tissues surrounding teeth periodontium includes structures and tissues that surround and support the...
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Tissues surrounding teeth PERIODONTIUM
Includes structures and tissues that surround and support the teeth
Alveolar Process Gingiva Periodontal Ligament/Membrane Cementum
Cementum Characteristics:
Covers root of tooth – forms a thin layer around the root
Has same density as bone 55% inorganic Contains fibers that attach tooth to the
alveolar bone
Cementum Cementum is a tissue of the tooth
and an important part of the supporting structure
Function: attachment of the tooth in its socket
Cementum Clinical concerns:
May be exposed with recession of gingiva
Removal of some of cementum could expose dentin
Extreme sensitivity is experienced by patients with exposed cementum and dentin
Cementum Clinical concerns:
Cemental spurs may form at C E J• Calculus is easy to remove, spurs are not
Hypercementosis – occurs at apex in response to trauma
Alveolar Bone Structure:
Bones in the maxilla and mandible are formed by osteoblasts
Extended areas of bone that hold the teeth are referred to as the alveolar process
Alveolar bone/process Lamina dura – outside layer of bone
surrounding the periodontal ligament
Lamina dura – ‘hard layer’ (like the crust of bread)
Cortical bone – compact or dense layer of bone
Alveolar bone/process Cancellous bone – inner or central
part of alveolar bone Cancellous bones is also referred to
as trabecular bone Spongy or porous in appearance
Alveolar bone/process Function:
Supports the tooth
Stabilizes the root
Alveolar bone Clinical concerns:
Periodontal disease can cause loss of bone
Bone is stimulated from chewing and speech – if teeth are removed this stimulation is lost and bone resorbs
Alveolar Process
Lamina dura, cortical, spongy
Periodontal Ligament Surrounds the root of the tooth Composed of fibers, or ligaments,
that support and suspend the tooth in the socket
Fibers are arranged in bundles Forms a ‘shock-absorber’ for the
tooth in the socket
Periodontal ligament Contains fibers for attachment Contains nerves, blood vessels and
lymph vessels
Periodontal ligament FUNCTIONS: Supportive – maintains tooth in socket Sensory – nerves supply ‘sense of touch Formative – fibroblasts, cementoblasts Protective- cushion-like action from shock Nutritive– blood vessels provide nutrients
Periodontal fiber groups Alveolar crest fibers-extend from cervical
area of tooth to alveolar crest Horizontal group – run at right angles Oblique group – slants into alveolar bone Apical group – extend from apex Interradicular –only in multi-rooted teeth Transseptal – from one tooth to another
PDL Fibers
Periodontal fiber groups Most important fibers:
Oblique – largest group – resist vertical (up and down) force• Work like shock absorbers
Transseptal or interdental – support interdental gingiva
Gingival fiber group Found above the alveolar bone crest
and below the epithelium Dentogingival fibers Circular ligament fibers Alveologingival fibers Dentoperiosteal fibers
Periodontal ligament Clinical considerations:
Occlusal trauma does not cause periodontal disease but can accelerate an existing condition
Chronic periodontal disease causes the fiber groups to become disorganized and lose attachment due to resorption
Gingiva Only portion of periodontium visible
in oral cavity Made up of epithelial tissue covered
with mucosa Surrounds cervix of tooth Fills interproximal spaces
Gingiva Free Gingiva – movable – fits snugly
around the crown just above the cervix of tooth
Attached Gingiva – non-movable – extends from the base of the sulcus to the mucogingival junction Attached directly to the cementum and
alveolar process
Gingiva
Gingiva Characteristics of normal tissue:
1) adapts tightly to tooth and bone 2) firm and resistant 3) surrounds tooth in collar-like fashion 4) color varies from pink to coral 5) surface is stippled
• Stippling – like surface of an orange
Gingiva Alveolar mucosa – appears thin and
loosely attached Attached gingiva – part that is stippled Gingival sulcus – space between the
unattached gingiva and the tooth Normal depth is about 2 mm
Gingival papilla – interdental extension of free gingiva (between teeth)
Mucosa -- differences
Masticatory mucosa – dense covering in the mouth Withstands activity of mastication (chewing) Covers gingiva and hard palate
Lining mucosa – covers the oral soft tissues that are not covered by masticatory mucosa Covers insides of cheeks, soft palate, floor of
mouth; tears and injures easily
Gingiva Clinical considerations:
Certain drugs can affect the gingiva and cause gingival hyperplasia, (over growth of tissue)
Tissue can become inflamed to fight infection – appearing swollen and red, bleeds easily, and looses its stippling
Gingival description Healthy gingiva is pink and stippled
on the attached portion. Normal gingiva is firm and resilient;
it follows the contour of the bone and fills the interproximal spaces, forming a sharp, knifelike triangular point at the contact area.
Gingival description Attached gingiva adheres tightly to
the bone and is pale, compared to the smooth shiny alveolar mucosa, which contains many blood vessels and thus appears more red in color.
Review: Periodontium – supporting structure
of the tooth – composed of:
Cementum Periodontal ligament Gingiva Alveolar process
Review: Healthy gingiva: Fits tightly around tooth and bone Surrounds like a collar Color varies with ethnicity Surface is stippled
Review: Two types of gingiva: Free gingiva Attached gingiva
Review: Function of periodontal ligament Most important function is
supportive – maintains the tooth in the socket by fiber attachment
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