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
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2. BLOOD SUPPLY TO THE PERIODONTIUM
Dr. APOORVA. G
DEPARTMENT OF PERIODONTOLOLGY AND ORAL IMPLANTOLOGY
KVG DENTAL COLLEGE AND HOSPITAL
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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
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4. INTRODUCTION
• Periodontium
Tissue that is investing and supporting the tooth.
It consists of 4 main components:
1) Gingiva
2) Cementum
3) Periodontal ligament
4) Alveolar bone.
 All this components together function as single unit.
 The normal periodontium provides the support necessary to
maintain teeth in function.
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5. MAIN BLOOD SUPPLY BRANCHES TO PERIODONTIUM
• The main branch is EXTERNAL CAROTID ARTERY.
• The MAXILLARY ARTERY supplies both the maxillary
and mandibular teeth.
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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 1ST molar and molars
canine
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7. BLOOD SUPPLY TO MAXILLARY TEETH AND PERIODONTIUM
• Maxillary arch is supplied by a plexus of 3 arterial branches.
1. 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.
2. 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.
3. 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.
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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.
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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
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11. • GINGIVA
The source of blood supply to gingiva are as follows:
1. 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.
2. VESSELS OF PERIODONTAL LIGAMENT : They extend
into the gingiva and anastomose with the capillaries in
the sulcus area.
3. 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
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12. PERIODONTAL LIGAMENT
• Periodontal ligament is highlt vascularized tissue
• It is supplied by branches derived from three sources
1. DENTAL ARTERY before it enters apical foramen gives off
branches to the periodontal ligament which also supplies
the pulp.
2. The INTERRADICULAR ARTERY gives off branches in the
alveolar process that supplies the periodontal ligament
through the cribriform plate.
3. INTERDENTAL ARTERY emerges fromm the crest of the
alveolar bone and supplies the coronal part of the
periodontal ligament.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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20. REFERENCES
• Carranza’s clinical periodontology, 11th edition.
• Glickman’s Carranza – 7th 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.
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