PERIODONTAL

LIGAMENT
 Introduction
- Periodontal ligament is the soft, specialized connective
tissue situated between the cementum covering the root of
the tooth and bone forming the socket wall
- Its width ranges from 0.15 to 0.38 mm
- The periodontal space is diminished around teeth that are
not in function and in unerupted teeth, but it is increased in
teeth that have been subjected to hyperfunction
- Periodontal ligament is thinnest at the axis of rotation in
the middle and widens coronally and apically
 Introduction
- It is composed of a complex vascular and highly cellular
connective tissue that surrounds the tooth root and
connects it to the inner wall of the alveolar bone
- It is continuous with the connective tissue of the gingiva,
and it communicates with the marrow spaces through
vascular channels in the bone
 Constituents
A. Periodontal ligament fibers
B. Cellular elements
C. Ground substances
i. Glycosaminoglycans
ii. Glycoproteins
 Periodontal Ligament Fibers
- The most important elements of the periodontal ligament
are the principal fibers, which are collagenous and
arranged in bundles and which follow a wavy course when
viewed in longitudinal section
- The terminal portions of the principal fibers that are
inserted into cementum and bone are termed Sharpey’s
fibers
- The principal fiber bundles consist of individual fibers that
form a continuous anastomosing network between tooth
and bone
Periodontal Ligament Fibers
 Periodontal Ligament Fibers
The principal fibers of periodontal ligament are arranged in
six groups and are named according to their location and
direction of attachment:
1. Transseptal group:
- Extends interproximally over alveolar bone crest and are
embedded in the cementum of adjacent teeth
- They are reconstructed even after destruction of the
alveolar bone has occurred in the periodontal disease and
are responsible for returning teeth to their original state
after orthodontic therapy
 Periodontal Ligament Fibers
2. Alveolar crest group:
- Extends obliquely from the cementum just beneath the junctional
epithelium to the alveolar crest
- They prevent extrusion and lateral tooth movements
3. Horizontal group:
- Extends at right angles to the long axis of the tooth from
cementum to alveolar bone
- This fiber group resists horizontal pressure against the crown of
the tooth
4. Oblique group:
- Extends from the cementum in a coronal direction obliquely to the
bone.
- They bear vertical masticatory stresses and transform vertical
stress into tension on the alveolar bone
 Periodontal Ligament Fibers
5. Apical group:
- The apical fibers radiates in irregular fashion from
cementum to bone at apical region of socket
- They prevent tooth tipping, resist luxation and protect
neurovascular supply to the tooth
6. Interradicular group:
- These are found only between roots of multirooted teeth
running from cementum into bone, forming crest of
interradicular septum
- They prevent luxation, tooth tipping and torquing
Periodontal Ligament Fibers
Periodontal Ligament Fibers
 Cellular Elements
Cells have been identified in the periodontal ligament:
1- connective tissue cells
2- epithelial rest cells
3- immune system cells
4- cells associated with neurovascular elements
5- progenitor cells
 Cellular Elements
1. Connective tissue cells
a. Synthetic cells:
• Fibroblasts:
- These are the most predominant connective tissue cells
- Fibroblast are a spindle shaped or stellate cells with an
oval-shaped nucleus containing one or more nucleoli
- They originate from mesenchymal cells
- These cells synthesize collagen and possess the capacity
to phagocytose “old” collagen fibers and degrade them
 Cellular Elements
• Cementoblasts:
These are the cells responsible for secreting the organic
matrix of cementum within the periodontal ligament
• Osteoblasts:
Covers the periodontal surface of the alveolar bone
 Cellular Elements
b. Resorptive cells:
• Osteoclasts:
- These are bone resorbing cells which are formed by fusion of
mononuclear cells arising from bone marrow
- These are the cells that resorb the bone and tend to be large
and multinucleated
• Fibroblasts:
- These cells are also responsible for degrading collagen fibers
- The fibroblasts responsible for resorption contain fragments of
collagen that appear to be undergoing digestion
- The presence of these cells indicates resorption of fibers
occurring during either disease or physiological turnover or
remodeling of periodontal ligament
 Cellular Elements
• Cementoclasts:
These are mononuclear cells resembling osteoclast located
in howships lacunae
 Cellular Elements
2. Epithelial cells
- These are remnants of Hertwig’s root sheath which are
present close to cementum throughout the periodontal
ligament and more in apical and cervical areas
- The physiologic role of these cells is not known
- When certain pathologic conditions are present, cells of
the epithelial rests can undergo rapid proliferation and can
produce a variety of cysts and tumors of the jaw ( periapical
cysts and lateral root cysts )
 Cellular Elements
3. Immune system cells
Various defense cells present in periodontal ligament are
neutrophils, lymphocytes, macrophages, mast cell and
eosinophils
4. Cells associated with neurovascular elements
5. Progenitor cells
 Ground substance
- The space between cells, fibers, blood vessels and
nerves in the periodontal space is occupied by ground
substance
- The ground substance is made up of two major groups of
substances:
* Glycosaminoglycans such as hyaluronic acid,
proteoglycans
* glycoproteins such as fibronectin and laminin
- It also has high water content (70%).
 Functions of Periodontal Ligament
The functions of the periodontal ligament are categorized
as:
1- Physical
2- Formative and remodeling
3- Nutritional and sensory
 Functions of Periodontal Ligament
Physical Functions:
1. Provision of a soft-tissue “casing” to protect the vessels
and nerves from injury by mechanical forces
2. Transmission of occlusal forces to the bone
3. Attachment of the teeth to the bone
4. Maintenance of the gingival tissues in their proper
relationship to the teeth
5. Resistance to the impact of occlusal forces (i.e., shock
absorption)
 Functions of Periodontal Ligament
Formative and Remodeling Function:
- Periodontal ligament and alveolar bone cells are exposed
to physical forces in response to mastication, parafunction,
speech, and orthodontic tooth movement
- Cells of the periodontal ligament participate in the
formation and resorption of cementum and bone, which
occur during physiologic tooth movement, during the
accommodation of the periodontium to occlusal forces, and
during the repair of injuries
- Periodontal ligament undergoes constant remodeling; old
cells and fibers are broken down and replaced by new ones
 Functions of Periodontal Ligament
Nutritional and Sensory Functions:
- The periodontal ligament supplies nutrients to the
cementum, bone, and gingiva by way of the blood vessels,
and it also provides lymphatic drainage
- In relation to other ligaments and tendons, the periodontal
ligament is highly vascularized tissue; almost 10% of its
volume in the rodent molar is blood vessels
- The periodontal ligament is abundantly supplied with
sensory nerve fibers that are capable of transmitting tactile,
pressure, and pain sensations via the trigeminal pathways
- Nerve bundles pass into the periodontal ligament from the
periapical area and through channels from the alveolar
bone that follow the course of the blood vessels
 Blood Supply
- The blood supply is derived from the inferior and superior
alveolar arteries to mandible and maxilla respectively
- Blood supply reaches the periodontal ligament from 3
sources:
i. Apical vessels
ii. Penetrating vessels from the alveolar bone
iii. Anastomosing vessels from the gingiva
 Blood Supply
- These blood vessels are closer to the bone than to
cementum
- The blood supply increases from the incisors to the
molars; is greatest in the gingival third of single rooted
teeth, less in the apical third, and least in the middle; is
equal in the apical and middle thirds of multirooted teeth; is
slightly greater on the mesial and distal surfaces than on
the facial and lingual; and is greater on the mesial surfaces
of mandibular molars than on the distal
Blood Supply
 Nerve Supply
- The periodontium receives both autonomic and sensory
innervations
- Autonomic nerves are sympathetic arising from the
superior cervical ganglion and terminating in the smooth
muscles of the periodontal arterioles
- Sensory nerves that supply the periodontium arise from
maxillary and mandibular divisions of trigeminal nerve