MD Iii Ro 1
MD Iii Ro 1
MD Iii Ro 1
PARODONTOLOGIE
Dept de
PARIODONTOLOGIE
Sef de lucrari,
Solomon Sorina
MD,PhD
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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
MUCOASA
de
CAPTUSIRE
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MUCOSA ORALA
- este un tesut dens, rezistent, destinat sa reziste la
frictiunea si presiunea ce apar in timpul masticatiei
MUCOASA
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MUCOSA ORALA
Papila retroincisiva
Papila bunoida
Rafeu palatin
Rugile palatine
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LIMBA
este un grup de muschi flexibili atasati doar la
capatul posterior
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LIMBA
Fata ventrala a limbii captusita cu
mucoasa de acoperire
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LIMBA
Papile filiforme
Papile
fungiforme
Papile
circumvalate
Papile foliate
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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
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
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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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
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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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Anatomic exista:
gingia marginala (gingia libera)
gingia atasata
gingia interdentara (papila interdentara)
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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
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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
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Gingia
Vedere a palatului dur ilustrand
absenta jonctiunii mucogingivale
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Gingia
Gingia care ocupa spatiile interdentare coronar de
creasta alveolara este numita gingia interdentara
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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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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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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
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EPITELIUL GINGIVAL
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0.1m
EPITELIUL GINGIVAL
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ORAL EPITHELIUM
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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.
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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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
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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
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JUNCTIONAL EPITHELIUM
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JUNCTIONAL EPITHELIUM
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JUNCTIONAL EPITHELIUM
Segment of
junctional
epithelium (JE)
from an area just
apical to the
gingival sulcus.
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JUNCTIONAL EPITHELIUM
normal, uninflamed
junctional epithelium
(JE)
junctional
epithelium in
inflamed
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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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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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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
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gingival fibers
ground substance
cells
blood and lymphatic vessels
nerves
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gingival fibers
ground substance
cells
blood and lymphatic vessels
nerves
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.
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gingival fibers
ground substance
cells
blood and lymphatic vessels
nerves
collagen fibers
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gingival fibers
ground substance
cells
blood and lymphatic vessels
nerves
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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gingival fibers
ground substance
cells
blood and lymphatic vessels
nerves
The collagen fibers of the gingiva are subdivided into 8 principal fiber groups
(A) -dentogingival
fibers
(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 fibers,
ground substance
cells
blood and lymphatic vessels
nerves
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gingival fibers
ground substance
cells
blood and lymphatic vessels
nerves
Fibroblasts,
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
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gingival fibers
ground substance
cells
blood and lymphatic vessels
nerves
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gingival fibers
ground substance
cells
blood and lymphatic vessels
nerves
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Questions???
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