Professional Documents
Culture Documents
In Ihe preceding partof ihis series relaljng to the reslorotive alveolar inlerfoce, II: 3, 1981, Ihe analomical
position of the restorative olveolar interface R.AJ.) was described as
being that portion of the root surface
extending from the alveolar crest
opically to ihe restorative margin
coronally. The advantages of tooth
preporation of the R.A.I, al the time
of periodontal surgery as related to
the reattochment of ihe gingival fiber
apparatus and to Ihe placement of
the restorative
margins were
documented with clinical coses.
Since publication, it has been
brought to our attention that other
clinicians are concerned about the
placement of the restorative margin
in the gingival sulcus, and subsequent problems with periodontal
health on this R.A.I, as c result of
under- or over-preparotion.
Here we will describe a human histologie section that was taken after
surgicol preparation af the restorative alveolar interface. We believe
that the lower position of the surgical
preparation near the alveolar base
was not well demarcated in this section, and thus we plan another study
with additianal human histologie
material to enhance the information
avouable relative to surgical intervention and its long-standing implications for the health of the adjacent
tissue.
Surgical intervention in the periodontal structures of the oral cavity is
evaluated with both human ond histologie material to confirm clinical information
and
to
enhance
techniques. The human histologie
material presented here parallels
mony of the clinical observations already reported.
As an introduction to the anatomic
10
Fig. la A mssiodis/al histologie section ihowing o nortnal psnaaontiun} ot tiis iinte oferupiiofi and sxotiafion. The enamel is slit! completely t rtvelopea in the ortativs epithelium ona will cotilinue to be so
unlil the lip o he erupting laoth pierce! the orai epitheLim. Noie the almost complete tor/notion of the
root. The QFFOW points to o normal aiveiitar crest-to-tooth letotionship.
The connective tissue is able to wilhstand mechanical stresses. The dentogingival fibers extend from the
cementum and fan aut into the gingiva. This attochment is reinforced by
the other fibers of the gingiva, which
provide firmness and strengfh. The
connective tissue also contains fhe
circulatory supply.
The unctional epithelium, in a braad
sense, pravides a seal at the base of
the sulcus ogoinst the penetration of
chemical and bacferiol substances.
The ultra structural nature of the
epithelial attachment of the tooth
surface has been demonstrated by
Stern.^"^ Both reduced omeloblasts
and gingival epithelial cells have
been shown to form a basal lamina
on enamel and cementum. Hemidesmosomes of these cells ottach to the
bosal lomina in the same manner as
a basal cell. The epithelial attachment is submicroscopic, approximately 400 A.*
To understand the attochment of fhe
gingivo lo the tooth more fully, we
must appreciate the mechanism of
the changing position of the gingiva
to the tooth during eruption. After the
tooth is formed and calcified, it is
covered
by
reduced
enamel
epithelium. During the eruption of the
tooth,
fhe
reduced
enamel
epithelium comes into contact with
the gingival epithelium, and these
two tissues join. When the tip of the
tooth emerges from the mucous
membrane, the reduced epithelium is
ottached to almost the entire enamel
surface. However, the epithelium
separates from the surface of the
enamel, gradually exposing more of
the crown.
The unctional epithelium is initially
composed of omeloblosts. After
eruption, the relationship of the unc-
12
Fig 2o The exftocted mesial fool o a mandibtilai molar in black, t is the experimental model io
gain hnher knowledge al the R.A I.
cetnenhiw.
bj The epitheliol aHochment.
c) lymphocyte iulilttalion.
df The ispofrsd connsclivs U551JG ottochmenl oppofafus snowing the periodonfat ligomenf to be
perp&ndicutor to Ihs sunacs 01 fns root ond ol'
veolar crest Note the Sharpey liber attochmenl.
13
ment. This removal of periodontal ligament fibers from the root surface is
unintentional. Despile Ihe troumafic
insult to these tissues, we can see a
rather acceptoble tissue response at
the 30-doy interval (Fig. 2b). The microscopic preparation shows the
complete removal of enamel and
cemenium n the area of tooth preparation. The dentin surface of the
tooth preparation has a basophilic
stained layer similar to cementum.
The sulcus has well-developed sulcular and unclional epithelium with the
epithelial attachment evident at the
level of the remoining cementum at
the most apical extent of the crown
spoce (Fig. 2), the stratified squamous epithelium is porakeralotic ond
is supported by loosely arranged
connective tissue fibers that ore infiltrated by small lymphocytes and
plasma cells. The gingiva is attached
to the tooth via gingival fibers connecting into cementum at the most
coronal margin of the remoining
cementum. The tooth side shows attachment by supracrestal fibers and
the horizontal fibers of the periodontoi ligament.
14
tooth preparation beyond the crevice as this already would have been
accomplished at the time of surgery.
It will be necessary to use an animal
model research project to test this
hypothesis further.
15
Fig. This diaprom shoves o tooth with on inceosed dinicaf crown foliovving pocket elimination theiopy. There 15 an incteosed rise rom the iabiol surface to the interproximoi surioce as noted
by the orrow. The tooth preporotion ends in the
gsngivot crevice Note fhe chonge in onn of the
tooth preparation inci$aly from the triangular form
found in Figures 4 ond 5. Thi$ occurs because of
thefopenng morphofogy o( the rootos it proceeds
opicoHy
Fig 8 The vanotion of root morphology ond the proximai relationship ofodjoirjing teeth is of prime importance to the dinican '^en considering tooth preparotion. Proximal fOOt concavities ore of particular
importonce
16
fig 9 The arrowy no's the nse ^rom fhe buccol furcaUon between the
ouccO' ^oots to the fOU'CLfiOf Q'rrgivo' iriofQin oficf ths onotoiny of Ins interpioxtraoi inoiof ftjTCot'O^ on the tnsfo! sunocG of ths TioxiUoiy first motor
The periodontal probe on ths mesiol $urface of the first bicuspid depicts
\ .
Fig. 19
in place.
Thelultladah
18
Fig. 24 A rodiogrophic
e cemented in place
19
References
1. Stetn, I B..
The fine structure of the omelobloslenamel iunction in rol incisors; epithelial attachment and cuticular membrane. In Brese, S. S., editor: Electron
Microscopy. New York: Academic
Press, Inc. 1962.
2. Slern, I 6.:
Electron microscopic observations of
the dento-gingivol attachrrenl m rot incisors Abstract. I.A.D.R. 41.96, 1963
3. Grant, D., Stern, I B and Everett, F.G.'
Otban's Periodontics, ed. 2. Si. Louis:
The CV, Mosby Company, 1963.
4 Lisfgorten, M. A..
Phase-contrasI and electron microscopic study of the junction between reduced enamel epithelium and enamel
in unerupted human teeth. Arch Oral
Bid. 11:999, 1966.
5. Schroeder, H. E. and Listgarten, M A.:
The fine structure of the developing
epithelial altochment of human teeth. In
Wolsky, A., editor: Development Biology, vol. 2 Basel: A. KorgerAG, 1971
6. Schulfe-Houdt, S, D., Woerhaug, J.,
From S. H ond Altromodal, A..
On the nature of contact betvueen the
qingivol epithelium and the tooth surface. Periodontics 1103, 1963.
7. Gorgiulo, A. W , Wentz, F. M. and
Orban, B, J.:
Dimensions ond relations of the dentogingival junclion in humans J.
Periodontol, 32:261, 1961.
8 Weinmonn, J. P, Svobodo, J. F. and
Woods, P. W..
Hereditary disturbonces of enamel formation and calcification. JADA 32.397,
1945.
9. Gottlieb, B,:
Biology of the cementum. J. Periodontol. 13:13, 19'12.
10. Rose, G. G. and Robertson, P. B.:
Collogenolysis by human gingival fibroblast cell lines. J. Dent Res. 56'416,
1977
11. Fullmer, H M. ond Gibson, W j
Collagenolyfic activity in gingivo of
man Nature 209:728, 1966.
12. Schroeder, H. E.:
Quantitative parameters of early
human gingival inflommalion. Arch
OralBiol. 15:383, 1970.
13. Schroeder, H. E. end Poge, R. C :
Lymphocyte-fibioblast interaction in the
pathaqenesis of inflammatory gingival
disease. Experientio 28:1228, 1972.