2. Contents
• Introduction.
• Definition.
Anatomy of gingiva.
1.Macroscopic feature.
a. Marginal gingiva.
b. Attached gingiva.
c. Interdental gingiva
2.Microscopic feature of gingiva.
a. Epithelium
b. Connective tissue
3. • Clinical feature of gingiva
a. Applied aspects
• Conclusion
• References
4. Definition-
The gingiva is the part of the oral
mucosa that covers the alveolar
prosses of the jaw & surronds the
neck of the teeth. ~carranza
Anatomically divided into :
1.Macroscopic feature of gingiva
a. Marginal gingiva
b. Attached gingiva.
c. Interdental gingiva.
6. Marginal gingiva
• The marginal gingiva
(unattached gingiva) is the
terminal edge or border of
The gingiva surrounding the
teeth in collar-like fashion.
• It is demarcated from the a
shallow linear depression , the
FREE GINGIVAL GROOVE.
8. • Definition:
The sulcus consists of the shallow
space that is coronal to the
attachment of the junctional
epithelium & bounded by the tooth
on one side & sulcular epithelium
on the other. ~Carranza’s
The coronal extent of the
gingival sulcus is the gingival
margin.
9. • It is ‘V’ shaped.
• Depth of gingival sulcus:
-In ideal condition- 0 mm
[Gottlieb B 1933]
-Histologically- 1.8mm with variations from 0-
6mm
[Orban,Kohler 1924]
-Clinically- 2-3 mm.
10. Development of gingival
sulcus
• This process takes between 1 & 2
years. ~Schroeder & Listgarten (
1968 ).
• It is formed when the tooth erupts
into the oral cavity.
• The junctional epithelium & REE
form a broad band attached to the
tooth surface from near the tip of
the crown to CEJ.
11. Gingival fluid ( sulculsr fluid)
• It may be either transudate/exudate in
manner.
• It contains:
Inflammatory cells
Serum
Epithelial cells
Connective tissue components
12. Diffusion of the sulcular fluid
Basement membrane.
Intracellular space of
junctional epithelium
Gingival sulcus.
13. Function of sulcular fluid
• Cleanse material from the sulcus.
• Improve adhesion of the epithelium
to the tooth.
• Antimicrobial properties.
• Antibody activity to defend the
gingiva.
15. • It is firm, resilient & tightly bound to the
underlying periosteum of the alveolar bone.
• It is continuous with marginal gingiva.
• It extends to the relatively loose & movable
alveolar mucosa & is demarcated by the
mucogingival junction.
• The width of the attached gingiva on the facial
aspect differs in different areas of the
mouth.[Bowers 1963]
16. • Greatest in incisior region:
- 3.5-4.5 mm in maxilla.
- 3.3-3.9mm in mandible.
• Narrower in posterior segments:
- 1.9mm in maxilla
- 1.8mm in mandible (premolar region)
[Ainamo J,Loe 1966]
• The width of the attached gingiva increases
with age & in supraerupted teeth.
18. • It is occupies the gingival
embrasure, which is the
interproximal space beneath the
area of tooth contact.
• Can be pyramidal or col shaped
• The shape depends on the contact
point between the two adjoining
teeth & the degree of recession.
• If a diastema is present, the gingiva
is firmly bound over the interdental
bone & form, rounded surface
without interdental papillae.
20. 1.Gingival epithelium
• Stratified squamous epithelium.
Functions-
• It provides a physical barrier to
infection
• Mechanical , chemical, water &
microbial barrier
• It acts as an innate defense
response to gingival health &
disease. ~Caffesse RG (1966)
24. Keratinocytes
• Most of the gingiva covered with
parakeratinized or nonkeratinized
epithelium.
• Orthokeratinized –some areas
present.
• These areas are progress to
maturity/ differentation under
different physiological /
pathological condition.
25. • It is activated by,
1.Proliferation
2.Differentiation
26. 1.Proliferation
• By mitosis in the basal layer.
• Less frequently in the suprabasal
layer.
• Larger number of cells begin to
migrate to the surface from basal
layer.
27. 2.Differentiation
• It consists of progressions of
biochemical & morphologic events
that occur in the cell as they migrate
from basal layer.
• Morphological changes:
1. Progressive flattening of the cell.
2. Increasing prevalence of
tonofilaments
3. Production of keratohyalin granules.
4. Disappearance of the nucles.
28. Orthokeratinized epithelium
• It is produced by complete process
of keratinization.
• No nucleus in stratum corneum.
• Well defined nucleus in stratum
granulosum.
• It is present in some areas of the
gingival epithelium.
29. Parakeratinized epithelium
• Most of the gingiva covered by
parakeratinized epithelium.
• The stratum corneum retains
pyknotic nuclei.
• The keratohylin granules are
dispersed.
• Not giving rise to a stratum
granulosum
30. Nonkeratinized epithelium
• It has granulosum / corneum strata,
whereas superficial cells have viable
nuclei.
• The epithelial cell connections are
tight junctions (zonae occludens)
32. Melanocytes
• These are dendritic cells.
• Located in the basal & spinous layer
of the gingival epithelium.
• They synthesize melanin
• Also called premelanosomes /
melanosomes.
• Melanin granules are phagocytosed
in cells of epithelium & connective
tissue.
34. Langerhans cells
• These are dendritic cells.
• Located in keratinocytes at all
suprabasal levels.
• They are modified monocytes.
• They also act as antigen presenting
cells.
• Absent in junctional epithelium.
35. Merkel cells
• Located in deep layer of the
epithelium, nerve endings.
• Tactile perceptors.
36. Basal lamina
• The epithelium is joined to the
underlying connective tissue by a
basal lamina. Stern IB (1965)
• It is 300 – 400 A thick
• The basal lamina consists of:
1. Lamina lucida
2. Lamina densa
38. 2.Lamina densa
• Composed of type IV collagen.
• The fibrils are 750nm in length from
epithelium end to connective tissue
end.
• PAS +ve.
39. • The gingival epithelium different
from the morphologically &
functionally, there are;~ Karring T,
Loe H (1975)
1. The oral or outer epithelium
2. Sulcular epithelium
3. Junctional epithelium
40. I. Oral [outer] epithelium
• Covers the crest & outer surface of
marginal gingiva & surface of the
attached gingiva.
• Average thickness of the oral
epithelium is 0.2 to 0.3mm
• It is keratinized or parakeratinized
or various combinations of these
conditions.
42. Composition of oral
epithelium
• The oral epithelium composed of 4
layers:
1. Stratum basale.
2. Stratum spinosum.
3. Stratum granulosum.
4. Stratum corneum
43. • The degree of keratinization
diminishes with age & the onset of
menopause.
• It is parakeratinized or
orthokeratinized.
• Keratinization of the oral mucosa
varies in different areas (in
descending order palate, gingiva,
ventral aspect of the tongue,&
cheek)
44. 2. Sulcular epithelium
• The sulcular epithelium lines the
gingival epithelium.
• It is thin & extends from the
junctional epithelium to the crest of
the gingival margin.
• It is act as a semi permeable
membrane.
48. • The junctional epithelium consists of a
collar like band of stratified squamous
non keratinizing epithelium.
• It is 3-4 layers thick in early life, but
the number of layers increases with
age to 10 or even 20 layers.
• The junctional epithelium taper from
its coronal end.
• The length of the junctional
epithelium ranges from 0.25-1.35mm
49. • The junctional epithelium is formed by the
oral epithelium & the reduced enamel
epithelium, during tooth eruption.
• The junctional epithelium attached to the
tooth surface by internal basal lamina & it
attached gingival connective tissue by
external basal lamina.
• The junctional epithelium attachment to the
tooth by gingival fibers, which brace the
marginal gingiva against the tooth surface. it
is referred to as the dentogingival unit.
• The internal basal lamina consists of lamina
densa & lamina lucida, which hemi
desmosomes are attached.
50. Renewal of gingival
epithelium
• The mitotic rates is higher in
nonkeratinized areas.
• Is increased in gingivitis.
• Without significant gender
defferences.
• The mitotic rate is increased /
decreased with age.
51. • The mitotic rate varies of the oral
epithelium in descending order:
Buccal mucosa.
Hard palate.
Sulcular epithelium.
Junctional epithelium.
Outer surface of the marginal
gingiva & attached gingiva.
52. • Varies turnover time of the oral
epithelium.
• Palate, tongue, & cheek ~ 5-6days.
• Gingiva ~10 -12days.
• Junctional epithelium ~1-6days.
54. Cuticler
• A thin, acellular structure with a
homogeneous matrix.
• Classified into: ~Listgarten (1963 ).
1. developmental origin.
2. Acquired coatings.
55. Development origin
• Coatings of normally formed as
part of tooth development.
• They include the REE, coronal
cementum, & dental cuticle.
56. Coronal cementum
• It deposit a thin layer of the
cementum on the enamel.
• A thin patches of afibrillar
cementum may be seen in the
cervical half of the crown.
57. Dental cuticle
• It consisting of a layer of
homogeneous organic material.
• Variable thickness [ ~0.25Um].
• It overlying the enamel surface.
• It is nonmineralized.
• Not always present.
• Near the CEJ, it is deposited over a
layer of afibrillar cementum, which
in turn overlies enamel.
59. Gingival connective tissue
• The major components of the gingival
connective tissue are collagen fibers ,
fibroblasts, vessels, nerves & matrix.
• The connective tissue of the gingiva is
known as the lamina propria.
• it is consists of 2 layers, there are,
1. Papillary layer.
2. Reticular layer.
• Connective tissue has a cellular &
extra cellular compartment,
composed of fibre & ground
substance.
60. Connective tissue fibers
They are 3 types.
1. Collagen
2. Reticular
3. Elastic
• Collagen type I forms the bulk of
lamina propria & provide the tensile
strength to gingival tissue.
• Type IV collagen fibres branches
between collagen type I & fibres of
basement membrane & blood
vessels walls.
61. Ground substance
• It is fills the space between fibre &
cells, is amorphous,& has a high
content of water.
• It is composed of proteoglycans,
hyaluronic acid & condroitin sulfate,
& glycoproteins, fibronectin.
• Laminin, another glycoprotein
found in basal lamina, serves to
attach it to epithelial cells.
64. Blood supply
1. Vessels of
periodontal
ligament.
2. Arterioles from
alveolar bone.
3. Supraperiosteal
arteries.
65. Nerves & Lymphatics supply
• The nerve fibers arising from the
periodontal ligament,& labial,
buccal, palatal nerves.
• Neural elements are distributed
throughout the gingival tissues.
• Most nerve fibers are mylinated &
are closely associated with the
blood vessels.
• The lymphatic drainage of the
gingiva into the regional lymph
nodes.
