© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © JonesPart & Bartlett Learning,1 LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION The Periodontium © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONin HealthNOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning LLC, an Ascend Learning Company. NOT FOR SALE OR DISTRIBUTION. 9781284209273_CH01_001_022.indd 1 28/02/20 7:13 PM © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning LLC, an Ascend Learning Company. NOT FOR SALE OR DISTRIBUTION. 9781284209273_CH01_001_022.indd 2 28/02/20 7:13 PM CHAPTER © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION Periodontium:NOT FOR SALE ORThe DISTRIBUTION Tooth-Supporting © Jones & BartlettStructures Learning, LLC © Jones & Bartlett Learning, LLC NOT1 FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © JonesSection & 1 BartlettTissues Learning, of the Periodontium LLC © Jones & Bartlett Learning,4 LLC The Gingiva NOT FOR SALEPeriodontal OR DISTRIBUTIONLigament NOT FOR SALE OR DISTRIBUTION Root Cementum Alveolar Bone Section 2 Nerve Supply, Blood Supply, and Lymphatic System 16 © Jones & Bartlett Learning,Nerve LLC Supply to the Periodontium © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONBlood Supply to the Periodontium NOT FOR SALE OR DISTRIBUTION Lymphatic System and the Periodontium Section 3 Focus on Patients 21 Clinical Patient Care © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOTClinical FOR SALEApplication. OR DISTRIBUTION Dental health care providers continuously interactNOT with FOR patients SALE when OR DISTRIBUTION making clinical decisions, performing clinical procedures, evaluating new techniques, and adapting to emerging treatment approaches. Nearly every action taken by a clinician requires a detailed knowledge of the anatomy of the tooth-supporting structures—the periodontium. Chapters 1 and 2 outline current knowledge about the anatomy of the periodontium. Chapter 1 deals with what is known about the fundamental structure of the complex system of tissues that support the teeth and can serve as a basis for organizing thoughts about additional anatomical information as it © Jones & Bartlettbecomes Learning,available through LLCadditional research. Chapter 2 deals with© Jonesthe microscopic & Bartlett anatomy of these Learning, same structures. LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Learning Objectives • Identify the tissues of the periodontium on an unlabeled diagram depicting the periodontium in cross section. • Describe the function that each tissue serves in the periodontium, including the gingiva, periodontal ligament, cementum, and alveolar bone. • In a clinical setting or on a color photograph, identify the following anatomical areas of the gingiva: free gingiva, © Jones & Bartlett Learning,gingival LLC sulcus, interdental gingiva, and attached© Jones gingiva. & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION• In a clinical setting or on a color photograph,NOT identify FOR the followingSALE boundaries OR DISTRIBUTION of the gingiva: gingival margin, free gingival groove, and mucogingival junction. • In a clinical setting, identify the free gingiva on an anterior tooth by inserting a periodontal probe to the base of the sulcus. • In a clinical setting, compare and contrast the coral pink tissue of the attached gingiva with the darker, shiny tissue of the alveolar mucosa. • In the clinical setting, use compressed air to detect the presence or absence of stippling of the attached gingiva. ©• IdentifyJones the &alveolar Bartlett process (alveolar Learning, bone) on aLLC human skull. © Jones & Bartlett Learning, LLC • Describe the position and contours of the alveolar crest of the bone in health. NOT• Describe FOR the nerve SALE and blood OR supply DISTRIBUTION to the periodontium. NOT FOR SALE OR DISTRIBUTION • Explain the role of the lymphatic system in the health of the periodontium. Key Terms © Jones & BartlettPeriodontium Learning, LLCMucogingival junction Gingival© Jones crevicular & fluid BartlettPeriosteum Learning, LLC NOT FOR SALEGingiva OR DISTRIBUTIONFree gingiva SharpeyNOT fibers FOR SALE ORInnervation DISTRIBUTION Periodontal ligament Attached gingiva Alveolar process Trigeminal nerve Cementum Stippling Alveolar bone proper Anastomose Alveolar bone Interdental gingiva Alveolus Lymphatic system Gingival margin Papillae Cortical bone Lymph nodes Alveolar mucosa Gingival col Alveolar crest © Jones & Bartlett Learning,Free gingivalLLC groove Gingival sulcus© Jones & BartlettCancellous bone Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning LLC, an Ascend Learning Company. NOT FOR SALE OR DISTRIBUTION. 9781284209273_CH01_001_022.indd 3 28/02/20 7:13 PM 4 Part 1 The Periodontium in Health © Jones & Bartlett Learning, LLC © Jones & BartlettSection Learning, 1 LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Tissues of the Periodontium The periodontium (peri = around and odontos = tooth) is the functional system of tissues that surrounds the© teeth Jones and &attaches Bartlett them Learning, to the jawbone LLC (Figs. 1-1 and 1-2). The© Jones & Bartlett Learning, LLC periodontium is alsoNOT called FOR the SALE “supporting OR DISTRIBUTION tissues of the teeth” and “the attachmentNOT FOR SALE OR DISTRIBUTION apparatus.” The tissues of the periodontium include the following: 1. Gingiva—the tissue that covers the cervical portions of the teeth and the alveolar processes of the jaws. 2.© Periodontal Jones & ligamentBartlett (PDL) Learning, —the fibers LLC that surround the root© ofJones the tooth. & Bartlett These Learning, LLC fibers attach to the bone of the socket on one side and to the cementum of the root NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION on the other side. 3. Cementum —the thin layer of mineralized tissue that covers the root of the tooth. 4. Alveolar bone —the bone that surrounds the roots of the teeth. It forms the bony sockets that support and protect the roots of the teeth. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Figure 1-1. Tissues Comprising the Gingiva Periodontium. A graphic representation of the periodontium in cross section. Cementum Tissues © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC of the NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Periodontium Periodontal Ligament Alveolar Bone © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Figure 1-2. Healthy Periodontium. Clinical photograph and drawing depicting the © Jones & Bartlett Learning, LLC © Jones structures& Bartlett of the Learning, periodontium. LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning,Sulcus LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONGingiva NOT FOR SALE OR DISTRIBUTION Crest of alveolar bone Periodontal ligament © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Cementum NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Alveolar bone © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones &