Gingiva is the part of oral mucosa that covers the alveolar process of the jaw and surround the neck of teeth in collar like fashion. It is a combination of epithelium and connective tissue.

1. GINGIVA

2. Contents
• Introduction
• Definitions
• Development
• Macroscopic anatomy
• Marginal gingiva
• Attached gingiva
• Interdental gingiva
• Microscopic anatomy
• Gingival epithelium
• Gingival connective tissue
• Blood supply
• Nerve supply
• Lymphatic drainage
• Age changes
• Conclusion
• References

3. Introduction
Parts of oral mucosa

4. Definitions of Gingiva
• Carranza :
Is the part of oral mucosa that covers the alveolar process of jaw and
surrounds the neck of teeth in a collar like fashion.
• Shroeder :
It is the 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 process.

5. • Grant :
Is the part of oral mucous membrane attached to the teeth and the
alveolar processes.
• Lindhe :
Is that part of masticatory mucosa covering the alveolar processes and
the cervical portions of teeth.
• GPT 2001:
The fibrous investing tissue covered by keratinized epithelium that
immediately surrounds a tooth and is contiguous with periodontal
ligament and with the mucosal tissues of the mouth .

6. Macroscopic features
Alveolar mucosa
Mucogingival junction
Marginal gingiva
Interdental gingiva
Free gingival groove
Attached gingiva

7. Marginal gingiva
Marginal or unattached gingiva is the terminal edge or
border of the gingiva surrounding the teeth in collar like
fashion.
(Carranza )
Free gingiva :That part of the gingiva that surrounds the
tooth and is not directly attached to the tooth surface.
(GPT2001)
Marginal gingiva :The most coronal portion of the
gingiva. Often used to refer to the free gingiva that
forms the wall of the gingival crevice in health .
(GPT 2001)

8. Free gingival groove
• In about 50% of cases, it is demarcated from
the adjacent attached gingiva by a shallow
linear depression, the Free gingival groove.
(Ainamo J,Loe H 1966)
• GPT 2001: A shallow, V-shaped groove or
indentation that is closely associated with the
apical extent of free gingiva and runs parallel
to the margin of the gingiva. The frequency of
its occurrence varies widely.
• Orban 1948 : A shallow V –shaped groove
which runs parallel to the margin of the
gingiva at a distance of 0.5-1.5mm
• Significance

9. Attached gingiva • GPT 2001 :The portion of the gingiva that is firm, dense,
stippled, and tightly bound to the underlying periosteum,
tooth, and bone.
• It is the distance between the mucogingival junction and
the projection on the external surface of the bottom of
the gingival sulcus or the periodontal pocket.
• Measurements
• A study done by Rajiv Subbaiah , Balaji Manohar on Indian
population – the average width of attached gingiva was

10. • Attached gingiva ranges 1mm- 9mm and appears to exhibit a
consistent pattern of variation throughout the dentition
(Bowers 1963)
• Attached gingiva on deciduous teeth < adult dentition, but the
pattern of variation is similar in two.
• The width of attached gingiva increases with age and in supra-
erupted teeth.

11. Inadequate zone of gingiva
• Dissipate the pull because of muscles of adjacent mucosa (Friedman 1957)
• Increase in subgingival plaque formation (Friedman 1962)
• Attachment loss and soft tissue recession due to apical spread of plaque
associated gingival lesions (Stern 1976)
• Along with decreased vestibular depth causes accumulation of food particles
during mastication and impedes oral hygiene measures (Gottsegen 1954)
Clinical significance
• Increases resistance to external injury and contribute in stabilization of gingival
margin.
• Against frictional forces
• Dissipating physiological forces exerted by the muscular fibres of the alveolar
mucosa on the gingival tissues.

12. How much zone of attached gingiva is necessary to
maintain the zone of attached gingiva?

13. Attached Gingiva around Implants
• Absence of keratinized mucosa increases the susceptibility of peri
implant lesions and plaque induced destructions
• Keratinized gingiva around implant has more hemidesmosomes.
Clinical significance
• Prevent spread of inflammation.
• Prevents recession of marginal tissue.
• Provides tight collar around implants.
• Enable patients to maintain good oral hygiene

14. Feature which are specific to attached gingiva
are:
• Deep rete pegs, Thick lamina propria.
• Abundant collagen with elastic fibers, Indistinct sub
mucosa.
Stippling
(Carranza):
It is a form of adaptive specialization or reinforcement for
function and feature of healthy gingiva .
(GPT 2001)
The pitted, orange-peel appearance frequently seen in
attached gingiva .
• Best viewed by drying Gingiva.
• Healthy Gingiva, More numerous in lower jaw (Cleaton
Jones 1978)
• Absence of stippling in Infancy, gingival diseases,
inflammation etc.
• The papillary layer of the connective tissue projects into
the elevation .

15. Interdental Papilla
• COHEN in 1959 first described interdental gingiva
• GPT 2001
Gingival Papilla : That portion of the gingiva that
occupies the interproximal spaces. The interdental
extension of the gingiva.
Anterior region- Pyramidal
Molar region-Papillae more flattened in buccolingual
direction (tent shaped)
• Shape of interdental gingiva depends on
• Contact relation between the two adjoining teeth
• Width of proximal tooth surfaces
• Course of CEJ
• Presence or absence of some degree of recession

16. • Interdental papilla has a shape in conformity with the outline of the
interdental contact surfaces which leads to formation of a concavity
called as ‘A col’
• GPT 2001
A valley-like depression of the interdental gingiva that connects facial
and lingual papillae and conforms to the shape of the interproximal
contact area.
• Seen in premolar and molar regions
• It is covered by a thin non-keratinised epithelium

17. Gingival sulcus
• (Carranza)
• Shallow crevice or space around the tooth bounded by
the surface of tooth on one side and the epithelium
lining the free margin of gingiva on other side
• (GPT 2001)
• The shallow fissure between the marginal gingiva and
the enamel or cementum.
• It is ‘V’ shaped.
• Clinically determined by introduction of the metallic
instrument, the periodontal probe and estimation of
distance it penetrates
• In periodontal health, the gingival crevice is known as
a sulcus, whereas in disease, it is called a pocket.

18. Gingival Sulcus
GPT 2001: Tissue fluid that seeps through the crevicular and junctional
epithelium. It is increased in the presence of inflammation.
Seeps through the thin sulcular epithelium
Cleanse material from the sulcus
Contains plasma proteins that improves adhesion of the epithelium to
the tooth
Antimicrobial properties
Antibody activity

19. Transduate /Exudate?
• Alfano (1974) and Pashley Hypothesis (1976)
• The initial fluid produced could simply represent interstitial fluid which
appears in the crevice as a result of an osmotic gradient.
• This initial, pre-inflammatory fluid was considered to be a transudate, and, on
stimulation, this changed to become an inflammatory exudate
• Brill in 1959 demonstrated that increased vascular permeability plays
an important role in the production of gingival fluid.
• GCF Flow

20. Microscopic anatomy
Overlying stratified squamous epithelium
Underlying core of connective tissue
Cells of gingival epithelium

21. Keratinocytes
• Have large round or oval nucleus with one or
more nuclei
• Cytoplasm is densely packed with organelles
• Golgi complex is prominent, lamellae of rough
endoplasmic reticulum and mitochondria present
• Most of ribosomes are present as free bodies

22. Clear cells /
Non Keratinocyte
• These cell types are often stellate and have
cytoplasmic extensions of various size and
appearance.
Melanocytes and spinous layer.
• They produce the pigment melanin.
• This cell contains melanin granules
• Tonofilaments or hemidesmosomes absent.

23. Langerhans cell
• Derived from the progenitor
cells present in the bone marrow.
• Present in suprabasal layers
• They have potential to present antigen to T-
lymphocytes and activate them
• They contain g-specific granules (Birbeck's granules)
and have marked adenosine triphosphatase activity
• They found in oral epithelium, smaller amount in
sulcular epithelium but not in junctional epithelium

24. Merkel cells
• Merkel cells are located in deeper layers of the epithelium.
• They harbor nerve endings and are connected to adjacent cells by
desmosomes.
• They have been identified as tactile perceptors.

25. Keratinized stratified
squamous epithelium.
4 classical epithelial strata
• Stratum Basale
• Stratum spinosum
• Stratum granulosum
• Stratum corneum

26. Stratum Basale
• Cells in the basal layer : Cylindrical or
Cuboidal
• In contact with the basement membrane
• Stratum germinativum : Progenitor cell
compartment of the epithelium

27. • The basal cells are found immediately adjacent to the connective
tissue and are separated from this tissue by the basement membrane
• This membrane appears as a structureless zone approximately 1–2
μm wide
• This reacts positively to a PAS stain (periodic acid-Schiff stain).
• Contains carbohydrate-glycoproteins
• Epithelium - Connective tissue junction :
• The boundary between the oral epithelium & underlying
connective tissue has a wavy course.
• Connective tissue portions project into the epithelium, called as
connective tissue papillae & are separated from each other by
epithelial ridges-so called rete pegs.

28. Stratum spinosum
• Consists of 10–20 layers of relatively large,
polyhedral cells.
• Presence of cytoplasmic processes resembling
spines.
• The cytoplasmic processes occur at regular
intervals and give the cells a prickly
appearance.
• Cohesion between the cells - “desmosomes”
• Acid phosphatase containing dense granules –
keratinosome or Odland bodies

29. Stratum granulosum
• Keratinocytes migrating from the
underlying stratum spinosum become
known as granular cells in this layer
• Electron dense keratohyalin bodies –
synthesis of keratin
• They are filled with histidine- and
cysteine-rich proteins that appear to
bind the keratin filaments together.
• Therefore, the main function of
keratohyalin granules is to bind
intermediate keratin filaments together

30. Stratum corneum
• There is an abrupt transition of the cells
from the stratum granulosum to the
stratum corneum because of a very
sudden keratinization.
• And it produces horny stratum corneum
• The cytoplasm of the cells in the stratum
corneum is filled with keratin.

31. Orthokeratinized
•No nuclei in the
stratum corneum
•Well-defined
stratum granulosum
Nonkeratinized
•Has neither
granulosum nor
corneum strata
•Superficial cells :
Viable nuclei
Parakeratinized
•Stratum corneum retains
pyknotic nuclei
•Keratohyaline granules :
Dispersed
•No stratum granulosum

32. Gingival epithelium
The epithelium covering the free gingiva
may be differentiated as follows:
• Oral epithelium (OE)
• Oral sulcular epithelium (OSE)
• Junctional epithelium (JE)

33. Oral Epithelium
Covers crest & outer surface of the
marginal gingiva & the surface of the
attached gingiva.
Thickness-0.2-0.3 mm
Orthokeratinized / Parakeratinized

34. Sulcular epithelium
• 1. Lines the gingival sulcus
• 2. Thin & Nonkeratinized
• 3. Stratified squamous epithelium
• 4. No rete pegs
• 5. Coronal limit of JE to the crest of to gingival
margin
• 6. Presence of cells with hydropic degeneration
• 7. Semipermeable membrane

35. Junctional epithelium
• GPT 2001 : A single or multiple layer of
nonkeratinizing cells adhering to the tooth
surface at the base of the gingival crevice.
Formerly called epithelial attachment
• Junctional epithelium contains mainly 3 zones:
• Coronal : more permeable
• Middle : adhesion
• Apical :germination

36. Features
• Collar like band of stratified squamous , non-keratinized epithelium.
• Thickness : 3-4 layers thick (early life) & 10-20 layers (as age increases)
• Thickness: Coronally 10-29 cells & apically 1-2 cells
• Length : 0.25 to 1.35mm.
• Cells are arranged into basal and supra basal layers
• Absence of granular or cornified layer
• Intercellular space is wider
• Highly permeable

37. • Attaches to tooth surface by means of an internal basal lamina and to
the connective tissue by an external basal lamina.
• The internal basal lamina consists of a lamina densa and lamina
lucida to which hemidesmosomes are attached
• Hemidesmosomes may act as specific sites of signal transduction & may
participate in gene expression, cell proliferation & cell differentiation
(Jones JC,Hopkinson SB et al)

38. The attachment of the junctional epithelium to the tooth is reinforced by the
gingival fibers, which brace the marginal gingiva against the tooth surface.
Therefore the junctional epithelium and gingival fibers are considered a
functional unit called as dentogingival unit.
(Listgarten et al, 1970)
Functions
• Provides attachment to the tooth.
• Act as a barrier against plaque bacteria & invading microbes.
• Rapid cell division & funneling of junctional epithelial cells towards the
sulcus hinders bacterial colonization & repair of damaged tissues
rapidly.
• Active antimicrobial substances are produced by junctional epithelial
cells which includes defensins, lysosomal enzymes, calprotein &
cathelicidin.

39. • Allows the access of GCF , inflammatory cells & components of the
immunological host defense to the gingival margin.
- two way movement:
1. from connective tissue to crevice
2. from crevice to connective tissue
• Epithelial cells activated by microbial substances secrete chemokines
examples: IL1, IL6, IL8 & TNF alpha that attract & activate professional
defense cells such as lymphocytes & PMNs.

40. Gingival connective tissue
• Lamina Propria
• Papillary layer subjacent to the
epithelium.
• Consists of papillary projections between
the epithelial rete pegs.
• Reticular layer contiguous with the
periosteum of the alveolar bone

42. Fibers in gingiva
• The connective tissue of gingiva is referred to as lamina propria
• Approximately 60-65% of the connective tissue compartment of
healthy gingiva is occupied by collagen, with the individual fibrils
highly organized into discrete and easily discernible fiber bundles
(Arnim and Hargerman 1953)
• Collagen fiber bundles have been referred to as the Gingival
Ligament, which is contiguous with the periodontal ligament.

43. •Functions of gingival fibers
• To brace the marginal gingiva firmly against the tooth
• To provide the rigidity necessary to withstand the forces of
mastication without being deflected away from the tooth surface.
• To unite the free marginal gingiva with the cementum of the root
and the adjacent attached gingiva.

45. Cells of connective tissue
• The periodontium is a dynamic structure and the cells normally
present in the soft connective tissues of the periodontium reflect
this dynamism.
• Individual cells comprise approximately 8% by volume of the
connective tissue compartment
(Schroeder H, Munzel-Pedrazzoli S, Page R 1973)

46. Fibroblast
• The preponderant cellular element in the
gingival connective tissue .
• Mesenchymal origin
• Role in the development, maintenance, and
repair of gingival connective tissue.
• Although the biologic and clinical significance of
fibroblast heterogeneity is not year clear, it
seems that this is necessary for the normal
functioning of tissues in health, disease, and
repair .

47. PLASMA CELL
PMN MAST
CELL
LYMPHOCYTE MACROPHAGE

48. Correlation of clinical and microscopic features
Color
Contour
Consistency
Surface texture
Shape
Position

49. Active eruption –
Movement of teeth
in direction of
occlusal plane.
Passive eruption-
Exposure of tooth
by apical migration
of gingiva.
Rate of Active
eruption is in pace
with tooth wear in
order to preserve
vertical dimension.

50. Clinical Considerations
• Biological width- is defined as the dimension
of soft tissue which is attached to the portion
of the tooth coronal to the crest of alveolar
bone.
• Gingival Biotype
• Thick / Thin
• Thick biotype- reacts to surgical and
restorative insults with pocket formation.
• Thin biotype- Bony dehiscence and
fenestration defects, reacts to surgical or
restorative interventions with soft tissue
recession

51. Blood supply

52. Lymphatic drainage
Lymphatics beneath the junctional epithelium extend into the
periodontal ligament and accompany the blood vessels.

53. Gingival innervation
• Nerves in the periodontal ligament
• Labial, buccal and palatal nerves
• Nerve structures are present in the
connective tissue.
• Meissner type tactile corpuscles – Touch
receptors
• Krause type of end bulbs-Temperature
receptors seen as coiled terminals.
• Fine fibers in the papilla pain receptors.
• All are found in the free and attached
gingiva.

54. Age changes in connective tissue
• Decreased keratinization
• Decreased connective tissue cellularity
• Decreased oxygen consumption
• Atrophy of connective tissue with loss of elasticity
• Greater amount of intercellular substance
• Reduced or no changes in stippling
• Increase in width of attached gingiva with constant location of the
mucogingival junction throughout the life

55. conclusion
• Gingiva is the part of oral mucosa that covers the alveolar process of
jaw and surrounds the neck of teeth.
• Anatomically divided into marginal, attached and interdental gingiva
• Microscopically consists of outer epithelium ,sulcular epithelium and
junctional epithelium
• Connective tissue consists of cellular and fibrous components
embedded in matrix.

56. References
• Carranza’s clinical periodontology, 10th edition
• Lindhe ‘s Clinical periodontogy and implant dentistry, 5th edition
• Angelo Mariotti . The extracellular matrix of the periodontium:
dynamic and interactive tissues. Periodotology 2000, Vol. 3, 1993, 39-
63
• Antonio Nanci & Dieter D. Bosshardt. Structure of periodontal tissues
in health and disease. Periodontology 2000, Vol. 40, 2006, 11–28
• Malathi K .Attached gingiva : A Review . IJSRR 2013, 3(2),188-198
• Marja T .Structure and function of the tooth–epithelial interface in
health and disease. Periodontology 2000, Vol. 31, 2003, 12–31

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