Week 9 Structure, Function and Repair of Hard and Soft Tissue

Periodontium: hard and Consists of Gingival tissue, periodontal ligament, alveolar bone, cementum
soft tissue
Periodontium Formation Tooth development: bud, cap, then bell
Periodontium: forms from dental follicle (from the ectomesenchyme), forming the cementum, perio
ligament, and the alveolar bone
Oral mucosa: forms the gingiva
Dental papilla: forms the dentin and pulp
The outer enamel epithelium and inner enamel epithelium merge to form the herwig’s epithelial root
sheath, and then the HERS degenerates and the roots of malassez are left

Gingiva -Parts: marginal, attached, and interdental

-Function: protection from microbial and mechanical damage
-Mucogingival junction separates the keratinized from non-keratinized tissue
-The oral epithelium consists of Stratified squamous epithelium
- Major cell types:
o Keratinocytes
o Langerhans cells: antigen presenting cells
o Melanocytes
o Merkel cells
-Sulcular epithelium is thin and consists of non-keratinized stratified squamous epithelium
Note: As the tooth erupts, the oral epithelium and reduced enamel epithelium fuse to forms a collar
around the tooth forming the Junctional epithelium

Major differences between the oral and Junctional epithelium:

Junctional epithelium has immune cells: PMNs, T-cells, B cells
Has filtration, polarization, migration, adhesion, and
differentiation
OE: oral epithelium Junctional turns over faster and has larger cells
OSE: oral sulcular The intercellular spaces are wider
epithelium The cells are non-keratinized
JE: junctional epithelium Takes about 3 weeks for a juntioncal epithelium to reform
CT: connective tissue after gingivectomy
Takes 3-6 weeks for the connective tissue adjacent to the
JE to reform

Gingival Connective Consists of:

tissue • Collagen Fibers (60%)
– Collagen, Reticular, Elastic
• Fibroblasts
• Vessels
• Nerves
• Matrix (35%)
2 layers: Papillary and Reticular
Fibers: circular, Transseptal, dentogingival, and dentoperiosteal

Gingivitis Inflammation of the gingival tissues

• Confined to the gingiva
• Presence of plaque
• Reversible
• Signs of inflammation: pain, heat, swelling and redness
• Loss of function
Progression of gingivitis: inflammation of papilla, vascular dilation, vascular proliferation, infiltration
by PMNs, lymphocytes, plasma cells
Supporting structures: Periodontal ligament, bone, and cementum
Periodontal ligament • Specialized connective tissue
• Cells:
– Fibroblasts (most abundant)
– Osteoblasts (bone forming)
– Cementoblasts
– Osteoclasts
– Epithelial rests of Malassez (from HERS)
– Immune cells: macrophages, neutrophils, lymphocytes, mast cells and eosinophils
• Extracellular Matrix is 70% water
Functions:
• Physical: Anchors teeth to the bone and Protects from mechanical force
• Formative: Undifferentiated precursor cells
• Sensory
• Nutritive
• Key role in periodontal regeneration
Formation: Originates from the dental follicle and connects tooth to the bone; becomes modified by
tooth eruption and occlusion
Fibers: Transseptal, Alveolar crest, Horizontal, Oblique, Apical, Interradicular

Alveolar Bone/Process Consists of Buccal and lingual plate, Trabecular bone, Alveolar bone
• Function:: Support the tooth and Force distribution of occlusion
• Components: dynamic and active
– 70% inorganic
– 20-‐25% organic matrix
– Cells (main cells):
• Osteoblasts, Osteocytes, Osteoclasts
– Contains blood and lymph vessels
Usually bone is 1.5-2mm below the CEJ
Teeth can literally move through the bone creating a fenestration or dehiscence leading to recession
After tooth extraction, the connective tissue is completely remodeled by day 100 but height and width
of the bone decreases (40-60 % in the first 3 years and 0.25-.5% annually after)

Cementum • Avascular, bone-‐like mineralized tissue

• Origin: Dental follicle after the disintegration of the Hertwig’s epithelial root sheath
• Function:
• Anchors PDL fibers
• Helps maintain occlusal relationship
• Repair
CEJ: there can either be overalap (most common), butt joint, or gap between cementum and enamel
Compared to bone, cementum has much less remodeling ability

Cementum = collagen 1, 3, 5, 8
Bone = collagen 1, 3, 5, 12

Periodontitis • An inflammatory disease of the supporting tissues of the teeth

• Caused by specific microorganisms
 • Resulting in the progressive destruction of the periodontium, affecting the ligament and the
bone
• You cannot regularly regenerate the periodontium
• Goal of perio treatment is To preserve the dentition in the state of health, comfort and
function:
-Prevent disease
-Arrest disease progression
-Regain lost periodontium
-Maintain newly regained tissues
• Treatment: scaling and Root Planing followed by Periodontal Surgery
• Scaling and root planing (non-surgical) achieves removal of bacterial biofilm, calculus, and
contaminated cementum; during healing there is repair of the long Junctional epithelium
• Pocket elimination (surgical flap surgeries): repair/resection (eliminates the open pocket
access, but the healing does not fully restore the original architecture or the function and
instead restores the area with long junctional epithelium), regeneration (ideal treatment but
not always possible!; consists of reproduction of the lost Periodontium; ideally you would
assess the regeneration with histology but clinically we can perform periodontal probing,
radiographs and re-entry evaluation to visualize the regeneration), tooth extraction
Origin of cells during Development vs. Wound healing:

How do Periodontal Tissues Regenerate? Guided Tissue Regeneration

Clean root surface and remove the bacteria
PDL must regrow using growth/differentiation factors**
Bone must reform using bone grafts and tissue engineering
Oral epithelium needs to stay away using a scaffold (barrier membrane) to maintain the space before
it regrows too early and develops into a Long Junctional Epithelium

**Growth/Differentiation Factors:
• Enamel matrix proteins: e.g. Emdogain shows evidence of new cementum (cementogenesis)
and new bone with inserting connective tissue fibers -or- Amelogenin
• Growth factors: Cause Cell proliferation, cell activity, chemotaxis
– Insulin-‐like growth factors
– Platelet-‐derived growth factor e.g. GEM 21S using a B-TCP B-tricalcium phosphate
scaffold will increase attachment level and cause bone growth
Only can achieve regeneration sometimes!!!!! But not predictable, due to a lack of histology we do not
know for sure if we have achieved true regeneration, but still a lot of challenges (morphology, pulpal
status, healing capabilities, oral hygiene, smoking, maxillary teeth harder)
Lecture 10
Enamel hypoplasia
Enamel Hypomineralization
Bloom’s Taxonomy
Cognitive/Knowledge Domain
Psychomotor Skills Domain
Affective Domain
Clinical Implications
Quantitative defect in enamel. Wasn't built the right way
Qualitative defect in the enamel. May have been formed correctly but a later process destroyed
the mineralization.
 Hypomineralization occurs predominantly in permanent first molars and incisors
 Hypomineralization may occur in primary second molars
 Enamel lesions consist of poorly packed hydroxyapatite crystals and retained
proteins
 Dentin under the lesions has increased bacterial infiltrates
 Pulp under the lesions has increased inflammatory markers and greater innervation
density
 Increased prevalence in children with early childhood illnesses, particularly
respiratory

 Understanding tooth development is important for the understanding of disease
progression and treatment
 Distinguishing between developmental defects and dental disease is important for the
understanding of disease progression and treatment
 Understanding tooth development is important for the understanding of disease
progression and treatment
 Distinguishing between developmental defects and dental disease is important for the
understanding of disease progression and treatment

Final:
85 Multiple Choice Questions
53-105
Nothing related to experimental design
Paper Exam