L2 - Tour Continued Flashcards

1
Q

vascular supply of periodontium in the maxilla

A

anterior and posterior superior alveolar arteries + the infraorbital artery and greater palatine artery

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2
Q

vascular supply of periodontium in the mandible

A

inferior alveolar artery and branches including the mental and sublingual branches
+ buccal
+facial arteries

remember the long buccal

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3
Q

gingival plexus importance?

A

the vessels supply major capillary plexuses that are located in the connective tissue adjacent to the otal epithelium and the junctional epithelium
- important that these receive the anesthetics that get put into the vascular system

so getting supply from the blood vessels within the alveolar process also contributing

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4
Q

anastamoses in the oral mucosa?

A

arteries that supply the oral mucosa with the branches of the superior and inferior dental artieries

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5
Q

gingiva dual blood supple?

A

YES
INTERNAL –> bone and PDL

EXTERNAL –> through periosteum

but ALSO within the alveolar process we have vessels contributing to regional blood supply

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6
Q

lymph drainage of gingival tissue mainly through?

A

submandibular lymph nodes

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7
Q

submental lymph drains?

A

mandibular anteriors

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8
Q

upper deep cervical lymph drains?

A

the third molars

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9
Q

deep cervical nodes drain?

A

palatal gingiva

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10
Q

what do the nerves of periodontium register?

A

pressure, touch, temperature, and pain

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11
Q

which branches provide sensory and propooceptive functions?

A

TRIGEMINAL

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12
Q

innervation of the max and mandibular GINGIVA

A
  1. maxillary –> anterior middle and posterior superior alveolar
    - infraorbital
    - greater palatine
    - nasopalatine
  2. mandibular –> long buccal, mental (vestibular) and lingual for lingual gingival tissue
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13
Q

what do autonomic nerves control within the periodontium?

A

smooth muscles associated with the periodontal vasculature – which originate from the superior cervical ganglion

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14
Q

three zones of the intraoral tissue and general description of each

A
  1. MASTICATORY MUCOSA – gingiva and the tissue covering the hard palate
  2. SPECIALIZED MUCOSA – the dorsum of the tongue
  3. ORAL MUCOUS MEMBRANE - lines the remainder of the oral cavity
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15
Q

4 main functions of the oral mucosa

A
  1. protection (primarily from keratinized)
  2. sensation (taste)
  3. secretion (minor salivary glands)
  4. thermal regulation
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16
Q

gingiva - general description and only one of periodontal tissues that is what?

A

only one that is VISIBLE IN HEALTH *

gingiva is part of the oral mucosa that covers the alveolar process of the jaws and the necks of the teeth

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17
Q

how is gingva attached to alveolus and tooth complex- general of each

A

TWO COMPONENTS

  1. fibrous connective tissue
    - COLLAGEN FIBER BUNDLES that connect cementum and alveolar bone
  2. epithelial attachment
    - HEMIDESMOSOME -mediated attachments to an inner basement membrane lining the hard tissues surface of the tooth
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18
Q

clinical appearance of gingiva and its overall size

A

distinguished from the alveolar mucosa (more red) by its lighter more salmon color and is KERATINIZED surrounding the tooth anywhere from 1-9mm (depending on tooth and location in mouth)
- stippling

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19
Q

color of gingiva dependent on?

A

level of

  • keratiization
  • vascular supply
  • thickness
  • pigmentation
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20
Q

melanin pigment synthesized where and by?

A

MELANOCYTES IN BASAL LAYER OF EPITHELIUM

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21
Q

3 clinical boundaries of gingiva - general

A
  1. marginal
  2. attached
  3. interdental
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22
Q

is the gingival margin attached to tooth? location

A

NO - it is the most coronal boundary of the gingiva

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23
Q

marginal gingiva describe and what is the free gingival groove?

A

portion of gingiva near the gingival margin and is UNNATTACHED surrounding the tooth in a collar fashion
- usually about 1 mm wide and forms the soft tissue wall of the sulcus which we can probe

the free gingival groove is present in about 50% of people and demarcates the marginal gingiva from the attached gingiva
- DOES NOT signify health in presence or absence

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24
Q

mucogingival junction - location and what it separates

A

MOST APICAL part and separates the gingiva from the alveolar mucosa

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25
Q

describe palatal gingiva

A

THERE IS NO MUCO-GINGIVAL JUNCTION

- the gingiva blend in with the masticatory mucosa that protects the hard palate

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26
Q

“free” gingiva

A

the part of gingiva that surrounds the tooth and is not directly attached to the TOOTH SURFACE
- anatomically ‘incorrect’

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27
Q

“attached” gingiva

A

what is APICAL to the “free” gingiva

  • firmly bound to underlying tooth and alveolar processes via collagenous inerstions into the periosteum
  • firm
  • dense
  • excellent barrier to mechanical stress
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28
Q

shape of the interdental gingiva

A

PARABOLIC FORM with the interproximal tissue MORE CORONAL to the direct facial or lingual sufaces
“SCALLOPED” appearance

  • can be pyramidal or have a “col” shape
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29
Q

interproximal papilla shape?

A

knife edged when teeth in contact and should FILL ENTIRE GINGIVAL EMBRASURE COMPLETELY

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30
Q

col shaped or pyramidal shape of interdental gingiva?

A

pyramidal - more anterior teeth

col - more posterior shape and has a ‘valley’ like depression that connects the facial and lingual papilla which conforms to the shape of the interproximal contact - where it is more broad in the posterior

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31
Q

shape of ‘col’ depends on

A

gingiva in any interdental space is related to the CONTACT point b/w two interproximal surfaces

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32
Q

where is col most broad?

A

in a bucco-lingual direction in posterior teeth

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33
Q

is the col keratinized?

susceptible?

A

no not keratinized - so is more susceptible to noxious agents or trauma – so common site for initiation of periodontal pathologic breakdwon

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34
Q

what forms the col

A

fusion of interproximal junctional epithelia of two teeth

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35
Q

col if no contacts exists?

A

then the col does not exist and neither does the interdential papilla —> and the attached keritinized gingiva courses uninterrupted facio-lingually

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36
Q

describe alveolar mucosa

A
  • moveable, delicate and poorly bound down to bone
  • continous with vestibular mucosa and mucosa of floor of mouth and cheeks
  • more reddish
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37
Q

If gingiva is lost beyonf the mucogingival junction?

A

goes right to alveolar mucosa which is a BAD REPLACEMENT for the gingiva

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38
Q
compare attached gingiva to alveolar mucosa 'keratinization?
stippled?
rete pegs? 
lamina propria?
elastic fibers?
submucosa?
attachement?

THIS IS IMPORTANT

A

‘keratinization? ONLY attached

stippled? – only attached as alveolar is smooth unstippled

rete pegs? – wider/short/few in alveolar

lamina propria? – thick in attached

elastic fibers? - many in moveable vs few in attached

submucosa? - indistinct in attached and alveolar has distinct

attachement? non-moveable = attached vs moveable in alveolar

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39
Q

TWO cell layers in alveolar mucosa

A
  1. basal cell layer

2. stratum spinosum – ABOVE BASAL CELL layer

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40
Q

collagen in alveolar mucosa?

A

yes - but random arrangements

+ elastin and some muscle

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41
Q

cornoapical dimension of gingiva as ages?

A

tends to INCREASE with age

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42
Q

average thickness of attached gingiva?

relation to health?

A

1.41 mm (if went buccally into the tissue)

NO minimum thickness for health –> as long as oral hygiene habits are good

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43
Q

sulcus aka

A

DENTO-GINGIVAL SPACE

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44
Q

surfaces of sulcus and shape

A

tooth on one side anf the epithelial lining of the free gingival margin on the other

“V-shaped”

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45
Q

probing depth of clinically normal heathly sulcus?

crevice?

A

sulcus = 2-3 mm
(have seen 1.8mm to 6mm)

crevice = 0mm–> but only experiemntally

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46
Q

histological sulcus means

A

this is the term used for the gingival sulcus in the state of absolute clinical health

NEVER PROBE THE DEPTH OF THE HISTOLOGIC SULCUS

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47
Q

lateral boundary of the gingival sulcus

A

oral sulcular epithelium and enamel of tooth

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48
Q

coronal border of sulcular epithelium?

A

free gingival margin

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49
Q

apical /BASE aspect of sulcular epithelium?

A

coronal apect of the junctional epithelium

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50
Q

probe the histological sulcus?

A

NO - base is the coronal aspect of the JUNCTIONAL EPITHELIUM - and can be easily penetrated
- impossible to clinically identify the depth

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51
Q

histological sulcus vs. clinical sulcus

A

clinically - depth you prob from free gingival margin to the CEJ

histologically – depth to the coronal aspect of the junctional epithelium

52
Q

clinical sulcus

A

potential space that spans from the free gingival margin down to the CEJ

  • varies depending on probe, inflammation presnt, degree of force used with probe
53
Q

three subdivisions of gingival epithelium

A
  1. oral epithelium
  2. sulcular
  3. junctional
54
Q

oral epithelium extends from what to what?

A

from the mucogingival junction to the gingival margin – cotinuous with the LATERAL aspect of the sulcular epitelium

55
Q

junctional epithelium extends from what to what

A

forms the dentoepithelial junction apical to the sulcus and is continous with the sulcular epithelium

so its coronal end = apical end of sulcus

56
Q

oral epithelium compromised of?

A

free and attached gingiva that is keratinized stratified squamous with four classic strata

57
Q

4 levels of the oral epithelium

A

stratum cornium (outermost)

stratum granulosum

stratum spinosum

stratum basale / basal cell layer

58
Q

describe stratum basale

A

innermost layer

single layer of thick cuboidal cells attached to underlying connective tissue via the basement lamina

germinative element responsible for replacement

59
Q

stratum spinosum

A

WIDEST with several layers and is known as the “prickle- layer”

dominant cytoplasmic processes

rich in tonofilaments

desmesomes evident

diminished cellular activity - compared to basale

60
Q

stratum granulosum

A

above the spinosum –

several layers thich and has keratohyline – precursor to keratin

flattened appearance

diminished organelles and pykonotic nuclei

61
Q

stratum cornium

A

outermost layer – may or may not have a nuclei in the cells here

  • cells filled with keratin and are lost to oral cavity via desquamation
62
Q

major role of oral epithelium - how it does this

A

protection and resistance to mechanical injury - especially through the INTERCELLULAR JUNCTIONS
- mostly desmosomes in the corniied layer - outermost

also relatively impermeable due to the narrow intercellular spaces so lack of diffusion and barrier to foregin particles

63
Q

desmesomes vs hemidesmosomes

A

desmosomes = most common cell junction and consist of outer leaflet of cell membrane of two adjoining cells, - the thicker inner leaflets of the cell membrane and attachment plaques which are granular or fibrillar material in the cytosplams – more resistnat to inflammation

hemidesmosomes –> between the epithelial cells to basemement membranes AND TO TOOTH SURFACE (gingival epithelium to the tooth)

64
Q

keratinocytes mostly found where?

A

basal cell layer – formation of keratin – then up to stratum granulosum where the granules are contained

65
Q

epithelial cells in the basal cell layer

A
mostly keratinocytes (90%) 
then have inflammaotry cells, lymphocytes, melanocytes
66
Q

cytoplasmic filaments of epithelial cells that are in basal cell layer

A

tonofilaments

67
Q

describe melanocytes and function?
abundance?
location?
life cycle?

A

basal epithelial cells to melanocytes is 7:1

DO NOT MIGRATE UP but the basal epithelium cells will

PRODUCE MELANOSOME – which are packaged into keratinocytes as travel upwards

68
Q

level of pigementation is dependent on?

A

ACTIVITY LEVEL of the melanocytes because EVERYONE HAS SAME NUMBER OF MELANOCYTES – so it is not a funciton of number but a function of their activity

69
Q

merkel cells
where?
function?

A

in basal cell layer

function –> believed to act as touch-sensory cells and are NON-DENDRITIC which have sparse tonofilaments and associated more with nerve fibers

70
Q
langerhans cells 
where?
function?
describe
are they epithelial cells?
A

NOT EPITHELIAL CELLS
= derived from C.T and are suprabasalar and are DENDRITIC-SHAPED – so believed to be involved in uptake and processing of antigens
- immune surveillance system
- are processed by lymphocytes – so involved in cell-mediated immunity
- thought to be in first line of defense agaisnt surface penetration of host by antigens

71
Q

epithelial - connective tissue interaction/ connection?

A

RETE pegs

through underlying connective tissues of lamina propria

72
Q

rete pegs extend?

A

connective tissue – epithelium

papillary layer extending into depressions on the undersurface of the epithelium

lamina propria (baasement of epithelium)

73
Q

two parts of the basement membrane

A
  1. lamina lucida – adjacent to the epithelial cells - clear zone on microscopy – have fibrils that are anchoring to lamina densa – TYPE VII
  2. lamina densa– lies adjacent to the connective tissue and is an electron dense zone – afibrillar TYPE IV collagen
  • both are are derived from epithelium not connective tissue
  • have glycoproteins and mucopolysaccharides
74
Q

two purposes of the basement membrane

A
  1. protection from things coming up from underlying connective tissue
  2. attachment to the connective tissue via the
    - hemidesmosomes
    - connecting fibrils
    - chemical attachements between anions and cations (cations in connective tissue)
75
Q

where do you find type IV collagen

A

lamida densa in basement mebrane – which is afibrillar

76
Q

where do you find type VII collagen

A

anchoring fibrills from the undersurface of lamina densa into the lamina propria

77
Q

lamina lucida composed of?

A

laminin + other glycoproteins

78
Q

what layer does the sulcular epithelium lack?

A

stratum corneum

79
Q

general description of sulcular epithelium

A

STRATIFIED SQUAMOUS

NON -KERATINIZED or PARA

coronally –> border is the free gingival margin

apically –> base is the coronal portion of the junctional epithelium

80
Q

compare sulcular epithelium to oral and juncitonal

A

shares more with oral – good resistance to stresses and impermeable but fewer rete egs than oral and less/ no keratinization

compared to junctional – few transmigrating inflammatory cells in the sulcular

81
Q

3 facts of keritinization of the sulcular epithelium

A
  1. remove it away and it will keratinize – so if exposed to oral cavity it will keratinize (if you physiclaly remove it away)
  2. if you put the keratinized sulcular epithelium back – it will lose its keritinzation
  3. so it CAN BUT DOES NOT KERATINIZE because of inflammation caused by normal, everl present microorganisms in the flora

so remove the inflammation – will keratinize – but since impossible to remove all there is a constant turn over rate of sulcular epithelium - less time to differentiate or keratinize before they are lost

82
Q

histological inflammation refers to

A
  • subclinical inflammation the lack of keratinization of the sulcular epithelium
  • completely normal - but presence is because sulcular epithelium does not keratinize
83
Q

junctional epithelium - describe

A

STRATIFIED NON-KERATINIZED

  • surrounds the tooth like a collar
  • provides attachemtn mechanism of the epithelium to the surface of the tooth
  • limited protection for the PDL

tooth – junctional epithelium — gingival connective tissue

84
Q

intercellualr spaces in the junctional epithelium?

A

yes – spaces are wider than those in the oral epithelium

  • so LOWER DENSITY OF INTRACELLULAR JUNCTIONS / desmosomes present
  • approx. 1/3 junctions as seen in oral and sulcular epithelium
85
Q

permeability of junctional?

A

more permeable than the oral and sulcular so preferential route for the passge of bacterial products from sulcus into the C.T

86
Q

layers in junctional?

A

HAS BASALE
no stratum spinosum, granulosum, or corneum

  • all cells NOT IN BASALE – FOUND IN THE “SUPRABASAL CELL LAYER”
87
Q

2 basal laminas in the junctional epithelium

A

internal –> faces the tooth

external –> faces connective tissue

88
Q

does desquamination occur in junctional epithelium?

A

YES- occurs at its coronal end (bottom of the sulcular epithelium)

89
Q

proliferative cell layer in junctional epithelium?

A

in conteact with connective tissue so more associated with the external basal lamina

90
Q

T/F it is not uncommon to see marked distension of the intercellular spaces by PMN’s in junctional epithelium

A

TRUE
- also fluide exudate - gingival crevicular fluid from C.T also flows into sulcus through enlarged intercellular spaces present

91
Q

does C.T adjacent to junctional epithelium become infiltrated with chronic inflammatory cells?

A

YES - mostly lymphocytes and plasma cells becayse permeablity in junctional epithelium

92
Q

attachment apparatus

A

internal basal lamina and hemidesmosomes that connects junctional epithelium to the tooth surface

93
Q

Is attachment appratus synonymous with junctional epithelium

A

NO – JUNCTIONAL IS ENTIRE EPITHELIUM

attachemnt is just internal lamina to the tooth surface

94
Q

most coronal part of junctional epithelium

A

becomes connected as the ‘col’ near the interdental gingival margin

95
Q

sulcular fluid orginiates where?

A

in the gingival connective tissues – specifically from the blood vessels of the C.T

96
Q

can fluids seep out oral aspects of gingiva?

A

NO – because of the keritnization

97
Q

flow of sulcular fluid

A

gingival connective tissue –> through epithelium –> and out through the sulcus

98
Q

primary protein in sulcular fluid?

primary composition in normal conditions?

A

albumin = primary protein

but mostly amino acids, peptides, suagars, epithelial cells, and some inflamamtory cells (primary one is neutrophil)

99
Q

amounts of sulcular fluid and its implications?

A

normal human – smal amounts

absolute state of clinical health – no flow of fluid

so result of a subclinical or histological inflammation

100
Q

turnover in keratinized vs non-keratinized epithelium

A

keratinized = longer

101
Q

rate of turnover in oral epithelium?

A

normal/ health = 21 days

102
Q

rate of turnover in sulcular epithelium?

A

14 days

103
Q

rate of turnover in junctional epithelium? and describe movement

A

7 days

cells shed from here travel to the histologival sulcus and combine with cells desquamated there – then into orla cavity

104
Q

time it takes for chemical attachment to be restored b/w enamel and junctional epithelium should it be broken by like probing

A

5-20 days to reattach

105
Q

gingival TISSUE migration rate

A

6-8 weeks / .5-1mm a day

- if surgically excise gingiva - you will reformation of sulcus and juncitonal epithelium in 6-8 weeks

106
Q

timeline of restoration after gingival surgery?

A

6-8 weeks so we can safely pinpoint where gingiva will end up

107
Q

which width is altered when we have gingival attachment loss? must be maintained for proper gingival attachment?

A

distance between CEJ and bone whcih is approximately 1 mm

YES

108
Q

3 compositions of biological width

A
  1. non-attached sulcular space / gingival crevice
  2. epithelial attachment - 1mm dimension w/ the junctional epithelium
  3. connective tissue attachment
    1-2 mm with supra-crestal collagen fiber bundles
109
Q

describe gingival connective tissue

A

gingival fibers, ground substance, cells, including neural and vascular elements

  • PRINCIPLE FIBERS – dense collagenous matrix running in recognized fiber groups
  • LAMINA PROPRIA
  • GINGIVAL CORIUM
110
Q

Where do all the gingival fibers that attach into cementum attach?

A

in the 1mm of free cementum that exists between the CEJ and osseous crest of bone

111
Q

dentogingival fibers
location
function

A

location
attach to cementum then travel HORIZONTALLY AND CORONALLY and terminate in the free gingival margin area

function
- provide gingival support
112
Q

dentoperiosteal fibers
location
function

A

location
attach to cementum and run HORIZONTALLY THEN APICALLY and merge with the periosteum that covers the bone

function
- anchor tooth to bone and protect PDL
113
Q

alveologingival fibers
location
function

A

location
“fan” out CORNOALLY into the lamina propria from the periosteum at the alveolar crest

function
attach gingiva to bone
114
Q

transseptal fibers
location
function

A

location
INTERDENTAL fibers that go from MESIAL aspect of one tooth to the DISTAL aspect of the adjacent tooth and inserts into the CEMENTUM OF BOTH TEETH

function
maintain relationship between adjacent teeth and protect interproximal bone
115
Q

circumferential fibers
location
function

A

location
DO NOT ATTACH TO CEMENTUM AT ALL - they are present in the free gingival margin area and WRAP AROUND TOOTH circumferentially

function
maintain contour and position of the free gingival margin
116
Q

five primary gingival fibers

A
  1. dentogingival
  2. dentoperiosteal
  3. alveologingival
  4. transspetal
  5. circumferential
117
Q

secondary gingival fiber groups

A
  1. periostogingival
  2. interpapillary
  3. transgingival
  4. intercircular
  5. intergingival
  6. semicicular
118
Q

most fibers in gingival C.T.

A

typep I collagen

119
Q

ground substance of C.T?

A

occupies space between cells, fibers, and neurovascular elements – major components are water glycoproteins and proteoglycans

  • PERMITS DIFFUSION of biological substances between various structural elements
120
Q

principle cell type in gingival C.T? what else?

A

fibroblast - 65%
- responsible for production of ground substance and fibers - type 1 collagen is majority of fibers

2-10% are inflammatory cells - lymphocytes

121
Q

what do fibroblasts produce?

A

structural components of the C.T. like collagen, elastin, oxytalin plus GAGS

secrete MMPs (matrix-metalloproteinases) and the inhibitors (TIMPs) 
- homeostasis maintainance
122
Q

Gelatinase
MMP number
substrate

A

MMP-2, -9

denatures collagens

123
Q

Collagenases
MMP number
substrate

A

MMP-1, -8

collagen I,II,III,VII,VIII and X

124
Q

Stromelysins
MMP number
substrate

A

MMP number
-3, -10, 11
substrate
fibronectin, laminin, collagen IV, V, Ix, X, elastin

125
Q

Matrilysin
MMP number
substrate

A

MMP-7

fibronectin, laminin, and collagen IV

126
Q

theory of fibroblasts in gingival in bacteria present?

A

phenottypically distinct and functionally different subpopulatiouns of fibroblasts exist in periodontium - even if similar on LM or EM

  • different subsets have different roles in CT

cells in this theory ARE NOT DYSFUNCTIONAL DUE TO INJURY – but cells present in pathologically altered tissues are functioning as prescribed by genetic predispositions