The gingiva is the investing tissue of the periodontium that surrounds and is attached to the teeth. It consists of stratified squamous epithelium and an underlying connective tissue. The gingiva has several functions including protecting the underlying structures, withstanding forces of mastication, and maintaining periodontal health through defense mechanisms. Microscopically, it contains keratinized epithelium and fibers that attach it firmly to the tooth and provide rigidity. The gingiva has a blood supply from the surrounding bone and periodontal ligament and lymphatic drainage to regional lymph nodes. Changes in disease include variations in color, size, and consistency as the gingiva becomes edematous from inflammatory fluid
Certains medications have been associated with gingival enlargement.
the seminar gives a complete analysis of etilogy and pathogenesis involved in digo as well as sequlae of it
Blood supply,nerve supply and lymphatic drainage of the periodontium finalDr. Neha Pritam
Discussion of the various basic topics required to understand in the subject of periodontics. Periodontium being the tooth supporting tissue ,it is necessary to know the blood supply, nerve supply and the lymphatic drainage of the same in dentistry
Certains medications have been associated with gingival enlargement.
the seminar gives a complete analysis of etilogy and pathogenesis involved in digo as well as sequlae of it
Blood supply,nerve supply and lymphatic drainage of the periodontium finalDr. Neha Pritam
Discussion of the various basic topics required to understand in the subject of periodontics. Periodontium being the tooth supporting tissue ,it is necessary to know the blood supply, nerve supply and the lymphatic drainage of the same in dentistry
This presentation describes the gingival recession, its classifications and theories of pathogenesis and different etiological factors in its progression.
Introduction
A sound knowledge of the anatomy of the periodontium and the surrounding hard and soft structures is essential to determine the scope and possibilities of surgical periodontal procedures and to minimize their risks.
Blood vessels, and nerves located in the vicinity of the periodontal surgical field, are particularly important during various surgical procedures.
Arterial Supply
Common Carotid Artery
Carotid Sinus & Carotid Body
Applied Anatomy of CCA
CAROTID PULSE :
CCA may be compressed against the carotid tubercle of transverse process of C6 vertebra about 4cm above the sternoclavicular joint.
External Carotid Artery
Generally it lies anterior to the Internal Carotid Artery.
It is the chief artery of supply to structures in the front of neck, oral cavity and in the face.
In carotid triangle
Crossed superficially by:
Cervical branch of facial nerve
Hypoglossal nerve
Facial, lingual &superior thyroid vein
Deep to artery lies:
Wall of pharynx
Superior laryngeal nerve
Ascending pharyngeal artery
Above the carotid triangle
ECA lies deep in the substance of parotid gland
Branches
Lingual Artery
Principal artery of tongue.
Arises anteromedially from ECA opposite the tip of greater cornu of hyoid bone.
Divided into three parts by hyoglossus muscle.
Applied anatomy
Sublingual artery injury occurs in premolar & molar region, when sharp instrument or rotating disks slips off a lower molar & injure the floor of mouth.
Sublingual and submental arteries may course anteriorly in close proximity to the lingual plate, and branches of these blood vessels enter accessory foramina along the lingual cortex.
Hofschneider et al (1999)
Inadvertent penetration through the lingual cortical plate into the floor of the mouth while preparing an osteotomy can cause arterial trauma, thereby resulting in development of a sublingual or submandibular hematoma
Flanagan D. et al.2003
Facial Artery
ORIGIN: Arises from the ECA just above the tip of greater cornua of hyoid bone.
COURSE:
Runs upwards in neck as cervical part ;
On face as facial part.
Tortuous course—
In neck allows free movements of pharynx during deglutition,
On face allows free movements of mandible , lips, & cheek during mastication & facial expressions, escapes traction & pressure during movements.
Cervical part :
Cervical part runs upwards on superior constrictor of pharynx deep to the posterior belly of digastric.
It grooves the posterior border of submandibular gland, makes S-bend [2 loops]
1st winding down over submandibular gland &
then up over the base of mandible.
Facial part:
The vessel enters the face by winding around the base of the mandible, and by piercing the deep cervical fascia,at the anteroinferior angle of the masseter muscle, here it can be palpated & is called as anaesthetist’s artery. Using contracted masseter as a landmark, pulse of facia
Coronal advanced flap in combination with a connective tissue graft. Is the t...MD Abdul Haleem
Coronal advanced flap in combination with a connective tissue graft. Is the thickness of the flap a predictor for root coverage? - A prospective clinical study.
Department of Periodontology and Oral Implantology.
"A Journal Club Presentation"
Every periodontal surgical procedure has its own indications. With proper knowledge of the etiology of the disease, correct diagnosis and treatment planning, the clinician is able to draw predictable success with periodontal flap surgery.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
This presentation describes the gingival recession, its classifications and theories of pathogenesis and different etiological factors in its progression.
Introduction
A sound knowledge of the anatomy of the periodontium and the surrounding hard and soft structures is essential to determine the scope and possibilities of surgical periodontal procedures and to minimize their risks.
Blood vessels, and nerves located in the vicinity of the periodontal surgical field, are particularly important during various surgical procedures.
Arterial Supply
Common Carotid Artery
Carotid Sinus & Carotid Body
Applied Anatomy of CCA
CAROTID PULSE :
CCA may be compressed against the carotid tubercle of transverse process of C6 vertebra about 4cm above the sternoclavicular joint.
External Carotid Artery
Generally it lies anterior to the Internal Carotid Artery.
It is the chief artery of supply to structures in the front of neck, oral cavity and in the face.
In carotid triangle
Crossed superficially by:
Cervical branch of facial nerve
Hypoglossal nerve
Facial, lingual &superior thyroid vein
Deep to artery lies:
Wall of pharynx
Superior laryngeal nerve
Ascending pharyngeal artery
Above the carotid triangle
ECA lies deep in the substance of parotid gland
Branches
Lingual Artery
Principal artery of tongue.
Arises anteromedially from ECA opposite the tip of greater cornu of hyoid bone.
Divided into three parts by hyoglossus muscle.
Applied anatomy
Sublingual artery injury occurs in premolar & molar region, when sharp instrument or rotating disks slips off a lower molar & injure the floor of mouth.
Sublingual and submental arteries may course anteriorly in close proximity to the lingual plate, and branches of these blood vessels enter accessory foramina along the lingual cortex.
Hofschneider et al (1999)
Inadvertent penetration through the lingual cortical plate into the floor of the mouth while preparing an osteotomy can cause arterial trauma, thereby resulting in development of a sublingual or submandibular hematoma
Flanagan D. et al.2003
Facial Artery
ORIGIN: Arises from the ECA just above the tip of greater cornua of hyoid bone.
COURSE:
Runs upwards in neck as cervical part ;
On face as facial part.
Tortuous course—
In neck allows free movements of pharynx during deglutition,
On face allows free movements of mandible , lips, & cheek during mastication & facial expressions, escapes traction & pressure during movements.
Cervical part :
Cervical part runs upwards on superior constrictor of pharynx deep to the posterior belly of digastric.
It grooves the posterior border of submandibular gland, makes S-bend [2 loops]
1st winding down over submandibular gland &
then up over the base of mandible.
Facial part:
The vessel enters the face by winding around the base of the mandible, and by piercing the deep cervical fascia,at the anteroinferior angle of the masseter muscle, here it can be palpated & is called as anaesthetist’s artery. Using contracted masseter as a landmark, pulse of facia
Coronal advanced flap in combination with a connective tissue graft. Is the t...MD Abdul Haleem
Coronal advanced flap in combination with a connective tissue graft. Is the thickness of the flap a predictor for root coverage? - A prospective clinical study.
Department of Periodontology and Oral Implantology.
"A Journal Club Presentation"
Every periodontal surgical procedure has its own indications. With proper knowledge of the etiology of the disease, correct diagnosis and treatment planning, the clinician is able to draw predictable success with periodontal flap surgery.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
• Introduction
• Definitions
• Macroscopic Features
• Microscopic Features
• Blood supply
• Nerve supply
• Lymphatic drainage
• Role of epithelium in defence mechanism
• Oxygen consumption of gingiva
• Correlation of Macroscopic with microscopic features
• Conclusion
macroscopic/ clinical features of gingiva
With video clips
Short video descriptions
Lecture for 3rd BDS students
Periodontology
Periodontics aspect
Clinical features of the gingiva
Macroscopic features of Gingiva.
This presentation will help and let u know about the Development and Macroscopic features of gingiva in detail. Thank you.
Opportunity for Dentists (BDS/MDS )to relocate to United kingdom -Register as a DENTAL HYGIENIST/ DENTAL THERAPIST without Board exams and after approval you can register in GDC as a DH/DT and start working as a DH/DT Immediately and get paid.
You can complete the whole process in 3-4 months.Salary range for DH/DT is around 2500-3500 Pounds per month.
Eligibility / requirements-
1. An International English Language Testing System (IELTS) certificate
at the appropriate level.(Within 2 yrs of application date )
2: A recent primary dental qualification that has been taught and examined in English..(Within 2 yrs of application date )
3: A recent pass in a language test for registration with a regulatory authority in a country where the first language is English.
If you are interested Please contact us for more details.
1ST, 2ND AND 3RD ORDER BENDS IN STANDARD EDGEWISE APPLIANCE SYSTEM /Fixed ort...Indian dental academy
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals
who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry,
Periodontics and General Dentistry.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
I –Aligners are made with FDA approved transparent thermoplastic materials using 3D scanning, 3D Printing and finally Trays with Pressure vacuum formers.
Dear Doctor,
Indian Dental Academy Now offers comprehensive online Orthodontics course.
Course includes:
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4.Demo on Models
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Indian Dental Academy
Leader in continuing dental education
www.indiandentalacademy.com
skype:indiandentalacademy
+919248678078
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Cytotoxicity of silicone materials used in maxillofacial prosthesis / dental ...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Diagnosis and treatment planning in completely endntulous arches/dental coursesIndian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Properties of Denture base materials /rotary endodontic coursesIndian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Use of modified tooth forms in complete denture occlusion / dental implant...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
"Impact of front-end architecture on development cost", Viktor TurskyiFwdays
I have heard many times that architecture is not important for the front-end. Also, many times I have seen how developers implement features on the front-end just following the standard rules for a framework and think that this is enough to successfully launch the project, and then the project fails. How to prevent this and what approach to choose? I have launched dozens of complex projects and during the talk we will analyze which approaches have worked for me and which have not.
Smart TV Buyer Insights Survey 2024 by 91mobiles.pdf91mobiles
91mobiles recently conducted a Smart TV Buyer Insights Survey in which we asked over 3,000 respondents about the TV they own, aspects they look at on a new TV, and their TV buying preferences.
UiPath Test Automation using UiPath Test Suite series, part 3DianaGray10
Welcome to UiPath Test Automation using UiPath Test Suite series part 3. In this session, we will cover desktop automation along with UI automation.
Topics covered:
UI automation Introduction,
UI automation Sample
Desktop automation flow
Pradeep Chinnala, Senior Consultant Automation Developer @WonderBotz and UiPath MVP
Deepak Rai, Automation Practice Lead, Boundaryless Group and UiPath MVP
UiPath Test Automation using UiPath Test Suite series, part 4DianaGray10
Welcome to UiPath Test Automation using UiPath Test Suite series part 4. In this session, we will cover Test Manager overview along with SAP heatmap.
The UiPath Test Manager overview with SAP heatmap webinar offers a concise yet comprehensive exploration of the role of a Test Manager within SAP environments, coupled with the utilization of heatmaps for effective testing strategies.
Participants will gain insights into the responsibilities, challenges, and best practices associated with test management in SAP projects. Additionally, the webinar delves into the significance of heatmaps as a visual aid for identifying testing priorities, areas of risk, and resource allocation within SAP landscapes. Through this session, attendees can expect to enhance their understanding of test management principles while learning practical approaches to optimize testing processes in SAP environments using heatmap visualization techniques
What will you get from this session?
1. Insights into SAP testing best practices
2. Heatmap utilization for testing
3. Optimization of testing processes
4. Demo
Topics covered:
Execution from the test manager
Orchestrator execution result
Defect reporting
SAP heatmap example with demo
Speaker:
Deepak Rai, Automation Practice Lead, Boundaryless Group and UiPath MVP
The Art of the Pitch: WordPress Relationships and SalesLaura Byrne
Clients don’t know what they don’t know. What web solutions are right for them? How does WordPress come into the picture? How do you make sure you understand scope and timeline? What do you do if sometime changes?
All these questions and more will be explored as we talk about matching clients’ needs with what your agency offers without pulling teeth or pulling your hair out. Practical tips, and strategies for successful relationship building that leads to closing the deal.
Neuro-symbolic is not enough, we need neuro-*semantic*Frank van Harmelen
Neuro-symbolic (NeSy) AI is on the rise. However, simply machine learning on just any symbolic structure is not sufficient to really harvest the gains of NeSy. These will only be gained when the symbolic structures have an actual semantics. I give an operational definition of semantics as “predictable inference”.
All of this illustrated with link prediction over knowledge graphs, but the argument is general.
JMeter webinar - integration with InfluxDB and GrafanaRTTS
Watch this recorded webinar about real-time monitoring of application performance. See how to integrate Apache JMeter, the open-source leader in performance testing, with InfluxDB, the open-source time-series database, and Grafana, the open-source analytics and visualization application.
In this webinar, we will review the benefits of leveraging InfluxDB and Grafana when executing load tests and demonstrate how these tools are used to visualize performance metrics.
Length: 30 minutes
Session Overview
-------------------------------------------
During this webinar, we will cover the following topics while demonstrating the integrations of JMeter, InfluxDB and Grafana:
- What out-of-the-box solutions are available for real-time monitoring JMeter tests?
- What are the benefits of integrating InfluxDB and Grafana into the load testing stack?
- Which features are provided by Grafana?
- Demonstration of InfluxDB and Grafana using a practice web application
To view the webinar recording, go to:
https://www.rttsweb.com/jmeter-integration-webinar
Search and Society: Reimagining Information Access for Radical FuturesBhaskar Mitra
The field of Information retrieval (IR) is currently undergoing a transformative shift, at least partly due to the emerging applications of generative AI to information access. In this talk, we will deliberate on the sociotechnical implications of generative AI for information access. We will argue that there is both a critical necessity and an exciting opportunity for the IR community to re-center our research agendas on societal needs while dismantling the artificial separation between the work on fairness, accountability, transparency, and ethics in IR and the rest of IR research. Instead of adopting a reactionary strategy of trying to mitigate potential social harms from emerging technologies, the community should aim to proactively set the research agenda for the kinds of systems we should build inspired by diverse explicitly stated sociotechnical imaginaries. The sociotechnical imaginaries that underpin the design and development of information access technologies needs to be explicitly articulated, and we need to develop theories of change in context of these diverse perspectives. Our guiding future imaginaries must be informed by other academic fields, such as democratic theory and critical theory, and should be co-developed with social science scholars, legal scholars, civil rights and social justice activists, and artists, among others.
Kubernetes & AI - Beauty and the Beast !?! @KCD Istanbul 2024Tobias Schneck
As AI technology is pushing into IT I was wondering myself, as an “infrastructure container kubernetes guy”, how get this fancy AI technology get managed from an infrastructure operational view? Is it possible to apply our lovely cloud native principals as well? What benefit’s both technologies could bring to each other?
Let me take this questions and provide you a short journey through existing deployment models and use cases for AI software. On practical examples, we discuss what cloud/on-premise strategy we may need for applying it to our own infrastructure to get it to work from an enterprise perspective. I want to give an overview about infrastructure requirements and technologies, what could be beneficial or limiting your AI use cases in an enterprise environment. An interactive Demo will give you some insides, what approaches I got already working for real.
GraphRAG is All You need? LLM & Knowledge GraphGuy Korland
Guy Korland, CEO and Co-founder of FalkorDB, will review two articles on the integration of language models with knowledge graphs.
1. Unifying Large Language Models and Knowledge Graphs: A Roadmap.
https://arxiv.org/abs/2306.08302
2. Microsoft Research's GraphRAG paper and a review paper on various uses of knowledge graphs:
https://www.microsoft.com/en-us/research/blog/graphrag-unlocking-llm-discovery-on-narrative-private-data/
Leading Change strategies and insights for effective change management pdf 1.pdf
Gingiva (2)
1. GINGIVA
The periodontium (peri-around, dontium-tooth, greek) consists of
investing and supporting tissues. The investing tissue of the periodontium
is known as the GINGIVA. It is the most peripheral portion of
periodontium at large.
According to the Dorland Medical Dictionary, the word gingiva
means the ‘gum of the mouth’. It is that part of the oral mucosa overlying
the crown of unerupted teeth and encircling the necks of these that have
erupted, serving as the supporting structure for the subadjacent tissues.
DEFINITIONS
1. CARANZA
Is the part of oral mucosa that covers the alveolar processes of jaw
and surrounds the neck of teeth.
2. SCHROEDER
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.
3. GRANT
Is the part of oral mucous membrane attached to the teeth and the
alveolar processes.
1
2. 4. LINDHE
Is that part of masticatory mucosa covering the alveolar processes
and the cervical portions of teeth.
FUNCTIONS
As the gingiva represents both the masticatory mucosa as well as the
most peripheral part of the periodontium, its functions are two fold.
I] As part of the oral mucosa
It protects the supporting tissues from the oral environment.
a) As part of oral mucosa, it is subjected to friction and pressure in the
masticatory process. Its densely collagenous lamina propria,
peripheral sensory innervation and keratinization help in the
adaptation to these physical requirements.
b) It is a mucostable tissues because of its firmness, scalloped contour,
close adaptation and attachment to the underlying structures.
c) Gingival tissues fulfill the functions of sensitivity and resistance.
II] As part of the periodontium
The gingiva exhibits functional properties:
a) It ensures dental arch linkage and controls the positioning of teeth in
the horizontal plane by means of its supra-alveolar fibre apparatus.
These fibres along with those of PDL secure teeth against rotational
forces and generate forces resulting in mesial drift.
2
3. b) It maintains gingival and periodontal health by means of various
defense mechanism operating within the gingival tissues.
This peripheral defense action of gingiva has two arms:
1. The humoral arm which represents the generation of gingival
fluid.
2. The cellular arm which represents the continuous irrigation
of neutriphilic granulocytes via the junctional epithelium.
Both these arms keep a 24 hour watch on the periodontal health.
Development
Unlike, the other tissues of the periodontium which are derived from
the ectomesenchymal dental follicle, the gingiva is a derivative of
mesoderm.
According to Schroeder, the shape, topographical distribution and
width of the gingiva are functions of the presence and position of erupted
teeth.
He also says that, there are reasons to assume that the gingival
tissues exist and develop as a site specific portion of the oral mucous
membrane prior to the eruption of deciduous teeth. Thereafter, the gingiva
although increasing size serves both deciduous and permanent teeth.
3
4. Normal Clinical Features
Gingiva is divided into:
Oral part Vestibular part
Anatomically, it has been divided into:
- MARGINAL gingiva
- ATTACHED ginigiva
Pyramidal
- INTERDENTAL gingiva
Col
A] Marginal gingiva / Free gingiva / Margio Gingivalis
Definition
It is the terminal edge or border of the gingiva surrounding the teeth
like a collar.
Figure
4
5. It is demarcated from the adjacent attached gingiva by a shallow
linear depression – the free gingival groove. This is about 1mm wide and
forms the soft tissue wall of the gingival sulcus. According to Schroeder,
the term ‘free gingiva’ is a clinical designation and relates to the clinical
property of the gingival rim.
B] Attached Gingiva
It is continuous with the marginal gingiva. It is firm, resilient, and
tightly bound to the underlying tissues of the alveolar bone. On the facial
aspect, the attached gingiva extends to the relatively loose and movable
alveolar mucosa from which it is demarcated by the mucogingival junction
(3 M G Lines)
Facial maxillary Facial mandibular Lingual mandibular
# Lingual maxillary is not seen as there is not alveolar mucosa on
the palate and the palatal tissue is firmly attached to the bone.
Width of the attached gingiva
Is defined as the distance between the mucogingival junction and
the projection on the external surface of the bottom of the gingival sulcus /
periodontal pocket.
It is generally greatest in the incisor region (3.5 – 4.5mm in maxilla
and 3.3 – 3.9mm in mandible) and less in the posterior region with least in
the 1st
premolar area (1.9mm in maxilla and 1.8mm in mandible).
5
6. The width of the attached gingiva increases with age and
supraerupted teeth.
Reduced / Absent Attached gingiva may be due to:
- base of the pocket is close to the mucogingival line.
- frenal / muscle attachments that encroach on pockets and pull them
away from the tooth surface.
- denudation of root surfaces.
Adequacy of the attached gingiva can be determined by the
TENSION TEST which consists of retracting the cheeks and lips laterally
with fingers and checking if such tension polls the marginal gingiva from
the teeth. Reduced width of attached gingiva can be corrected with
mucogingival surgeries.
C] Interdental Gingiva
6
7. It occupies the gingival embrasure, which is the interproximal space
beneath the area of tooth contact
Types:
Pyramidal Col
Where there is one papilla with
its tip immediately beneath the
contact point.
Which represents as a depression
that connects a fascial and a lingual
papilla and conforms to the shape of
interproximal contact.
1) Various anatomic variations of the interdental col in the normal
gingiva and after gingival recession
GINGIVAL SULCUS
- Is the shallow space / crevice around the tooth bounded by the
surface of the tooth on one side and epithelium lining the free
margin of the gingiva on the other.
- It is V-shaped and rarely permits the entrance of a periodontal
probe. Under normal circumstances, the depth is 0
In histologic sections – 1.8mm. The probing depth is 2-3mm
GINGIVAL FLUID / SULCULAR FLUID (GCF)
The gingiva sulcus contains a fluid that seeps into it from the gingival
connective tissue through the thin sulcular epithelium.
7
8. Function of GCF:
- cleanses material from the sulcus.
- Contains plasma proteins that may improve adhesion of the
epithelium to the tooth.
- It also possesses antimicrobial properties.
- It exerts antibody activity in defense of the gingiva.
NORMAL MICROSCOPIC FEATURES
The gingiva consists of a central core of c.t. (lamina propria)
covered by stratified squamous epithelium.
Gingival Epithelium
From the morphologic and function points of view 3 different types
are seen. Oral / Outer Sulcular Junctional
Functions
To protect the deep structures while allowing a selective interchange
with the oral environment (achieved by proliferation and differentiation of
keratinocytes).
Later
The principle cell is the keratinocyte.
- Proliferation takes place by mitosis.
- Differentiation involves the process of keratinization.
8
9. The main morphologic change is the progressive flattening of the
cell.
3 types of keratinization can be seen:
Histologically, a keratinized epithelium shows a number of distinct
layer.
I] St Corneum
It is the surface of very flat eosinophilic cells.
II] St Granulosum
Larger flattened cells that contain kerato-hyaline granules. The upper most layer
of stratified spi contains numerous granules called keratinosomes / odland bodies.
III] St Spinosum / Prickle cell Layer
Larger elliptical / spheroidal cells. When prepared for histologic
sections, these cells shrink away from one another remaining in contact
only at patients known as intercellular bridges / desmosomes.
IV] St Basale
Proliferative layer.
3 types
Ortho Keratinocyte Para Keratinocyte Non-keratinocyte
- Complete
keratinocyte
- No nuclei in st
corneum
- Partial /
incomplete
keratinocyte
- Pyknotic nuclei
- No keratinocyte
- No corneum /
granulosum
9
10. - Well defined St.
granulosum e.g.
layers of outer
gingival epithelium
in st corneum
- Keratinohyaline
granules
- No st granulosum
e.g. most areas of
gingival epithelium
Keratinization
The prot syn during maturation process – keratolinin and involved
in form an envelope below the cell membrane (chemically resistant
structure). As the cells reach the corneum keratin or disappear and give rise
to a protein – fillagirin which forms the matrix of the most differentiated
epithelial cells – CORNEOLYTE.
Cell type Level in epithelium Functions
1. Melanocyte
2. Langerhans
cells
3. Merkels cells
Basal
Predominantly
suprabasal
Basal
Synthesis of melanin
pigment
Regulatory cell
Macrophage
(contain Birbeck’s
granules)
Tactile perception
Both epithelial proliferation and maturation are needed for
continuous cell renewal to maintain structural integrity.
The control over these two processes is mediated by substance
produced by maturing epithelial cells – CHALONES which acts by –ve
feedback mechanism.
10
11. STRUCTURE AND CHARACTERISTICS OF GINGIVAL
EPITHELIUM
I] Oral / outer epithelium
It covers the crest / outer surface of the marginal gingiva and the surface of
the attached gingiva. It is keratinized / parakeratinized or present various
combinations of these conditions. The prevalent surface is however
parakeratinized.
- In orthokeratinized areas Keratins K1, K2 and K-10, K-12 which
are specific for epidermal differentiation are expressed with high
intensity.
- K6 and K16 characteristic of highly proliferative epithelium K1,
K2, K-10, K-12 – expressed with low intensity in parakeratinized
area.
These also express K-19 which are absent from Ortho keratinized
area.
II] Sulcular epithelium
- Lines the gingival sulcus.
- It is a thin, non-keratinized squamous epithelium without retepegs,
which extends from the coronal limit of junctional epithelium to the
crest of the gingival margin.
- It shows cells and with hydropic degeneration.
11
12. - It contains keratins K4 and K13, also expresses K-19. It lacks
stratum granulosum and corneum, cytokeratins K1 and K2 and K10-
K12 and also lacks Merkels cells.
It has the potential to keratinize, if:
a) It is reflected and exposed to the oral cavity.
b) The bacterial flora of the sulcus is totally eliminated.
These findings suggest that the local irritation of the sulcus (due to
its contact with tooth) prevents sulcular keratinization.
12
13. Functions of sulcular epithelium
It acts as a semi-permeable membrane three which injurious
bacterial pass into the gingiva and three which tissue fluid from the gingiva
seeps into the sulcus.
III] Junctional epithelium
- Consists of a collar-like band of stratified squamous non-
keratinizing epithelium.
a) It is 3-4 layers thick in early life, but it increases with age to 10-20.
b) The length ranges from 0-25 – 1.35 mm.
c) It is widest in its coronal portion (15-20 cell layers) but becomes
thinner towards the CEJ.
d) It expresses K-19 and the stratification specific cytokeratins K5 and
K14.
Histology of junctional epithelium
Is a continuous self-renewal structure and is continuously renewed
through cell division occurring in the basal layer. The cells migrate to the
base of the gingival sulcus, from where they are shed.
Cells are arranged in 2 strata
Basal Suprabasal
Both are flattened with their long axis 11 to the tooth surfaces
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14. Functions
- Unlike the epithelial connective tissue interface, the lamina densa of
the internal basal layer (facing the enamel) has no anchoring fibrils
attached to it, which means that the junctional epithelium is
physically attached to the tooth via the hemidesmosomes
(Schroerder).
- The attachment of the junctional epithelium to the tooth is further
reinforced by the gingival fibres which brace the marginal gingiva
against the tooth surface for this reason.
Junctional epithelium and gingival fibres are a function unit
FIBRES
The connective tissue fibres are: Collagen Reticulum Oxytalan Elastic
Collagen – 65% of C.T. volume
Tropocollagen (smallest unit of a collagen are aggregated
longitudinally to form molecule) after synthesis, it is secreted out from the
fibroblasts into extracellular space.
Protofibril laterally aggregates to in II form collagen fibrils with an
overlapping of tropocollagen mole by about 25% of their lengths.
- These are bundles of collagen fibrils, aligned in such a way that
fibres exibit a cross-binding.
Collagen Type I
14
15. - Forms the bulk of lamina propria and provides tensile strength.
- Gingival collagen fibres – consists of Type I collagen.
Functions:
- To brace the marginal gingiva firmly against the tooth.
- To provide rigidity necessary to without and the forces of
mastication without being deflected from the tooth surfaces.
- To unlike the free marginal gingiva with the cementum of the root
and the adjacent attached gingiva.
Reticulum
- Are present at the epithelial connective tissue and the endothelium
c.t. interface.
Oxytalan
- are present in all c.t. structure of the periodontium and are composed
of long thin fibrils. They regulate vascular flow. In the PDL, these
fibres run 11 to the root surfaces in a vertical direction and bend to
attach to cervical 3rd
of cementum.
- Are present in all C.T. of gingiva and periodontal only in
association with the blood vessels.
GINGIVAL FIBRES Carranza (1996)
- Gingiovodental.
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16. - Circular.
- Transeptal.
- Semicircular
- Transgingival
MATRIX
- Constitutes the environment for the cell. It is produced by
fibroblasts and is composed of protein polysaccharides and
macromolecules.
Proteoglycans Glycoproteins
BLOOD SUPPLY
3 sources of blood supply to gingiva (Carranza 1996).
a) Supra-periosteal arterioles
Along the fascial and lingual surface of the alveolar bone, from
which capillaries extend along the sulcular epithelial and between the
retepegs of the external gingival surface.
b) 2 vessels of the PDL – which extend into the gingiva anastomose
with capillaries in the sulcus area.
c) Arterioles which emerge from crest of the interdental septa.
Nerve supply region Innervation
- Upper gingiva Anterior, post and middle
supraalveolar branches of maxillary
16
17. nerve, palatal nerves.
Lower gingiva buccal and lingual Infection alveolar branch of
mandibular nerve, buccal branch of
mandibular nerve, sublingual branch
of lingual nerve.
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18. Lymphatic drainage
- Brings in the lymphatics of the C.T. papillae. It progresses to the
regional lymph nodes.
CO-RELATION OF NORMAL CLINICAL FEATURES AND MICROSCOPIC
FEATURES
Appearance in
health
Changes in
disease / clinical
appearance
Causes for
changes
1. Colour Uniformly pale
pink / coral pink
Variations in
pigmentation
related to race
a) Chronic –
bluish pink /
bluish red
- Vessels
engorged
- Blood flow
sluggish and
- Venous
return impaired
2. Size Not enlarged fits
snugly around the
tooth
Enlarged - Edematous
inflammatory
fluid, cellular
exudates
hemorrhage
3. Shape a) Marginal
gingiva : Knife
edge, follows a
curved line
around the tooth
Rolled / rounded Inflammation
changes, edema
or fibrosis
4. Consistency Firm Soft, spongy, red
colour, dents
readily when
pressed with a
probe, smooth
and shiny surface
Edematous
fluid between
cells in the
connective
tissue
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19. 5. Surface texture Represents that of an orange pell and is known as stippling.
The attached gingiva is stippled – not the marginal.
It varies with age, is absent in infancy increase till adulthood
and disappears in old age.
It is produced by alternate protruberances & depressions in
the gingival surfaces.
- Exposure of the tooth by the apical migration of gingiva is called
gingival recession / atrophy Physiologic /Pathologic occurs.
References:
1. Clinical Periodontology by Carranza, Newman and Takei.
2. Periodontics by Grant, Stern and Listgarten.
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21. Contents
1. Definition
2. Function
3. Development
4. Normal Clinical Features
5. Gingival Fluid / Sulcular Fluid (Gcf)
6. Normal Microscopic Features
7. Structure and Characteristics Of Gingival
Epithelium
8. Gingival Fibers
9. Blood supply* Nerve supply * Lymphatic
drainage
10. Normal clinical features and microscopic
features
11. References
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