Gingiva

2. GINGIVA

3. CONTENTS
 Introduction
 Macroscopic features
 Microscopic features
Gingival epithelium
Oral epithelium
Sulcular epithelium
Junctional epithelium
 Renewal of gingival epithelium
 Cuticular structures
 Gingival crevicular fluid
 Gingival connective tissue
 Gingival fibres
 Blood supply, nerve supply and lymphatics
 Correlation of clinical & microscopic features
 Age changes

4. INTRODUCTION
ORAL MUCOSA

5. GINGIVA
Carranza
Gingiva is the part of the oral mucosa that covers the alveolar
processes of the jaws & surrounds the necks of the teeth

6. MACROSCOPIC FEATURES
Schluger et al 1990

7. Marginal gingiva
 The terminal edge / border of the gingiva surrounding the
teeth in collarlike fashion.
 Free gingival groove
 1 mm wide
 1.5- 2mm coronal to CEJ
Incisor & premolar molar

8. Gingival sulcus
 Shallow crevice/space around the tooth bounded by the
surface of tooth on one side & the epithelium lining the
free margin of the gingiva on the other side
 V shaped

9.  Depth of gingival sulcus
 Normal/ideal conditions: 0
Gottlieb, Orban 1933
 Histologic sections:
1.8 mm (Larjava et al)
1.5 mm (Saito et al)
0.69 mm (Everts et al)
 Probing depth: 2-3 mm

10. Attached gingiva
 Firm, resilient, and tightly bound to the underlying
periosteum of alveolar bone
 Mucogingival junction
 Absent on palate
 Stippling- orange peel
appearance

11. Width of keratinized gingiva
Distance between the mucogingival
Junction & the projection on the external
surface of the bottom of gingival sulcus

12. 3.5-4.5 mm : Maxilla
 3.3-3.9 mm : Mandible
•1.9 mm : Maxilla
•1.8 mm : Mandible
Ainamo J & Loe H 1966

13.  Narrow  Incisors
 Wide  Molar region
 Range 1-9 mm

14.  Increases with age

15. Roll test
Schillers iodide test
Total width of gingiva – Sulcus depth

16. Importance of attached gingiva

17. PREDISPOSING FACTORS
 INADEQUATE ATTACHED GINGIVA
• Narrow zone of gingiva is considered insufficient to:
– Protect the periodontium from masticatory forces
– Dissipate the pull because of muscles of adjacent mucosa (Friedman 1957)
• Inadequate zone of gingiva favors:
– Subgingival plaque formation (Friedman, 1962)
– Attachment loss and soft tissue recession due to decreased resistance to apical
spread of plaque associated gingival lesions (Stern, 1976)
– Along with decreased vestibular depth it causes accumulation of food particles
during mastication and impedes oral hygiene measures (Gottsegen, 1954)

18. • Bowers, 1963: Classic study on width of attached gingiva. To clarify meanings of
ADEQUATE / INADEQUATE gingiva.
• Width varied for different teeth and different individuals
• Mean width increased from deciduous to permanent dentition, but changed
little after maturity
• Ranged from 1 – 9mm
• Lowest in the premolar canine region
• Influenced by tooth malposition, frenum attachment and recession
• Recession was most common in 1st premolar-canine, maxillary 1st molar and
mandibular incisor regions
Gingiva could be maintained with <1mm
present

19. • Ainamo and Loe, 1966:
• Band of attached gingiva moved apically with recession by unknown
mechanism
• Greatest width on maxillary and mandibular anteriors
• Lang and Loe, 1972: to determine how much of gingiva id ADEQUATE
(118 randomly selected plaque free surfaces)
Surfaces with <2mm
of keratinized gingiva
Inflammation
Surfaces with > 2mm
keratinized gingiva 
80% were clinically
healthy
“2mm of keratinized
gingiva/1mm of
attached gingiva is
adequate to maintain
health”

20. • Maynard and Wilson, 1979  subgingival restorative procedures require
2mm free
gingiva
3mm
attached
gingiva
5mm
keratinized
gingiva

21. • Miyasato et al., 1977
Study on dental
students
Mid facial plaque
free surface of
mandibular
premolars
Minimal
keratinized gingiva
 1mm
Appreciable
keratinized gingiva
 2mm
25 days 
experimental
gingivitis
Increases in plaque,
gingival exudate and
inflammation were
similar in both
groups

22. • Dorfman et al., 1980  2 year study on 92 patients
Experimental side  free gingival grafts
Control side  root planing and oral hygiene
instructions every 3 months
Grafted areas had an increase of 4mm of
attached gingiva but no difference in GI, PI and
loss of attachment compared to the controls
Patient can be maintained in gingival health
with excellent oral hygiene and regular
periodontal care at 3 month intervals

23. Interdental gingiva
 Occupies gingival embrasure, which is the interproximal
space beneath the area of tooth contact
 Determined:
 Contact relationships between the teeth
 Width of approximal tooth surfaces
 Course of the CEJ

24.  Pyramidal
 Col shaped Cohen

25. MICROSCOPIC FEATURES
 Stratified squamous epithelium
 Central core of connective tissue

26. GINGIVAL EPITHELIUM
 Function:
 Protects deep structures
 Mechanical, chemical, water, microbial barrier
 Signalling function
General aspects of gingival epithelium biology

27.  Oral/ outer epithelium
 Sulcular epithelium
 Junctional epithelium

28.  Four cell layers:
 Stratum Basale (Basal layer)
 Stratum spinosum (prickle cell
layer)
 Stratum granulosum (granular
layer)
 Stratum corneum (cornified layer)

29.  Principal cell: keratinocytes
 Clear cells / Nonkeratinocytes:
Langerhans cells
Merkels cells
Melanocytes
Inflammatory cells

30. keratinocytes
 Main function
PROLIFERATION
DIFFERENTATION
keratinocytes

31.  Morphologic changes:
1. Progressive flattening of the cell with
an increasing prevalence of
tonofilaments
2. Intercellular junctions coupled to the
production of keratohyaline granules
3. Disappearance of the nucleus
Schroeder 1981

32.  Stratum Basale:
 Cylindric/cuboid.
 Contact with basement membrane
 Mitotic cell division
 Stratum germinativum
 Progenitor cell compartment of
the epithelium
1 month

33.  Basal lamina : Joins the epithelium to the underlying
connective tissue
 300-400 Å
 App 400 Å beneath the epithelial basal layer
 Produced by the basal cells
 Light microscope
 Structure less zone
 PAS stain positive

34.  Permeable to fluids, barrier to particulate matter

35.  Stratum spinosum
 10-20 layers
 Large, polyhedral cells
 Short cytoplasmic processes resembling spines
 Prickly appearance
 Cohesion : Desmosomes Located between the cytoplasmic
processes of adjacent cells

36.  Interconnections:
 Desmosomes
 Tight junctions
(Zonae occludens)

37.  Stratum granulosum
 Keratohyalin granules
 Very sudden keratinization of the
cytoplasm of the keratinocyte &
conversion into horny squame

38.  Stratum corneum
 Filled with keratin
 Apparatus for protein synthesis & energy production lost
 Complete keratinization Orthokeratinized
 Parakeratinized epithelium
 Nonkeratinized epithelium

39. Orthokeratinized
 Superficial horny layer
 No nuclei in stratum corneum
 Well defined stratum
granulosum

40. Parakeratinized
 Pyknotic nuclei
 Dispersed keratohyaline
granules
 Absence of stratum
granulosum

41. Nonkeratinized
 Viable nuclei
 Absence of stratum granulosum
& corneum

42. keratinization
 Immunohistochemistry, Gel electrophoresis, Immunoblot
technique
 Keratin proteins  different polypeptide subunits
 Basal cells: K19 (40 KD)
 Stratum corneum: K1 (68 KD)

43.  Other proteins:
 Keratolinin
 Involucrin
 Filaggrin
 In sudden transition
 Keratohyalin granules Filaggrin
 Matrix of Corneocyte
Precursors of chemical
resistant structure- Envelope
Precursors packed in
keratohyaline granules

44.  Cytoplasmic organelles: Deeper strata
 Numerous mitochondria
 Succinic dehydrogenase
 Nicotineamide-adenine dinucleotide
 Cytochrome oxidase
Active Tricarboxylic
cycle

45.  Activity towards cell surface:
 Pentose shunt  Glucose-6-phosphatase
Ribonucleic acid (RNA)
Synthesis of keratinization proteins

46.  Uppermost cells: Stratum spinosum
 Keratinosomes/Odland bodies
 Acid phosphatase:Enzyme involved in the destruction of
organelle membranes
 Degree of keratinization

47. Nonkeratinocytes
Langerhans
cells
Inflammatory
cells
Melanocytes
Merkels
cells

48. Melanocytes
 Dendritic cells
 Basal & spinous layers
 Premelanosomes/melanosomes
Tyrosine
Tyrosinase
Melanin
Dihydroxyphenylalanine
(dopa)
Melanophores/
Melanophages

49. Langerhans cells
 Dendritic cells
 Suprabasal layer
 Modified monocytes
 Immune reaction  antigen-presenting cells
 g-specific granules (Birbeck’s granules)
 Found: Oral epithelium & sulcular epithelium
 Absent: Junctional epithelium

50. Merkel cells
 Deeper layer
 Harbor nerve endings
 Tactile perceptors

51. Inflammatory cells
 Clinical normal areas of mucosa
 Lymphocytes : Most frequent
Associated with langerhans cells
 Polymorphonuclear leukocytes
 Mast cells

52. Difference between attached gingiva &
alveolar mucosa
ATTACHED GINGIVA ALVEOLAR MUCOSA
Keratinized Nonkeratinized
Stippled Unstippled
Deep rete pegs Short,wide rete pegs
Thick lamina propria Thin lamina propria
Few elastic fibers Numerous elastic fibers
Indistinct submucosa Distinct submucosa
Firmly attached Movable
Squier GA, Johnson NW

53. Extracellular matrix
 Glycoproteins, lipids, water
 Proteoglycans: Hyaluronan, decorin, syndecan
 CD 44 – cell surface Hakkinen L
 Cell adhesion molecules: ICAM-1, β1 integrin family
Cawford
 Serves:
 Cell adhesion
 Adhesion to tooth surface & basement membrane
 Diffusion of water, nutrients & toxic materials

54.  Crest & outer surface
 0.2-0.3 mm in thickness
 Keratinized/parakeratinized
 Degree of keratinization
 Age & onset of menopause
 Palate > Gingiva > ventral aspect of tongue > cheek
Oral epithelium

55.  Keratins:
Ortho-
keratinized
areas
• K1
• K2,
• K10 - K12
Highly
proliferative
epithelia
• K6
• K16
Stratification-
specific
cytokeratins
• K5
• K14
Para-
keratinized
areas
• K19

56.  Thin, non-keratinized stratified squamous epithelium
 No rete pegs
 Lacks:
 Stratum granulosum
 Stratum corneum
 Merkels cells
 Keratins: K4, K13= Esophageal-type
Cytokeratins
Sulcular epithelium

57.  Enzymes: low degree of activity
 Acid phosphatase staining negative
 Semipermeable membrane
 Potential to keratinize:
 It is reflected & exposed to oral cavity Bral & Caffesse
 Absence of bacterial flora Caffesse

58.  The junctional epithelium is the epithelial component of
the dentogingival unit that is in contact with the tooth
surface. The innermost cells of the JE form & maintain a
tight seal against the mineralized tooth surface, the so
called epithelial attachment
Schroeder & Listgarten, 1977
 Collar-like band of stratified squamous nonkeratinizing
epithelium
Glickman
Junctional epithelium

59. Junctional
epithelium
Gingival
fibers
Dentogingival
unit

60. Current concepts of dentogingival
junction
 Upto 1912  Min information regarding junction between
tooth & epithelium
 Attachment = CT fibers inserting into
cementum & bone
 GV Black 1915 Presence of subgingival space extending
upto CEJ under a loose fitting gingiva
 Gottlieb 1921 Presence of a firm attachment (Organic
union) between gingiva & tooth = Epithelial attachment
/epithelansatz

61.  Orban 1931  during eruption REE forms epithelial
attachment
 Waerhaug 1952  Gingiva seperated from tooth by a
capillary space forming a “Epithelial cuff”
Epithelial attachment Epithelial cuff

62.  Orban 1956  Agreed to both concepts & gave term
“Attached epithelial cuff”
 Stern 1962  Demonstrated the DGJ in rat incisors
consisting of Basal Lamina & Hemidesmosomes
 The above concepts were incorrect
 Junctional Epithelium, a tissue capable of forming &
renewing itself continuously throught life
 Term JE = Anderson & Stern in 1966

63.  Transformation of REE to junctional epithelium:
1-2 years Schroeder & Listgarten

64. Tencate 1966
Secondary junctional epithelium
Undifferentiated basal cells originating from
oral gingival epithelium
Primary junctional epithelium
Reduced enamel epithelium

65. Structure of Junctional epithelium
 Stratified squamous non-keratinized epithelium
 3-4 layers thick
 10-20 layers
 Tapers: from coronal end
 located: CEJ
 Length of junctional epithelium:
0.25-1.35 mm
 2 strata:
 Basal layer
 Suprabasal layer

66.  Basal cells = face gingival CT
 Suprabasal cells = tooth surface
also called as DAT cells (Directly Attached to Tooth)
Salonen 1989
 Lymphocytes & macrophages
 Sensory nerve fibers
Byers and Holland 1977, Maeda et al,1994

67.  Keratins: K19
 Stratification specific: K5 & K14
 Lack of expression:
 Morgan et al : Junctional area is the only stratified
nonkeratinized epithelium in the oral cavity that does not
synthesize K4 or K13
 Lack of K6 & K16 : Though turnover of the cells is very
high

68.  Interconnections
 Few desmosomes only
 Occasional gap junctions
Schroeder & Listgarten, 1977 Saito et al, 1981 Hashimoto et
al, 1986
 Wide fluid-filled intercellular spaces
Schroeder& Münzel-Pedrazzoli, 1970

69.  3 Zones:
 Apical zone  germinative characteristics
 Middle zone  higher density of hemidesmosomes
role in adhesion
 Coronal zone numerous intercellular space
increased permeability

70. Epithelial attachment
Internal basal lamina
External basal laminaLamina lucida
Lamina densa
Signal transuduction

71.  Histochemical evidence  Neutral polysaccharide
Thonard JC
 Basal lamina:
 Laminin: similar to endothelial & epithelial cells
 Lack type IV & VII collagen, perlecan,lamina
fibroreticularis. Salonen & Santti 1985

72. Dynamics of junctional epithelium
 Turnover is very high protective & regeneration
 Earlier thought epithelial cells facing external basal
lamina divide rapidly
 Evidence  DAT cells high mitotic activity
 DAT cells  Role in tissue dynamics & reparative capacity
of JE

73.  Mechanism of DAT cell turnover:
 Daughter cells replace degenerating
cells on tooth surface
 Daughter cells enter exfoliation
pathway & gradually migrate coronally
between basal cells & DAT cells
 Epithelial cells move in coronal
direction along tooth surface
Periodontology 2000
Vol 31, 2003

74.  Structural & functional features:
 Firm attachment: epithelial barrier
 Immunologic host defense: Gingival fluid, inflammatory
cells
 Rapid cell turnover
 Endocytic capacity equal to that of macrophages and
neutrophils
Cho.Garant.2000

75.  Antimicrobial defense:
1. Quick cell exfoliation-rapid cell
division
2. Funnelling effect-Rapid shedding &
effective removal of bacteria adhering to
epithelial cells
3. Basement membrane- barrier
4. Antimicrobial substances JE cells
5. Epithelial cells secrete chemokines
& cytokines
Periodontology 2000
Vol 31, 2003

76. Renewal of Gingival epithelium
 Mitotic activity: 24 hr periodicity
 Highest Morning
Nonkeratinized areas
Gingivitis
 Lowest  Evening
New cell
formation
Shedding
of old cells

77.  Cell turnover time:
 Palate, tongue, cheeks: 5-6 days
 Gingiva: 10-12 days
 Junctional epithelium: 1-6 days
Beagrie G S

78. Epithelial repair & regeneration
 Gingivectomy & incisional wounds:
 Undamaged epithelial cells from wound margin, migrates within hours of
injury
 Migrate over exposed connective tissue
 New hemidesmosomes are formed
 1-2 days = epithelial surface is 2-3 cell thick & str basale forms
 By day 5 = wound is fully covered
 By day 7 = epithelium has matured & new str corneum formation
Green RJ et al
 Periodontal flaps: heals long junctional epithelium
Stahl SS et al

79. Dental cuticular structure
 A thin, acellular structure with a homogeneous matrix,
sometimes enclosed within clearly demarcated, linear
borders
 Listgarten
Coatings of developmental
origin
Formed as part of tooth
development
Reduced enamel
epithelium
Coronal cementum
Dental cuticle
Acquired coatings
Exogenous origin
Saliva
Bacteria
Calculus
Surface stains

80. Gingival crevicular fluid
 Seeps through the thin sulcular epithelium
 Cleanse material from the sulcus
 Improve adhesion of the epithelium to the tooth
 Antimicrobial properties
 Antibody activity

82. GINGIVA

83. CONTENTS
 Introduction
 Macroscopic features
 Microscopic features
Gingival epithelium
Oral epithelium
Sulcular epithelium
Junctional epithelium
 Renewal of gingival epithelium
 Cuticular structures
 Gingival crevicular fluid
 Gingival connective tissue
 Gingival fibres
 Blood supply, nerve supply and lymphatics
 Correlation of clinical & microscopic features
 Age changes

84. Gingival connective tissue
 Collagen fibers  60%
 Fibroblast  5%
 Vessels, nerves & matrix  35%
 CT lamina propria
1. Papillary layer
2. Reticular layer

85. Cellular Extracellular
• Fibroblasts
•Mast cells
•Macrophages
•Inflammatory cells
• Fibers
•Ground substance

86. Cellular elements
 Fibroblasts: Predominant
 Mesenchymal origin
 Synthesize: collagen & elastic fibers
 Glycoproteins & GAG
 Degradation of collagen

87.  Role of fibroblast in maintaining tissue homeostasis

88.  Mast cells:
 Numerous, located perivascular region
 Vasoactive substances:
 Histamine
 Heparin
 Proteolytic enzymes

89.  Macrophages:
 Phagocytic function
 Numerous in inflammed tissue
 Circulating blood monocytes

90.  Inflammatory cells:
 Polymorphonuclear leukocytes
 Lymphocytes
 Plasma cells

91.  Clinically normal gingiva : Small foci of plasma cell &
lymphocytes : base of the sulcus
 Neutrophils : High numbers in gingival connective tissue
& sulcus
 Recently erupted teeth in children : Area below the
junctional epithelium of healthy gingiva : T-lymphocytes
Early defense recognition system

92.  As time elapses : B-lymphocytes & plasma cells
 Specific antibodies against already recognized antigens,
always present in the sulcus of clinically normal gingiva

93. Fibers
Fibers
Collagen
Reticulin Oxytalan
Elastic

94. Collagen fibers
 Predominate
 Type I collagen
 Cross banding 700 Å
 Fibroblast
 Cementoblasts
 Osteoblasts

95. Synthesis of collagen fibers
1/3 rd : Glycine
20% : Proline &
Hydroxyproline

96. Synthesis of collagen fibers

97. Reticulin fibers
 Argyrophilic staining
 Adjacent to basement membrane
 Blood vessels
 Epithelial-connective tissue
 Endothelial-connective tissue
interface

98. Oxytalan fibers
 Scarce in gingiva
 Long thin fibrils
 Diameter =150 Å
 Parallel to long axis of tooth
 Function= not known

99. Elastic fibers
 Blood vessels

100. Functions:
 To brace marginal gingiva firmly against the tooth
 To provide the rigidity necessary to withstand the forces of
mastication without being deflected away from tooth
surface
 To unite the free marginal gingiva with the cementum of
the root & the adjacent attached gingiva

101.  Principal groups
Arnim S, Hargerman D. 1953
 Secondary groups
Page R 1974

102. Principalgroup
Dentogingival
Alveologingival
Dentoperiosteal
Circular
Transeptal
Secondarygroup
Periostogingival
Interpapillary
Transgingival
Intercircular
Intergingival
Semicircular

103. Principal group

104. Dentogingival fibers
 Facial, lingual & interproximal surfaces
 Originate at cementum
 Fanlike conformation
 Interproximally : Extend towards
crest of the interdental gingiva
 Provide gingival support

105. Alveologingival fibers
 Emanate from periosteum
covering height of alveolar crest
 Splay coronally into
substance of the attached gingiva
 Attach gingiva to bone

106. Dentoperiosteal fibers
 Arise in cementum
 Insertion
 Crest of alveolar process
 Lateral aspect of cortical plate
 Anchor tooth to bone
 Protect PDL

107. Circular fibers
 Marginal & Interdental gingivae
 Encircle each tooth
 Cuff /Ring like fashion
 Purse string manner
 Maintain contour & position
of free marginal gingiva

108. Transseptal fibers
 Interproximally
 Horizontal bundles
 Between epithelium at base of the
gingival sulcus & crest of interdental bone
 Sometimes classified
as principal fibers

109.  Support for interdental gingiva
 Secure positions of adjacent teeth
 Protect interproximal bone
 Maintain integrity of dentition within dental arch

110. Secondary group

111. Periostogingival fibers
 Most abundant of secondary fibres
 Originate:
 Lateral aspect of alveolar bone
 Splay laterally, coronally & apically
 Attach gingiva to bone
 Provide support & tone
within attached gingiva

112. Interpapillary fibers
 Within substance of interdental papilla
 Coronal to transeptal fiber
 Provide support for interdental gingiva

113. Transgingival fibers
 Zigzag course around dental arch
 Serpentine fashion in-and-out between the teeth

114.  Coronal to CEJ
 Maintain tissue consistency, enhance arch alignment &
provide additional support for marginal gingiva

115. Intercircular fibers
 Originate from cementum near the distal line angles
 Insert into mesial cementum of next distal tooth
 Aid in maintaining arch integrity

116. Intergingival fibers
 Course in a mesiodistal direction within attached gingiva
 Do not insert into any calcified structure
 Provide form, support &contour of attached gingiva

117. Semicircular fibers
 Form a half-ring about each tooth on both oral and facial
aspects
 support free marginal gingiva

118. Ground substance
 Fills the space between fibers & cells
 Amorphous
 Water
 Proteoglycan
 Glycoprotein

119.  Glycosaminoglycans
 Dermatan sulfate (60%)
 Chondroitin sulfate (30%)
 Hyaluronan and Heparan sulfate (10%)
 Decorin, Biglycan, Versican, Syndecan, CD-44 & Perlecan

120.  Glycoprotein
 Fibronectin
 Distributed throughout gingival connective tissues
 Localized over collagen fibers
 Binds fibroblasts to fibers
 Mediate cell adhesion & migration

121.  Osteonectin, Vitronectin, Elastin & Tenascin
 Present diffusely
 Near the subepithelial basement membrane in the upper
connective tissue & capillary blood vessels
 Laminin
 Basal laminae
 Attach it to epithelial cells

122. Repair of gingival connective tissue
 High turnover rate
 Remarkably good healing and regenerative capacity
 Generally shows little evidence of scarring after surgical
procedures
 Rapid reconstruction of the fibrous architecture of tissues
Melcher 1976

123.  Within hours
 Wound site stabilized by fibrin clot formation
 Heavy infiltrate of neutrophils
 Within 3 days
 Granulation tissue evident
 Heavily infiltrate of inflammatory cells
 Fibrin clot is slowly degraded

124.  Day 7
 Rich in newly formed granulation tissue
 Collagen fibers align parallel along root surface
 Day 14
 Collagen fibers show signs of attachment to root surface
 3 weeks
 Fully functional connective tissue attachment
 Reformation of Sharpey’s fibers

125. Blood supply
 Posterior superior alveolar artery
 Infra orbital artery
 Greater palatine artery
 Inferior alveolar artery

126.  Supraperiosteal arterioles
 Arterioles from crest of interdental septa
 Vessels of PDL

127.  Supraperiosteal arterioles
 Facial & lingual surfaces of alveolar bone
 Capillaries extend along sulcular epithelium
 Between rete pegs of outer epithelium
 Occasional branches
 Alveolar bone  PDL
 Over crest of the alveolar bone

128.  Vessels of PDL
 Extend into gingiva
 Anastomose with capillaries
in sulcus area

129.  Arterioles from crest of interdental septa
 Extend parallel to crest of bone
 Anastomosis
 Vessels of PDL
 Capillaries in gingival crevicular areas
 Vessels that run over alveolar crest

130.  Beneath the epithelium
 Subepithelial plexus
 Thin capillary loops
 Terminal hairpin loops
 Efferent & Afferent branches
 Spirals
 Varices
 Sometimes linked by cross-communications

131.  Beneath JE
 Dentogingival plexus
 Blood vessels : ~ 40µm
 Mainly venules
 Healthy gingiva
 No capillary loops

132.  Sulcular epithelium : Flat anastomosing plexus
 Col area : Mixed pattern of anastomosing capillaries &
loops
 Absence of inflammation
 Regular, repetitive & layered pattern
 Inflamed gingival vasculature
 Irregular vascular plexus pattern

133. Lymphatics
 Remove excess fluids, cellular and protein debris,
microorganisms & other elements
 Control diffusion
 Resolution of inflammatory processes

134. Lymphatics of connective tissue papillae
Collecting network external to periosteum
Regional lymph nodes
Lymphatics beneath JE
PDL
Accompany blood vessels

135.  Labial & lingual gingiva of mandibular incisor region
 Submental lymph nodes
 Palatal gingiva of maxilla
 Deep cervical lymph nodes

136.  Buccal gingiva of maxilla
 Buccal & lingual gingiva in
mandibular premolar-molar region
 Submandibular lymph nodes

137. Nerve supply
 Maxillary & Mandibular branches of Trigeminal nerve
 Labial aspect of maxillary incisors, canines & premolars
 Superior labial branches from infraorbital nerve
 Buccal gingiva in maxillary molar region
 Posterior superior alveolar nerve

138.  Palatal gingiva
 Greater palatine nerve
 Area of incisors
 Long sphenopalatine nerve

139.  Lingual gingiva in mandible
 Lingual nerve
 Labial gingiva of mandibular incisors & canines
 Mental nerve
 Gingiva at buccal aspect of molars
 Buccal nerve

140.  Gingival connective tissues
 Most nerve fibres : Myelinated
 Blood vessels
 Gingival innervation : Derived from fibers arising from
nerves in the PDL & from the labial, buccal, and palatal
nerves

141.  Nerve structures in connective tissue
 Meshwork of terminal argyrophilic fibers
 Meissner-type tactile corpuscles
 Krause type end bulbs : Temperature receptors
 Encapsulated spindles

142. Correlation of clinical & microscopic
features
 Color
 Size
 Contour
 Shape
 Consistency
 Surface texture
 Position

143. Color
 Attached or marginal gingiva
 Coral pink
 Vascular supply
 Thickness
 Degree of keratinization of epithelium
 Presence of pigment-containing cell

144.  Alveolar mucosa
 Red, smooth & shiny
 Epithelium : Thinner
 Nonkeratinized
 No rete pegs
 Connective tissue : Loosely arranged
 Blood vessels : Numerous

145.  Physiologic Pigmentation (Melanin)
 Non-hemoglobin derived brown pigment
 Skin, gingiva, oral mucous membrane
 Gingiva : 60%
 Hard palate : 61%
 Mucous membrane : 22%
 Tongue : 15%
Dummett 1946

146.  Diffuse, deep-purplish discoloration
 Irregularly shaped brown & light brown patches
 As early as 3 hours after birth

147. Size
Cellular &
Intercellular
elements
Vascular
supply
size

148. Contour
 Shape of the teeth
 Alignment in the arch
 Location & Size of proximal contact
 Facial & lingual gingival embrasures
 Marginal gingiva : Scalloped outline
 Flat surfaces : Straight line

149.  Pronounced mesiodistal convexity
 Teeth in labial version
 Contour accentuated
 Teeth in lingual version
 Horizontal & Thickened

150. Shape
 Interdental gingiva
 Contour of proximal tooth surfaces
 Location & shape of gingival embrasures

151. Proximal surfaces relatively flat faciolingually
Roots are close together
Interdental bone thin mesiodistally
Gingival embrasures & interdental gingiva are narrow
mesiodistally

152. Proximal surfaces flare away from area of contact
Mesiodistal diameter of interdental gingiva is broad
 Anterior region : Pyramidal
 Molar region : Flattened in buccolingual direction

153. Consistency
 Firm & Resilient
 Tightly bound to underlying bone
 Exception : Movable free margin
 Collagenous lamina propria
 Contiguity with mucoperiosteum
 Gingival fibers

154. Surface texture
 Stippled
 Orange peel
 Lingual < Facial surfaces
 Absent : Infancy
 Appears : About 5 years
 until adulthood
 Disappear : Old age

155.  Microscopically
 Alternate rounded protuberances & depressions

156.  Degree of keratinization
 Low magnification : Rippled surface interrupted by
irregular depressions (50 µm)
 Higher magnification : Cell micropits
 Adaptive specialization/ Reinforcement for function
 Reduction or loss of stippling
 Gingival disease

157. Position
 Refers to the level at which the gingival margin is attached
to the tooth
 JE, OE, REE : Undergo extensive alterations & remodeling

158.  Continuous Tooth Eruption
Gottlieb & Orban, 1933
 Active eruption : Movement of the teeth in the direction
of the occlusal plane
 Passive eruption : Exposure of the teeth by apical
migration of the gingiva

159.  Anatomic crown
 Clinical crown
 Anatomic root
 Clinical root

160.  Active & passive eruption proceed together
Gottlieb & Orban, 1933
Attrition
Loss of tooth substance
Tooth eruption
Cementum deposited at
apices and furcations of
roots
Bone formed along
fundus of alveolus and at
crest of alveolar bone

161.  Passive eruption is divided into 4 stages
 Physiologic process Pathologic process

162. Age changes
 Gingival Epithelium
 Thinning of epithelium
Shklar 1966
 Decreased keratinization
Glickman 1950

163.  Shape of the Rete pegs (Conflicting results)
 Flattening of rete pegs
Shklar 1966
 Height of epithelial ridges increased
Wentz 1952
 Formation of epithelial cross ridges
Loe & Karring 1972

164.  ↑ cell density
Meyer 1956,Ryan 1974
 Morphology : Do not change
Wentz 1952
 Regeneration time (Conflicting results)
 Mitotic activity ↑
Meyer 1956,Gargiulo 1961
 Constant
Ryan 1974
 Mitotic activity↓
Karring and Loe 1973

165.  Location of JE
 Health: Apical termination of JE located at CEJ
 Dental plaque : Etiological factor in development of
gingivitis
Suami,1971

166.  Absence of plaque : Periodontal breakdown does not
occur : periodontal pocket will not occur
Lindhe & Nyman 1975; Axellsson & Lindhe 1978
 Continuous presence of plaque & its quantity :
Development & course of periodontal disease

167. Contradicting studies
 Apical migration of JE can occur in absence of plaque &
inflammatory cells
Skilleni 1930, Rushton 1951, Beersten et al 1982
 Continuous passive eruption theory
Gottlieb and Orban 1933
 Age : Gradual physiological recession of gingiva
concomitantly with apical migration of epithelium

168.  Recession : Occlusal migration of teeth compensating for
occlusal wear + Stable location of gingival margin

169.  In contrast
 Recession
 Mechanical trauma e.g. tooth brushing
Loe et al 1978
 Extrusion of teeth
Batenhorst et al 1974
 Occlusal movement of teeth does not imply apical
migration of JE
Manson 1963, Anneroth & Ericsson 1967, Loe 1967

170. Gingival Connective Tissue
 Coarser & dense
 Rate of maturation changes
 Cellular elements
 Rate of collagen synthesis
 Soluble - Insoluble collagen
 Mechanical strength
 Denaturing temperature
 Collagen stabilization

171. Conclusion
 knowledge of architecture of the gingiva, how the tissue
structure develops & how it relates to function is fundamental
importance for understanding the disease process, and for
devising effective therapeutic strategies

172.  Newman MG, Takei HH, Klokevold PR, Carranza FA. Carranza’s Clinical
Periodontology. Saunders Elsevier;10th Edition.
 Lindhe, Karring, Lang: Clinical Periodontology & Implant Dentistry. Blackwell
Munksgaard; 5th Edititon.
 P. Mark Bartold, Laurence J. Walsh & A. Sampath Narayanan. Molecular and cell
biology of the gingiva. Periodontology 2000, Vol. 24, 2000, 28–55.
 D.D. Bosshardt and N.P. Lang. The Junctional Epithelium: from Health to
Disease. J Dent Res 2005; 84(1); 9-20.
 Thomas M. Hassell. Tissues and cells of the periodontium. Periodontology 2000,
Vol. 3, 1993, 9-38.
 Van Der Velden. Effect of age on the periodontium. Journal of Clinical
Periodontology 1984: 11; 281-294.
 Marja T. Pollanen, Jukka I. Salonen & Veli-Jukka Uitto. Structure and function of
the tooth–epithelial interface in health and disease. Periodontology 2000, Vol.
31, 2003, 12–31
 Stern IB . Current concepts of the dentogingival junction: The epithelial and
connective tissue attachments to the tooth. J Periodontol 1981;52:465-476.
References