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Curs Introductiv

U.M.F. Gr. T. Popa Iai


Facultatea de Medicina
Dentara

PARODONTOLOGIE
Dept de
PARIODONTOLOGIE

Sef de lucrari,
Solomon Sorina
MD,PhD

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03/22/16

Parodontologie, istoric, terminologie, conceptul medical in parodontologie.


Elemente de morfofiziologie ale parodontiului superficial sanatos si aspecte
clinice in context etiopatogenic. (2 ore)

Parodontologia: definitie, importanta cunoasterii elementelor de morfologie ale


parodontiului superficial si profund.
Anatomia parodontiului superficial (de invelis) ca parte componenta a mucosei orale.
Structura histologica a componentei epiteliale si a celei conjunctive cu variatiile ei in
functie de topografia tisulara.
Pozitionarea componentei fibrilare si alcatuirea atasamentului epitelio-conjunctiv.
Aspecte clinice topografice ale gingiei: marginale si papilare interrelatia cu punctul
de contact.
Sulcusul gingival, elemente componente epiteliul de atasament; fluid crevicular.
Gingia atasata si relatiile ei cu formatiunile anatomice de vecinatate.

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03/22/16

Ce este PARODONTOLOGIA?
Bolile gingivale si parodontale au afectat
omenirea inca de la inceputurile istoriei.
Tartrul alaturi de patologiile sistemice coexistente
au fost adesea incriminate in aparitia tulburarilor
parodontale
Prima abordare terapeutica metodica a fost gasita
in Tratatul de chirurgie Araba din Evul Mediu
Tratamentul modern cu texte ilustrate si
instrumentari sofisticate a inceput sa fie dezvoltat
in sec. XVIII (Pierre Fouchard)
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CAVITATEA ORALA

Plici alveolo-jugale
Frenul Labial

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Vestibul

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MUCOSA ORALA

- reprezinta mucoasa ce
acopera intreaga cavitate orala
- este specializata si adaptata nevoilor
ariei de acoperire
Mucoasa de captusire
Mucoasa masticatorie
Mucoasa specializata

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MUCOSA ORALA

- este un tesut foarte fin, delicat ce poate fi lezat cu usurinta

MUCOASA

- acopera tesuturile moi care nu sunt tapetate de


mucoasa masticatorie

de
CAPTUSIRE

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- se gaseste pe fata interna a buzelor, obrajilor, vestibulului


oral (pana la gingia atasata), fata ventrala a limbii si palatul
moale (1/3 posterioara a palatului)

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MUCOSA ORALA
- este un tesut dens, rezistent, destinat sa reziste la
frictiunea si presiunea ce apar in timpul masticatiei

MUCOASA

- este lipsit de mobilitate, fiind ferm atasat la osul subiacent

MASTICATORIE - captuseste palatul dur (2/3 anterioare ale palatului)


papila bunoida / retroincisiva
rafeul median / palatin
rugile palatine
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MUCOSA ORALA
Papila retroincisiva

- este un tesut de forma ovala sau piriforma localizat pe linia


mediana, in spatele incisivilor centrali maxilari
- acopera gaura palatina anterioara

Papila bunoida

Rafeu palatin
Rugile palatine

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- este o creasta de mucosa masticatorie care se extinde de


la papila bunoida posterior pe mijlocul palatului.
- sunt creste sau pliuri neregulate de mucoasa masticatorie
care se extind lateral de la papila bunoida si sectiunea
anterioara a rafeului median
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LIMBA
este un grup de muschi flexibili atasati doar la
capatul posterior

- dorsum linguale (deasupra) este acoperit de un


epiteliul gros, inalt specializat
MUCOASA
- fata ventrala (dedesubt) a limbii este bogat
SPECIALIZATA
vascularizata si acoperita de o mucoasa de captusire
foarte subtire.
- mugurii gustativi sunt localizati pe fata dorsala a
limbii
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LIMBA
Fata ventrala a limbii captusita cu
mucoasa de acoperire

Fata dorsala a limbii cu


mugurii gustativi

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LIMBA
Papile filiforme

- sunt proiectii ale unor arii mici punctiforme localizate pe


fata dorsala a limbii in 2/3 anterioare
- au aspect catifelat
- ofera sensibilitate tactila dar nu contin receptori gustativi
- ofera tractiune pt manevrarea obiectelor in cavitatea orala.

Papile
fungiforme

-sunt papile mici rotunde, localizate in 2/3 anteriora a fetei


dorsale a limbii
- au culuare rosu intens si sunt mai mari decat cele filiforme
- contin receptori gustativi (muguri gustativi)

Papile
circumvalate

- sunt papile voluminoase localizate posterior pe fata dorsala


a limbii, fiind dispuse in forma de V
- contin muguri gustativi

Papile foliate
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- sunt papile mici nediferentiate localizate in pliurile suprafetei


posterioare si laterale ale limbii
- sunt proeictii rosii, in forma de frunza care contin muguri
gustativi
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LIMBA

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LIMBA
MUCOASA SPECIALIZATA

dulce
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acru

sarat
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amar

MORFOLOGIE
PARODONTALA
CONSIDERATII
CLINICE
1. INTRODUCERE
2. PARODONTIUL
DE INVELIS
GINGIA MARGINAL
GINGIA INTERDENTAR
GINGIA ATAAT

3. PARODONTIUL
DE SUSTINERE
CEMENT
LIGAMENT PARODONTAL

Familiarizarea cu morfologia si aspectele clinice


normale ca si cu variatiile fiziologice ale tesuturilor
parodontale constituie conditie esentiala pentru
intelegerea:
-patologiei bolilor parodontale,
-obiectivelor si a principiilor terapeutice urmarite
pentru recastigarea integritatii structurale si
functionale a parodontiului.

OS ALVEOLAR

4. CONSIDERATII
CLINICE

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MORFOLOGIE
PARODONTALA
CONSIDERATII
CLINICE
1. INTRODUCERE
2. PARODONTIUL
DE INVELIS

PARODONTIUL
poate fi impartit in:
a. Pardontiu de INVELIS:

GINGIA MARGINAL
GINGIA INTERDENTAR

1. Gingia

GINGIA ATAAT

3. PARODONTIUL
DE SUSTINERE
CEMENT

b. Parodontiu de SUPORT:

LIGAMENT PARODONTAL
OS ALVEOLAR

4. CONSIDERATII
CLINICE

2. Cement
3. Ligament parodontal
4. Os alveolar

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PARODONTIUL

MORFOLOGIE
PARODONTALA
CONSIDERATII
CLINICE
1. INTRODUCERE
2. PARODONTIUL
DE INVELIS
GINGIA MARGINAL

Smalt
Coroan
a

Dentina

GINGIA INTERDENTAR
GINGIA ATAAT

Pulpa

3. PARODONTIUL
DE SUSTINERE

Cement

CEMENT
LIGAMENT PARODONTAL
OS ALVEOLAR

4. CONSIDERATII
CLINICE

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Membrana
Parodontala

Radacin
a

Pachet
Vasculonervos
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MORFOLOGIE
PARODONTALA

PARODONTIUL

CONSIDERATII
CLINICE
1. INTRODUCERE

UNITATE embriologica - biologica - funcionala

2. PARODONTIUL
DE INVELIS
GINGIA MARGINAL
GINGIA INTERDENTAR
GINGIA ATAAT

3. PARODONTIUL
DE SUSTINERE
CEMENT
LIGAMENT PARODONTAL

FUNCTII cele mai importante sunt de a asigura:


integritatea mucoasei masticatorii
(PARODONTIUL de INVELIS)
atasamentul dintilor la osul alveolar
(PARODONTIU de SUSTINERE)

OS ALVEOLAR

4. CONSIDERATII
CLINICE

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MODIFICARI morfologice si functionale:


FIZIOLOGICE: varsta, adaptari functionale
PATOLOGICE: boala parodontala
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MORFOLOGIE
PARODONTALA

PARODONTIUL

CONSIDERATII
CLINICE
1. INTRODUCERE
2. PARODONTIUL
DE INVELIS
GINGIA MARGINAL
GINGIA INTERDENTAR
GINGIA ATAAT

3. PARODONTIUL
DE SUSTINERE
CEMENT
LIGAMENT PARODONTAL
OS ALVEOLAR

4. CONSIDERATII
CLINICE

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PARODONTIUL
SULCUS GINGIVAL
MARGINE
GINGIVALA

GINGIA LIBERA

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SULCUS GINGIVAL

EPITELIU de
JONCTIUNE

MARGINE
GINGIVALA

GINGIA LIBERA

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SULCUS GINGIVAL

ATASAMENT
EPITELIAL

MARGINE
GINGIVALA
GINGIA LIBERA
GINGIA ATASATA
JONCTIUNE
MUCOGINGIVALA
MUCOASA
ALVEOLARA

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SULCUS GINGIVAL

ATASAMENT
EPITELIAL

MARGINE
GINGIVALA
GINGIA LIBERA

LIGAMENT
PARODONTAL

GINGIA ATASATA

MUCOASA
ALVEOLARA

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SULCUS GINGIVAL

ATASAMENT
EPITELIAL

MARGINE
GINGIVALA
GINGIA LIBERA

LIGAMENT
PARODONTAL

GINGIA ATASATA

OS
CORTICAL

OS
SPONGIOS

MUCOASA
ALVEOLARA

LAMINA
DURA
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PARODONTIUL
Sectiune histologica - incisiv
central maxilar

!! Absenta smaltului ca rezultat al demineralizarii


din procesarea histologica
Cementul (CE) este conectat la
osul alveolar (AB) adiacent printr-un
ligament parodontal (PDL) fin.
Gingia acopera osul si se ataseaza in
regiunea cervicala a dintelui.
Pe aspectul palatal al dintelui se disting
clar canalul incisiv (C) si
gaura retroincisiva (F).
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G, gingia palatina.
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Gingia

MORFOLOGIE
PARODONTALA
CONSIDERATII
CLINICE
1. INTRODUCERE
2. PARODONTIUL
DE INVELIS
GINGIA MARGINAL
GINGIA INTERDENTAR
GINGIA ATAAT

3. PARODONTIUL
DE SUSTINERE
CEMENT
LIGAMENT PARODONTAL
OS ALVEOLAR

4. CONSIDERATII
CLINICE

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MUCOASA ORALA cuprinde trei zone:


mucoasa masticatorie (include gingia)
gingia
mucoasa specializata (limba)
Mucoasa de acoperire
GINGIA
- este o componenta a mucoasei orale,
- reprezinta parodontiul de invelis,
invelis
- acopera osul alveolar, si inconjura coletele dintilor
delimitand coroana clinica.
- morfologia finala se atinge dupa terminarea eruptiei
dintilor

Anatomic exista:
gingia marginala (gingia libera)
gingia atasata
gingia interdentara (papila interdentara)
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Vedere schematica a structurilor parodontale adiacente


regiunii cervicale a unui dinte mandibular

Gingia
AB, os alveolar;
AC, creasta alveolara;
AM, mucoasa alveolara,
CB, os compact;
CEJ, cjonctiunea smalt-cement;
CT, tesut conjunctiv;
DEJ, jonctiunea dinte-epiteliu
(sin. atasament epitelial);
ES, spatiu pt smalt;
G, gingie;
GE, epiteliu gingival;
GG, sant gingival;
GM, margine gingivala;
GS, sulcus gingival;
JE, epiteliu jonctional;
MGJ, jonctiunea mucogingivala;
MS, spatiu medular;
OE, epiteliu oral;
PDL, ligament parodontal;
RC, cement radicular;
SE, epiteliu sulcular

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ASPECTE
CLINICE
-Forma
-Culoare
-Textura
-Structura

Gingia
Gingia este mucoasa keratinizata ce inconjoara dintii
Formeaza un guler in jurul fiecarui dinte, si are o
latime intre 1 - 9 mm
Cea mai ingusta zona de gingie se regaseste obisnuit
pe versantul vestibular mandibular de la canin la
primul premolar.
Cea mai lata zona este adesea localizata pe
aspectul lingual al ultimului molar mandibular
Gingia se prinde in parte la cement si in parte la
procesele alveolare. Este compusa din mucoasa
masticatorie

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Gingia

La pacientii cu piele deschisa la culoare, gingia (G)


roz-pal, poate fi deosebita usor de mucoasa alveolara
(AM) de culoare rosu inchis.

La limita apicala, ce o separa de mucoasa alveolara


adiacenta, se gaseste jonctiunea mucogingivala (MGJ).
Un raport tisular asemanator se poate observa pe
aspectul lingual al mandibulei
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Gingia
La persoanele de culoare, gingia poate
avea un continut crescut de melanina
(pigment) fata de mucoasa alveolara
inconjuratoare
Melanina este sintetizata dde celule specializate - melanocites, localizate in stratul
bazal al epiteliului.
Melanina este produsa sub forma de granule -melanozomi, ce sunt depozitai in
citoplasma melanocitelor, dar si in citoplasma keratinocitelor adiacente.
Melanocitele deriva embriologicdin celulele crestei neurale care migreazza ulterior in
epiteliu.
Daca gingia pigmentata este rezecata chirurgical se va cicatriza adesea fra su doar cu
pigmentare redusa.
Trebui tinut cont la conceperea procedurilor chirurgicale pentru ca tesutul pigmentat
sa fie sau nu pastrat.
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Gingia
Aspect lingual al mandibulei cu gingie
atasata strins (G) si adiacent mucoasa
alveolara ne-keratinizata (AM) ce captuseste
o parte din procesul alveolar si planseul
gurii(F). MGJ, jonctiune mucogingivala

Vedere similara. Se remarca micile semne


mucozale lingual, in dreptul caninilor ( P).
Aceste structuri se numesc papile retrocanine.
Constituie variatie anatomica normala a gingiei
in aceasta locatie. Nu necesita tratament
corectiv.
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Gingia
Vedere a palatului dur ilustrand
absenta jonctiunii mucogingivale

Mucoasa masticatorie a gingiei (G) se continua imperceptibil cu mucoasa masticatorie


a palatului dur (PM).
Se observa rugile palatine (RR), creste de mucoasa din spatele dintilor anteriori, de o
parte si de alta a papilei incisive (IP)

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Gingia
Gingia care ocupa spatiile interdentare coronar de
creasta alveolara este numita gingia interdentara

Este reprezentata de o papila interdentara piramidala, in regiunea incisiva (A).


In regiunea posterioara (B) este alcatuita dintr-o papila orala si una vestibulara ( P) unite
printr-un "col interdentar (C).
Gingia interdentara este atasata la dinte printr-un epiteliu jonctional (JE) in portiunea
coronara si prin fibre de tesut conjunctiv apical ( nu sunt prezentate).
The Portiunea cea mai coronara a gingiei interdentare este acopperita de epiteliul
sulcular (SE)
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EPITELIUL GINGIVAL

MORFOLOGIE
PARODONTALA
CONSIDERATII
CLINICE
1. INTRODUCERE
2. PARODONTU DE
INVELIS
GINGIA MARGINAL
GINGIA INTERDENTAR
GINGIA ATAAT

3. PARODONTIUL
DE SUSTINERE
CEMENT
LIGAMENT PARODONTAL
OS ALVEOLAR

4. CONSIDERATII
CLINICE

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EPITELIUL GINGIVAL
Epiteliul gingival cuprinde:
- tesutul epitelial ce acopera suprafata externa a gingiei (OE)
- epiteliul ce captuseste sulcusul gingival (SE)
- epiteliul jonctional (JE)
OE se extinde de la jonctiunea mucogingivala la
marginea gingivala.

OE epiteliul oral
SE epiteliul sulcular
JE epiteliul jonctional
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SE captuseste aspectul lateral al sulcusului


gingival.
JE formeaza jonctiunea dento-epiteliala apical
de sulcus. Extremitatea coronara a sa
formeaza baza sulcusului gingival si se
continua cu epiteliul sulcular.
Aceste epitelii difera intre ele prin functiile lor si, de
aceea, si prin unele caracteristici histologice
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OE oral epithelium

EPITELIUL GINGIVAL
Este un epiteliu stratificat, scuamos keratinizat, ce
acopera suprafetele vestibulare si orale ale gingiei.
Se intinde de la jonctiunea muco-gingivala la marginea
gingiei, exceptand suprafata palatina unde se continua
cu epiteliul palatin.

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- strat bazal (stratum basale, SB),


- strat spinos (stratum spinosum,
SS),
- strat granular (
stratum granulosum, SG)
- strat keratinizat (
protectie fata de injuriile mecanice din timpul
stratum corneum, SC)
masticatiei
datorita numeroaselor jonctiuni intercelulare, in
majoritate desmozomi, ce tin celulele strins legate
impreuna si stratului cornos,
relativ inpermeabil stratul
cornos si spatiile
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EPITELIUL GINGIVAL
Epiteliul oral este conectat la testul
conjunctiv subiacent numit lamina
propria printr-o interfata neregulata

B
Aceasta interfata consta din proiectii digitiforme de tesut conjunctiv din stratul
papilar (sageti, A) ce se extind in depresiuni ale zonei de subsuprafata
epiteliului.
Aceste ddepresiuni (B) sunt localizate intre Rete ridges interconectate si care
formeaza stratul de subsuprafata al epiteliului.
Sectiuni transverale prin aceste creste, cum se vad in sectiunile histologice
sunt denumite si Rete pegs

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EPITELIUL GINGIVAL

Micrografia de transmisie electronica a jonctiunii


dintre o celula bazala a epiteliului oral gingival si
tesutul conjunctiv subiacent - lamina propria.

Membrana celulelor epiteliale dinspre lamina propria este impanzita cu numerosi


hemidesmozomi (HD) si este conectata cu ea printr-o lamina bazala (BL).
Lamina bazala consta dintr-un strat electron-dens, lamina densa (LD) si un strat
transparent, lamina lucida (LL).
- lamina densa este alcatuita dintr-un tip afibrilar de colagen, colagen tip IV.
- lamina lucida este alcatuita din laminina si alte glicoproteine.
Fibrilele de ancoraj (AF), compuse din colagen tip VII, se exxtind de sub suprafata laminei
densa in lamina propria

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EPITELIUL GINGIVAL

Celulele epiteliale individuale


(EC) sunt atasate intre ele prin
numeroase jonctiuni
interrcelulare.
Aceste jonctiuni sunt cel mai
binee vizualizate ca priectii
spinoase ce strabat in punte
spatiile intercelulare (ICS)
Section through the spinous
layer or stratum spinosum

Zonele dense ale jonctiunilor


intercelulare impiedica dilatarea
marcata a spatiilor intercelulare.
Inflamatia poate afecta jonctiunile intercelulare, cauzand
ruperea lor si permitand largirea spatiilor
intercelulare.Celulale inflamatorii adesea vor ocupa
acceste spatii intercelulare largite.
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0.1m

EPITELIUL GINGIVAL

Jonctiunile sunt realizate in


principal de desmozomi
Desmozomii (D) sunt dispusi
in dinti de fierastrau.
Micrografie de transmisie
electronica a unei jonctiuni
intercelulare dintre celule
adiacente din stratul sinos al
epiteliului oral
Manunchiuri de tonofilamente sau

tonofibrile (TF) se extind din desmozomi in


citoplassma adiacenta.

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Tonofibrilele servesc drept citoschelet ce


ajuta la disiparea stresului mecanic
exercitat asupra desmozomilor si a
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membraneelor celulare

ORAL EPITHELIUM

The epithelial cells in the superficial portion


of the stratum spinosum become flattened.
Tonofibrils take up an increasing volume of the cytoplasmic contents.
Relatively sparse, round cytoplasmic granules appear in the
stratum granulosum (SG).
The stratum corneum (SC) is characterized by an increased packing of the
tonofibrils within a markedly flattened cell.
Nuclei and most organelles disappear and the staining characteristics of the
cells in this layer are markedly altered.

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ORAL EPITHELIUM
Note the electron-dense keratohyalin granules
(KHG) within the cytoplasm of the flattened
cells.
The degree of flattening of the cells can be
estimated by the proximity of adjacent
intercellular junctions (ICJ).
Transmission electronmicrograph
of
The increased
stratum granulosum.

density of tonofibrils within the

cytoplasm
The
stratum corneum consists of tightly packed
cornified cells.
Intercellular junctions (ICJ) between the
flattened cells are still distinguishable. The cells
contain densely packed tonofilaments.
No nuclei or cytoplasmic organelles are
detectable.
This form of keratinization is referred to as
orthokeratinization. Orthokeratinized epithelia
provide the best protection against mechanical injury .

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The most superficial cells


peel off or desquamate
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SULCULAR EPITHELIUM
It is the stratified, squamous epithelium,
non-keratinized or parakeratinized, that is
continuous with the oral epithelium and
lines the lateral surface of the sulcus

SE sulcular epithelium

Apically, it overlaps the coronal border of


the junctional epithelium, a structural
design that minimizes ulceration of the
epithelial lining in this region.

(SE) shares many of the characteristics of the


oral epithelium:
- good resistance to mechanical
forces
- relative impermeability to fluid
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SULCULAR EPITHELIUM
The overall structure of the sulcular epithelium
resembles that of the oral epithelium, except
for the surface layer that is less keratinized
than its counterpart in the oral epithelium.
CT, gingival connective This incomplete type of keratinization is
tissue;
referred to as parakeratinization.
GS, gingival sulcus;
PKE, parakeratinized
epithelial layer

Note the presence in the parakeratinized


surface layer of incompletely keratinized
epithelial cells (PKC) with residual nuclei.
Note the tightly sealed intercellular spaces
(ICS) that contribute to the low
permeability of this portion of the gingival
epithelium.
higher magnification
GS, gingival sulcus03/22/16

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JUNCTIONAL EPITHELIUM

It is the stratified non-keratinizing epithelium,


that surrounds the tooth like a collar with a
cross-section resembling a thin wedge
It is attached by one broad surface to the tooth
and by the other to the gingival connective
JE junctional epithelium tissue.
The junctional epithelium has 2 basal laminas,
one that faces the tooth (internal basal lamina)
and one that faces the connective tissue (
external basal lamina).
The proliferative cell layer responsible for most
cell divisions is located in contact with the
connective tissue, i.e. next to the external
basal lamina.
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The desquamative (shedding)


surface of the
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JUNCTIONAL EPITHELIUM

(JE) is more permeable than the oral or


sulcular epithelium.
It serves as the preferential route for the
passage of bacterial products from the
sulcus into the connective tissue and for
fluid and cells from the connective tissue
The
term
into
theepithelial
sulcus. attachment: refers to the
attachment apparatus, i.e. the internal basal
lamina and hemidesmosomes, that connects the
junctional epithelium to the tooth surface.
epithelial attachment is not synonymous with
junctional epithelium which refers to the entire
epithelium.
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JUNCTIONAL EPITHELIUM

The width of the junctional epithelium


may consist of as many as 30 cells in
the sulcus region to as few as one cell
in its most apical portion.

Segment of
junctional
epithelium (JE)
from an area just
apical to the
gingival sulcus.

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The intercellular spaces between the


cells of the junctional epithelium are
wider than in the oral or sulcular
epithelia. This is due in part to the
lower density of intercellular junctions
between the cells of the junctional
epithelium.
The density of junctions is
approximately one03/22/16
third of that in the

JUNCTIONAL EPITHELIUM

normal, uninflamed
junctional epithelium
(JE)

junctional
epithelium in
inflamed
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The cells are orientated with their long axis


parallel to the tooth surface.
The intercellular spaces are relatively narrow.
The epithelium is attached to the enamel by
an internal basal lamina (IBL) and to the
connective tissue (CT) by the
external basal lamina (EBL). ES, enamel space
The cytoplasm of the junctional epithelium
contain dispersed tonofilaments, but lack
tonofibrils. Under normal circumstances these
cells do not undergo keratinization.
Note the marked distension of the intercellular
spaces by (PMN) polymorphonuclear leucocytes
that are migrating from the connective tissue
toward the gingival sulcus (located toward the
top of the micrograph).
Fluid exudate from the connective tissue also
flows into the sulcus through the enlarged
intercellular spaces.
The spaces enlarge in part through rupture of the
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JUNCTIONAL EPITHELIUM
The bi-directional arrows indicate that the junctional
epithelium (JE) is the most permeable portion of the
gingival epithelia. Soluble substances can diffuse from
the oral cavity into the underlying gingival connective
tissue (CT), while both fluids and cells can travel
through the junctional epithelium from the connective
tissue into the gingival sulcus (S) on their way to the
oral cavity.
Because of its permeability to bacterial products and
other antigens originating in the oral cavity, the
OE, oral
connective tissue adjacent to the junctional
epithelium
tends to become infiltrated with chronicepithelium;
inflammatory
SE, sulcular
cells,
primarily
lymphocytes
mesio-distal
section
throughand
the plasma cells.
epithelium
interdental
gingiva
The junctional epithelium (JE) forms a collar around the

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apical border of each adjacent tooth. The junctional


epithelia of the adjacent teeth are united in the most
coronal part of the interdental space, near the
interdental gingival margin (GM), or "col". Following
histological processing, the enamel of the crowns is
lost, leaving
enamel
space (ES).
AB, an
bone
of alveolar
GF, gingival fibers in crossprocess;
section;
AC, alveolar crest;
PDL, periodontal ligament;
CE, cementum;
TF, transseptal fiber group.
CEJ, cemento-enamel
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Gingiva

MORFOLOGIE
PARODONTALA
CONSIDERATII
CLINICE

EPITELIAL COMPONENT

1. INTRODUCERE
2. PARODONTIU DE
INVELIS

Langerhans Cells

Merkel Cells

GINGIA MARGINAL
GINGIA INTERDENTAR
GINGIA ATAAT

3. PARODONTIUL
DE SUSTINERE
CEMENT
LIGAMENT PARODONTAL

Melanocit

OS ALVEOLAR

4. CONSIDERATII
CLINICE

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03/22/16

Gingiva

PERIODONTAL
MORPHOLOGY
CLINICAL
CONSIDERATIONS
1. INTRODUCTION
2. COATING
PERIODONTIUM
MARGINAL GINGIVA
INTERDENTAL GINGIVA

EPITHELIAL COMPONENT
oral versant
sulcular versant
jonctional epitelium
EPITHELIAL ATTACHEMENT

ATTACHED GINGIVA

3. SUSTAINING
PERIODONTIUM
CEMENTUM
PERIODONTAL LIGAMENT
ALVEOLAR BONE

4. CLINICAL
CONSIDERATIONS

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CONNECTIVE COMPONENT
(lamina propria)
Papillary layer
Reticular layer
adheres tightly to the root
surface and to alveolar bone
undernith

CONJUNCTIV ATTACHEMENT
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gingival fibers,
ground substance
cells
blood and lymphatic vessels
nerves

GINGIVAL CONNECTIVE TISSUE


The gingival connective tissue is composed of :

The bulk of the gingival connective tissue is composed of a dense,


predominantly collagenous matrix that contains collagen fibers
running in recognized fiber groups = principal fibers of the gingival
connective tissue
The dense gingival connective tissue is referred to as a
lamina propria.
consists
of: layer, finger-like projections of
It
the
papillary
connective tissue that are contained within
depressions on the undersurface of the overlying
epithelium, and
the reticular layer, located between the epithelial
undersurface and the root surface or adjacent
At its junction with
the lining
mucosa, in the region delineated by
alveolar
process.
the mucogingival junction, the lamina propria becomes continuous
with the much looser and elastic connective tissue of the
alveolar submucosa
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03/22/16

gingival fibers
ground substance
cells
blood and lymphatic vessels
nerves

GINGIVAL CONNECTIVE TISSUE

Most of the fibers are composed of collagen, with


minor contributions from elastic fibers and
oxytalan fibers.
Elastic and oxytalan fibers are generally confined to
perivascular regions
Oxytalan fibers are also found as thin fiber bundles
within collagen-rich regions like the lamina propria

A large collagen fiber (CF) consisting of hundreds


of collagen fibrils.
C, capillary blood vessel containing a single
erythrocyte;
FB, fibroblasts
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03/22/16

gingival fibers
ground substance
cells
blood and lymphatic vessels
nerves

GINGIVAL CONNECTIVE TISSUE

Fibroblasts

- form an interconnected
fibers
network of cell
ground
- the intercellular spaces are
substance
The fibroblasts
are responsible for
:
filled
with :
the production of the fibers and ground
substance
are capable of removing fibers and ground
substance during remodeling of the gingival
Most of the fibers in gingival connective tissue are
tissues
composed of collagen.

The bulk of the collagen is type I collagen, the most


abundant form of collagen in the human body.

The structural unit of type I collagen is a typically


striated fibril with a characteristic banding
pattern that repeats every 64 nm. The banding
results from the packing arrangement of the
collagen
molecules
thatdetectable
make up the
The typical banding of
type I collagen
is readily
in individual
fibril.
longitudinally sectioned
fibrils
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03/22/16

gingival fibers
ground substance
cells
blood and lymphatic vessels
nerves

collagen fibers

GINGIVAL CONNECTIVE TISSUE

Type I collagen fibrils are normally organized into bundles


of fibrils, or fibers. They are found throughout the
lamina propria.
Type III collagen fibers are thinner than the type I fibers
and tend to be found close to basal laminas of vascular
channels and epithelial tissues. They are also known as
reticular fibers
Type VII collagen is found as anchoring fibrils, located in
intimate contact with epithelial basal laminas.
Type IV collagen, an amorphous form of collagen, is found
in the basal laminas of the epithelial lining and blood
vessel walls, primarily in the lamina densa

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03/22/16

gingival fibers
ground substance
cells
blood and lymphatic vessels
nerves

GINGIVAL CONNECTIVE TISSUE

The other fiber types found in the periodontium are:

elastic fibers
are rather scarce in the lamina propria.
they are a more common constituent of the lining submucosa
they consist of 2 major components:
microfibrils made of fibrillin
elastin an amorphous component that
provides the fiber with its elastic properties

oxytalan fibers
are a fiber type related to elastic fibers
they appear to consist of the microfibrillar component only,
thereby resembling very immature elastic fibers
can be found mixed in among collagen fibers

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03/22/16

gingival fibers
ground substance
cells
blood and lymphatic vessels
nerves

GINGIVAL CONNECTIVE TISSUE

The collagen fibers of the gingiva are subdivided into 8 principal fiber groups
(A) -dentogingival
fibers

insert into the supracrestal root cementum and fan


out into the adjacent connective tissue.

(B)
insert into the supracrestal root cementum and blend with
-dentoperiosteal
the periosteal covering of the adjacent alveolar process
fibers
(C)
insert into the alveolar crest and fan out into the adjacent
-alveologingival
gingival connective tissue.
fibers
(D)
follow a circular course around individual
-circumferential
dental units
(E)
-semicircular
fibers
insert on the approximal surfaces of a tooth and follow a
fibers
semicircular course to insert on the opposite side of the
same tooth
(F) -transgingival fibersinsert into the approximal surface of a tooth and fan out
toward the oral or vestibular surface
(G) -intergingival fibers
course along the oral or vestibular surfaces of the
dental arch
(H) -transseptal fibers course from one approximal tooth surface to the approximal
surface of the adjacent tooth
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gingival fibers
ground substance
cells
blood and lymphatic vessels
nerves

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GINGIVAL CONNECTIVE TISSUE

gingival fibers,
ground substance
cells
blood and lymphatic vessels
nerves

GINGIVAL CONNECTIVE TISSUE

The ground substance occupies the space between cells,


fibers and neurovascular elements.
Its major constituents are water, glycoproteins and
proteoglycans.
The ground substance permits the diffusion of biological
substances between various structural elements

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03/22/16

gingival fibers
ground substance
cells
blood and lymphatic vessels
nerves

GINGIVAL CONNECTIVE TISSUE

Fibroblasts,

play a key role in the maintenance and remodeling of


the connective tissue

The major
cellular elements
in the gingival
connective
tissue are:

Inflammatory cells
include

macrophages,
mast cells,
osteoblasts and osteoblast precursor cells,
cementoblasts and cementoblast precursor cells,
osteoclasts and odontoclasts,
assorted inflammatory cells,
cells that make up vascular channels and nerves.
polymorphonuclear leucocytes (PMN)
lymphocytes
plasma cells

Under normal circumstances they may be found in small numbers,


as isolated cells
In the presence of
they can be found in large numbers, often as dense
inflammation
cellular aggregates that have replaced the fibrous
elements in the connective tissue
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03/22/16

gingival fibers
ground substance
cells
blood and lymphatic vessels
nerves

GINGIVAL CONNECTIVE TISSUE

Note the major vessels originating from the


supraperiosteal region (SP) and the periodontal
ligament space (PL) that supply the capillary
beds adjacent to the junctional epithelium (A)
and the oral epithelium (B).

Note in addition to the blood vessels from the


periodontal ligament (1) and the supraperiosteal
region (3), that blood vessels from within the
alveolar process (2) also contribute to the
regional blood supply

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The gingival tissues are supplied with lymphatic


vessels that drain principally to submaxillary
lymph nodes
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gingival fibers
ground substance
cells
blood and lymphatic vessels
nerves

GINGIVAL CONNECTIVE TISSUE

Branches of the trigeminal nerve provide


sensory and proprioceptive functions.
In addition, autonomic nerve endings are
associated with the vasculature.

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03/22/16

Questions???

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03/22/16