PERIODONTAL TISSUE

Drg. Ade Ismail A. K. , MDSc.

Failures

CAVUM ORIS

Oral Muc sa de!i"isi# adalah selaput rongga mulut !u"gsi# 1. perlindungan mekanis 2. Barrier hatinya tidak mikroorganisme dan racun 3. pertahanan imunologi 4. Pelumasan (air liur) 5. Innervations (sentuhan rasa sakit dll) Oral mu$ sa %erdiri dari %iga & "a 'erdasar$a" !u"gsi# !ingiva dan tudung dari langit"langit keras dise#ut mukosa pengunyahan $em#ran mukosa mulut lapisan sisa rongga mulut (lapisan mukosa) %orsum lidah ditutupi oleh mukosa khusus T(e )e"gu"*a(a" Mu$ sa !ingiva mengelilingi gigi tulang alveolar dan meluas ke per#atasan mucongival. &pitel kedua gingiva dan mukosa dari langit"langit keras (' 3 mm te#al rata"rata) +i"gi,a( adalah #agian dari mukosa mulut yang meliputi proses alveolar rahang dan mengelilingi leher gigi. T(e Li"i"g Mu$ sa $ukosa mulut seram#i $ukosa pipi dan #i#ir $ukosa dasar mulut dan sisi ventral lidah $ukosa langit"langit lunak

S)eciali&ed Muc sa

-ARIN+AN PERIODONTAL )natomi dan *isiologi +itur mikroskopis Pengem#angan T(e %issue %(a% su)) r% %(e %ee%( # !ingiva Periodontal ligament ,ementum )lveolar process

TU-UAN $en-elaskan *itur"*itur makroskopik normal gingiva( mar-inal terpasang dan gingiva interdental .elaskan *itur mikroskopis normal dari epitel gingiva -aringan ikat gingiva %iskusikan korelasi klinis dan mikroskopis yang normal +IN+IVA

Bagian dari mukosa oral (pengunyahan) yang meliputi proses alveolar rahang dan mengelilingi leher gigi. .agia" gi"gi,a Margi" gi"gi,a A%%ac(ed gi"gi,a I"%erde"%al gi"gi,a/ )a)il +i"gi,al sulcus

MAR+INAL +IN+IVA

$arginal / margin / #e#as / gingiva terikat $ar-inal (tidak terikat) gingiva adalah tepi terminal atau per#atasan gingiva yang mengelilingi gigi di collarlike mode 0al ini ditandai dari terlampir gingiva yang #erdekatan dengan depresi linear dangkal alur gingiva #e#as. Biasanya sekitar 1 mm le#ar marginal gingiva mem#entuk dinding -aringan lunak dari sulkus gingiva dan dapat dipisahkan dengan pemeriksaan periodontal.

SULKUS +IN+IVA

!ingiva sulkus )dalah celah dangkal atau ruang di sekitar gigi 1 #er#entuk Parameter diagnostik. 2ormal adalah kurang dari 3 mm

Cli"ical c rrela%i "

)ttached !ingiva

+irm tangguh terikat erat ke periosteum mendasari tulang alveolar. 3e#ar terpasang gingiva adalah -arak dari margin gingiva persimpangan mukogingival. 3e#ar terpasang gingiva #ervariasi pada aspek 4a-ah

Cli"ical c rrela%i "

I"%erde"%al gi"gi,a/ )a)il $enempati lu#ang di dinding gingiva ruang interproksimal di #a4ah area kontak gigi. Piramida atau memiliki #entuk col (depresi valleylike yang menghu#ungkan papil 4a-ah dan #ahasa) Bentuknya tergantung pada titik kontak antara dua gigi yang #erdekatan

Cli"ical c rrela%i "

A'se"ce ! i"%erde"%al )a)illae a"d c l 0(ere )r 1imal c "%ac% is missi"g

Si%e ! e1%rac%i " s( 0i"g %(e !acial da" )ala%al i"%erde"%al )a)illae a"d %(e i"%er,e"i"g c l

+IN+IVAL EPIT2ELIUM ral r u%er e)i%(elium sulcular e)i%(elium, a"d 3u"c%i "al e)i%(elium/e)i%(elial a%%ac(me"%.

.ucc 4li"gual sec%i "

CT, gi"gi,al c ""ec%i,e %issue ES, e"amel s)ace -E, 3u"c%i "al e)i%(elium OE, ral e)i%(elium SE, sulcular e)i%(elium

Sulcular E)i%(elium T(e sulcular e)i%(elium li"es %(e gi"gi,al sulcus . I% is a %(i", " "$era%i"i&ed, s%ra%i!ied s5uam us e)i%(elium 0i%( u% re%e )egs a"d e1%e"ds !r m %(e c r "al limi% ! %(e 3u"c%i "al e)i%(elium % %(e cres% ! %(e gi"gi,al margi" . T(e sulcular e)i%(elium is e1%remel* im) r%a"%, 'ecause i% ma* ac% as a semi)ermea'le mem'ra"e %(r ug( 0(ic( i"3uri us 'ac%erial )r duc%s )ass i"% %(e gi"gi,a a"d %(r ug( 0(ic( %issue !luid !r m %(e gi"gi,a see)s i"% %(e sulcus

-u"c%i "al e)i%(elium T(e a%%ac(me"% ! %(e 3u"c%i "al e)i%(elium % %(e % %( is rei"! rced '* %(e gi"gi,al !i'ers. F r %(is reas ", ' %( are c "sidered a !u"c%i "al u"i%, dentogingival unit. T(eir !u"c%i "s#

 3u"c%i "al e)i%(elium is !irml* a%%ac(ed % %(e % %( sur!ace, ! rmi"g a" e)i%(elial 'arrier agai"s% )la5ue 'ac%eria. i% all 0s access ! gi"gi,al !luid, i"!lamma% r* cells, a"d c m) "e"%s ! %(e immu" l gic ( s% de!e"se % %(e gi"gi,al margi". 3u"c%i "al e)i%(elial cells e1(i'i% ra)id %ur" ,er, 0(ic( c "%ri'u%es % %(e ( s%4)arasi%e e5uili'rium a"d ra)id re)air ! damaged %issue. +i"gi,al Fluid 6Sulcular Fluid7 I% ca" 'e re)rese"%ed as ei%(er a %ra"suda%e r a" e1uda%e I% is ) %e"%ial use as a diag" s%ic r )r g" s%ic 'i mar$er ! %(e 'i l gic s%a%e ! %(e )eri d "%ium i" (eal%( a"d disease. I% is c "%ai"s c m) "e"%s ! c ""ec%i,e %issue, e)i%(elium, i"!lamma% r* cells, serum, a"d micr 'ial !l ra i"(a'i%i"g %(e gi"gi,al margi" r %(e sulcus 6) c$e%7. I" %(e (eal%(* sulcus %(e am u"% ! %(e gi"gi,al !luid is ,er* small. Duri"g i"!lamma%i ", ( 0e,er, %(e gi"gi,al !luid !l 0 i"creases T(e mai" r u%e ! %(e gi"gi,al !luid di!!usi " is %(r ug( %(e 'aseme"% mem'ra"e, %(r ug( %(e rela%i,el* 0ide i"%racellular s)aces ! %(e 3u"c%i "al e)i%(elium, a"d %(e" i"% %(e sulcus. T(e !u"c%i "s are# clea"se ma%erial !r m %(e sulcus, c "%ai" )lasma )r %ei"s %(a% ma* im)r ,e ad(esi " ! %(e e)i%(elium % %(e % %(, ) ssess a"%imicr 'ial )r )er%ies, e1er% a"%i' d* ac%i,i%* % de!e"d %(e gi"gi,al.

+IN+IVAL FI.ERS T(ere are !u"c%i "s# T 'race %(e margi"al gi"gi,a !irml* agai"s% %(e % %(. mas%ica%i " 0i%( u% 'ei"g % a"d %(e ad3ace"%

T )r ,ide %(e rigidi%* "ecessar* % 0i%(s%a"d %(e ! rces ! de!lec%ed a0a* !r m %(e % %( sur!ace.

T u"i%e %(e !ree margi"al gi"gi,a 0i%( %(e ceme"%um ! %(e r a%%ac(ed gi"gi,a.

T(e gi"gi,al !i'ers are arra"ged i" %(ree gr u)s# gi"gi, de"%al, circular, a"d %ra"sse)%al

84 De"% 4gingival fibers# e5tend *rom the cervical cementum into the gingiva. 94 Alveolo-gingival gr u)# e5tends *rom the alveolar crest into the gingiva. :4 Circular group# a small group o* *i#ers that encircles the tooth and interlaces 4ith the outer *i#ers. ;4 Dento-periosteal !i'ers# they e5tend *rom the cementum directed over the #one crest and then incline apically #et4een the periosteum o* the alveolar #one and the gingiva. Cli"ical Fea%ures ! 2eal%(* +i"gi,a ,linician must recogni6e the appearance o* healthy gingiva and its variations in health. C l r Si&e C u"% ur S(a)e C "sis%e"c* Sur!ace %e1%ure P si%i "

COLOR T(e c l r ! A+ a"d M+ is c ral )i"$, is )r duced '* ,ascular su))l*, %(e %(ic$"ess a"d degree ! $era%i"i&a%i " ! %(e e)i%(elium a"d %(e )rese"ce ! )igme"%4c "%ai"i"g cells.

7I8&

T(e si&e ! %(e gi"gi,a c rres) "ds 0i%( %(e sum % %al ! %(e 'ul$ ! cellular a"d i"%ercellular eleme"%s a"d %(eir ,ascular su))l*. Al%era%i " i" si&e is a c mm " !ea%ure ! gi"gi,al disease.

,92:9;< F ll 0s a scall )ed u%li"e " !acial a"d li"gual sur!aces. De)e"ds " %(e s(a)e ! %(e %ee%( a"d %(eir alig"me"% i" %(e arc(, l ca%i " a"d si&e ! %(e area ! )r 1imal c "%ac% a"d %(e dime"si "s ! %(e !acial a"d li"gual gi"gi,al em'rasure.

S2APE

S(a)e ! i"%erde"%al gi"gi,al )a)illae c rrela%ed 0i%( s(a)e ! %ee%( a"d em'rasures. A, .r ad i"%erde"%al )a)illae. ., Narr 0 i"%erde"%al )a)illae. ,927I7:&2,= !irm, resilie"%. Tig(%l* ' u"d % u"derl*i"g ' "e 6e1ce)% ! r M+7

7;<+),& :&>:;<& T(e gi"gi,a )rese"%s a %e1%ured sur!ace similar % a" ra"ge )eel a"d is re!erred % as 'ei"g stippled. S%i))li"g#

< a%%ac(ed gi"gi,a#=*es. < margi"al gi"gi,a#=" . Less )r mi"e"% i" li"gual as)ec%s. 7tippling is #est vie4ed #y drying the gingiva. The attached gingiva is stippled; the marginal gingiva is not.The central portion of the interdental papillae is usually stippled, but the marginal borders are smooth. The pattern and extent of stippling vary among individuals and different areas of the same mouth

POSITION T(e position of the gingiva refers to the level at which the gingival margi" is a%%ac(ed % %(e % %(. >(e" %(e % %( eru)%s i"% %(e ral ca,i%*, %(e margi" a"d sulcus are a% %(e %i) ! %(e cr 0"? as eru)%i " )r gresses, %(e* are see" cl ser % %(e r %.

PERIODONTAL LI+AMENT C ""ec%i,e %issue %(a% surr u"ds %(e r % a"d c ""ec% i% % %(e ' "e.

c "%i"u us 0i%( c ""ec%i,e %issue ! gi"gi,a.

FUNCTION OF PERIODONTIUM Tooth support Shock absorber: Withstanding the forces of mastication Sensory receptor necessary for proper positioning of the jaw

Nutritive: blood vessels provide the essential nutrients to the vitality of the PD CEMENTUM The calcified avascular mesenchymal tissue that form the outer covering of the anatomic

C INIC! CORRE !TION Cementum is more resistant to resor"tion# Im"ortant in "ermitting tooth movement orthodontic

! $EO !R %ONE the "ortion of the ma&illa and mandi'le that forms and su""or the tooth soc(ets) It forms *hen tooth eru"ts and disa""ears gradually after tooth loss)

T+E ,ECTION OF +UM!N -!. The dotted line indicates the se"aration 'et*een 'asal 'one and alveolar 'one