Healthy Periodontium

Healthy Periodontium
Periodontal Morphology – Healthy
Periodontium
Alveolar Bone
Root Cementum
Periodontal Ligament
Gingiva
  The Periodontium
  Gingiva
  Periodontal
Ligament
  Root Cementum
  Alveolar Bone
(Alveolar Process)
Gingiva
Alveolar mucosa
Attached gingiva
Free gingiva
Interdental gingiva
Gingiva
  Tissue covering the
cervical portions of the
teeth and the alveolar
processes of the jaws
  Composed of thin outer
layer of epithelium and
an underlying core of
connective tissue
  Provides a tissue seal
around the cervical
portions of the crowns
Clinical Anatomy of the Gingiva
Clinical Anatomy of the Gingiva
  Attached gingiva
  Free gingiva
  Free gingival groove
  Gingival margin
  Gingival sulcus
(gingival crevice)
  Interdental gingiva
  Papilla/Papillae
  Col
  Alveolar mucosa
  Mucogingival junction
Clinical Anatomy of the Gingiva
  Free gingiva
  Gingival margin
  Gingival sulcus (gingival
crevice)
  Attached gingiva
  Mucogingival junction
  Alveolar mucosa
Clinical Anatomy of the Gingiva
  Interdental gingiva
  Facial papilla
  Lingual papilla
Clinical Anatomy of the Gingiva
  Col
  Proximal contact
area
Col
Proximal
contact area
Clinical Anatomy of the Gingiva
Free Gingiva
  Unattached portion of the
gingiva that surrounds the
tooth in the region of the
cemento-enamel junction
(CEJ).
  Located coronal to (above)
the CEJ. It surrounds the
tooth in a turtleneck or cufflike manner
  Also known as the
unattached gingiva or the
marginal gingiva
Clinical Anatomy of the Gingiva
Free gingiva characteristics
Free gingiva
  Fits closely around the tooth
but is not directly attached to it
  May be stretched away from
the tooth surface with a
periodontal probe
  Forms soft tissue wall of
gingival sulcus
  Meets the tooth in a thin
rounded edge called the
gingival margin
  Gingival margin follows the
contours of the teeth, creating a
scalloped (wavy) outline
around them
Clinical Anatomy of the Gingiva
Gingival Sulcus  The space between the
free gingiva and the tooth
surface
  V-shaped, shallow space
around the tooth
  Junctional epithelium –
forms base of sulcus
Clinical Anatomy of the Gingiva
This periodontal
probe is divided
into 3 millimeter
colored segments
Periodontal probe being used to
measure depth of the sulcus
Gingival Sulcus  The depth is 1-3 mm for
a clinically normal
gingival sulcus
  The depth is measured
using a periodontal probe
Dental floss being used to clean
the gingival sulcus and the tooth
Clinical Anatomy of the Gingiva
Gingival Sulcus  Probing the sulcus depth
interproximally is best
accomplished by angling
the probe so its tip is
located at the center of the
root
  A = incorrect technique for interproximal probing
  B = correct probing technique
  C = incorrect probing technique
Clinical Anatomy of the Gingiva
Junctional Epithelium
  Specialized type of
epithelium that
attaches to the tooth
surface
  Located at the base of
the gingival sulcus
Clinical Anatomy of the Gingiva
Attached gingiva
  Gingiva that is tightly
connected to the
cementum on the cervicalthird of the root and to the
periosteum (connective
tissue cover) of the
alveolar bone
  Lies between the free
gingiva and the alveolar
mucosa
Clinical Anatomy of the Gingiva
Attached gingiva functions
  Allows the gingival tissue to
withstand mechanical forces
  Mastication,
  Speaking,
  Toothbrushing
  Prevents free gingiva from
being pulled away from the
tooth when tension is applied
to the alveolar mucosa.
Clinical Anatomy of the Gingiva
Interdental gingiva
  The portion of the gingiva
that fills the area between
two adjacent teeth apical
to the contact area
Clinical Anatomy of the Gingiva
Papilla
  The interdental (or
interproximal) gingiva
consists of two interdental
papillae
  one facial papilla
  one lingual papilla
  Papilla (singular)
  Papillae (plural)
Clinical Anatomy of the Gingiva
Col
  Valley-like depression in
the interdental gingiva
  Lies directly apical to the
contact area
  The col is not present if
the adjacent teeth are not
in contact or if the gingiva
has receded
Clinical Anatomy of the Gingiva
  Left = incorrect vertical technique for probing interproximal craters
  Right = correct angled position of the probe to reach the depth of an interproximal crater
Clinical Anatomy of the Gingiva
Alveolar Mucosa
  Movable tissue loosely attached to
underlying bone
  Nonkeratinized
  Thin, smooth and shiny epithelium
  Dark red in color
  Underlying vessels may be seen
through the epithelium.
  Alveloar mucosa also covers the
vestibule and floor of the mouth
and becomes the buccal and labial
mucosa
Clinical Anatomy of the Gingiva
Mucogingival junction
  The clinically visible
boundary where the
pink attached gingiva
meets the red, shiny
alveolar mucosa
Microscopic Anatomy of the
  Gingival Epithelium
Gingiva
  Oral epithelium (OE)
  Sulcular epithelium (SE)
  Junctional epithelium (JE)
  Gingival connective tissue
Microscopic Anatomy of the
Gingiva
Sulcular
epithelium
Oral
epithelium
  Gingival Epithelium
  Oral epithelium – faces
Junctional oral cavity on outer
epithelium surface of the free
gingiva and attached
gingiva
  Sulcular epithelium –
lines the gingival sulcus
  Junctional epithelium –
provides contact
between the gingiva and
the tooth. Often referred
to as the epithelial
attachment
Microscopic Anatomy of the
Gingiva
OE = oral epithelium
SE = sulcular epithelium
JE = junctional epithelium
CEJ = cementoenamel
junction
  Gingival connective tissue –
underlies the epithelium and
provides support through an
organization of collagen
fibers
Periodontal Ligament
Periodontal Ligament (PDL)
  Layer of soft connective
tissue
  Covers the root of the tooth
  Attaches the root to the bone
of the tooth socket
  Composed mainly of fiber
bundles
  Fibers attach on one side to
the root cementum
  Fibers attach on the other
side to the alveolar bone of
the tooth socket.
Periodontal Ligament
Functions of the Periodontal Ligament
  Support - suspends and maintains the
tooth in its socket
  Sensory - provides sensory feeling to
the tooth; pressure and pain sensations
  Nutritive - provides nutrients to the
cementum and bone
  Formative - builds and maintains
cementum and the alveolar bone of the
tooth socket
  Resorptive - can remodel the alveolar
bone in response to pressure
  Example: pressure applied
during orthodontic treatment
(braces)
Root Cementum
Root Cementum
  Thin layer of hard,
mineralized connective
tissue
  Covers tooth from the
cementoenamel junction
to, and around, apical
foramen
  Overlies and is attached to
the dentin of the root
  Periodontal ligament
attaches to the cementum
Root Cementum
Root Cementum
  Light yellow in color
  With normal gingival
position, it is not visible
but can be seen when
gingival recession is
present
Gingival recession is present on the
facial surface due to trauma from
overly vigorous toothbrushing
Alveolar Bone
Alveola
r proce
Basal
ss
bone
Alveolar Bone (also called alveolar
process)
  The bony portion of the maxilla
or mandible that extends occlusal
to the basal bone and surrounds
and supports the roots of the teeth
  The existence of the alveolar
bone is dependent on the
presence of teeth
  When teeth are extracted, in
time, the alveolar bone resorbs
so only basal bone remains
  If teeth do not erupt, the
alveolar bone does not develop
Alveolar Bone
Function of Alveolar Bone
  Forms the bony sockets
that provide support and
protection for the roots of
the teeth
one
Alveolar B
Alveolar Bone
Anatomical Areas of the
Alveolar Bone:
  Alveolar crest
  Interproximal bone
  Interradicular bone (bone
between the roots of the same
tooth)
Anatomical Areas of the Alveolar Bone
Alveolar Crest
  Most coronal portion of the
alveolar process
  Located 1-2 mm apical to the
CEJs of the teeth (in health)
  Viewed from the facial
aspect, alveolar crest meets
the teeth in a scalloped
(wavy) line that follows the
contours of the CEJs
Anatomical Areas of the Alveolar Bone
Interproximal Bone
  The area of bone that lies
between the proximal
surfaces of two adjacent
teeth
  Also known as interdental
septum
Anatomical Areas of the Alveolar Bone
Crestal Contour of
Interproximal Bone
  The contour of the crest of
the interproximal bone is a
good indicator of periodontal
health
  In posterior sextants, the
contour of the interproximal
crest is parallel to an
imaginary line drawn
between the CEJs of the
adjacent teeth
Anatomical Areas of the Alveolar Bone
Radiograph showing horizontal
contour of the interproximal
bone in the maxilla due to
good tooth alignment
Radiograph showing angular
crest due to tilted mandibular
second molar
Horizontal Crest Contour
  Crest has horizontal
contour when the CEJs
of the adjacent teeth are
at the same level
Angular Crest Contour
  Crest has vertical contour
when one of the adjacent
teeth is tilted or erupted
to different heights
Anatomical Areas of the Alveolar Bone
jaw
Interradicular Bone
(multirooted teeth only)
  Bone between the roots of
a multirooted tooth
Components of the Alveolar Bone
jaw
  Cortical bone
  Supporting bone
  Alveolar bone proper
  Alveolus
  Periosteum
Components of the Alveolar Bone
Cortical bone
  Forms the hard, outside
wall of the mandible and
maxilla on the facial and
lingual aspects
  Buccal cortical bone
  Thin in the incisor,
canine, and premolar
regions
  Thicker in the molar
regions
Components of the Alveolar Bone
Defects of cortical bone
  Fenestration
  Window-like defect in
the cortical bone
  Results in an isolated
area of the root that is
not covered by bone
  Dehiscence
  Cleft-like defect in the
cortical bone
  Includes bone margin
Components of the Alveolar Bone
Supporting Bone
  Lattice-like bone
  Fills interior portion of the
alveolar process
  Between the cortical bone
and the alveolar bone
proper
  Also known as spongy
bone, cancellous bone
Components of the Alveolar Bone
Alveolar bone proper
  Thin layer of bone that lines
each alveolus
  In radiographs, the alveolar
bone proper is identified as
the lamina dura
  Contains numerous holes
that allow the blood vessels
from the cancellous bone to
connect with the vessels of
the periodontal ligament
space
Components of the Alveolar Bone
Alveolus
  The alveolus is the bony
socket in the alveolar bone
  It is the cavity in the
alveolar bone that houses
the root(s) of a tooth
  Alveolus (singular)
  Alveoli (plural)
Components of the Alveolar Bone
Periosteum
  The thin layer of
connective tissue that
covers bone and is
overlaid by the soft tissue
(gingiva or alveolar
mucosa)