinous cells layer 2- spinous cells layer 3- granular cells layer3- granular cells layer
4- keratinized cells layer;4- keratinized cells layer;keratine filled flattened cell, keratine filled flattened cell,
deprived of energy production deprived of energy production & its of 2 types,& its of 2 types,
Orthokeratine without Orthokeratine without nucli & parakeratine with nucli & parakeratine with
nuclinucli
Epithelium composed Epithelium composed ofof
Oral Epithelium also hasOral Epithelium also has melanocytes, melanocytes, langerhans & langerhans &
non-specific cells that are non-specific cells that are stellate cellsstellate cells
MelanocytesMelanocytes
pigment containing cells ,pigment containing cells ,they synthesize melanin,they synthesize melanin,
melanin granules that phagocytosed & melanin granules that phagocytosed & contained within other cells of contained within other cells of
epithelium & connective tissue called epithelium & connective tissue called melanophagesmelanophages or or melanophoresmelanophores
LangerhanseLangerhanse
immune cells that react with Ag, its immune cells that react with Ag, its belong to mononuclear phagocyte belong to mononuclear phagocyte
system (reticuloendothelial system) system (reticuloendothelial system) as modified monocyte derived from as modified monocyte derived from
bone marrowbone marrow
Merkel cellsMerkel cells
located in deeper layer of epithelium located in deeper layer of epithelium harbor nerve ending & connected to harbor nerve ending & connected to
adjacent cells by desmosoms,adjacent cells by desmosoms,its identified as tactile perceptorsits identified as tactile perceptors
HemidesmosomHemidesmosom
Cell membrane of epithelial cells that Cell membrane of epithelial cells that face Basement Membrane has a no. face Basement Membrane has a no.
of electron dense thicker zones of electron dense thicker zones appearing at various intervals along appearing at various intervals along
cell membrane, tonofilament of cell membrane, tonofilament of cytoplasm converge toward these cytoplasm converge toward these
structurestructure It involves in attachment of epithelial It involves in attachment of epithelial
cells to Basement Memranecells to Basement Memrane
Pair of adjacent Pair of adjacent Hemidesmosom formHemidesmosom form Desmosom Desmosom among among
adjacent cellsadjacent cells
Junctional Junctional EpitheliumEpithelium
Its formed by joining of Reduced Its formed by joining of Reduced Enamel Epithelium (ameloblast + Enamel Epithelium (ameloblast + outer Enamel epithelium) & Oral outer Enamel epithelium) & Oral
EpitheliumEpithelium
Its 0.25-1.35mm in Its 0.25-1.35mm in coronoapical dimension & coronoapical dimension &
about 0.15mm wideabout 0.15mm wide
Larger cells, wider Larger cells, wider intercellular space & less intercellular space & less
desmosomsdesmosoms
Junctional Junctional EpitheliumEpithelium
The junctional epithelium is attached to the tooth
surface (epithelial attachment) by mean of an internal basal lamina
and to the gingival connective tissue by anexternal basal lamina that has the same
structure as other epithelial-connective tissue attachments elsewhere
in the body.
The internal basal lamina consists of a
lamina densa adjacent to the enamel
and a lamina lucida to which hemidesmosomes are attached Organic strands from the enamel
appear to extend into the lamina densa
The junctional epithelium attaches to afibrillar
cementum present on the crown
(usually restricted to an area
within 1 mm of the cementoenamel junction) and root cementum in a
similar manner
The attachment of the junctional epithelium to
the tooth is reinforced by the gingival fibers,
which brace the marginal gingiva
against the tooth surface
For this reason, the junctional epithelium
and the gingival fibers are considered
a functional unit, referred to as
the dentogingival unit
Connective tissues of Gingiva
Composed of Collagen fibers (60%),
fibroblast(5%),vessels, nerves & matrix (35%)
with mast cells, macrophage, lymphocyte, neutrophil, plasma cells
Connective tissue fibers are produced by fibroblast &
divided into collagen , reticulin & elastic fibers
Collagen fibers are predomanent one & their
synthesis is started inside fibroblasts that produce
tropocollagen molecules composed of 3 chains of polypeptide then they are secreted outside to start polymerization where they are
aggregated longitudinally to produce protofibril that aggregated laterally to
collagen fibrils which bundle together to form
Collagen fibers
Reticular fibersReticular fibers
occur in loose connective tissue surrounding occur in loose connective tissue surrounding blood vesselsblood vessels
& adjacent to Basement membrane& adjacent to Basement membrane
Elastic fibers systemElastic fibers system
composed of oxytalan, elaunin composed of oxytalan, elaunin & elastin fibers destributing & elastin fibers destributing
among collagen fibersamong collagen fibers
Collagen fibers arrange in groups of Collagen fibers arrange in groups of bundles with destinct oreintationbundles with destinct oreintation; ;
1- 1- CircularCircular; in free Gingiva; in free Gingiva2- 2- DentogingivalDentogingival from root to free Gingiva from root to free Gingiva3- 3- DentopereostealDentopereosteal to attached Gingiva to attached Gingiva ( both groups called ( both groups called GingivodentalGingivodental ) )4- 4- Transeptal Transeptal to the root of neighboring
tooth across interdental septum
FFunctionunction? ? 1-Give1-Give Gingiva its resiliency &Gingiva its resiliency &
2- attached it to tooth 2- attached it to tooth 3-provide rigidity to resist force of 3-provide rigidity to resist force of mastication without being deflected mastication without being deflected
away from toothaway from tooth4- unite the free Gingiva with 4- unite the free Gingiva with cementum & adjacent Attached cementum & adjacent Attached
GingivaGingiva
MatrixMatrixground substanceground substance
derived mostly from fibroblast & some from derived mostly from fibroblast & some from mast cell & bloodmast cell & blood,,
composed from watercomposed from water,,Glyco- Protein like FibronectinGlyco- Protein like Fibronectin, ,
Polysaccharide MoleculesPolysaccharide Molecules,,proteoglycans mainly Hyaluronic Acid & proteoglycans mainly Hyaluronic Acid &
Chondroitin SulphateChondroitin Sulphate,,
Matrix (ground substance)Matrix (ground substance)
it transports water, Electrolyte it transports water, Electrolyte & Nutrient to & from cells& Nutrient to & from cells, , also this Macromoleculs also this Macromoleculs
important for resiliency of important for resiliency of GingivaGingiva