2016. 12. 05.

PERIODONTIUM

G- gingiva PL – periodontal ligament Morphology and Embryology ABP – alveolar bone of the proper (boundle bone) RC –root AP – István GERA & Attila HORVÁTH

Department of

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GINGIVA

I - LOOSE ALVEOLAR MUCOSA II- III- ORANGE PEAL FEATURE IV-MARGINAL GROOVE V- FREE VI- TEETH VII- INTERDENTAL GINGIVA VIII- VERTICAL INTERDENTAL GROOVES IX- ATTACHED GINGIVA

PARTS OF GINGIVA FREE GINGIVAL MARGIN ATTACHED GINGIVA LOOSE ALVEOLAR MUCOSA Garguilo AW, Wentz FM, Orban B. Dimensions and relations of thedentogingival junction in humans. J Periodontol 1961; 32:261-267.

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Epithelial-connective tissue boundary OE – Oral Epithel OSE – Oral Sulcus Epithel JE – Junctional Epithel CT – Connective Tissue

CT

CT

Heavy gingival Dentogingival fibers and endogen pigmentation the interdental col area due to characteristic race feature

Orange peal appearance

DENTAL LAMINA BUD STAGE Fibers of the free and Dentinogenesis attached gingiva and the development of the epithelial attachment

CUP STAGE BELL STAGE

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The dentinogenesis and the development of the epithelial attachment Outer enamel epithelium Inner enamel epithelium Cervical loop Ameloblasts

Enamel organ – enamel and primary epithelial attachment

Dental papilla – pulp,

Dental follicle – periodontal attachment apparatus – cementum, pdl, alveolar bone proper

JUNCTIONAL EPITHELIUM ON PRIMARY EPITHELIAL ATTACHMENT THE ERUPTED Hemidesmosomes E – Enamel

Ree - Reduced Enamel Epithelia

Oe – Oral Epithelium

Je -

C - Cementum

Ac - Afibrillar- Acellular Cementum

Cej-cemento Enamel Junction

GINGIVAL SULCUS AND JUNCTIONAL EPITHELIUM Gingival Crevicular Fluid

•From normal gingiva is minimal and rather a transsudate •The more inflammed the gingiva the more sulcular fluid is produced •Than it is a typical inflammatory exudate •With IgG, IgM, IgA, complement, fibronectin, PMN leukocytes

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Gingival Crevicular Fluid

•Defensive Mechanisms Mucogingival keratinised junction •Lubricating Effect •Epithelial Desquamation

Attached Interdental Gingival •Immunoglobulins Mucosa gingiva papilla margin •Complement •PMN Leukocytes Barrier non •Chronic Inflammatory Reaction keratinised

Horváth A. et al. A novel technique and material to enhance peri-implant keratinised mucosa

The turnover of the stratified squamous epithelia Stratified scquamous epithelium with parakeratinisation

The old basal cells (ob) are transversing into the spinocellular layer and differenciated to prickle cells

Clinical criteria of normal gingiva

•color •surface •form •consistency •sulcus exudate •sulcus bleeding

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PERIODONTIUM

Enamel organ – enamel and primary PERIODONTAL LIGAMENT epithelial attachment

1. Alveolar crestal group Dental papilla – pulp, dentin 2. Horizontal group 3. Oblique (main) group Dental follicle 4. Apical group – periodontal attachment apparatus – cementum, pdl, alveolar bone proper

FORMATION OF THE ROOT

Outer enamel epithelium

Inner enamel epithelium

Ameloblasts

Hertwig’s epithelial root Bone Cementum Periodontal ligament sheath

Investing fibrocellular dental follicle

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Developing dento-alveolar (PDL) Sharpey’s fibre bundles

ACELLULAR PDL EXTRINSIC FIBER CEMENTUM

Longitudinal section of the attachment apparatus

•Periodontal ligament •Root cementum •Inner cortical plate

Note the appositional growth of cellular Cross section image cementum around the apex of the periodontal ligament

Tooth movement

ROOT CEMENTUM a. Tipping b. Bodily movement movement Acellular cementum with embeded Sharpey’s fibers Cellular cementum –more bonelike structure No coupled remodeling Appsitional growth

Reitan, K. (1951). The initial tissue reaction incident to orthodontic tooth movement as related to the influence of function. Acta Odontologica Scandinavica 10, Suppl 6.

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ACELLULAR EXTRINSIC FIBER CEMENTUM

ACELLULAR CEMENTUM

1 – root dentin 2 – root cementum 3 – periapical 1 periodontal ligament 4 – lateral periodontal ligament 5 – alveolar bone 2 4

1-cementocytes

ALVEOLAR BONE Inner cortical plate of the alveolar socket

OnlyIT the DEVELOPS inner cortical plate withFROM embeded THE periodontal ligamentDENTAL fibers SAC is considered as part of periodontal attachment apparatus

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CONTINUOUS BONE REMODELING –BONE RESOPRTION FOLLOWED BY BONE FORMATION

BONE FORMATION IN ALVEOLAR BONE LAMELLAR BONE osteoblasts are laying down new bone matrix that is calcified

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OSTEOBLAST –OSTEOCYTE COMMUNICATION IN BONE

VASCULAR SUPPLY OF THE GINGIVA

[email protected] Biological Width

•Páciensfüggő és oldalspecifikus, 2.04 mm (Gargiulo), 0.75- 4.3 mm Vacek) •Gingivalis zárás a titán fejhez való tapadás révén

•Hosszabb a JE (kötőszövetes tapadás) frézelt felszínek esetén (átlagosan 2.9 mm) mint savmaratott felszínek (átlagosan 1.4 mm) vagy oxidált felszínek esetében (átlag. 1.6 mm) – (Glauser, 2005)

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