week 2 Flashcards
healthy gingiva
color:
contour:
consistency:
texture:
pale pink/salmon pink/coral pink
knife edged, scallop
firm
stippling
should gums bleed when you brush or floss?
no
macro-anatomy parts of the gingiva
marginal gingiva
attached gingiva
interdental papilla
what is the marginal gingiva in between?
the gingival sulcus ad marginal groove
what is the attached gingiva between?
the marginal groove and mucogingival junction
width of the attached gingiva
facial: greatest in the ______ region, narrower in the _______ region
linguals of mandible: greatest in _______; narrowest in the _______
incisor, posterior
molars, incisors
when will width of inadequate attached gingiva in childhood correct itself?
6-12 yrs
interdental papilla shape
anterior:
posterior:
pyramidal
col shaped
periodontal ligament space shape
shape depends on:
hour glass
- widest at apex and cervix, narrowest in middle
age and tooth function
if there is trauma to the tooth/periodontum, what happens to the PDL?
it can widen/change shape
PDL physical function
resistance to impact of occlusal force
transmission of occlusal force to bone
PDL formative and remodeling function
formation and resorption of bone and cementum
PDL nutritional function
via blood vessels; lymphatic drainage
PDL sensory function
transmitting tactile, pressure and pain
4 main functions of PDL
physical function
formative and remodeling function
nutritional function
sensory function
why is PDL important in implants?
the PDL is missing around implants
–>
what does the cementum cover?
the root surface
where do the fibers of the PDL attach?
to the cementum (Sharpey’s fiber)
is the cementum distinguishable on an X ray?
no
cementum is thickest at _______ and thinnest at ______
Apex
CEJ
what does the cementum do as a person ages?
thickens
What is Sharpey’s fiber?
Where the PDL attaches to cementum
what does the alveolar bone do?
Housing for the roots of the teeth
the alveolar process is part of the ______ and _________
maxilla
mandible
the morphology of the alveolar bone is ______ dependent
tooth
the shape of the alveoli (socket) follows the?
root
alveolar bone structure: 3 parts (inner to outer)
1) alveolar bone proper (lamina dura): cribriform plate
2) trabecular bone
3) compact bone
trabecular bone supports the:
alveolar bone proper
compact bone formed by:
haversian bone and bone lamellae
dehiscence vs fenestration
dehiscence:
- no bone from top to bottom
- will find deep pockets
- no bone –> gingival recession
fenestration:
- isolated bone loos, still see some bone on cervical
- more genetic
- won’t effect clinical outcome as much
- don’t usually find deep probing depth
where does the vascular supply come from for the maxilla? (4)
Anterior superior alveolar artery (incisors, canines)
posterior superior alveolar artery (premolar, molar)
infraorbital artery
greater palatine artery
where does the vascular supply come from for the mandible?
inferior alveolar artery and branches
vascular supply of the periodontum comes from what main artery?
maxillary artery
what is the pathway of blood supply to the periodontum once it reaches the alveolar artery?
alveolar artery –> dental artery –> intraseptal artery –> PDL vessels and supraperiosteal vessels
what lymph node is correlated with the lower incisors?
submental LN
what lymph node is correlated with the 3rd molars?
Jugulodigastric LN
what lymph node is correlated with the palatal gingiva?
the deep cervical LN
what does the trigeminal nerve sense?
pressure, touch, temperature, pain
proprioception from PDL
- tooth position, movement
- thickness between teeth in occlusion
what are the main cells in the gingival epithelium?
Keratinocytes
what do keratinocytes do?
produce tonofilaments
soft tissue renewal
majority of gingival epithelium is?
stratified squamous epithelium
what are the non-keratinocytes in the gingival epithelium?
langerhans cells
merkel cells
melanocyte
what do langerhans cell do?
antigen presenting cells
what do merkel cells do?
tactile preceptors
what do melanocytes do?
produce melanin/skin pigmentation
Epithelial Cell layers
ortho-K:
all 4 layers?
nuclei?
Para K:
all 4 layers?
nuclei?
Non K
all 4 layers?
nuclei? `
ortho k:
- all 4 layers, no nuclei seen in stratum corneum (keratinized layer)
Para K:
- nuclei found in stratum corneum
- missing stratum granulosum/granular layer
Non-K
- missing stratum corneum and stratum granulosum
layers of epithelium surface to deep
stratum corneum
stratum granulosum
stratum spinosum/prickle cell layer
stratum basale/basal cell layer
how does tissue renewal work in epithelial cells?
cells loose ability to divide
- -> produce increased protein
- -> loose organelle (for protein synthesis and energy production)
- -> cell degradation (degenerate into stratum corneum)
- -> cell sloughs away
epithelial turn over time
10 days
oral epithelium faces:
the oral cavity
oral epithelium extends from ______ to ______
gingival margin, MGJ
types of cells in the oral epithelium
keratinocytes (serves as a barrier)
3 types of gingival epithelium
oral
sulcular
junctional
sulcular epithelium extends from ______ into _______
oral epithelium
sulcus
sulcular epithelium does not have _______ or _______ layers
stratum corneum, granulosum
non keratinized!
junctional epithelium attaches _______ to _____
gingival epithelium, tooth
junctional epithelium important in ____ and ______
disease, health
in the junctional epithelium, there are less ______ between cells
adhesion
in the junctional epithelium, it allows ____ to pass
fluids
junctional epithelium is thin/thick
thin
Junctional Epithelium:
______ layers of basal lamina and what are they
what is the external basal lamina attached to?
what is the internal basal lamina attached to?
- what does it provide a barrier against?
2
external and internal basal lamina
external attached to connective tissue
internal attached to tooth
provides barrier against plaque and bacteria
the junctional epithelium is highly permeable, which gives access to: (3)
gingival fluid,
inflammatory cells
immunologic host defense
does the junctional epithelium renew a lot?
if so what is the turnover rate?
yes
4-6 days
oral epithelium:
location
length
keratinized?
outer layer, crest, marginal gingiva and attached gingiva
0.2-0.3mm
K or para K
sulcular epithelium
location:
length:
keratinized?
prone to infection?
gingival sulcus
0.5mm
thin non K
susceptible to infection
junctional epithelium
location:
length:
keratinized?
prone to infection?
attaches gingival epithelium to tooth (along tooth)
0.25-1.35mm
non K
defensive to bacteria
majority of connective tissue fibers are:
collagen fibers (60%) - type I and IV
other connective tissue fibers
elastic fiber
reticular fiber
what are the 2 layers of the connective tissue?
papillary layer: next to epithelium
reticular layer: next to periosteum of bone
what is the main cell type in connective tissue and what does it do
fibroblasts
- collagen synthesis and degradation regulation
besides connective tissue fibers and cells, what else makes up the connective tissue?
ground substance between fibers and cells
2 functions of the connective tissue interface
ensure sufficient adhesion
provide nutrition and waste disposal
- diffusion between epithelial layer and connective capillary loops within connective tissue projection
connective tissue is in between ______ and ______
epithelial layer
bone
2 layers of the epithelial connective junction
lamina lucida
lamina densa
2 layers of the epithelial connective junction
location of lamina lucida and lamina densa
lucida: immediately beneath basal cell membrane
densa: underneath lamina lucida
- connects to connective tissue
2 layers of the epithelial connective junction
lamina lucida is made of:
lamina densa is made of:
lucida: proteoglycan laminin
densa: type IV collagen
what is collagen made of?
protein with different amino acids
function of collagen
framework maintenance
maintain the tissue tone
collagen is synthesized by:
fibroblasts, chondroblasts, osteoblasts, odontoblasts, etc
what type of collagen is most common?
type I
gingiva-gingival fibers are a system of:
collagen fiber bundles
what type of collagen is the gingiva-gingival fibers made of?
type I
function of the gingiva-gingval fibers (3)
brace the marginal gingiva against the tooth
provide rigidity for masticatory force
unite the free gingiva margin with cementum and attached gingiva
PDL composition is made up of what types of collagen? what is the majority?
I and III
I is majority (80%)
what is in between the collagen fibers in the PDL? (4)
loose connective tissue
vessels
PDL cells
Nerve
what is the most common cellular element of the PDL and what does it do?
fibroblasts
- regulate collagen turnover
other types of cells in the PDL besides fibroblasts
cementoblasts
osteoblasts
epithelial rests of malassez
defense cells
cells associate with neurovascular elements
6 principle fibers of PDL
1) alveolar crest fibers
2) oblique fibers
3) transseptal fibers
4) horizontal fibers
5) interradicular fibers
6) apical fibers
which principle fiber of the PDL prevents tooth extrusion, resists lateral tooth movement
alveolar crest fibers
which PDL fiber bears and transforms the brunt of vertical masticatory stresses
oblique fibers
what PDL fiber is over the alveolar bone crest with no osseous attachment
transseptal fibers
what PDL fibers do NOT occur in incomplete formed roots
apical fibers
the cementum does not have _______ and there is only ________ (this is why it thickens with age)
vascularization
deposition
cementum composition Inorganic content (45-50%): Mainly \_\_\_\_\_\_\_\_\_
Organic content:
- Type __ collagen (90%)
- Type ___ collagen (5%)
- Non-collagenous component:
hydroxyapatite
I
III
proteoglycans, glycoproteins, phosphoproteins
Acellular/Primary cementum
location:
formed after or before the tooth reaches the occlusal plane?
more or less sharpey’s fibers, more or less calcified
cervical 1/3-1/2
before
more sharpey’s, more calcified
Cellular/Secondary cementum
location
formed after or before the tooth reaches the occlusal plane?
more or less sharpey’s fibers, more or less calcified
apical 2/3-1/2
after
less sharpey’s, less calcified
alveolar bone is ______, _______, and _______
alveolar bone is constantly _____-
mineralized, vascular, and innervated
remodeling
outer surface of bone
has ____ layers:
covered by:
inner layer contains what 2 cells?
outer layer contains what?
2, inner and outer layer
periosteum
inner layer contains osteoblasts and osteoprgogenitor cells
outer layer contains blood vessels, nerves, fibroblasts, and collagen
inner surface of bone
covered by:
single layer of _______
small amounts of ______-
endosteum
single layer of osteoblasts
connective tissue
bone composition organic vs inorganic amounts:
organic = 1/3
inorganic = 2/3
organic bone composition is mostly made of:
the noncollagenous proteins are:
collagen type I
osteocalcin
Osteonectin
Bone morphogenetic protein
Phosphoproteins
Proteoglycans
Osteoponin & bone sialoprotein:
cell-adhesive protein
inorganic bone composition
mainly the minerals _____ and _____ in the form of _______
cells are (3):
calcium
phosphate
hydroxyapatite crystals
osteoblasts
osteocytes
osteoclasts
bone vs cementum % inorganic
bone = 60%
cementum = 45-50%
bone vs cementum lamination
both are laminated
bone vs cementum remodeling
bone = remodeling
cementum = deposition only
bone vs cementum vascularization
bone = vascularization
cementum = non-vascularization
describe the process of bone remodeling
osteoblasts produce osteoid (soft type of bone)
–> calcifies to form real bone that contains osteocytes
–> after bone is triggered, osteoclasts take away bone
