The Normal Periodontium 1-Gingiva

7/28/2019 The Normal Periodontium 1-Gingiva

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The Normal Periodontium I:The Gingiva

Periodontology 1

DENT 371

Dr. Hisham Al-Shorman, PhD


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Periodontium:

Around the Tooth

The functional system of

tissues that surrounds the

teeth and attaches them to

the bone


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The Periodontium

GINGIVA

PERIODONTAL LIGAMENTS

CEMENTUM

ALVEOLAR BONE


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THE GINGIVA


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ORAL MUCOSA:

1. Masticatory: gingiva & hard palate

2. Specialized: tongue

3. Lining: other parts

GINGIVA is a part of the masticatory mucosa Fibrous mucosa surrounding the necks of teeth,

covering the coronal portion of the alveolar

process


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Mucogingival Junction

The junction between the gingiva and the

lining oral mucous membrane


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The Gingiva

Anatomically, consists of 3 parts:

Free gingiva

Attached gingiva

Interdental gingiva


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Free Gingiva

Extends from the gingivalmargin to the free gingival

groove (FGG) at the level ofthe CEJ

Can be separated form thetooth by a probe


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The space between thefree gingiva and the tooth

surface is gingival sulcus

The base of the sulcus isformed by the junctionalepithelium.

Depth of normal gingivalsulcus (crevice) : 0-3 mm

Copyright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Gingival Sulcus


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Copright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Forms soft tissue wall

of the gingival sulcus

The margin of the freegingiva follows the

contours of the teeth,creating a wavy outline

Free Gingiva


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Attached Gingiva

Extends from the FGG toMGJ

On the palate, the wholemucosa is keratinisedand there is no MGJ


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Attached Gingiva

Firmly attached to the

underlying bone to:

Withstand masticatoryforces

Withstand tooth brushing Prevent movement of

marginal gingiva


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Width varies in differentparts of the mouth,

For example:Maxilla, buccally:

widest around incisors,

narrowest aroundpremolars

Mandible, lingually:narrowest aroundincisors,

widest around molars

Attached Gingiva


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The portion of

gingiva that fillsthe area betweentwo adjacent teethapical to thecontact area

Copyright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Interdental Gingiva


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Interdental Gingiva (Papilla)

Shape determined by:

Contact relationship between

teeth Width of proximal surfaces

Shape of the CEJ

Anterior : PyramidalMolars : Flattened in a

buccolingual direction

Between buccal & lingual

papillae COL


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Clinical Features of Normal

(Healthy) Gingiva

Colour: pink (physiologic/

racial pigmentation)

Contour: scalloped outline

Margins: thin, knife-edge

Surface texture: stippled

Consistency: resilient Pointed interdental papillae

Probing depth: 0-3 mm

No BOP


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Coral Pink Gingiva Pigmentation


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Stippling of the Attached Gingiva

Caused by the

connective tissuefibers that attach

the gingival

tissue to thecementum and

bone Copyright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins


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Histology

The gingiva consists of 2 main types of

tissue: Epithelium

Connective tissue


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Epithelium: Stratified Squamous

(parakeratinized)

Epithelium is attached to the underlying connective

tissue by a basement membrane

Ortho-keratinized Para-keratinized


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Structure

Main cell type: keratinocyte

4 layers of cells:1. stratum basale

(basal cell layer)

2. stratum spinosum

(spinous cell layer)

3. stratum granulosum

(granular cell layer)

4. stratum corneum

(corneal cell layer)


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Structure

The oral mucosa is mostly parakeratinized

Ortho- Vs para-keratinization

Epithelial cells contain a specific protein

called cytokeratin (K1-K19), in addition toother proteins such as keratolinin,

involucrin and filaggrin


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Structure

Other cell types within gingival epithelium:

Langerhans cells: modified monocytes playing a

role in immunity

Merkel cells: contain nerve endings

Melanocytes: contain melanin


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Oral epithelium (OE)

Sulcular epithelium (SE)

Junctional epithelium (JE)

Anatomic Parts of Epithelium


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The epithelial ridges of

the OE extend downinto the underlying

connective tissue

A dense network ofcollagen fibers tightly

anchors the epithelium

Oral Epithelium (OE)


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Gingival Crevicular Fluid (GCF)

Fluid in the gingival sulcus (sulcular fluid)

In healthy state, its volume is small

With inflammation, its flow increases and

composition changes

Source: diffusion through JE


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Gingival Crevicular Fluid (GCF)

Functions:

Cleansing

adhesion of epithelium to the tooth (plasma

proteins)

Antimicrobial properties

Antibody activity


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Epithelial lining of the gingival

sulcus

Thin, nonkeratinized epithelium;

making it less resistant to

stresses

The SE is permeable, allowingfluid to flow from the gingival

connective tissue into the

sulcusgingival crevicular fluidCopyright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Sulcular Epithelium (SE)


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Epithelium that forms the base

of the sulcus

Joins the gingiva to the tooth

Length = 0.71 mm to 1.35 mm

15 to 30 cells thick at the coronal

zone

4 to 5 cells thick at the apical

zoneCopyright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Junctional Epithelium (JE)


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Connective Tissue

Lies beneath epithelium

Gingival CT is largelyfibrous

Major component: Collagen

Cellular component and ground

substance

Contains the vascular, lymphatic

and nerve supply/drainage to/

from the gingival tissues


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Arrangement of Gingival Fibers

Arranged in groups:

DG

dentogingival Circular

AGalveologingival

PG

periostogingival Transseptal:

between teeth

Copyright 2011 W olters Kluwer Health | Lippincott Williams & Wilkins


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Functions of Gingival Fibers

To brace firmly marginal gingiva to

the tooth

Rigidity against mastication without

deflection

Unite marginal gingiva withcementum and attached gingiva


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Thank you

The Normal Periodontium 1-Gingiva

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