basics about gingiva, gingiva structure, anatomy, aging, age changes in gingiva, with common examples and more pictures, easy, easy understanding

1. GINGIVA
PRESENTED BY:
SAI LAKSHMI C
MDS 1STYEAR
PERIODONTOLOGY

2. CONTENTS
• Introduction
• Oral mucosa
• Role of Gingiva
• Development of gingiva
• Clinical anatomy of gingiva
• Macroscopic features
• Microscopic features
• Gingival epithelium
• Gingival epithelium – connective tissue interface
• Gingival connective tissue
• Age changes

3. o The periodontium consists of the investing and supporting tissues of the tooth.
o Periodontium- Peri = ‘around’
-odontos = ‘tooth’,
i.e. structures around the tooth.
o Comprises:
 Gingiva
 Periodontal ligament
 Cementum
 Alveolar bone
INTRODUCTION

4. The knowledge of the microscopic and macroscopic details of components of
periodontium will provide a greater understanding of functional operation.
 A thorough understanding of the components that form the supporting structures of
the teeth will provide appreciation of interactive and adaptive nature of the system
as well as reference point of how the periodontium changes when pathologic,
normal and excessive physiologic and inflammatory stimuli stress the components..

5. Oral mucosa – 3 zones :-
Masticatorymucosa Specialized mucosa Lining mucosa

6. Oral mucosa consists of 3 zones:
Masticatory mucosa - Gingiva and covering of the hard palate [25%]
Specialized mucosa - The dorsum of the tongue [15%]
Lining mucosa - Oral mucous membrane lining the remainder of the oral
cavity [60%]

7. GINGIVA
• Gingiva is that part of oral mucosa which covers the alveolar processes of the jaws and surrounds the
necks of teeth.
-Carranza
• The fibrous investing tissue, covered by keratinized epithelium, which immediately surrounds a tooth
and is contiguous with its periodontal ligament and with the mucosal tissues of the mouth.
-AAP 1992

8. • It is a combination of epithelium and connective tissue and is defined as that portion of
oral mucous membrane, which in complete post eruptive dentition of a healthy young
individual surrounds and is attached to the teeth and the alveolar processes.
-Schroeder
• Gingiva is the part of oral mucous membrane attached to the teeth and the alveolar
processes.
-Grant
• Gingiva is that part of oral mucous membrane that covers the alveolar processes of
the cervical portions of the teeth.
-Genco

9. • Connects soft tissue to hard tissue, establishing a seal around the teeth
• Fastens to the tooth along an extensive area
• Provides sensation for control of biting & chewing
• Controls oral microbes
• Protects the PDL & alveolar bone
• Adapts to changing oral conditions & eruption
• Attaches firmly to the bone thus supporting the tooth
• Joins with the adjacent alveolar mucosa

10. Development of Gingival epithelium

11. The oral mucosa, including most of the gingiva, develop
from ectoderm and mesoderm during tooth development.
Ectoderm forms the oral epithelium, while mesoderm
forms the lamina propria and sub mucosa.
During odontogenesis, ectodermal cells of the tooth germ
separate from oral ectoderm; and the REE develops into
junctional epithelium.
Formation of gingival sulcus begins as the tooth erupts.
A separation occurs between the attached epithelium and
the tooth surface.

12. Clinical Anatomy of Gingiva

14. Unattached Gingiva
Terminal edge or border
of gingiva .
in 50% cases it is
demarcated by free
gingival groove.
It forms the soft tissue
wall of the Gingival
Sulcus.

15. Marginal gingiva / Gingival margin/ Margo gingivalis
• The terminal edge / border of the gingiva
surrounding the teeth in collar-like fashion.
• Varies in width from 0.5 - 2.0 mm from the free
gingival crest to the attached gingiva.
• More translucent appearance (than attached
gingiva)
• Lacks stippling, and the tissue is mobile or free
from the underlying tooth surface (can be
demonstrated with a periodontal probe).
• 1.5-2mm coronal to CEJ

16. • Ashallow line or depression on the gingival surface at the
junction of the free and attached gingiva.
• Presence of free Gingival Groove in different regions-
Region %of FreeGingival Groove
Right lower Premolars (44,45) 55%
Right lower Canine (43) 54%
Upper left Molars (26,27) 15%
FREE GINGIVAL GROOVE

17. GINGIVAL SULCUS / Sulcus gingivalis
• The space between the free gingiva and the
tooth surface
• “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

18. • Depth of gingivalsulcus: 0 – 3 mm for a clinically
normal gingival sulcus.
Gottlieb Orban 1933
The depth is measured using a periodontal probe.
• Histologic sections:
1.8 mm
1.5 mm
0.69 mm
Probing depth: 2-3mm

19. o Study related to depth of sulcus in different aspects of the tooth in a healthy gingiva-
Location Highest Lowest
Mesio-buccalAspect Right upper second molar
(1.96 mm)
lower left canine
(1.14 mm)
Disto-buccal aspect Left upper first molar
(1.71 mm)
Left lower first premolar
(1.13 mm)
Buccal aspect Upper right molars
(1.37 mm)
left lower canine
(0.86 mm).
Lingual &
Palatal aspect
Right upper second molar (1.31
mm)
right lower incisors (0.79
mm)

20. Definition: It is firm & resilient gingiva, tightly
bound to the underlying periosteum of alveolar
bone.
( Glossary of Periodontal terms,4th Edition)
Demarcation: It extends to the relatively loose and
movable alveolar mucosa, from which it is
demarcated by the mucogingival junction.
c

21. Functions andclinical importance
• Dissipates functional and masticatory stresses.
• Provides a resistant barrier to plaque induced inflammation.
• Prevents Recession.
• Deepens vestibule to provide better access for tooth
brushing.
• Improves esthetics, patient comfort and ease of hygiene.

22. Definition:
The distance between the mucogingival junction and the projection on the external
surface of the bottom of gingival sulcus or the periodontal pocket.
The width of attached gingiva varies in different individuals and on different teeth
of the same individual.

23. Facial:
• Widest in incisor region-
Maxilla: 3.5 – 4.5 mm
Mandible: 3.3 – 3.9 mm
• Most narrow adjacent to
premolars-
Maxilla: 1.9 mm
Mandible: 1.8 mm
Lingual:
•Wider in molar region
•Narrow in incisor region
Increases- by age of 4 years
- supraerupted teeth

24. Measuring the width of Attached Gingiva
1.Visual Method
• HALL WB, 1982: the width of attached gingiva is determined by subtracting the sulcus or
pocket depth from total width of gingiva
• Total width of gingiva = from MGJ to crest of marginal gingiva
2.Rolltest 3.Histochemicalstaining

25. • Clinical Method

27. • Definition: Junction between masticatory mucosa & lining mucosa (i.e.
attached gingiva & alveolar mucosa)
• Location: on all gingival surfaces except the palatal surface in humans.
• Clinical Relevance: Important anatomic landmark for determining the "width"
of keratinized gingiva; flap designs, gingival grafts, etc.

28. Methods to determine Mucogingival Junction (MGJ)
1)By stretching the lip or cheek while the pocket / sulcus is being probed:
The amount of attached gingiva is considered to be insufficient when stretching of lip or
cheek induces movement of free gingival margin.
(Carranza 1996)
2)Painting the mucosa with Schiller’s iodide solution:
The glycogen-containing alveolar mucosa takes on a brown color, while the attached,
glycogen-free gingiva remains unstained (Fassek in 1953)

29. DEFINITION: The interdental gingiva is the part of gingiva that occupies the gingival embrasures, which
is the interproximal space beneath the area of tooth contact.
Shape: The interdental gingiva have two shapes: pyramidal & a "col" shape.
“Col”: it is a valley-like depression that connects facial and lingual papilla.

30. Shape depends on:
1. Contact point
2. Presence or absence of recession
3. Course of CEJ
In posterior region, the teeth have contact surface rather than contact point hence the
shape of papilla follows the outline of interdental contact surfaces forming a concavity-
a COL

31.  In the area of the col, the gingival epithelium
is thin and non keratinized.
 If a diastema is present, the gingiva is
firmly bound over the interdental bone
and forms a smooth, rounded surface
without interdental papilla.

32. The tissue that resides in the interproximal embrasure is called interproximal or ‘interdental papilla’.
Shape: The shape of this papilla varies from triangular and knife-edge in the anterior regions due to
point-sized contacts of the teeth, to broader and more square-shaped tissue in the posterior sextants
due to the teeth having broad contact areas.

33. Facial Papillae Lingual Papillae

34. COLOUR:
Attached and marginal gingiva- coral pink
Alveolar mucosa- red, smooth & shiny

35. SIZE:
Sum total of the bulk of -cellular and intercellular elements
-and their vascular supply
Alteration of size is a common feature of gingival disease.

36. CONTOUR:
Marginal gingiva envelops the teeth in collar-like fashion and follows a
scalloped outline on the facial and lingual surfaces.
 straight line - along teeth with relatively flat surfaces.
 accentuated - pronounced mesiodistal convexity (e.g., maxillary
canines)on teeth in labial version.
horizontal and thickened - in lingual version.
SHAPE:
Correlated with shape of the teeth & contacts/embrasures.
Also depends on the presence / absence of recession & course of CEJ.

37. CONSISTENCY:
Firm and resilient & tightly bound to the underlying bone
SURFACE TEXTURE:
Attached gingiva is stippled (orange peel appearance).This is due
to the normal protuberances and depression in the gingiva.

38.  The level at which the gingival margin is attached to the tooth.
• Continuous eruption, even after meeting their functional antagonists occurs through out life
• Active Eruption : Movement of teeth in the direction of occlusal plane
• Passive Eruption: exposure of the tooth by apical migration of Gingiva
Gingival Zenith :
• The most apical point of marginal gingival scallop.
• The apico-coronal and mesio-distal dimension – 0.06 - 0.96 mm.
POSITION:

39. Physiologic Pigmentation (melanin)
 Melanin (non haemoglobin derived brown pigment)
Prominent in blacks, diminished in albinos.
As a diffuse, deep purplish discoloration or as irregularly shaped brown and light brown
patches and may appear as early as 3 hours after birth.

40. MICROSCOPIC
ANATOMY
Histologically, gingiva is composed of :
1. Gingival epithelium
2. Gingival epithelium-connective tissue interface
3. Gingival connective tissue

41. • Continuous lining of stratified squamous epithelium.
• Function:
 Physical barrier to Infection
 Participate actively -in responding to infection
-in signaling further host reactions
-in integrating innate and acquired
immune responses
 To protect deep structures
 Allow a selective interchange with the oral environment.
GINGIVAL
EPITHELIUM

42. GINGIVALEPITHELIUM–
types
Outer oral epithelium
Sulcular epithelium
Junctional epithelium

43. 4 layers of stratified squamous epithelium as seen
by electron microscopy:

44. 1) Stratum Basale
• Basal layer - made of cells that synthesize DNA& undergo mitosis.
• Basal cells show ribosomes & elements of RER indicative of a protein synthesizing activity.
• Found immediately adjacent to the connective tissue separated by a basement membrane.
• Germinative layer: having the ability to divide.

45.  Structure-less zone seen under light microscope is 'basement membrane’.
• 1 – 4 microns wide.
 Under electron microscope,
Basal lamina:
• lamina lucida – light zone
• lamina densa – dark zone
 It takes approximately 1 month for a keratinocyte to reach the outer epithelial surface, where it is
shed from the stratum corneum.

46. 2) Stratum Spinosum
• Prickle cell layer
• Large polyhedral cells with short cytoplasm processes.
• Show first sign of maturation.
• Nuclei stains less intense
• Intercellular spaces of the ‘prickle’ layer are large and distended, with more
prominent desmosomes

47. 3) Stratum granulosum
• Flatter & wider cells
• Nuclei show signs of degeneration & pyknosis.
• Flattened cells, in a plane parallel to the gingival surface.
• Keratohyalin granules: Associated with keratin formation; are 1 μm in diameter & round in shape
and appear in the cytoplasm of the cell.
• Protein synthesis rate progressively gets diminished as cell approaches stratum corneum.

48. 4) Stratum corneum
• Made up of keratinized squamae, which are larger & flatter than the granular cells.
• Nuclei & other organelles disappear.
• Closely packed, flattened cells that have lost nuclei and most other organelles as they become
keratinized.
• Clear, rounded bodies, representing lipid droplets appear within the cytoplasm of the cell.
• The cells are densely packed with tonofilaments.

49. KERATINIZED EPITHELIUM -TYPES
ORTHOKERATINIZATION
PARAKERATINIZATION
1.NONKERATINIZATION

50. Orthokeratinized epithelium
• Complete keratinization superficial horny layer
• No nuclei in stratum corneum layer.
• Well-defined stratum granulosum.
• Few areas of outer gingival epithelium.

51. Parakeratinized epithelium
• Intermediate stage of keratinization.
• Most prevalent surface area of the gingival epithelium.
• Can progress to maturity or de-differentiate under different
physiologic or pathologic conditions.
• Stratum cornea retains PYKNOTIC NUCLEI.
• Keratohyalin granules are dispersed.

52. Non-keratinized epithelium
• Viable nuclei in superficial layer.
• Has neither granulosum nor corneum strata.
• Layers of nonkeratinized epithelium:
1. Stratum superficiale
2. Stratum intermedia
3. Stratum basale

53. Keratinized epithelium Nonkeratinized epithelium
Layers - basal, spinosum, granular,
cornified layer.
Layers-basal, intermediate, surface layer.
Produce a cornified surface layer. Do not produce a cornified surface layer.
Prickly appearance. Intercellular spaces not obvious- no
prickly appearance.
No nuclei- orthokeratinized contains nucleated cells
Numerous tonofilaments, keratohyalin
granules present.
Less developed and dispersed
tonofilaments; no keratohyalin granules

54. EPITHELIAL CELL CONNECTIONS:
• Together with intercellular protein-carbohydrate complexes, cohesion between cells is provided by
numerous structures called “DESMOSOMES”.
• DESMOSOMES:
 Located between the cytoplasmic processes
of adjacent cells.
 Two hemidesmosomes facing each other.
 Large number of desmosomes gives a
solid cohesion between cells.

55. A Desmosome comprises the following structural components:
1. the outer leaflets (OL) of the cell membrane of two adjoining cells,
2. the thick inner leaflets (IL) of the cell membranes
3.the attachment plaques (AP), which represent granular and fibrillar material in the cytoplasm.

56. • TONOFILAMENTS:
Cytoskeleton of keratin
proteins which radiate in
brush like fashion from the
attachment plaques into
cytoplasm of the cells.
• TIGHT JUNCTIONS
(ZONAE OCCLUDENS):
Rarely observed forms of
epithelial cell connections
where the membranes of the
adjoining cells are believed
to be fused

57. CELLS PRESENT IN GINGIVAL EPITHELIUM:
Non-keratinocytes
•Langerhans cells
•Merkel cells
Melanocytes
Inflammatory cells
Keratinocytes

58. • 90% of the total gingival cell population.
• Main function:
KERATINOCYTES
Proliferation
Differentiation
Helps in barrier action of the
epithelium, while allowing a selective
interchange with the oral
environment.

59. • Move from basal to superficial layers of the epithelium as the process of
differentiation occurs, forming a keratin barrier.
• The microfilaments present in the keratinocytes help in cell motility and
maintenance of the polarity.

60. Langerhans
cells
Melanocytes Merkel's cells
NON-
KERATINOCYTES
Inflammatory
cells
• They together make up 10% of cell population in the oral epithelium.
• In light microscope- No tonofilaments & No maturation
• Do not possess cytokeratin filaments, hence do not have the ability to keratinize.
• Not arranged in layers
• Dendritic and appear unstained or clear
• Function Protective

61. Langerhans
cells
Melanocytes Merkel's cells
NON-
KERATINOCYTES
Inflammatory
cells
Types of Non-keratinocytes

62. Langerhans cells
• Reside chiefly in suprabasal layers.
• Role in immune reaction as antigen -presenting cells for lymphocytes.
• Characterized by: Birbeck Granules.
• Found = normal gingiva > sulcular epithelium
• Absent = healthy junctional ep.

63. Melanocytes
• Residing in thebasal layer
• Establishes contact with about 30-40 keratinocytes through their
dendritic processes.
• Melanin produced by melanocytes: Melanosomes
• Keratinocytes release mediators essential for normal
melanocytes function.

64. Merkel cells
• Originate from neuralcrest
• Present in Basal layer
• Located in deeper layers of epithelium
• Not dendritic cells
• Possess keratin, tonofilaments and
desmosomes.
• Sensory in nature - respond to touch – Tactile
perceptors

65. Inflammatory cells
• Nucleated cell layers
• Transient
• Lymphocytes: Most frequent
Associated with Langerhans cells
• Polymorphonuclear leukocytes
• Mast cells

66. • Lines the gingival sulcus.
• Thin, nonkeratinized stratified squamous epithelium
• No rete pegs.
• Extends from the coronal limit of the junctional
epithelium to the crest of the gingival margin.
• Hydropic degeneration of cells.
• Contains K4 and K13, K19.
• Don’t have merkel cells.
SULCULAR
EPITHELIUM

67.  Sulcular epithelium has the potential to keratinize:
• If it is reflected and exposed to the oral cavity.
• If the bacterial flora of the sulcus is totally eliminated.
 Outer epithelium loses its keratinization:
• When it is placed in contact with the tooth.
 These findings suggest that the local irritation of the sulcus prevents sulcular keratinization.
 Sulcular epithelium is extremely important because it act as a semi permeable membrane
through which injurious bacterial products pass into gingival fluid.
 Permeability SE < JE.

68. • Consists of a Collar-like band of stratified squamous non-
keratinizing epithelium.
• 3 to 4 layers thick in early life, but the number increases with
age to 10 or even 20 layers.
• Tapers from its coronal end to apical termination, located at the
CEJ in healthy tissue.
• Length: 0.25 to 1.35 mm.
JUNCTIONAL
EPITHELIUM

69. • Junctinal epithelium is the non-keratinized stratified squamous epithelium which
attaches and form a collar around the cervical portion of the tooth that follows
CEJ.
Carranza’s clinical periodontology
• It provides the attachment mechanism of the epithelium to the hard tooth surface.
• It also provides a protective function relative to the subjacent periodontal ligament.

70. What is Junctional Epithelium?
• JE tapers from its coronal end, which may be 10 to 29 cells wide, to 1 or 2 cells wide at its apical
termination, located at the CEJ in healthy tissue.
• Those cells are grouped into two strata:
 BASAL LAYER facing the connective tissue and
 SUPRABASAL LAYER extending to the tooth surface.
• It provides the attachment mechanism of the epithelium to the surface of tooth hard substance.
• It also provides a protective function relative to the subjacent periodontal ligament.

71. What are it’s functions?
• JE is firmly attached to the tooth and thus forms an epithelial barrier against the
plaque bacteria.
• It allows the access of GCF, inflammatory cells and components of the
immunological host defense to the gingival margin.
• JE cells exhibit rapid turnover, which contributes to the host-parasite
equilibrium and rapid repair of damaged tissue

72. DEVELOPMENT OF JUNCTIONAL EPITHELIUM
1. Formation of reduced enamel epithelium
2. Union of REE and Oral epithelium
3. As the tooth erupts REE is converted into JE

73. 1. REE surrounds the crown of tooth from
the moment enamel is properly
mineralized till it erupts.
3. Migrating epithelium produces an epithelial mass
between oral epithelium and REE so that tooth can
erupt without bleeding.
2. When tooth has penetrated in oral cavity, large portions
immediately apical to incisal area of enamel are covered by
junctional epithelium containing few layers of cell.
4. During later phases of tooth eruption all cells of REE
is replaced by the JE.

74. 1. Cuboidal cells derived from the ameloblasts begin to flatten
2. Align parallel to the tooth surface and take appearance of junctional epithelium
3. Since these cells which have lost capacity to divide get exfoliated at base of the
sulcus
4. Cells from stratum intermedium which have proliferative capacity get transformed
into Junctional epithelium
Changes during conversion into junctional epithelium:

75. STRUCTURE OF JUNCTIONAL EPITHELIUM
 Anatomical aspects
 Junctional epithelium and interstitial cells
 Epithelial attachment apparatus

76. JE: ANATOMICAL FEATURES:
• JE forms a collar peripheral to cervical region of tooth of about 0.25 to 1.35 mm
• Interproximally JE of adjacent teeth fuse to form the lining of the col area
• Epithelial connective tissue interface is smooth (no rete pegs)
• JE is thickest at bottom of sulcus and tapers off in apical direction

77. JE: MICROSCOPIC FEATURES
• Collar-like band of nonkeratinised stratified squamous epithelium
• Extends from CEJ to bottom of gingival sulcus
• Coronally, 15-30 cells thick. Apically narrows to 1-3 cells.
• Two strata- stratum basale and stratum suprabasale
• Two basal lamina – External and internal

78. DAT CELL:
The single layer of cell lying in contact with
tooth surface (directly attached to tooth surface).
Recent studies indicate that DAT cells
are capable of –
Undergoing cell- division.
Exclusive proliferating population of epithelial cells (DAT) in suprabasal location is a unique
feature of junctional epithelium.
DAT cells possess the capacity to form and renew the components of the epithelial attachment.

79. These cell layers can be grouped in two strata:
The basal layer: that faces the connective tissue
(External Basal Lamina)
The suprabasal layer: that extends to the tooth
surface – DAT CELLS (Internal basal lamina)
3 zones of junctional epithelium:
 Apical – germination
 Middle – adhesion
 Coronal- permeable

80. Widened spaces allow the transmigration of GCF and
leukocytes, and thus prevent the entry of bacteria;
Simultaneously, it provides passage for bacterial
products into the connective tissue
JE: Wide intercellular space may
be a double-ended sword-

81. JE: Role in Anti-Microbial Defense:
• Junctional epithelium consists of active populations of cells and antimicrobial functions,
which together form the first line of defense against microbial invasion into tissue.
• Even though junctional epithelial cell layers provide a barrier against bacteria, many bacterial
substances, such as lipopolysaccharide, pass easily through the epithelium but have only
limited access through the external basal lamina into the connective tissue (Shwartz et al
1972).

82. JE in the Anti-Microbial Defense:
• Rapid turnover, as such, is an important factor in the microbial defense of JE.
• The area covered by the dividing cells in the junctional epithelium is at least 50 times larger
than the area through which the epithelial cells desquamate into the gingival sulcus.
• There is a strong funneling effect that contributes to the flow of epithelial cells (Schroder et
al 1967).
• Rapid shedding and effective removal of bacteria adhering to epithelial cells is therefore an
important part of the antimicrobial defense mechanisms at the dentogingival junction.

83. PERMEABILITY OF JUNCTIONAL EPITHELIUM
• The bi-directional arrows indicate that the junctional
epithelium is the most permeable portion of the gingival
epithelia.
• Because of its permeability to bacterial products and other
assorted antigens, the connective tissue adjacent to the
junctional epithelium tends to become infiltrated with
chronic inflammatory cells, primarily lymphocytes and
plasma cells.

84. PRIMARY ATTACHEMENT
EPITHELIUM
SECONDARY ATTACHEMENT
EPITHELIUM
EPITHELIUM ATTACHMENT
APPARATUS
Attachment of reduced enamel
epithelium to the enamel of the
unerupted tooth .
After conversion of REE to JE the
attachment is referred to as
junctional epithelium.
Mediated by the hemidesmosomes
of DAT cells and internal basal lamina
EPITHELIALATTACHMENT

85. Attachment of JE – ultramicroscopic mechanism defined as epithelial
attachment apparatus
Consists of:
• Hemidesmosomes – at plasma membrane
of cells directly attached to the tooth
• Basal lamina like extracellular matrix
• Internal basal lamina on the tooth surface

86. DYNAMICS (TURNOVER RATE) OFJE
• The turnover rate of JE cells is exceptionally rapid. In non-human primates it is about 5 days
(twice that of oral epithelium).
• The DAT cells express a high density of transferrin receptors supporting the idea of active
metabolism and high turnover.
• DAT cells have an important role in tissue dynamics and reparative capacity of the JE.
• The existence of a dividing population of DA
T cells in a suprabasal location in several
layers from connective tissue is a unique feature of JE.

87. Characteristics Outer Oral
epithelium
Sulcular epithelium Junctional
epithelium
Origin Oral epithelium Oral epithelium Reduced enamel epithelium
Keratinization Parakeratinized Sometimes
orthokeratinized
Nonkeratinized Nonkeratinized
Stratification Well stratified Stratified but granulosam
and corneum are absent
Poorly stratified
Proliferation Lesser proliferation among
three
Higher than OEE but lesser
than JE
Higher proliferation
Permeability Not permeableto water
soluble substances
Moderately permeable Highly permeable
Intercellular Space
Desmosomes& tonofilaments
Narrowest
More than SE& JE
Narrower than JE More than
JE
Widest among three
Least among three
Retepegs Present Normally absent, appears in
inflammation
Normally absent, appears in
inflammation

88. • Ultrastructurally this interface is composed of 4 elements:
1. Basal cell plasma membrane.
2. Lamina lucida: 25 to 45 nm wide.
3. Lamina densa: 40 to 60 nm thickness.
4. Reticular layer.
• From the lamina densa so called anchoring fibrils project in a fan- shaped fashion into
the connective tissue.
EPITHELIUM-CONNECTIVE TISSUE
INTERFACE

89. Various junctional complexes present in gingiva are:
• Tight junctions/Zonae occludens
• Adhesive junctions:
 Cell to cell
– Zonula adherens
– Desmosomes
 Cell to matrix
– Focal adhesions
– Hemidesmosomes
• Gap junctions:
 Intercellular pipes/channels bridge both adjacent membranes and intercellular
space.
 Intercellular space in gap junction is approx. 3 nm.
 Major pathway for direct intercellular communication.

90. • Predominant tissue component of gingiva: ‘Lamina Propria’.
• The gingival connectivetissue is composed of:
1. Ground substance
2. Gingivalfibers
3. Cells
4. Blood vessels
5. Nerves and,
6. Lymphatic vessels
• Layers of connective tissue:
1. Papillary Layer
2. Reticular Layer
CONNECTIVE TISSUE

91. 1) Ground substances
• Connective tissue cells and fibers, together with vessels and nerves are embedded in a matrix which is
synthesized by fibroblast and it is made upof:
a. Glycoproteins: it is a protein-polysaccharide molecule in which protein component is predominating.
Glycoprotein mediates attachment and migration of fibroblasts.
b. Proteoglycans: it is a protein polysaccharide molecule in which polysaccharide component is
predominating.
c. Glycosaminoglycans: are polysaccharides which can bind large amounts of water providing the
characteristic resiliency of the gingiva (i.e. resist compressive force). Glucosaminoglycans also
facilitate transport of: nutrients, metabolic products, cells and cytokines which are chemical
messengers that modulate cellular function.

92. 2) Gingival fibers
• The gingival connective tissue fibers are produced by the
fibroblasts and can be divided into:
1. Collagenfibers
2. Reticulin fibers
3. Elastic fibers.
• Connective tissue of marginal gingiva is densely
collagenous containing a prominent system of
collagen fiber bundle
• Consists mainly of type 1 collagen.

93. FUNCTIONS OF GINGIVAL FIBRES

94. 07/12/16
COLLAGEN FIBRES
• Predominate in gingival connective tissue & constitute
the most essential components of the periodontium
• The smallest unit, collagen molecule, is often referred
to as “tropocollagen”.

95. 07/12/16
RETICULIN FIBRES
• Argyrophilic staining properties
• Numerous in tissue adjacent to basement membrane
• Occur in large no. in loose connective tissue
• Present at epithelium - connective tissue interface
OXYTALAN FIBRES
• Scarse in gingiva but numerous in PDL
• Composed of long thin fibrils with diameter of ~150 Å

96. 07/12/16
ELASTIC FIBRES
• Only present in association with blood
vessels of gingiva and PDL.
• Gingiva coronal to mucogingival junction
(MGJ) does not contain elastic fibres except
in association with blood vessels.

97. 07/12/16
Gingival fibers

98. • Originates from cementum and spreads laterally
into lamina propria
Dentogingival
• Orginates from periosteum and spreads into
lamina propria
Alveologingival
• Originates from cementum near CEJ into
periosteum of alveolar crest
Dentoperiosteal
• Originates from within the free marginal and
attached gingiva coronal to alveolar crest and
encircles each tooth
Circular
• Originates from interproximal cementum coronal
to crest and courses mesially and distally in the
interdental area into cementum of adjacent teeth
Transseptal

99. •Originates from the periosteum of the lateral aspect of
alveolar process and spreads into attached gingiva.
Periosteogingival
•Originates from within interdental gingiva and follows
an orofacial course
Interpapillary
•Originates within the attached gingiva interwing along
dental arch between and around teeth
Transgingival
•Originates from cementum on distal surface of tooth
spreading buccally and lingually around adjacent tooth
and inserting on mesial cementum of next tooth
Intercircular
•Originates from attached gingiva immediately subjacent
to basement membrane and courses mesiodistally
Intergingival
•Originates from cementum of the mesial surface of tooth
and courses distally and inserts on the cementum of
distal surface of same tooth
Semicircular

100. GINGIVAL CELLS

101. • Predominant connective tissue cells(65%)
• Spindle or stellate shaped with oval nucleus
containing one or more nucleoli
• Function- maintains structural integrity of
connective tissue by secreting extracellular matrix.
FIBROBLASTS
MAST CELLS
• Large spherical or elliptical mononuclear cell
• Present in relation to blood vessels so they play a role
in maintaining normal tissue stability and vascular
homeostasis

102. 07/12/16
• Well developed nucleus, Golgi apparatus
• Numerous vesicles
• Scarse granular endoplamic reticulum
• Phagocytic function
Includes-
• Neutrophils
• Lymphocytes
• Plasma cells
MACROPHAGES
INFLAMMATORY CELLS

103. Blood supply to periodontium
• The gingiva receives its blood supply mainly through supraperiosteal blood vessels
which are terminal branches of-
 Sublingual artery
 Buccal artery
 Facial artery
 Greater palatine artery
 Infraorbital artery
 Posterior superior artery

104. VESSELS OF PERIODONTAL LIGAMENT
• Extends into gingiva.
• Anastomosis:
-With capillaries in sulcular area

105. SUPRAPERIOSTEAL ARTERIOLES
• Facial and lingual surfaces of alveolar bone
• Capillaries extend along sulcular epithelium
• Between rete pegs of outer epithelium
• Occasional branches of arterioles pass through
Alveolar bone PDL
• Over the crest of alveolar bone
ARTERIOLES FROM CREST OF
INTERDENTAL SEPTA
Extend parallel to crest of alveolar bone
Anastomosis:
• Vessels of PDL
• Capillaries in gingival crevicular areas
• Vessels that run over alveolar crest

106. • Blood supply originating from the vessels in the periodontal ligament pass the alveolar bone
crest and contribute to the blood supply of the free gingiva.
• The main blood supply of free gingiva is from the supraperiosteal blood vessels (SV) which,
in the gingiva, anastomose with blood vessels from the alveolar bone and periodontal
ligament.

107. Venous drainage
• Buccal,
• lingual,
• greater palatine &
• nasopalatine veins.
• Veins run into the pterygoid plexus.

108. Lymphatic drainage
The lymph vessels from teeth usually run directly into ipsilateral submandibular lymph nodes.
Lymph from mandibular incisors drain into submental lymph nodes.
Lymphatic drainage starts in connective tissue papillae and drains into regionallymph nodes; from-
-mandibular incisor-region gingiva  submentallymph nodes
-maxillary palatal gingiva  deep cervical lymph nodes
-maxillary buccal gingiva  submandibular lymph nodes
-mandibular premolar-molar-region gingiva  submandibular lymph nodes

109. Nerve supply
• The nerve supply is derived from branches
of Trigeminal nerve.
Anumber of nerve endings havebeen
identified in the gingival connective tissue,
such as tactile corpuscles, temperature and
pain receptors (Krause type end bulbs).

111. REPAIR / HEALING OF GINGIVA
• Turnover rate is 10-12 days.
• It is one of the best healing tissues in the body with little
or no scarring.
• However, the reparative capacity is lesser than that of
periodontal ligament and epithelial tissue.

112.  Stippling usually disappears with age.
 Width of the attached gingiva increases with age.
a. Gingival epithelium:
• Thinning and decreased keratinization
• Rete pegs flatten
• Migration of junctional epithelium apically.
• Reduced oxygen consumption.
Age Changes

113. a. Gingival connective tissue:
• Increased rate of conversion of soluble to insoluble
collagen
• Increased mechanical strength of collagen
• Increased denaturing temperature of collagen
• Decreased rate of synthesis of collagen
• Greater collagen content.
Age Changes

114. • The biological width is defined as the dimension
of the soft tissue, which is attached to the portion
of the tooth coronal to the crest of the alveolar
bone.
BIOLOGICALWIDTH-
Clinical considerations

115. Biologic Width Evaluation:
1. Clinical (discomfort when the restoration margin levels are being assessed with a periodontal probe)
2. Radiographs (for interproximal violation but mesiofacial and distofacial line angle not seen
properly)
3. Bone sounding (probing under anesthesia)- If this distance is less than 2 mm or more at one or more
locations, a diagnosis of biologic width violation can be confirmed
Biologic width violation:
• Unpredictable bone loss
• Gingival recession
• Persistence of gingivitis

116. Conclusion
• Gingival tissues play a key role in the protection of tooth structures and supporting
periodontal tissues against trauma and / or infection
• Making the gingival health, a very essential component for the success of all
periodontal treatment procedures.
• Proper functioning of the periodontium is achieved only through structural
integrity and interaction between the various tissues which are its components.

117. References
 Clinical Periodontology, By Carranza, 12th Edition
 Clinical Periodontology And Implant Dentistry By Jan Lindhe, 4th Edition
 Oral Histology, Development, Structure And Function – A.R. Ten cate, 5th Edition