CHAPTER NINE PERIODONTAL LIGAMENT -cell rich, fiber rich, dense CT -bet.

Root surface of tooth and alveolar bone proper -binds cementum of root to alveolar bone -at crest of alveolar bone, PL is continuous with the CR of the alveolar gingiva syndesmoses -joint-like connection bet. Tooth and bone -formed by PL, cementum and alveolar bone proper FUNCTIONS 1) Supportive -as they attach teeth to jaw, they support teeth in their sockets -permit them to withstand forces of mastication -act as a hydraulic damper or shock absorber with GS, tissue fluid, blood in BVs ! viscoelastic system 2) Sensory -a sensory receptor, necessary for proper positioning of jaw in normal fx -ability to estimate amt. of pressure in mastication - register pain and pressure >free nerve endings of sensory fibers- plentiful in PL nearest cementum (pain perception) >ruffini-like endings mechanoreceptors (pressure reception) 3) Homeostatic -fiber system of PL is not a static system -undergoes continuous remodeling after tooth eruption has been completed -fibroblast population constantly renewed -continuous remodeling of PL subjected to functional, metabolic and aging effect 4) Nutritive -blood bessels of PL provide essential nutrients for vitality of PL, cementum, and alveolar bone Cells of the Periodontal Ligament

-multinuclear cells that resorb the cementum or root portion -located in depression of cementum (Howships lacuna) -during root resorption c) osteoblasts -found in peripheral part of PL adjacent to bone d) osteoclasts -multinucleated cells obserbed in active phases of bone resorption -located in superficial bone concavities (howships lacuna) 3) Epithelial cells -found in PL, remnants of Hertwigs epithelial root sheath >epithelial rests of malassez- parallel with the cementum form dental cysts 4) Undifferentiated Mesenchymal cells or Progenitor Cells -perivascular location -produce new cells for the PL -balanced by apoptosis 5) Macrophages -important defense cells bec. Of phagocytic activity and mobility 6) Leukocytes -individual leukocytes, specially small lymphocytes and plasma cells appear in periodontium when stressed by dse Connective Tissue Fibers 1) Collagen Fiber -basic component of collagen fiber is collagen fibril -fibril bundle = collagen fiber = fiber bundle -main component = type I collagen, 20% type III(correspond to reticulin) >Dentoalveolar group- fiber apparatus

1) Fibroblasts - principal cells of the PL -shaped like spindles/ flat disks -cytoplasm associated with protein syn. And secretion -show cell-to-cell contacts of adherens and gap junction types >fibronex- morphologic relationship bet. Intercellular filaments, dense cell membrane, extracellular filaments, and glycoprotein fibronectin 2) Cementoprogenitor and Osteoprogenitor cells -in secretions of PL adjacent to cementum and bone a) cementoblasts -inside cementum -in phases of active deposition of cellular cementum -ovoid to cuboidal shape -cytoplasm is basophilic b) cementoclasts

five fiber groups a) Alveolar Crest Group -attached to cementum below CEJ, resist vertical and intrusive force, and anchor tooth to the alveolus b) Horizontal Fiber Group -apical to alveolar crest at right angles to axis of tooth -horizontally from cementum to bone -resist horizontal or lateral pressures applied to the tooth crown c) Oblique Fiber Group -most numerous and largest froup in PL -run from cementum in oblique direction to insert into bone coronally -func: sustain occlusal/vertical forces (intrusive masticatory forces) d) Apical Fiber Group

-from cemetum around apex of root of bone -form base of socket -prevents vestibule-oral tipping e) Interradicular Fiber Group -bet. Roots of multirooted tooth -form crest of interradicular septum -resists tipping and torque Sharpeys Fibers -embedded portion Periodontal Space -location of the PL -narrow gap bet. Cementum and alveolar bone -narrower at middle of root Interstitial Space -space bet. Each group of fibers -contain BVs, nerves, lymphatics and LCT ! Interstitial (Indefinite) Tissue (maintain vitality of PL) 2) MATURE ELASTIN FIBERS 2 forms a) Oxytalan Fibers -bundles of microfibrils -acid-resistants -insert in cementum -near BV walls -register tooth position under fx and regulate blood flow b) Eluanin fibers -another form of elastic tissue -form cementum to bone 3) Elastic Fibers confined to walls of BV 4) Reticular Fibers- aid in support of blood and lymphatic vessels and nerves VASCULAR SUPPY Superior and Inferior Alveolar Arteries -main blood supply Periodontal BV system from 3 sources 1) Branches from the dental artery -extend coronally thru PL to gingival tissues 2) Branches of Interalveolar and Interradicular Arteries -extend coronally inside spongiosa of interdental and interradicular bone septa, pass thru Volkmanns canals (foramina of cribriform plate) 3) Branches of the Periosteal Arteries -extend coronally through the facial and lingual mucous membranes of alveolar processes to reach gingivae NERVE SUPPLY Innervated by 2 groups of nerve fibers 1) SOMATOSENSORY SYSTEM -Superior Dental Plexus

-Inferior Dental Plexus -Canals of Zuckerkandl and Hirschfeld 4 types of neural termination 1) Free Nerve Endings- most frequent Neural Termination, tree-like configuration 2) Ruffini Corpuscle- found at root apex, mechanorecpetors 3) Coiled Ending- in midregion of PL, fx and ultrastructure not determined 4) Encapsulated Spindle Type Ending- lowest frequency, spindle-like endings surrounded by fibrous capsule 2) AUTONOMIC SYSTEM -few sympathetic -no parasympathetic LYMPHATICS -thin walled lymphatic capillaries -thick run parallel to venous blood supply DEVELOPMENT OF PL -from dental follicle (also cementum and bone) -in bell stage >cemental fibers- collagen fiber attached to cementum >alveolar fibers- collagen fiber attached to alveolar bone >Intermediate fibers- between the 2 >Cushion Hammock Ligament0 between these 2 fibers, prevent apical movement of epithelial diaphragm, help tooth erupt towards oral cavity >Intermediate plexus-collagen fibers appearing in the center of the Periodontal space, doesnt exist after eruption >orientation of PL: parallel to axis of tooth at first Physiologic Changes 1) Mesial migration- physiologic mesial drifting (teeth of complete dental arch in Perm. And decid. Drift toward center of arch) ! more mesial with increasing age, due to loss of enamel in contact areas *bone resorption in mesial *apposition in distal in bone remodeling, mesial: PL is relaxed and interstitial space is round distal: PL is stretched and interstitial space is elliptical 2) PL wide in newly erupted, roots not complete yet, when receives pressure becomes narrower w/ stronger tooth attachment 3) increased functional stresses will lead to development of thicker principal fiber bundles and less interstitial tissue, PL decrease with age in width 4) PL in permanent man. Ca tend to become thinner with age bec. Of deposition of cementum and bone CLINICAL CONSIDERATIONS 1) excessive forces ! necrosis (irreversible) 2) death of PL important to dental health and fx 3) renewal capability repair, maintain (ortho)

4) adjustment period after bridge abutment 5) acute trauma to PL ! fracture, resorption of cementum, tears of fiber bundles, hemorrhange, necrosis 6) PL in periapical area- often site of pathologic lesion like pranuloma w/c may become cyst 7) Integrity must be maintained >gingivitis- inflammation will start at gingiva (most common dse of oral cavity aside fr. Caries) may lead to >periodontitis-destruction of PL and bone