BLOOD SUPPLY FOR PERIODONTIUM

THIS PRESENTATION INCLUDES:
INTRODUCTION
MAIN BLOOD SUPPLY BRANCHES TO PERIODONTIUM
BLOOD SUPPLY TO MAXILLARY TEETH AND PERIODONTIUM
BLOOD SUPPLY TO MANDIBULAR TEETH AND PERIODONTIUM
VENOUS DRAINAGE OF MAXILLARY AND MANDIBULAR TEETH AND PERIODONTIUM
BLOOD SUPPLY TO EACH COMPONENT OF PERIODONTIUM
CLINICAL SIGNIFICANCE OF BLOOD SUPPLYING THE PERIODONTIUM
CLINICAL CORELATIONS WITH GINGIVITIS AND PERIODONTITIS
CONCLUSION
REFERENCES

1. GOOD MORNING 1 /21

2. BLOOD SUPPLY TO THE PERIODONTIUM Dr. APOORVA. G DEPARTMENT OF PERIODONTOLOLGY AND ORAL IMPLANTOLOGY KVG DENTAL COLLEGE AND HOSPITAL 2 /21

3. CONTENTS INTRODUCTION MAIN BLOOD SUPPLY BRANCHES TO PERIODONTIUM BLOOD SUPPLY TO MAXILLARY TEETH AND PERIODONTIUM BLOOD SUPPLY TO MANDIBULAR TEETH AND PERIODONTIUM VENOUS DRAINAGE OF MAXILLARY AND MANDIBULAR TEETH AND PERIODONTIUM BLOOD SUPPLY TO EACH COMPONENT OF PERIODONTIUM CLINICAL SIGNIFICANCE OF BLOOD SUPPLYING THE PERIODONTIUM CLINICAL CORELATIONS WITH GINGIVITIS AND PERIODONTITIS CONCLUSION REFERENCES 3 /21

4. INTRODUCTION Periodontium Tissue that is investing and supporting the tooth. It consists of 4 main components: Gingiva Cementum Periodontal ligament Alveolar bone. All this components together function as single unit. The normal periodontium provides the support necessary to maintain teeth in function. 4 /21

5. MAIN BLOOD SUPPLY BRANCHES TO PERIODONTIUM The main branch is EXTERNAL CAROTID ARTERY . T he MAXILLARY ARTERY supplies both the maxillary and  mandibular teeth . 5 /21

6. EXTERNAL CAROTID ARTERY Maxillary artery Mandibular branch Pterygoid branch Pterygopalatine branch Inferior alveolar artery Infraorbital PSAA artery Dental Mental Incisive Branch artery artery ASAA MSAA Molar lower lip lower Incisors and Premolars and Premolars Premolar and chin Incisors canine 1 ST molar and molars canine 6 /21

7. BLOOD SUPPLY TO MAXILLARY TEETH AND PERIODONTIUM Maxillary arch is supplied by a plexus of 3 arterial branches. POSTERIOR SUPERIOR ALVEOLAR ARTERY : stem from third division of maxillary artery. * before maxillary artery enters the pterygopalatinal fossa it branch itself to PSAA. * it continues on and enter the infra temporal surface of the maxilla to supply maxillary sinus, premolar and molars. MIDDLE SUPERIOR ALVEOLAR ARTERY : Arises from the infraorbital artery as does the ASAA. It arises within the infraorbital canal where it descends to supply the maxillary sinus and the plexus at the level of canine. ANTERIOR SUPERIOR ALVEOLAR ARTERY : Arises at the level of MSAA and runs with it to supply the anterior portion of maxillary arch, the maxillary sinus and the upper anterior teeth. 7 /21

8. BLOOD SUPPLY TO MANDIBULAR TEETH AND PERIODONTIUM Maxillary artery give rise to a single branch to supply the mandibular teeth which is known as the INFERIOR ALVEOLAR ARTERY It descends inferiorly along with the Inferior alveolar nerve and enters the bone through the mandibular foramen . At the level of second premolar, it terminates into the branches of the mental and incisive arteries, after it has supplied all the mandibular teeth and periodontium. The mental and incisive arteries supplies the Labial gingiva of anterior teeth and the anterior teeth themselves respectively. 8 /21

9. VENOUS DRAINAGE Maxillary Mandibular Superior alveolar vein Inferior alveolar vein Pterygoid plexus of vein ( infra temporal region ) maxillary vein Retro mandibular vein Jugular system of vein 9 /21

10. VENOUS DRAINAGE OF MAXILLARY AND MANDIBULAR TEETH AND PERIODONTIUM 10 /21

11. GINGIVA The source of blood supply to gingiva are as follows: SUPRAPERIOSTEAL ARTERIOLES : Overlying the alveolar bone along the facial and lingual surfaces, from which the capillaries extends along the sulcular epithelium and between the retepegs of external gingival surface. VESSELS OF PERIODONTAL LIGAMENT : They extend into the gingiva and anastomose with the capillaries in the sulcus area. ARTERIOLES WHICH EMERGE FROM THE CREST OF INTERDENTAL SEPTA . and extend parallel to crest of the bone to anastomoses with the vessels of periodontal ligament in the cervical region. Blood supply to each component of periodontium 11 /21

12. PERIODONTAL LIGAMENT Periodontal ligament is highlt vascularized tissue It is supplied by branches derived from three sources DENTAL ARTERY before it enters apical foramen gives off branches to the periodontal ligament which also supplies the pulp. The INTERRADICULAR ARTERY gives off branches in the alveolar process that supplies the periodontal ligament through the cribriform plate. INTERDENTAL ARTERY emerges fromm the crest of the alveolar bone and supplies the coronal part of the periodontal ligament. 12 /21

13. ALVEOLAR BONE The vessels enter the interdental septa through nutrient canals together with veins, nerves, and lymphatics. The alveolar arteries send of branches through periodontal ligament and enter the marrow spaces through the perforations in the cribriform plate. CEMENTUM is a avascular component of periodontium. 13 /21

14. LYMPAHTIC DRAINAGE The role of lymphatic system in removing excess fluids, cellular and protein debris, microorganisms and other elements is important in controlling diffusion and the resolution of inflammatory process. The lymphatic drainage of gingiva drains into the submaxillary group. Lymph vessels from teeth and periodontium of labial and buccal side of maxillary and mandibular region unite to drain into submandibular lymph nodes. Lymph from mandibular incisors and surrounding periodontium drain into submental lymph nodes. Lymph vessels from lingual and palatal region drain into The jugulodigastric group of nodes ,either through the Submandibular nodes. 14 /21

15. CLINICAL SIGNIFICANCE OF BLOOD SUPPLYING THE PERIODONTIUM In periodontal ligament high blood vessel content may provide hydrodynamic damping to applied forces. The color of gingiva is determined by blood supply along with keratinization and presence of melanin. The blood supply to marginal gingiva is by the vessels of both the periodontal ligament and oral mucosa. In the presence of inflammation, the width and length of capillary increases twisting and looping of the vessels underlying sulcular and junctional epithelium. The vessels immediately below the sulcular epithelium and junctional epithelium are damaged in a flat layer. Since these epithelia do not possess ridges projecting into the connective tissue, their vasculature network is located in a very superficial position. Hence it is more prone for infections. 15 /21

16. Gingival bleeding on probing : it is one of the important diagnostic factor, as it is associated with inflammation and ulceration of the epithelium lining the gingival sulcus. Histopathological alteration Dilation and engorgement of capillaries Thinning / ulceration of sulcular epithelium capillaries are closer to the surface and are thinned Degenerated epithelium is less protective stimuli that are normally innocuous cause rupture of capillaries and bleeding. 16 /21

17. CLINICAL CORELATIONS WITH GINGIVITIS AND PERIODONTITIS Microcirculation, blood vessels, lymphatic vessels play an important role in drainage of tissue fluid and in the spread of inflammation. In case of gingivitis and periodontitis, the microcirculation and the vascular formation change greatly in the vascular network directly under the gingival sulcular epithelium and junctional epithelium. Expansion of microvasculature through increased vascular diameter and tortuosity as well as the development of high endothelial cells appears to protect from periodontitis by increasing the supply of both plasma defense factors and PMN’s to the tissue. 17 /21

18. Vascular changes that may oppose this and promote periodontitis are the formation of perivascular hyaline material and accumulation of basement membrane rests. The inadequate tissues turnover that accumulate in these vascular products representation can be argued as a vascular response to chronic inflammation that has failed to eliminate the irritant. It is suggested that these vascular changes may occur for the highly localized and burst – like pattern of pocket formation in periodontitis. 18 /21

19. CONCLUSION Blood supply is utmost prime factor in maintaining healthy and harmonious relationship of periodontium components in order to secure teeth in stable and proper functioning state. Any alteration in blood supply may be due to infection, leads to gingivitis and later progress to periodontitis, which alters the normal functioning of the teeth. It also act as a early marker in gingivitis. 19 /21

20. REFERENCES Carranza’s clinical periodontology, 11 th edition. Glickman’s Carranza – 7 th edition. Patterns of Blood Supply to Teeth and Adjacent Tissues - Charles C. Boyer and C. Marshall Neptune Microvasculature in Gingivitis and Chronic Periodontitis: Disruption of Vascular Networks With Protracted Inflammation HANS ZOELLNER,CHERYL C. CHAPPLE AND NEIL HUNTER Structure of periodontal tissues in health and disease ANTONIO NANCI & DIETER D. BOSSHARDT Microcirculation alterations in experimentally induced gingivitis in dogs --- Masato Matsuo • Toshimitsu Okudera1 • Shun- suke Takahashi Satoko Wada-Takahashi • Shingo Maeda1 • Akira Iimura . 20 /21

21. This Photo by Unknown Author is licensed under CC BY-NC-ND 21 /21