Term
| What are the tissues surrounding and supporting the tooth |
|
Definition
|
|
Term
| What are the subdivisions of the periodontium |
|
Definition
Gingival unit (gingiva and alveolar mucosa)
attachment apparatus (alveolar bone proper, PDL, cementum) |
|
|
Term
| What supports and maintains crown and root of the tooth? |
|
Definition
|
|
Term
| What "protects" the gingival unit? |
|
Definition
| tooth contours and contacts |
|
|
Term
| What "pro-tects" underlying attachment apparatus? |
|
Definition
|
|
Term
| What is alveolar process formation and maintenance dependent on? |
|
Definition
| the root and the forces transmitted via root to the bone of the alveolar process (when tooth is missing, loss of bone from lack of force- maybe place implant) |
|
|
Term
What part of the mandibular bone lines the inside of the tooth socket?
What part lines the jaw?
What part is in between the 2 above bones? |
|
Definition
alveolar bone proper
cortical plate
cancellous bone (lattice-like or spongy) |
|
|
Term
What part of the mandible contains the root of the tooth apical-coronally?
What part of the mandible is apical to the root? |
|
Definition
alveolar process
basal bone or body of the mandible |
|
|
Term
| *When a patient loses all of their teeth what part of the bone do they lose? |
|
Definition
| alveolar process (Not the basal bone) |
|
|
Term
| What does the cancellous (spongy) bone contain of? |
|
Definition
Trabeculae (lattice of bony spicules)
Marrow |
|
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Term
Is there more trabeculae bone is the maxilla or mandible?
Is there more trabeculae in the anterior or posterior of the jaw?
What does this relate to? |
|
Definition
maxilla
posterior
retention of teeth and placement of implants |
|
|
Term
What is the alveolar bone proper also known as? (because of many perforated holes)
what is it known as on an xray? |
|
Definition
cribiform plate
lamina dura |
|
|
Term
| *What makes up the 2 parts of the supporting alveolar bone? |
|
Definition
cortical plate
spongy or cancellous bone |
|
|
Term
| *What is the part in which the PDL inserts? |
|
Definition
| Alveolar bone proper (NOT supporting alveolar bone) |
|
|
Term
| Where do vessels and nerves run through in the mandible? |
|
Definition
|
|
Term
| What is the coating around the bone that contains neurovascular bundles, arterial blood supply,nerves, and blood to reach the bone |
|
Definition
|
|
Term
| Supporting bone may be absent or thin on certain aspects of (anterior or posterior teeth)? |
|
Definition
|
|
Term
| supporting bone thickens posteriorly, especially on the palatal and on the facial of which teeth? |
|
Definition
|
|
Term
| Supporting bone may be thin on the (facial or palatal/lingual) of canines and on the (DB, MB, DL, ML) root of maxillary molars? |
|
Definition
| The bone may be thin on the FACIAL of the canine and on MB root of maxillary molars |
|
|
Term
What is a gaping, "open" of teeth through the cortical plates?
What is window or "tear'; narrow isthmus of bone? |
|
Definition
|
|
Term
Where are dehiscences most often found?
Where are fenestrations most often found?
Where do dehiscences and fenestrations occur most often?
What maxillary tooth? |
|
Definition
mandible
maxilla
mandibular anterior teeth
max 1st molar (MB root) |
|
|
Term
| What is the only way you can describe the lamina dura? |
|
Definition
| radiopaque on a radiograph |
|
|
Term
| What does the presence of the lamina dura indicate? |
|
Definition
| represents alveolar bone proper or cribiform plate (periodontal stability) |
|
|
Term
| What are the openings in the alveolar bone proper/cribiform plate that allow vessels and nerves to enter and exit? |
|
Definition
|
|
Term
| What are the several kinds (3) of marrow in the spongy (medullary or cancellous) bone? |
|
Definition
1. Hematopoetic (blood forming-RBC and WBC)
2. Fatty (in most adult bones
3. Fibrous |
|
|
Term
| What is the major type of bone marrow in children? |
|
Definition
|
|
Term
| Where is hematopoietic bone marrow in adults? |
|
Definition
| sternum, iliac crest, and posterior parts of the jaw such as maxillary tuberosity and angle of mandible |
|
|
Term
| What is the bone marrow in most adult bones? |
|
Definition
|
|
Term
| Which bone marrow can be result of a disease? |
|
Definition
| fibrous (fatty may change to fibrous) |
|
|
Term
| What is the space called that is occupied by the junctional epithelium and gingival fibers (1-2 mm area between CEJs and crest of bone) |
|
Definition
| biological space or width (always want to leave this space alone when making a crown) |
|
|
Term
| The M-D profile of the bone is flatter (less scalloped) in the (anterior or posterior) regions? |
|
Definition
| posterior (more scalloped anteriorly) |
|
|
Term
| *In health, the scalloped profiles of the following 3 structures parallel: |
|
Definition
1. gingival margin
2. crest of alveolar bone
3. CEJ |
|
|
Term
| The healthy _______ is at the level of the CEJs and the ______ is 1-2 mm apical to the CEJs. |
|
Definition
gingival margin
bony crest |
|
|
Term
*What structures occupy the biological space?
What is their function? |
|
Definition
1. Junctional epithelium (epithelial attachment)
2. Gingival fiber groups (connective tissue)
Fastens gingiva to root and bone |
|
|
Term
Do clinician prefer (more or less) medullary bone in between adjacent teeth (i.e. interdental spacing)?
Why? |
|
Definition
| more medullary bone because of its increased cellularity and vascularity that is important in defense mechanisms and resistance to physical trauma |
|
|
Term
| What is the three-part blood supply to gingiva and attachment apparatus? |
|
Definition
1. Supraperiosteal artery
2. Artery of PDL - small branches
2. Interdental (Interproximal, Intraseptal, Septal) Artery - main blood supply |
|
|
Term
| What is the artery between the roots of multi-rooted teeth and is analoous to the interdental artery? |
|
Definition
|
|
Term
| What is the union/junction of the interdental arter, supraperiosteal artery, and artery to the PDL? |
|
Definition
|
|
Term
| Infectious process invades along connective tissue around ________ |
|
Definition
|
|
Term
| What influences the type of bony defect produced? |
|
Definition
| the bulk or amount of the bone (can become horizontal, vertical or crater-like bone defect when interdental bone is bulky) |
|
|
Term
|
Definition
| deposits of calcium hydroxyapatite and other mineral salts in an extracellular get matrix (also has collagen fibers) |
|
|
Term
What cell produce bone (apposition)
What cell remove bone (resorption) |
|
Definition
|
|
Term
| what are the 3 important factors to changes in alveolar bone? |
|
Definition
1. age
2. infections/disease
3. forces or function on or transmitted to the bone via teeth or directly |
|
|
Term
What is different in sites of disuse atrophy?
Can you see it externally? |
|
Definition
sparse trabeculae and narrow sparse PDL fibers
would not appear different grossly because atrophic changes are deep to the mucosa and cortical bone |
|
|
Term
| Describe the difference of PDL fibers and bone on the tension (apposition) side vs the pressure (resorption) side |
|
Definition
tension side- PDL fibers are more dense and defined. The bone is more dense is being deposited in surface layers
pressure side-PDL is dissolved and bone is removed by osteoclasts |
|
|
Term
| On the pressure side, after initial frontal resorption and hyalinization, can further bone resorption occur if there are no cells present? |
|
Definition
| No- tooth movement ceases until this area of the PDL is repopulated by new cells and bone is removed by osteoclasts from the endosteal surfaces of the marrow spaces (undermining or internal or rear resorption) -->tooth movement can now begin again |
|
|
Term
| What are the functions of the attachment apparatus? |
|
Definition
-Supportive (suspensory fibers hold tooth in place, hydraulic system allow vascular and tissue fluids to flow through)
-formative and homeostatic (Blast and clast cells, undifferentiated mesenchymal cells/stem cells (as needed))
-Nutritive (Three- Part Collateral (back up) Vasculature = neuromuscular bundles)
-Sensory (Tactile, pain, pressure, proprioception = know how hard you're biting or how teeth come back together) |
|
|
Term
| The tooth begins as a down-growth of __________, incorporating the _________ which becomes the dental papilla, from which the pulp and dentin come. |
|
Definition
oral epithelium
ectomesenchyme |
|
|
Term
| The attachment apparatus basically develops from the surrounding condensed ectomesenchyme called the __________. |
|
Definition
|
|
Term
| Formation and maintenance of the alveolar process is dependent on the development and continued presence of the ______. |
|
Definition
|
|
Term
| When does root formation begin? |
|
Definition
| as enamel and dentin formation reaches the future CEJ |
|
|
Term
| The inner dental epithelium (IDE) and the outer dental epithelium (ODE) grow apically ____________. |
|
Definition
| Hertwig’s epithelial root sheath (HERS) |
|
|
Term
| HERS guides the form of the root and, at the end of this task, breaks into cluster of cells called the _____________. |
|
Definition
| epithelial cell rests of Malassez |
|
|
Term
| _________ initiates dentin formation and molds the shape of the root. |
|
Definition
| Hertwig’s epithelial root sheath (HERS) |
|
|
Term
What does HERS disintegrates into?
This allows connective tissue cells of PDL to contact dentin and become ___________. |
|
Definition
cell rests of Malassez
cementoblasts |
|
|
Term
| What are the cementoblasts that get trapped in the cementum known as? |
|
Definition
|
|
Term
True or false:
Cementum can be slowly formed throughout life |
|
Definition
True
although not as actively as bone is produced |
|
|
Term
| Cementum is a mineralized connective tissue so is composed of? (4) |
|
Definition
(1) Fibers
(2) Cells-relatively few to none
(3) Intercellular matrix–some
(4)Minerals |
|
|
Term
| What is the main fiber in cementum? |
|
Definition
|
|
Term
| What are the fibers in cementum classed as? (2) |
|
Definition
(a)Matrix or Intrinsic-totally inside the cementum, running parallel to long axis of root
(b)Extrinsic–Run from PDL to enter perpendicularly into the cementum. The |
|
|
Term
| The mineralized ends of fibers of the PDL inside cementum and bone that provide anchorage of structures to bone and cementum are commonly called ____________. |
|
Definition
|
|
Term
| _____% of cementum is mineral. |
|
Definition
|
|
Term
| What are the main mineral in cementum? |
|
Definition
| Most is calcium and phosphoruswith some fluoride and other trace minerals |
|
|
Term
True or false:
Cementum exposed to saliva is going to have lower levels of fluoride than cementum that is still within the bone and gingival unit. |
|
Definition
False
Cementum exposed to saliva (especially if it has been exposed to fluoridated water or toothpaste, is going to have higher levels of fluoride than cementum that is still within the bone and gingival unit) |
|
|
Term
| What is the substance in between the collagen fibers into which the minerals are deposited in cementum? |
|
Definition
| Intercellular matrix or ground substance |
|
|
Term
What are the two classes of cementum based on cellular content?
Which one is greater and at which specific location? |
|
Definition
a. acellular cementum
b. cellular cementum
cellular cementum is much greater in amounts than the acellular type and is quite thick at the apex due to attrition |
|
|
Term
| What class of cementum is usually found as a thin layer on the outer surface. Usually is the only type of cementum at the CEJ or instrumentation area |
|
Definition
|
|
Term
| What class of cementum is it when cells (cementoblasts) are trapped in forming cementum and become the cells of cementum (cementocytes). |
|
Definition
|
|
Term
| Is acellular or cellular cementum at the CEJ? |
|
Definition
Acellular cementum covers dentin thinly (20-50 ùm –thickness of a hair) at the CEJ and often extents to the apex as a thicker layer.
Cellular cementumusually is on the surface of acellular cementum, except at the CEJ, and thickens greatly (250-400ùm)at the apex |
|
|
Term
| The cementocyteslie in depressions called _______. |
|
Definition
|
|
Term
| Cementum varies as to _________, _________, and _________. |
|
Definition
|
|
Term
| How do cementocytes in the cementum get their nutrients? |
|
Definition
| the cementocytes have cellular processes(red arrow) that radiate, in canals, toward the PDL, which (unlike cementum) has a blood supply from which nutrients diffuse into cementum. |
|
|
Term
True or False:
The PDL, like the cementum, has a blood supply from which nutrients diffuse into cementum. |
|
Definition
False
cementum is avascular and depends on diffusion of nutrients from the vessels of the PDL |
|
|
Term
| What indicates rest periods in the formation of cementum? |
|
Definition
|
|
Term
| As the cementum layers advance, the collagen fibers of the PDL are mineralized and incorporated into newly formed cementum as its __________. |
|
Definition
| extrinsic fibers (runs perpendicular) |
|
|
Term
| The ____________ fibers run longitudinally with the long axis of the root and are embedded in the mineralized cemental matrix |
|
Definition
|
|
Term
What percent of people have a space between enamel and cementum with dentin exposed?
What percent of people have end-to-end relationship of enamel and cementum?
What percent of people have cementum overlapping the enamel? |
|
Definition
|
|
Term
| What is a projection of enamel (particularly in furcation areas) onto the root surface to form a widow’s peek or triangle into the furcation area? |
|
Definition
| Cervical Enamel Projections |
|
|
Term
True or False:
PDLs (gingival fibers) can connect to the enamel but NOT to the cementum |
|
Definition
| PDLs (gingival fibers) can connect to the cementum but NOT enamel |
|
|
Term
| Why may a cervical enamel projection (CEP) predispose someone to pocket development? |
|
Definition
| Gingival fibers can attach to cementum, but not into enamel. Therefore, the only attachment to the CEP is a weak epithelial one via hemidesmosomes and such a weak union may predispose to pocket development. |
|
|
Term
What grade are the following CEP?
-up to the furcation entrance but not into the furcation
-extends into the furcation (most weakening of attachment)
-incipient; extends just below the CEJ but not to furcation entrance |
|
Definition
|
|
Term
Patent (open) _________ of roots are especially prevalent in fractional regions.
_______ and _________ of cementum (green arrows) increase the difficulty of calculus removal in furcations and on roots. |
|
Definition
accessory canals
ridges and depressions |
|
|
Term
| What is the difference between root scaling and root planing? |
|
Definition
scaling- cleaning calculus off roots
planing-smoothing out of root surface |
|
|
Term
| What is a large piece of cementum within the PDL that can cause foreign body reaction and acute periodontal abscess due to an acute trauma to the root that be microscopic or radiographic all detectable? |
|
Definition
|
|
Term
What are ectopic deposits of ―cementum or minerals that may exist near or in the root cementum?
What are the three types? |
|
Definition
Cementicles
Free, attached, embedded |
|
|
Term
| ________ in a pocket may be mistaken for calculus and which, also, provides a protective niche for the proliferation of bacteria. |
|
Definition
|
|
Term
| Increased deposits of cementum may result the roots to look ____-shaped. |
|
Definition
|
|
Term
____________ hypercementosis may result from systemic disorders of mineral metabolism.
____________ hypercementosis may result from traumatic forces or other local factors. |
|
Definition
|
|
Term
| Cementum, cementoblasts, & cementocytes work with the alveolar bone proper to regulate the width of the PDL (to Prevents extreme widening of PDL which likely causes tooth mobility) to prevent ______. |
|
Definition
| ankylosis (direct attachment of bone to tooth surface) |
|
|
Term
| How is medial migration of teeth (ortho) possible? |
|
Definition
| Mesial migration of teeth is possible because of continuous apposition of cementum and ―reattachment of PDL fibers as the tooth moves to midline. |
|
|
Term
| ________ forms at apical areas of roots to compensate for loss of tooth tissue caused by attrition and maintain occlusal contacts |
|
Definition
|
|
Term
| What are the functions of cementum? |
|
Definition
•Seals and covers open dentinal tubules
•Protects underlying dentin
•Repair of the root in some cases minor hori-zontal fractures (cracks) |
|
|
Term
Bone or Cementum:
More mineralized (70%)
Avascular
More cells
Generally more active metabolically and has more biological active components
Deposited and resorbed at a much less rapid rate. |
|
Definition
bone
cementum
bone
bone
cementum |
|
|
Term
| The PDL is about ____ mm wide and entirely within the alveolus and its fibers all insert, as ________, into cementum on one end and the alveolar bone at the other end. |
|
Definition
|
|
Term
| The PDL is located _____ to the gingival fiber apparatus |
|
Definition
|
|
Term
The PDL is __________ connective tissue.
What are the (3) components? |
|
Definition
unmineralized
Fibers-collagen, elastic, oxytalan
Cells-fibroblasts, osteoblasts, osteoclasts, cementoblasts, epithelial cell rests of Malassez, undifferentiated mesenchymal (stem cells) cells, other cells associated w/CT, vessels, nerves
Intercellular (ground) substance matrix |
|
|
Term
| What fiber group of the PDL runs from the cervical cementum to the rim (crest) of the alveolus, apical to the gingival fibers. |
|
Definition
|
|
Term
| What fiber group of the PDL runs from the cementum horizontally to the alveolar bone proper. |
|
Definition
|
|
Term
| What fiber group of the PDL run obliquely from the cementum to a more coronal insertion into bone. |
|
Definition
|
|
Term
| What fiber group of the PDL radiate in a sunburst fashion from cementum at the apex of the root to the bone forming the base of the alveolus. |
|
Definition
|
|
Term
| What fiber group of the PDL is found only between the roots of multi-rooted teeth. The fibers run from the furcational cementum to the bone forming the crest of the ______________. |
|
Definition
interradicular group
interradicular septum |
|
|
Term
| What is the most numerous of the principal fiber groups of the PDL? |
|
Definition
|
|
Term
| What is an advantage to having an arrangement of principal fibers of the PDL rather than just having one type? |
|
Definition
| Arrangement of principal fibers of the PDL best counteracts vertical forces (center) and lateral forces (right) may damage the attachment apparatus |
|
|
Term
| Are vertical or lateral forces more damaging to the PDL? |
|
Definition
| lateral (because majority of fibers are oblique and designed to absorb mainly vertical) |
|
|
Term
| How are PDL fibers formed? |
|
Definition
| A PDL fiber develops by fibrous outgrowths from both the bone and cementum. Fibers do not continue across the PDL space, but rather meet, branch, and anastomose with others from the opposite side. |
|
|
Term
Bone or cemental side of PDL fiber formation:
smaller diameter bundles but a greater number of them in a given vertical distance
larger diameter bundles but fewer of them in the same vertical distance? |
|
Definition
|
|
Term
How do Sharpey's fiber insert into bone and thick cementum and are the fibers completely mineralized or non-mineralized core?
How do they insert in thinner cementum? |
|
Definition
In bone and thick cementum, the Sharpey’s fiber insertion is straight and the fibers have an non-mineralized core.
In thinner cementum, the Sharpey’s fibers are completely mineralized and the insertion is as a spiral or corkscrew to give greater anchorage in a thin space. |
|
|
Term
| When do the development of the principal fiber bundles begin? |
|
Definition
| Development of the principal fiber bundles do not begin until eruption starts. |
|
|
Term
How are the PDL and fibers prior to eruption?
When do the bundles assume their classic arrangements? |
|
Definition
Prior to eruption, the PDL is disorganized and, generally, the fibers run longitudinally.
The bundles assume their classic arrangements sequentially, from coronal to apical, as the tooth becomes functional. |
|
|
Term
| The usual functional arrangement of all the principal fiber bundles is not formed until ??? |
|
Definition
| The usual functional arrangement of all the principal fiber bundles is not formed until the tooth is in full occlusion. |
|
|
Term
| What is the first of 3 successive stages of the elastic fiber system and when collagen is digested, these fibers are found quite extensively in the PDL? |
|
Definition
| Oxytalan (other 2 are collagen and elastic) |
|
|
Term
| Where are the oxytalan fibers more numerous and what direction do they run? |
|
Definition
| more numerous in the cervical region of the PDL and run longitudinally, compared to the collagen fibers (cross-banding characteristic). |
|
|
Term
| What fibers are resistant to pulling forces and are thought to regulate vascular flow in relation to tooth function by responding to variations in tension |
|
Definition
|
|
Term
| What is the unique joint between the tooth and body (where one hard tissue is suspended in another)? |
|
Definition
|
|
Term
What happens if there is an increased function on both the PDL and bone WITHIN tolerance limits? BEYOND tolerance limits?
What happens if there is decreased function on both? |
|
Definition
within-increased density
beyond-resorption
decreased function- atrophy and disorganization of structure |
|
|
Term
Determine the degree of function:
-may show a widened PDL spaceand the fiberbundles are thickened (upper right figure) or even torn, depending on tolerance levels.
-have a PDL space that is the usual 0.25mm width and the fibers are in the classic principal fiber arrangements.
-the PDL space is narrow and the fiber bundles are disorganized and run parallel to the long axis. |
|
Definition
Teeth in hyper function
Teeth in normal function
no or reduced function |
|
|
Term
True or false:
Osteoblasts respond more actively to stimuli than do cementoblasts . |
|
Definition
|
|
Term
| The turn-over (formation and degradation) of _______ of the PDL is among the most rapid in the body. |
|
Definition
| collagen (allows quick replacement of collagen fibers that have finished their life span or has been disrupted by function or trauma) |
|
|
Term
True or false:
Fibroblasts both form and degrade collagen |
|
Definition
|
|
Term
| ___________ can be used (animals) to trace the passage of molecules through the fibroblasts |
|
Definition
|
|
Term
| What are the epithelial cells that result from the disintegration of HERS and lie near the cementum? |
|
Definition
| Epithelial Cell Rests Of Malassez |
|
|
Term
| What may the Epithelial Cell Rests Of Malassez form? |
|
Definition
|
|
Term
What supplies blood to the gingiva and branches to cortical bone?
What supplies to the interdental bone and branches to PDL?
What supplies to the PDL and branches to surrounding bone and diffusion into cementum (main supply)? |
|
Definition
Supraperiosteal Artery
Interdental Artery ( or interproximal, septal, intraseptal)
Artery of the Periodontal Ligament |
|
|
Term
| The supraperiosteal artery, interdental artery, artery of the PDL all _________ (or connect); so an effective collateral (backup or supportive) blood supply is available to the ________? |
|
Definition
anastomose
periodontium (gingiva and attachment apparatus) |
|
|
Term
| What can bacterial enzymes and toxins destroy? |
|
Definition
| The collagen fibers and their mineralized Sharpey’s fiber ends and cementum (Destruction of The PDL Attachment to Cementum) |
|
|
