Griffith University Oral Biology 2 1009 DOH

The Periodontium
Dr. Mahmoud Bakr Lecturer in General Dental Practice B.D.S, M.D.S (Cairo University), ADC (Australia) Member of the Australian Dental Association (ADA), the Australian Biology Institute Inc. (ABI) and the Egyptian Dental Union (EDU)

Learning objectives:
After completing this lecture you should be able to: 1- Name, classify, identify and describe the structure and function of the components of Cementum, PDL and Alveolar Bone. 2- Describe age related changes to Cementum, PDL and Alveolar Bone and their effects. 3- By observing the histological details of cells and tissues, you should be able to use a microscope to identify different histological structures of Enamel and understand the histological processes involved in preparing slides.

 All Microscopic images are taken from the Digital Library of the Oral Biology Department (Cairo University).

 The Periodontium is the group of tissues responsible for supporting the tooth. In other words it is considered as the attachment apparatus of teeth. It consists of: Two hard tissues: Cementum Alveolar Bone Two soft tissues: PDL Gingiva

Physical Characteristics
1-Color Light yellow Lighter in color than dentin
2- Thickness
Acellular cementum (20-50 m) Cellular cementum (150-200 m)

3- Permeability
Permeable from dentin and PDL sides. Cellular C is more permeable than acellular C.

Chemical Composition
45-50 % Inorganic substances Collagen Hydroxyapatite crystals 50-55% Organic substances

protein
Polysaccharides Trace elements

Cementum contains the greatest amount of fluoride in all mineralized tissues

Cementum Structure
Malassez Cementocytes

Cementoid layer

Acellular cementum

Cellular cementum

Acellular Cementum
Thickness is 20-50 . It is clear and contains no cells. Covers the coronal half of the root. Less permeable than Cellular Cementum. Incremental lines of Salter are parallel to the surface and closer to each other. Sharpeys fibers space can be seen in it . Alternating layers of Acellular and Cellular Cementum could be seen.

Cellular Cementum
Lacunae of cementocytes

PDL side Dentin side

Cellular Cementum
Lacunae of cementocytes Incremental lines of Salter Cementocytes PDL side Dentin side

Cementocytes

Cementocyte And Osteocyte

Dentin side Osteocyte Lacuna

Canaliculi PDL side

Cementocyte And Osteocyte

Dentin side Osteocyte

Lacuna

Canaliculi

Periodontal ligament side

Have you spotted the difference?

The processes of Cementocytes are longer on the PDL side than on the Dentin side. While the processes of Osteocytes are of equal length from both sides.

WHY???????

Because the PDL side is where the superficial layers of Cementum get their nutrition from (so the processes are long), while the Dentin side is a just a hard tissue (no nutrition).

Cellular Cementum
Dentin side Viable superficial cementocytes

Degenerated deep layers cementocytes

PDL side

Incremental Lines Of Salter

In Acellular C

In Cellular C

They are hypermineralized area with less collagen fibers and more ground substance

Intermediate Cementum
Premature degeneration of epith. Root sheath of Hertwig ( after odontoblasts differentiation and before dentin formation) Contains entrapped epithelial cells

It occur at apical 2/3 of premolars and molars roots and rare in incisors and deciduous teeth

Afibrillar Cementum

The enamel at cervical area not covered by reduced dental epithelium before tooth eruption

The connective tissue of the dental sac lay down cementum on the exposed enamel

Types Of Cementum
1- Acellular cementum
2- Cellular cementum 3- Intermediate cementum 4- Afibirllar cementum

Cemento Dentinal Junction

Smooth in permanent teeth

Scalloped in deciduous teeth

Cemento Enamel Junction

10% cementum and enamel doesnt meet because of 30% cementum meets the enamel delayed separation of epith root sheath of Hertwig (area in a sharp line of dentin not covered by C).

60% cementum overlaps E (afibrillar cementum)

Functions Of Cementum
1- Acts as a medium for attachment of collagen fibers of PDL (Sharpeys fibers).

2- The continuous formation of cementum keeps the attachment apparatus intact.

Cementoid T

Cementoblast

3- Cementum deposition epically compensate for the attrition.

4- It is a major reparative tissue ( as in case of fracture or resorption of root)

Cementogenesis
1-Matrix formation 2- Maturation

Collagen fiber type I

Ground substance

Hydroxy apatite crystals

1- Matrix formation
Cementum is formed during root formation
Cementoblasts

D
HER

Future C E J

Epith. Diaph.

Cementoblast is a protein forming and secreting cell.

Maturation occur layer by layer for the collagen fibers D Cementoblast Collagen fibers + ground substance.

RER
Cementoid layer

Golgi apparatus

Mitochondria Secretory granules

Alkaline phosphatase

Cementoblasts

Cementum Large open face nucleus

Age Changes Of The Cementum 1- Hypercementosis.

Localised D D

May affect one tooth or all teeth

Hypercementosis

Types Of Hypercementosis

Hypercementosis hypertrophy

Hypercementosis hyperplasia

Increase number of Sharpeys fibers

Decrease number of Sharpeys fibers

Hypercementosis

2- Permeability

From dentin side remains at apical area ONLY

From periodontal side, but remain at the superficial recently formed layers

The periodontal ligament is the dense fibrous connective tissue that occupies the periodontal space between the root of the tooth and the alveolus.

Histological structure
The periodontal ligament is formed of :

cells
Synthetic

Intercellular substances
Fibers, ground substances blood vessels, nerves & lymphatics.

Resorptive
Progenitor

Defensive

The cells
Synthetic cells fibroblasts, osteoblasts cementoblasts. Resorptive cementoclasts , osteoclasts fibroclasts. cells Progenitor undifferentiated mesenchymal cells cells epithelial cells remnants of the epithelial Defensive macrophage, lymphocytes root sheath of Hertwig and mast cells cells

II- The fibers

*The fibers of the periodontal ligament are mainly collagen. They are divided into: A) The principal fibers. B) The accessory fibers. C) The oxytalan fibers.
*Elastic fibers are restricted almost entirely to

the walls of blood vessels.

A- The principal fibers of periodontal ligament are formed of collagen bundles, which are wavy in course and are arranged in three ligaments .
a) Gingival fibers. b) Transeptal or Interdental ligament. c) Alveodental ligament which is subdivided into the following five groups: 1- Alveolar crest group. 2- Horizontal group. 3- Oblique group. 4-Apical group. 5- Inter-radicular group.

1- The principal fibers: a- The gingival fibers:

1- Gingiva fibers: extend from the cervical cementum into the lamina propria of the gingival. 2- Alveogingival group: extends from the alveolar crest into the lamina propria. 3- Circular group: a small group of fibers that encircles the tooth and interlaces with the outer fibers . bone. 4- Dentoperiosteal fibers: they extend from the cementum direct over the crest and then incline apically between the periosteum of the alveolar bone to the lamina propria of the gingiva.
Dentogingival Circular fibers

Alveologingival

Dentoperiosteal

Gingival fibers form a rigid cuff around the tooth that can add stability.

b- The Transeptal ligament:

*It connects two adjacent teeth. *The ligament runs from the Dentin cementum of one tooth over the crest of the alveolus to the cementum of the adjacent tooth.
Bone

Dentin

c- The Alveolodental ligament:

1-Alveolar crest group: radiate from the crest of the alveolar process and attach themselves to the cervical part of the cementum. 2-Horizontal group: The fiber bundles run from the cementum to the bone at right angle to the long axis of the tooth.

Bone

Dentin

3- Oblique group: The fiber bundles run obliquely. Their attachment in the bone is somewhat coronal than the attachment in the cementum. It is the greatest number of fiber bundles found in this group. They perform the main support of the tooth against masticatory force.

bone dentin

4- Apical group: The bundles radiate from the apical region of the root to the surrounding bone. 5- Inter-radicular group: The bundles radiate from the inter-radicular septum to the furcation of the multirooted tooth.

dentin

bone

dentin

bone

B- Accessory fibers:
It is collagenous in nature and run from bone to cementum in different planes, more tangentially to prevent rotation of the tooth and found in the region of the horizontal group.

C- Oxytalan fibers
These are immature elastic (preelastic) fibers. They need special stains to be demonstrated. They tend to run in an axial direction, one end being embedded in bone or cementum and the other in the wall of blood vessels. At the apical region they form a complex network.

The function of the oxytalan fibers has been suggested that they play a part in supporting the blood vessels of the periodontal ligament during mastication i.e., it prevents the sudden closure of the blood vessels under masticatory forces.

Interstitial tissue
It is found between the fibers of the periodontal ligament. They are areas containing some of the blood vessels, lymphatics and nerves and surrounded by loose connective tissue.

Blood supply
The arterial blood supply of the periodontal ligament is derived from 3 sources:
1- Branches from the gingival vessels. 2- Branches from the intra-alveolar vessels, these branches run horizontally and these constitute the main blood supply.
3- Branches from the apical vessels that supply the dental pulp.

Nerve supply:
The nerve supply of periodontal ligament comes from either the inferior or superior dental nerves. 1- Bundles of nerve fibers run from the apical region of the root towards the gingival margin. 2- Nerves enter the ligament horizontally through multiple foramina in the bone.

Small fibers large fibers

mechanoreceptors

pain sensation touch & pressure

1- Supportive: *periodontal ligament permits the teeth to withstand the considerable forces of mastication. *As the force is applied on the teeth, the wavy course of the collagen fibers gradually straightening out and then acting as inelastic strings transmitting tension to the wall of the alveolus. *Also periodontal fibers being non elastic prevent the tooth from being moved too far.

Functions of the periodontal ligament:

During mastication or through application of an orthodontic force: Part of the periodontal ligament will be narrowed and compressed. Other parts of the periodontal ligament will be widened. This provides support for the loaded tooth, where the collagen fibers and the ground substance act as cushion.

Blood vessels and all the components of the ligament act

together as a hydraulic damper or shock absorber with the ground substance and the tissue fluid.

2- Sensory:
The periodontal ligament having the mechanoreceptor contributes to the sensation of touch and pressure on the teeth.
sudden overload
proprioceptive reflex

inhibition of the activity of the masticatory muscles

Opening the mouth

3- Nutritive:
The blood vessels in the periodontal ligament provide nutrient supply required by the cells of the ligament and to the cementocytes and the most superficial osteocytes.

4- Formative:
The fibroblasts are responsible for the formation of new periodontal ligament fibers and dissolution of the old fibers Cementoblasts and osteoblasts are essential in building up cementum and bone.

5- Protective
The protective function of the periodontal ligament is achieved by: a- The principal fibers. b- The blood vessels. c- The nerves. a- The principal fibers: The arrangement of the fiber bundles in the different groups is well adapted to fulfill the functions of the periodontal ligament. The Alveodental ligament transforms the masticatory pressure exerted on the tooth into tension or traction on the cementum and bone. If the exerted force on a tooth is transmitted as pressure this will lead to differentiation of Osteoclasts in the pressure area and resorption of bone.

b- The blood vessels: The capillaries form a rich network, they are arranged in form of a coil and attached to bone and cementum through the oxytalan fibers. This arrangement makes it possible when pressure is exerted on the tooth, the blood does not escape immediately from the capillaries and thus buffering the pressure action before it reaches the bone. The behavior of the blood in the capillaries may be simulated to a hydraulic brake. c- The nerves: By its mechanoreceptors nerves.

The Age Changes of periodontal ligament

*The periodontal ligament through aging shows

Vascularity Cellularity Thickness

*It may contain cementicles.

The cementicles appear near the surface of cementum may be free , attached or embedded in the cementum. They have nidus favoring the deposition of concentric layers of calcosphrite as degenerated cells, area of hemorrhage and epithelial rest's of Malassez. Cementicles are usually seen in periodontal ligament by aging but in some cases they may be seen in a younger person after local trauma.

Clinical considerations

1-Knocked out tooth (Avulsion)

The length of time before a tooth is re-implanted and how it is transported to the dentist are crucial in successfully saving and re-implanting the tooth.

The periodontal ligament will regenerate and re-vascularize. A tooth that is replaced within half an hour has a 90% chance of successful re-implantation.

2- Periodontal disease:
Adequate periodontal therapy and maintenance in patients with periodontal diseases

reduces tooth loss by 70%

3- Dental Implants:
Dental implants lack periodontal ligament fibers and they have a rigid connection to bone.

Thats why Implants may fail under excessive load as they cant withstand the forces applied on them due to lack of the flexibility of PDL.

Peri-implant tissues
Titanium implant Sulcular epithelium Junctional epithelium

Connective tissue

Bone

Bone is specialized type of connective

tissue with calcified intercellular substance.

Functions:
1-Skeletal support of the body.

2-Store for calcium and phosphate which may be mobilized according to needs of the body.
3-Protect for the internal organs. 4-Manufacturing for blood elements.

Bone components: 1 Cells

2 Matrix components

Mineral content 65% Organic extra-cellular matrix 35%

Organic extra-cellular matrix is the collagen fiber and the ground substance.

1- Cellular components:

Osteogenic cells.
That form and maintain bone.

Osteoclasts
That resorb bone.

b-Osteoblasts

d-Osteocytes c-Bone-lining cells

a-Osteoprogenitor cells

Cellular components:
Osteoprogenitor cells

a Osteoprogenitor cells:
*They derived from mesenchymal tissue

*They give rise to osteoblasts in well vascularized regions and to chondroblasts

in avascular region

a Osteoprogenitor cells:
*The cells have pale elongated nucleus and sparse eosinophilic cytoplasm.

*site:
1- In the deepest layer of the periostium. 2- In the endosteum.

b Osteoblasts:
*They are arising from condensing mesenchyme. *They are cuboidal or slightly elongated cells.

*Their cytoplasm is rich in protein synthetic and secretory organelles.

Following maturation, osteoblasts may

*Undergo Apoptosis,
*Become encased in matrix as osteocytes or

*Remain on the bone surface as bone-lining cells.

Osteoblasts:
2 4
1

By E\M osteoblasts contain well developed rough 4 endoplasmic reticulum (1), extensive Golgi apparatus(2),
numerous mitochondria(3) and secretory vesicles (4).

OSTEOID TISSUE

MINERALIZED BONE

c-bone-lining cells:
*They are osteoblasts that are no longer forming cells. *They contain few synthetic organelles. *They contact with osteocytes by Gap junctions. *They are considered a primary site for mineral ion exchange between blood and adult bone.

d-Osteocytes:
*They are surrounded by bone matrix, whether mineralized or not.

*The cells present in a space

called osteocytic lacunae.

*Narrow extensions of these lacunae form canaliculi, that house radiating osteocytic processes.

Osteocytes:
*Through these canaliculi osteocytes maintain contact with adjacent osteocytes and with the osteoblasts or lining cells on the bone surface via gap junctions.

Cytoplasmic process.

N
*Osteocytes have a decreased quantity of synthetic and secretory organelles.

Osteocytes:
Osteocytes are metabolically active cells:
1 - Maintain bone tissue and

2 - Play an important role in releasing calcium ions from bone matrix when calcium demands increase. Releasing calcium ions occurred by Osteocytic osteolysis which is local degradation of bone surrounding the cells, thus influencing the structure of the peri-lacunar matrix.

Osteoclasts:
Origin of osteoclasts:

1-The fusion of circulating blood-derived monocytes and thus belong to the mononuclear phagocyte system or
2 - Differentiate from the osteoprogenitor cells in situ.

Osteoclast

Osteoclasts:
They are located on the surface of bone tissue where resorption is taking place, in a bay like depressions, called Howships Lacunae

Howships lacuna

Osteoclasts:
*Large multinucleated (2 100 nuclei) cells; however, Mononucleated cells are also present, with a foamy eosinophilic cytoplasm. *The osteoclasts are variable in shape due to their motility *Rich in acid phosphatase enzyme, which is important for bone resorption.

Osteoclasts:
1-Adjacent to the bone surface the cells form finger like structure termed ruffled border. 2-At the periphery of this border a clear or sealing zone is found.

The plasma membrane of this zone is apposed to the bone surface and the adjacent cytoplasm is enriched in actin, vinculin and talin.

2
1-Ruffled Border

Function of the clear zone: *Attaches the cells to the mineralized surface. *Isolates an acidic micro-environment between them &the bone surface.

An electron dense matrix layer is often observed between the sealing zone and calcified tissue surface known as lamina limitans.
3-The basal portion of the osteoclasts contain nuclei, Golgi complex, mitochondria, RER and vesicular structures.

BONE RESORPTION
1-Attachment of osteoclasts to the bone. One of the mechanisms of attachment is the concentration of lamina limitans. 2-Demineralization: through hydrogen pump from ruffled border thus exposed the organic matrix.

Howships lacuna

3- Degradation of exposed organic matrix by the action of enzymes as acid phosphatase and cathepsin B. 4- Endocytosis: at the ruffled border to the degradation products (organic and inorganic). 5- Transport of soluble products to extra cellular fluid or the blood vascular system.

osteoclast

TYPES OF BONE
1 Lamellar bone. 2 Non lamellated bone.

3 Bundle bone.

LAMELLAR BONE

LAMELLAR BONE (site)

Skeleton and flat bones.

LAMELLAR BONE

A COMPACT BONE.
B CANCELLOUS (SPONGY) A BONE.

A COMPACT BONE

SITES
SHAFT OF LONG BONES

External covering of ribs, vertebrae, flat bones of the skull.

Histology
Three patterns of lamellar organization in the shaft of long bone:
1 Circumferential or basic lamellae. 2 Haversian lamellae. 3 Interstitial lamellae.

1 Circumferential or basic lamellae.

Exist immediately under the periosteum, outer circumferential lamellae (OCL). And surrounding the medullary cavity, inner circumferential lamellae (ICL). The ICL are of similar arrangement of OCL but with fewer lamellae.

2-Haversian lamellae:
Haversian lamellae

Volkmanns canals

H. canal

3-Interstitial lamellae
DECALCIFIED SECTION
GROUND SECTION

B - SPONGY BONE

SITES
SPONGY BONE

EPIPHYSIAL PLATE

Exist in the epiphysis of long bones, bony of the vertebrae, ribs and central part of the flat bone.

HISTOLOGY
Inter connected network of bone trabeculae with intervening bone marrow spaces (MS). This bone trabeculae surrounded by osteoblasts (OB) and consists MS

MS
OB

of bone lamellae containing

osteocytes

Incremental lines of bone

Three types of lines mark the successive layers of bone:

Resting lines
Reversal lines (Rev) Faint line
Resting lines

1- Resting lines
Indicates the rhythmic manner of bone formation with periods of rest alternating with periods of activity.
Appears blue in H & E stained sections

2- Revresal lines
They indicate a past Osteoclastic activity. They are scalloped lines corresponding to adjacent Howships Lacunae. The convex side is always towards old resorbed bone. They appear also blue in H & E stained sections.

3- Faint line
It appears only in sections stained with Silver (Ag).
It is a black line that appears due to the 45 degree angulation between different layers of collagen fibers preventing passage of silver particles.

PERIOSTEUM
Its specialized dense connective tissue. It consists of two layers: Outer layer is fibrous (Fi). Inner layer is osteogenic (Og).

Og

ENDOSTEUM
Medullary cavity

Medullary cavity

Its a thin fibrocellular layer of connective tissue lines the medullary surface of bones. The endosteal surface is less active in bone formation than the periosteal one.

SITE
Found in areas where bone is laid for the first time in a new situation: - Bone of the fetus =Embryonic bone. - Callus of fracture =Bone of emergency. - Healing sockets after tooth extraction.

The non lamellated bone is more radiolucent than lamellar bone.

Note: The bone of emergency never change directly into lamellar bone but it must be resorbed and then replaced by lamellar bone.

3 BUNDLE BONE

Adjacent to the PDL

SITES

Adjacent to the periosteum

medulla bundle bone

Bundle bone

periosteum

BUNDLE BONE
The term BUNDLE BONE was chosen because the bundles of the principal fibers, of either the periosteum or the periodontal ligament, continue into the bone as sharpeys fibers
(extrinsic collagen

fiber bundles).

PDL

Radiographically:
It appears more radiopaque than does lamellated bone. This increase in radiopacity is due to the presence of thick bone without trabeculations and not to any increased mineral content.

Alveolar process is that bone of the jaws containing the sockets of the teeth. *Its presence depends on the presence of teeth.

*The remaining bony part of the mandible or maxilla is called the basal bone.
*No line of demarcation.

Alveolar process

Basal bone

*Both are covered by the same periosteum.

The alveolar process has facial and lingual surfaces. There are ridges corresponding to the roots of the teeth that invest in it. Facial and lingual surfaces are separated by alveolar septa.

Ridges.
These septa include: a- interdental septa. B- inter-radicular septa.

Facial surface.

Lingual surface.

Alveolar process consists of: *1- Facial and lingual cortical plates. *2- Central spongiosa. *3- Alveolar bone

Alveolar bone and cortical plates merge at the alveolar process crest.

CEJ

1.5 to 2 mm below the cemento-enamel junction.

1- The cortical plates:

Anatomically:

Anterior teeth

Lower posterior

Upper posterior

Buccal plate is thicker Lingual plate is Lingual plate is thicker than labially. &denser than lingually. thicker than Lb B L buccally. L
B

L Lb L

Histologically:
The cortical plate consists of *layers of circumferential lamellae. *Supported by Haversian system of variable thickness.

C PDL

Alveolar Cortical plate bone

2- The central spongiosa (Trabecular bone):

Anatomically: *It form the main bulk of the alveolar septa. *In some cases the spongiosa is minimal or even absent. *Trabecular bone is only present in the apical third.

X-ray classification of the spongiosa:

Type I: present in the lower interdental and inter-radicular septa. The bone trabeculae arranged horizontally in the form of ladder. Below the root apices, the trabeculae radiating from the socket fundus in a distal direction
Type II: common in the maxilla. The bone trabeculae are irregularly arranged.

Histologically: The spongiosa is formed of interconnected network of bony plates enclosing bone marrow and surrounded by osteoblasts. Large trabeculae show Haversian system arrangement.

Note: bone marrow spaces are smaller compared with those present in the basal bone.

3- The alveolar bone proper:

Anatomically:
Its perforated by channels through which blood vessels &nerve fibers connect the marrow spaces to the PDL. So its called cribriform plate.
Alveolar bone

PDL

Radiographically: its referred as lamina dura.

Only excellent students would know that the name of those channels is

Zuckerkandle and Heirshefield canals

Histologically:

Alveolar bone is formed of two types of bone, bundle bone and lamellar bone. In some cases, alveolar bone can be made up almost completely of bundle bone.
The alveolar bone reveals double fibrillar orientation Intrinsic fibers Extrinsic fibers (Sharpeys fibers)

Clinical considerations:
During extraction the thickness of the cortical plates determines the direction of initial movement (always towards the thinner side). As a rule all teeth are extracted with a labial or buccal movement except lower Molars as the buccal cortical plate is thickened by the External Oblique Ridge so the initial movement is towards the thinner lingual plate.

Are you an excellent student?

What was the name of the canals connecting the bone marrow spaces to the PDL?