Periodontal fiber

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Periodontal ligament
Periodontium.svg
The tissues of the periodontium combine to form an active, dynamic group of tissues. The alveolar bone (C) is surrounded for the most part by the subepithelial connective tissue of the gingiva, which in turn is covered by the various characteristic gingival epithelia. The cementum overlaying the tooth root is attached to the adjacent cortical surface of the alveolar bone by the alveolar crest (I), horizontal (J) and oblique (K) fibers of the periodontal ligament.
Details
Precursor Dental follicle
Identifiers
Latin fibra periodontalis
Acronym(s)PDL
MeSH D010513
TA2 1611
FMA 56665
Anatomical terminology

The periodontal ligament, commonly abbreviated as the PDL, are a group of specialized connective tissue fibers that essentially attach a tooth to the alveolar bone within which they sit. [1] It inserts into root cementum on one side and onto alveolar bone on the other.

Contents

Structure

The PDL consists of principal fibers, loose connective tissue, blast and clast cells, oxytalan fibers and cell rest of Malassez. [2]

Alveolodental ligament

The main principal fiber group is the alveolodental ligament, which consists of five fiber subgroups: alveolar crest, horizontal, oblique, apical, and interradicular on multirooted teeth. Principal fibers other than the alveolodental ligament are thetransseptal fibers.

All these fibers help the tooth withstand the naturally substantial compressive forces that occur during chewing and remain embedded in the bone. The ends of the principal fibers that are within either cementum or alveolar bone proper are considered Sharpey fibers.

Transseptal fibers

Transseptal fibers (H) extend interproximally over the alveolar bone crest and are embedded in the cementum of adjacent teeth; they form an interdental ligament. These fibers keep all the teeth aligned. These fibers may be considered as belonging to the gingival tissue because they do not have an osseous attachment. [3] .These fibers are consistent and are reconstructed even after the destruction of alveolar bone.

Loose connective tissue

Loose connective tissue contains fibers, extracellular matrix, cells, nerves and blood vessels. The extracellular compartment consists of Type 1, 3, and 5 collagen fibers bundles embedded in intercellular substance. The PDL collagen fibers are categorized according to their orientation and location along the tooth. The cells include fibroblast, defence cells and undifferentiated mesenchymal cells.

Cell rest of Malassez

These groups of epithelial cells become located in the mature PDL after the disintegration of Hertwig epithelial root sheath during the formation of the root. They form a plexus that surrounds the tooth. Cell rests of Malassez might proliferate during inflammation which may lead to radicular cyst formation in later life.

Oxytalan fibers

Oxytalan fibers are unique to the PDL and are elastic in nature. It inserts into cementum and runs in two directions: parallel to root surface and oblique to root surface. The function is thought to maintain the patency of blood vessels during occlusal loading. Further research is needed to determine the function of oxytalan fibers. [4]

Composition

The PDL substance has been estimated to be 70% water, which is thought to have a significant effect on the tooth's ability to withstand stress loads. The completeness and vitality of the PDL are essential for the functioning of the tooth.

The PDL ranges in width from 0.15 to 0.38mm with its thinnest part located in the middle third of the root. The width progressively decreases with age.

The PDL is a part of the periodontium that provides for the attachment of the teeth to the surrounding alveolar bone by way of the cementum.

The PDL appears as the periodontal space of 0.4 to 1.5 mm[ citation needed ] on radiographs, a radiolucent area between the radiopaque lamina dura of the alveolar bone proper and the radiopaque cementum.

Development

PDL cells are one of the many cells derived from the dental follicle and this occurs after crown formation is completed and when the roots start developing. These cells will remodel the dental follicle to form the PDL. [5] Formation of PDL will start at the cementoenamel junction and proceeds in an apical direction. [6]

Effects of mechanical forces

Movement of teeth is determined by two factors: deposition of bone on the tension side and resorption of the bone on the compression side of the periodontal ligament (PDL). During this movement, bone remodelling is initiated by the PDL in which forces are transmitted from the tooth to the alveolar bone. Fibroblasts of the PDL will react to mechanical stress, therefore affecting osteoblastogenesis and osteoclastogenesis of the cells. When mechanical stimuli are introduced to the cells, osteocytes in the PDL will differentiate into osteoclasts which will then reform and remodel the bone structure in the affected area. For example, orthodontic treatment involves application of a mechanical force on to the teeth to align them and this is done through this complex combination of physical and cellular processes. [7]

Function

Functions of PDL are supportive, sensory, nutritive, and remodelling. [8]

Support

The PDL is a part of the periodontium that provides for the attachment of the teeth to the surrounding alveolar bone by way of the cementum. PDL fibres also provide a role in load transfer between the teeth and alveolar bone. (PDL fibers absorb and transmit forces between teeth and alveolar bone. It acts as an effective support during the masticatory function.) [9]

Sensory

PDL is heavily innervated; it involves mechanoreception, nociception and reflexes. Periodontal mechanoreceptors are present in PDL. They will transmit information about the stimulated tooth, direction and amplitude of forces. [10]

Nutritive

It maintains the vitality of the surrounding cells. (PDL is heavily anastomosed). There are three principal sources of blood vessels which are apical vessels, perforating vessels and gingival vessels. Apical vessels originate from vessels that supply the pulp. Perforating vessels originate from lamina dura and the vessels perforate the socket wall (cribriform plate). Gingival vessels are derived from the gingival tissue. Outer layers of blood supply in PDL may help in mechanical suspension and support of the tooth while inner layers of blood vessels supply surrounding PDL tissues. [11]

Remodeling

There are progenitor cells in the periodontal ligament that can differentiate into osteoblasts for the physiological maintenance of alveolar bone and, most likely, for its repair as well.

Clinical significance

Injury

Disease

Effect of tobacco smoking and nicotine

There is a relationship between smoking tobacco and periodontal disease, wound healing and oral cancers. [15]

Nicotine, the major pharmacologically active ingredient in tobacco smoke, lessens a host's ability to defend against bacterial invasion induced by plaque.[ citation needed ] It is also the ingredient responsible for addiction. [16]

Tobacco smoking impairs phagocytic and chemotactic activities of leukocytes [17] and impedes wound healing, [18] specifically by affecting gingival blood flow. [19] [20]

Cigarette smokers are more likely to experience destruction of the alveolar bone and periodontal ligament and are at a higher risk of developing periodontal disease. [21] [22]

Nicotine and lipopolysaccharides synergistically induce the production of nitric oxide (NO) and PGE2, and increase inducible nitric oxide synthase (iNOS) and COX-2 expression in human periodontal ligament (hPDL) cells.[ citation needed ]

At the cellular level, nicotine reduces the proliferation of red blood cells, macrophages, and fibroblasts and increases platelet adhesiveness.[ citation needed ]

Macroscopically, this affects healing and tissue perfusion due to micro clot formation in the blood vessels. [23] [24] Nicotine also has a sympathomimetic action, stimulating epinephrine and norepinephrine release, which causes vasoconstriction and limits tissue perfusion. Nicotine jeopardises bone formation by inhibiting neovascularization and osteoblastic differentiation. [25] [26] [27] [28] [29]

Ankylosis

Ankylosis is a condition where the cementum of the tooth's root fuses with the bone that is around the tooth. The osseous tissue replaces the periodontal ligament which causes the tooth to be fixed and cannot undergo eruptive change. Ankylosis usually occurs in primary molars; however, it can also take place in other primary teeth, as well as secondary dentition. Ankylosis is common in the anterior tooth after trauma and can be referred to as replacement resorption. In this process PDL cells are destroyed and as a result the cells of the alveolar bone will perform most of the healing. Radiographic examination of a patient with ankylosis may also reveal a loss of the PDL and bony bridging.[ citation needed ]

Effect of nutrition

Nutritional status of an individual can be a crucial factor in the progression and healing of periodontal tissues. The relationship between oral health and systemic health has become an increasingly important subject. Studies have suggested that vitamins D and C in particular have a certain grade of relationship with periodontal health. However, it is important to note that supplementation of vitamins is not enough to reverse the periodontium to a healthy state and that further research is needed to confirm theories.[ citation needed ]

For example, scurvy is a disease resulting from a severe deficiency of vitamin C (ascorbic acid). Vitamin C is essential for the synthesis of collagen fibers.[ citation needed ]

See also

Related Research Articles

<span class="mw-page-title-main">Human tooth</span> Calcified whitish structure in humans mouths used to break down food

Human teeth function to mechanically break down items of food by cutting and crushing them in preparation for swallowing and digesting. As such, they are considered part of the human digestive system. Humans have four types of teeth: incisors, canines, premolars, and molars, which each have a specific function. The incisors cut the food, the canines tear the food and the molars and premolars crush the food. The roots of teeth are embedded in the maxilla or the mandible and are covered by gums. Teeth are made of multiple tissues of varying density and hardness.

<span class="mw-page-title-main">Periodontal disease</span> Medical condition

Periodontal disease, also known as gum disease, is a set of inflammatory conditions affecting the tissues surrounding the teeth. In its early stage, called gingivitis, the gums become swollen and red and may bleed. It is considered the main cause of tooth loss for adults worldwide. In its more serious form, called periodontitis, the gums can pull away from the tooth, bone can be lost, and the teeth may loosen or fall out. Halitosis may also occur.

<span class="mw-page-title-main">Cementum</span> Specialized calcified substance covering the root of a tooth

Cementum is a specialized calcified substance covering the root of a tooth. The cementum is the part of the periodontium that attaches the teeth to the alveolar bone by anchoring the periodontal ligament.

<span class="mw-page-title-main">Periodontium</span>

The periodontium is the specialized tissues that both surround and support the teeth, maintaining them in the maxillary and mandibular bones. The word comes from the Greek terms περί peri-, meaning "around" and -odont, meaning "tooth". Literally taken, it means that which is "around the tooth". Periodontics is the dental specialty that relates specifically to the care and maintenance of these tissues. It provides the support necessary to maintain teeth in function. It consists of four principal components, namely:

<span class="mw-page-title-main">Human tooth development</span> Process by which teeth form

Tooth development or odontogenesis is the complex process by which teeth form from embryonic cells, grow, and erupt into the mouth. For human teeth to have a healthy oral environment, all parts of the tooth must develop during appropriate stages of fetal development. Primary (baby) teeth start to form between the sixth and eighth week of prenatal development, and permanent teeth begin to form in the twentieth week. If teeth do not start to develop at or near these times, they will not develop at all, resulting in hypodontia or anodontia.

Periodontology or periodontics is the specialty of dentistry that studies supporting structures of teeth, as well as diseases and conditions that affect them. The supporting tissues are known as the periodontium, which includes the gingiva (gums), alveolar bone, cementum, and the periodontal ligament. A periodontist is a dentist that specializes in the prevention, diagnosis and treatment of periodontal disease and in the placement of dental implants.

<span class="mw-page-title-main">Dental follicle</span> Anatomical entity

The dental follicle, also known as dental sac, is made up of mesenchymal cells and fibres surrounding the enamel organ and dental papilla of a developing tooth. It is a vascular fibrous sac containing the developing tooth and its odontogenic organ. The dental follicle (DF) differentiates into the periodontal ligament. In addition, it may be the precursor of other cells of the periodontium, including osteoblasts, cementoblasts and fibroblasts. They develop into the alveolar bone, the cementum with Sharpey's fibers and the periodontal ligament fibers respectively. Similar to dental papilla, the dental follicle provides nutrition to the enamel organ and dental papilla and also have an extremely rich blood supply.

<span class="mw-page-title-main">Alveolar process</span> Bulge on jaws holding teeth

The alveolar process is the portion of bone containing the tooth sockets on the jaw bones. The alveolar process is covered by gums within the mouth, terminating roughly along the line of the mandibular canal. Partially comprising compact bone, it is penetrated by many small openings for blood vessels and connective fibres.

Cementogenesis is the formation of cementum, one of the three mineralized substances of a tooth. Cementum covers the roots of teeth and serves to anchor gingival and periodontal fibers of the periodontal ligament by the fibers to the alveolar bone.

<span class="mw-page-title-main">Gingival sulcus</span> Space between tooth and gums

The gingival sulcus is an area of potential space between a tooth and the surrounding gingival tissue and is lined by sulcular epithelium. The depth of the sulcus is bounded by two entities: apically by the gingival fibers of the connective tissue attachment and coronally by the free gingival margin. A healthy sulcular depth is three millimeters or less, which is readily self-cleansable with a properly used toothbrush or the supplemental use of other oral hygiene aids.

<span class="mw-page-title-main">Gingival and periodontal pocket</span>

Gingival and periodontal pockets are dental terms indicating the presence of an abnormal depth of the gingival sulcus near the point at which the gingival tissue contacts the tooth.

<span class="mw-page-title-main">Scaling and root planing</span> Dental procedure

Scaling and root planing, also known as conventional periodontal therapy, non-surgical periodontal therapy or deep cleaning, is a procedure involving removal of dental plaque and calculus and then smoothing, or planing, of the (exposed) surfaces of the roots, removing cementum or dentine that is impregnated with calculus, toxins, or microorganisms, the agents that cause inflammation. It is a part of non-surgical periodontal therapy. This helps to establish a periodontium that is in remission of periodontal disease. Periodontal scalers and periodontal curettes are some of the tools involved.

<span class="mw-page-title-main">Tooth resorption</span> Medical condition

Resorption of the root of the tooth, or root resorption, is the progressive loss of dentin and cementum by the action of odontoclasts. Root resorption is a normal physiological process that occurs in the exfoliation of the primary dentition. However, pathological root resorption occurs in the permanent or secondary dentition and sometimes in the primary dentition.

<span class="mw-page-title-main">Debridement (dental)</span> Removal of plaque and calculus from teeth

In dentistry, debridement refers to the removal by dental cleaning of accumulations of plaque and calculus (tartar) in order to maintain dental health. Debridement may be performed using ultrasonic instruments, which fracture the calculus, thereby facilitating its removal, as well as hand tools, including periodontal scaler and curettes, or through the use of chemicals such as hydrogen peroxide.

In dentistry, enamel matrix derivative (EMD) is an extract of porcine fetal tooth material used to biomimetically stimulate the soft and hard tissues surrounding teeth to regrow following tissue destruction.

<span class="mw-page-title-main">Dental avulsion</span> Medical condition

Dental avulsion is the complete displacement of a tooth from its socket in alveolar bone owing to trauma, such as can be caused by a fall, road traffic accident, assault, sports, or occupational injury. Typically, a tooth is held in place by the periodontal ligament, which becomes torn when the tooth is knocked out.

Clinical attachment loss (CAL) is the predominant clinical manifestation and determinant of periodontal disease.

Tooth ankylosis refers to a fusion between a tooth and underlying bony support tissues. In some species, this is a normal process that occurs during the formation or maintenance of the dentition. By contrast, in humans tooth ankylosis is pathological, whereby a fusion between alveolar bone and the cementum of a tooth occurs.

Tooth replantation is a form of restorative dentistry in which an avulsed or luxated tooth is reinserted and secured into its socket through a combination of dental procedures. The purposes of tooth replantation is to resolve tooth loss and preserve the natural landscape of the teeth. Whilst variations of the procedure exist including, Allotransplantation, where a tooth is transferred from one individual to another individual of the same species. It is a largely defunct practice due to the improvements made within the field of dentistry and due to the risks and complications involved including the transmission of diseases such as syphilis, histocompatibility, as well as the low success rate of the procedure, has resulted in its practice being largely abandoned. Autotransplantation, otherwise known as intentional replantation in dentistry, is defined as the surgical movement of a tooth from one site on an individual to another location in the same individual. While rare, modern dentistry uses replantation as a form of proactive care to prevent future complications and protect the natural dentition in cases where root canal and surgical endodontic treatments are problematic. In the modern context, tooth replantation most often refers to reattachment of an avulsed or luxated permanent tooth into its original socket.

References

  1. ↑ Wolf HF, Rateitschak KH (2005). Periodontology. Thieme. pp. 12–. ISBN   978-0-86577-902-0 . Retrieved June 21, 2011.
  2. ↑ Listgarten MA. ". Principal fibers of the periodontal ligament". University of Pennsylvania and Temple University. Archived from the original on June 20, 2012. It is the different composition of collagens which give various ECM functions and abilities. There is a mixture of thick and thin fibres in the PDL. It is important to note that, in reality, the fibres are not as defined as these classifications.
  3. ↑ Naci A (2013). Ten Cate's Oral Histology. Elsevier. p. 274. ISBN   978-0-323-07846-7.
  4. ↑ Strydom H, Maltha JC, Kuijpers-Jagtman AM, Von den Hoff JW (August 2012). "The oxytalan fibre network in the periodontium and its possible mechanical function". Archives of Oral Biology. 57 (8): 1003–11. doi:10.1016/j.archoralbio.2012.06.003. PMID   22784380.
  5. 1 2 3 4 Yao S, Pan F, Prpic V, Wise GE (August 2008). "Differentiation of stem cells in the dental follicle". Journal of Dental Research. 87 (8): 767–71. doi:10.1177/154405910808700801. PMC   2553250 . PMID   18650550.
  6. ↑ de Jong T, Bakker AD, Everts V, Smit TH (December 2017). "The intricate anatomy of the periodontal ligament and its development: Lessons for periodontal regeneration". Journal of Periodontal Research. 52 (6): 965–974. doi:10.1111/jre.12477. PMID   28635007. S2CID   38159994.
  7. ↑ Li M, Zhang C, Yang Y (January 2019). "Effects of mechanical forces on osteogenesis and osteoclastogenesis in human periodontal ligament fibroblasts: A systematic review of in vitro studies". Bone & Joint Research. 8 (1): 19–31. doi:10.1302/2046-3758.81.BJR-2018-0060.R1. PMC   6359886 . PMID   30800296.
  8. ↑ Listgarten MA. "Periodontal ligament". University of Pennsylvania and Temple University. Archived from the original on June 16, 2010.
  9. ↑ McCormack SW, Witzel U, Watson PJ, Fagan MJ, Gröning F (2014). "The biomechanical function of periodontal ligament fibres in orthodontic tooth movement". PLOS ONE. 9 (7): e102387. Bibcode:2014PLoSO...9j2387M. doi: 10.1371/journal.pone.0102387 . PMC   4103804 . PMID   25036099.
  10. ↑ Trulsson M (April 2006). "Sensory-motor function of human periodontal mechanoreceptors". Journal of Oral Rehabilitation. 33 (4): 262–73. doi: 10.1111/j.1365-2842.2006.01629.x . PMID   16629881.
  11. ↑ Institute of Anatomy, University of Veterinary Medicine Hannover, Bischofsholer Damm 15, D-30173 Hannover, Germany
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  13. ↑ Layug ML, Barrett EJ, Kenny DJ (May 1998). "Interim storage of avulsed permanent teeth". Journal. 64 (5): 357–63, 365–9. PMID   9648418.
  14. ↑ Kim JH, Koo KT, Capetillo J, Kim JJ, Yoo JM, Ben Amara H, et al. (June 2017). "Periodontal and endodontic pathology delays extraction socket healing in a canine model". Journal of Periodontal & Implant Science. 47 (3): 143–153. doi:10.5051/jpis.2017.47.3.143. PMC   5494309 . PMID   28680710.
  15. ↑ World Health Organization Monograph on Tobacco Cessation and Oral Health Integration, Geneva (2017)
  16. ↑ Whiteford L (December 2003). "Nicotine, CO and HCN: the detrimental effects of smoking on wound healing". British Journal of Community Nursing. 8 (12): S22-6. doi:10.12968/bjcn.2003.8.sup6.12554. PMID   14700008.
  17. ↑ Tomar SL, Asma S (May 2000). "Smoking-attributable periodontitis in the United States: findings from NHANES III. National Health and Nutrition Examination Survey". Journal of Periodontology. 71 (5): 743–51. doi:10.1902/jop.2000.71.5.743. PMID   10872955.
  18. ↑ Genco RJ, Borgnakke WS (June 2013). "Risk factors for periodontal disease". Periodontology 2000. 62 (1): 59–94. doi:10.1111/j.1600-0757.2012.00457.x. PMID   23574464.
  19. ↑ Leite FR, Nascimento GG, Scheutz F, López R (June 2018). "Effect of Smoking on Periodontitis: A Systematic Review and Meta-regression". American Journal of Preventive Medicine. 54 (6): 831–841. doi:10.1016/j.amepre.2018.02.014. PMID   29656920. S2CID   4893172.
  20. ↑ Qandil R, Sandhu HS, Matthews DC (March 1997). "Tobacco smoking and periodontal diseases". Journal (Canadian Dental Association). 63 (3): 187–92, 194–5. PMID   9086680.
  21. ↑ Morozumi T, Kubota T, Sato T, Okuda K, Yoshie H (April 2004). "Smoking cessation increases gingival blood flow and gingival crevicular fluid". Journal of Clinical Periodontology. 31 (4): 267–72. doi:10.1111/j.1600-051x.2004.00476.x. PMID   15016254.
  22. ↑ Johnson GK, Todd GL, Johnson WT, Fung YK, Dubois LM (May 1991). "Effects of topical and systemic nicotine on gingival blood flow in dogs". Journal of Dental Research. 70 (5): 906–9. doi:10.1177/00220345910700050801. PMID   2022772. S2CID   28627546.
  23. ↑ Ciftçi O, Günday M, Calişkan M, Güllü H, Güven A, Müderrisoğlu H (June 2013). "Light cigarette smoking and vascular function". Acta Cardiologica. 68 (3): 255–61. doi:10.1080/ac.68.3.2983419. PMID   23882870. S2CID   42726406.
  24. ↑ Tomar SL, Asma S (May 2000). "Smoking-attributable periodontitis in the United States: findings from NHANES III. National Health and Nutrition Examination Survey". Journal of Periodontology. 71 (5): 743–51. doi:10.1902/jop.2000.71.5.743. PMID   10872955.
  25. ↑ Pi SH, Jeong GS, Oh HW, Kim YS, Pae HO, Chung HT, et al. (April 2010). "Heme oxygenase-1 mediates nicotine- and lipopolysaccharide-induced expression of cyclooxygenase-2 and inducible nitric oxide synthase in human periodontal ligament cells". Journal of Periodontal Research. 45 (2): 177–83. doi:10.1111/j.1600-0765.2009.01215.x. PMID   20470258.
  26. ↑ Jones JK, Triplett RG (March 1992). "The relationship of cigarette smoking to impaired intraoral wound healing: a review of evidence and implications for patient care". Journal of Oral and Maxillofacial Surgery. 50 (3): 237–9, discussion 239–40. doi:10.1016/0278-2391(92)90318-t. PMID   1542066.
  27. ↑ Saito Y, Sato S, Oginuma T, Saito Y, Arai Y, Ito K (May 2013). "Effects of nicotine on guided bone augmentation in rat calvarium". Clinical Oral Implants Research. 24 (5): 531–5. doi:10.1111/j.1600-0501.2011.02416.x. PMID   22276738.
  28. ↑ Donigan JA, Fredericks DC, Nepola JV, Smucker JD (December 2012). "The effect of transdermal nicotine on fracture healing in a rabbit model". Journal of Orthopaedic Trauma. 26 (12): 724–7. doi:10.1097/bot.0b013e318270466f. PMID   22955337. S2CID   29873064.
  29. ↑ Glowacki J, Schulten AJ, Perrott D, Kaban LB (February 2008). "Nicotine impairs distraction osteogenesis in the rat mandible". International Journal of Oral and Maxillofacial Surgery. 37 (2): 156–61. doi:10.1016/j.ijom.2007.08.001. PMID   17983728.
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