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Periodontium Anatomy and Physiology: A Comprehensive Guide for Dental Students, Exams of Dentistry

A detailed overview of the periodontium, its constituent tissues (gingiva, periodontal ligament, cementum, alveolar bone), and their functions. it explores the microscopic anatomy of gingival epithelium, connective tissue, and the interface between them. descriptions of key structures like the gingival sulcus, alveolar crest, and sharpey's fibers, making it a valuable resource for understanding periodontal health and disease.

Typology: Exams

2024/2025

Available from 05/05/2025

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Cianna TCDHA PERIO MIDTERM EXAMS FOR
DENTIST 2025-2026
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1.
periodontium
-
functional
system
of
TISSUES
that
surrounds
teeth
and
attaches
them
to
the
jawbone
- "supporting tissues of teeth" or "attachment apparatus"
peri = around. odontos = tooth
2.
tissues of the peri- -
gingiva
odontium
-
cementum
-
periodontal
ligament
-
alveolar
bone
3.
gingiva
the
part
of
mucosa
that
surrounds
CERVICAL
portions
of
teeth
and
COVERS
ALVEOLAR
PROCESS:
-
attached by specialized epithelial tissue (which makes up the junctional epithe-
lium)
-
composed
of
thin
outer
layer
of
epithelium
and
underlying
layer
of
CT
4.
function of gingi-
va
5.
gingival
margin
-
protects underlying tooth-supporting structures of periodontium from oral
environment (thru defense mechanisms such as saliva and immune system)
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DENTIST 2025- 2026

  1. periodontium - functional system of TISSUES that surrounds teeth and attaches them to the jawbone
    • "supporting tissues of teeth" or "attachment apparatus"

peri = around. odontos = tooth

  1. tissues of the peri- - gingiva odontium -^ cementum - periodontal ligament - alveolar bone
  2. gingiva the part of mucosa that surrounds CERVICAL portions of teeth and COVERS ALVEOLAR PROCESS:
    • attached by specialized epithelial tissue (which makes up the junctional epithe- lium)
    • composed of thin outer layer of epithelium and underlying layer of CT
  3. function of gingi- va
  4. gingival margin
    • protects underlying tooth-supporting structures of periodontium from oral environment (thru defense mechanisms such as saliva and immune system)

DENTIST 2025- 2026

  • upper edge (coronal)
  • follows tooth contour creating a scalloped outline
  1. alveolar mucosa - lower edge (apical)
  • dark red tissue
  1. free gingival groove
  2. mucogingival junction
  3. four anatomical areas of gingiva

a shallow linear depression separating FREE and ATTACHED GINGIVA (hard to see)

where the pink attached gingiva meets the red alveolar mucosa (clinically visible)

  1. free gingiva
  2. attached gingiva
  3. interdental gingiva
  4. gingival sulcus
  5. free gingiva - UNATTACHED, surrounds tooth in the region of CEJ
  • "unattached gingiva" "marginal gingiva"
  • turtleneck
  • fits closely around the tooth but is not directly attached
  • located ABOVE CEJ

DENTIST 2025- 2026

purpose of at- tached gingiva

  1. interdental gingi- va
  2. 2 interdental papillae
    • withstand forces during chewing, speaking and brushing
    • prevents free gingiva from being pulled apically from the tooth when tension is applied to alveolar mucosa
    • fills the interdental space (embrasure) just below contact area
    • prevents food between teeth
    • gingival col

- FACIAL & LINGUAL

  • lateral border and tip formed by free gingiva of adjacent teeth
  • centre is formed by attached gingiva
  1. gingival col - valley-like depression apical to the contact area of 2 adjacent teeth that connects facial and lingual papillae
  • col will NOT be present if there's a large space between 2 teeth/gingival recession
  1. gingival sulcus - v-shaped shallow space between free gingiva and tooth surface
  • measured by probe (1-3mm)
  • BASE OF SULCUS formed by JUNCTIONAL EPITHELIUM

DENTIST 2025- 2026

  1. gingival crevicular - seeps from underlying CT into the sulcular space fluid (GCF)
  2. periodontal liga- ment (PDL)
  3. 5 functions of periodontal liga- ment
  4. formative (func- tion of PDL)
    • LITTLE TO NONE in a healthy sulcus
    • increases with plaque, brushing and chewing, UNHEALTHY GINGIVA
    • CT that covers the ROOT of the tooth and ATTACHES IT to the BONE of the tooth socket (cementum and alveolar bone)
    • composed of DENSE FIBROUS TISSUE
    1. supportive
    2. sensory
    3. nutritive
    4. formative
    5. remodeling

providing cementoblasts and osteoblasts

DENTIST 2025- 2026

  1. hypercementosis excess deposit of cementum in apical third of root
    • may obstruct apical foramen
    • appears radiopaque on x-ray
  2. sharpey's fibres the terminal endings of periodontal ligaments attached to cementum
    • EMBEDDED IN ALVEOLAR BONE PROPER
  3. alveolar bone mineralized CT that forms BONES OF UPPER AND LOWER JAW to support roots of teeth
    • froms BONY SOCKETS
    • existence is DEPENDENT OF PRESENCE OF TEETH (extracted= bone will resorb, no eruption= bone does not develop)
  4. alveolar bone 3 layers

comprised of 3 layers of HARD TISSUE covered by a layer of CONNECTIVE TISSUE

  1. alveolar bone proper
  2. cortical bone
  3. cancellous bone

DENTIST 2025- 2026

alveolar bone proper

aka cribiform plate is a thing layer lining the socket:

  • alveolus, foramina, sharpeys fibres
  1. alveolus the BONY SOCKET that houses the tooth
  2. foramina holes that allow blood vessels to connect CANCELLOUS BONE to PERIODONTAL LIGAMENT (hence cribiform)
  3. cortical bone aka compact bone
  • layer of COMPACT BONE that forms the outer wall on facial bone and lingual surfaces: alveolar crest
  1. alveolar crest "peak of the mountain"
  • coronal-most portion of the alveolar process
  1. cancellous bone aka spongy/trabecular bone
  • fills the interior portion of the alveolar process
  • mostly in the interproximal areas

DENTIST 2025- 2026

  1. extracellular ma- trix in epithelial tissue
  2. connective tissue in epithelial tissue
    • sparse
    • thin mat called basal lamina underlies epithelium
    • more plentiful (lots between cells)
  3. mucosa when epithelial tissue lines body cavities ex. oral mucosa
  4. epithelial tissue - body's skin "edidermis" and lines body cavities
    • closely packed epithelial cells are bound into sheets or layers (strata) ex. stratified epithelium
  5. epithelial cells se- crete
  6. keratinized ep- ithelial cells

a thin mat of extracellular matrix called basal lamina

  • process by which epithelial cells on a surface become stronger and waterproof
  • must have NO NUCLEI

DENTIST 2025- 2026

  1. most heavily kera- - palm of hands and feet tinized body parts
  2. nonkeratinized epithelial cells
  3. blood supply ep- ithelial cells

- HAVE NUCLEI

  • SOFTER, more FLEXIBLE
  • found in mucosa: LINING OF CHEEKS allows flexibility to speak and chew
  • epithelial cells are AVASCULAR (NO blood vessels
  • receive o2 and nourishment from vessels in underlying CT by DIFFUSION
  1. connective tissue - fills space between tissues and organs in the body and supports or binds other tissue
  • CT cells are sparsely distributed (more apart then in epithelial tissue) in extracellular matrix
  • EXTRACELLULAR MATRIX is the major component of CT
  1. connective tissue is composed of
  • fibroblasts
  • macrophages
  • neutrophiles
  • lymphocytes
  1. fibrobalsts form extracellular matrix
  2. macrophages destroy invading MOs
  3. neutrophils destroy invading MOs

DENTIST 2025- 2026

  • binding is needed to form a structurally strong unit
  • the more the mechanical stresses, the more the abundant cell junctions
  1. types of epithelial cell junctions
  • desosome
  • demidesmosome
  1. desosome connects two neighbouring epithelial cells together:
  • CELL-TO-CELL connection
  • found in gingivannectionl epithelium
  1. hemidesmosome connects epithelial cells to the basal lamina
  • CELL-TO-BASAL LAMINA connection
  • also found in gingival epithelium
  1. epithelial vs con- nective tissue

DENTIST 2025- 2026

  1. microscopic anatomy of gingival epithelium
  2. 3 anatomical ar-

STRATIFIED SQUAMOUS EPITHELIUM in oral vanity functions well in a wet envi- ronment

  1. oral epithelium (OE) eas of gingival ep- 2. sulcular epithelium (SE) ithelium
  2. cell layers of gin- gival epithelium
  3. junctional epithelium (JE)
  4. oral epithelium - covers OUTER SURFACE of FREE GINGIVA and ATTACHED GINGIVA from the crest of the gingival margin to the mucogingival junction
  • keratinized or parakinized (partially keratinized)
  • joins CT wavy interface with epithelial ridges
  1. 4 layers of strat- ified squamous epithelium
  • CUBE shape cells in the BASAL cell layer
  • SPINE like cells in the PRICKLE cell layer
  • FLATTENED cells in the GRANULAR cell layer

Cianna TCDHA PERIO MIDTERM EXAMS FOR DENTIST 2025- 2026 sulcular epitheli- um

  1. 3 cellular layers
    • the epithelial lining of the gingival sulcus is THIN and NONKERATINIZED
    • continuous with oral epithlium extending from crest of gingival margin to coronal edge of junctional epithelium
    • PERMEABLE, allowing fluid to flow from gingival CT into sulcus (gingival crevic- ular fluid)
    • joins CT with a SMOOTH interface and no epithelial ridges
    • basal cell layer of sulcular epithe- - prickle cell layer lium - superficial cell layer
  2. junctional epithe- lium
    • forms the BASE OF THE SULCUS and joins gingiva to the tooth
    • THIN and NONKERATINIZED, easily penetrable by bacteria, etc.
    • easiest entry point for bacteria to invade into CT
    • SMOOTH tissue interface with CT
  3. attaches to the tooth slightly CORONAL (above) the CEJ

cianna TCDHA PERIO MIDTERM

  1. junctional epithe- closely packed epithelial cells lium comprised of - has a sparse extracellular matrix with a thin basal lamina between JE and the tooth surface and JE and gingival connective tissue
  2. 2 layers of junc- tional epithelium
  3. cells next to the tooth form
    • basal cell layer
    • prickle cell layer

15-30 cells thick at CORONAL zone (the highest attachment one) and tapers to 4-5 cells thick at the APICAL zone

hemidesmosomes that attach the INTERNAL basal lamina with the tooth surface

cianna TCDHA PERIO MIDTERM

  • fibroblasts
  • mast cells
  • immune cells (macrophages, neutrophils, lymphocytes)
  1. fibrooblasts produce extracellular matrix
  • transportation of water, nutrients, o2 and metabolites to the gingiva occurs within this matrix
  1. % of protein fibers including collagen fibers in gingival tissue - 55-65%

gel like material 30-35%

  1. collagen forms the rigid "cutt" around the tooth
  2. supragingival fiber bundles
  3. dentogingival unit
    • network of rope-like COLLAGEN fibre bundles located coronal to the crest of alveolar bone
    • strengthen attachment of JE to tooth by bracing the gingival margin against the tooth

junctional epithelium + gingival fibres

  • provides structural support tho the gingival tissue

cianna TCDHA PERIO MIDTERM

  1. supragingival fiber bundles function
  2. 9 supragingival fiber bundles
    • reinforce attachment of JE to tooth
    • provide rigidity to free gingiva so it can withstand chewing forces
    • connect free gingiva with root cementum and alveolar bone
    • connect adjacent teeth to one another
    • alveologingival
    • circular
    • dentogingival
    • periosteogingival
    • intergingival
    • intercircular
    • interpapillary
    • transgingival
    • transseptal
  3. alveologingival attach gingiva to the bone
  4. circular encircle the tooth in a ringlike manner
  5. dentogingival attach gingiva to the teeth