4. CARRANZA:
Gingiva is the part of oral mucosa that covers the alveolar
processes of jaws and surrounds the neck of teeth.
LINDHE:
Part of masticatory mucosa covering the alveolar processes of
the cervical portions of teeth.
GLOSSARY OF PERIODONTICS (AAP):
The fibrous investing tissue, covered by keratinized epithelium,
that immediately surrounds a tooth and is contiguous with its
periodontal ligament and with the mucosal tissues of the
mouth.
DEFINITIONS
4
5. SCHROEDER:
It is a combination of epithelium and connective tissue and it
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.
GRANT:
Gingiva is the part of oral mucous membrane attached to the teeth
and the alveolar processes.
GENCO:
Gingiva is that part of oral mucous membrane that covers the
alveolar processes of the cervical portions of the teeth.
5
6. ORAL MUCOSA
The oral mucosa consists of following 3 zones :
Gingiva & covering of hard palate , termed the masticatory mucosa .
Dorsum of tongue covered by specialized mucosa .
Oral mucous membrane lining the rest of the oral cavity .
6
10. • Terminal edge surrounding the
tooth in collar-like fashion.
• 1mm wide.
• Free gingival groove (30-40%
cases).
• Position: 1.5-2mm coronal to CEJ
MARGINAL
GINGIVA
10
11. • Firm, resilient and tightly bound to
the underlying periosteum of alveolar
bone by connective tissue fibers.
• Coronally: marginal gingiva
• Apically: palatally-palatal mucosa
facially-alveolar mucosa
• Mucogingival junction
• Stippling
• Significance
ATTACHED GINGIVA
11
12. Facial:
• Widest in incisor region
Maxilla: 3.5 – 4.5 mm
Mandible: 3.3 – 3.9 mm
• Most narrow adjacent to
premolar Maxilla: 1.9 mm
Mandible: 1.8 mm
Lingual:
• Wider in molar region
• Narrow in incisor region
Increases: by the age of 4yrs
supraerupted teeth
12
13. 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
Methods to determine mucogingival junction:
1. Visual method.
2. Functional method.
3. Visual methods after histochemistry staining.
13
14. • Occupies gingival embrasure
• Formed by:
Lateral borders & tip – marginal gingiva
Central intervening portion – attached
gingiva
• Shape: Pyramidal - Anteriors
Col – Posteriors
• Diastema: gingiva is firmly bound over
bone forming a smooth, rounded
surface without interdental papilla.
INTERDENTAL
GINGIVA
14
15. • Gingival crevice – Orban &
Mueller,1929
• Shallow crevice around the tooth
• V- shaped
• Significance:
Imp. Diagnostic parameter
Ideal conditions: 0/ close to 0mm
Biologic depth: 1.8mm
Probing depth: 2-3 mm
15
16. HOW MUCH ZONE OF ATTACHED GINGIVA IS
NECESSARY TO MAINTAIN THE HEALTH OF
PERIODONTIUM?
• Lang & Loe,1972: suggested that 2 mm of keratinized gingiva
(corresponding to 1 mm attached gingiva in this material) is adequate to
maintain gingival health.
• Bowers GM,1963: It is possible to maintain clinically healthy gingiva despite
a very narrow zone of attachment (less than 1 mm.).
• Wennstorm, 1987: the lack of minimum amount of attached Gingiva does
not necessarily result in a soft tissue recession. Proper plaque control
prevents soft tissue recession, even when it is out of adequate width.
16
17. Histologically, gingiva is composed of :
1. Gingival epithelium
2. Epithelium-connective tissue interface
3. Connective tissue
MICROSCOPIC ANATOMY
17
18. GINGIVAL EPITHELIUM – GENERAL ASPECTS :
• 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.
18
20. Stratum basale:
• Cells are cylindrical or cuboidal
• Found immediately adjacent to connective tissue separated by basement
membrane
• Germinative layer : has the ability to divide
• It takes approximately 1 month for the keratinocyte to reach the outer
epithelial surface where it is shed from the stratum corneum.
20
21. Stratum spinosum:
• Prickle Cell layer
• Large polyhedral cells with short cytoplasmic processes
• KERATINOCYTE OR ODLAND BODIES :
1. Modified lysosomes .
2. Present in the uppermost part of stratum spinosum.
3. Contain a large amount of acid phosphatase .
21
22. Stratum granulosum:
• Flattened cells in a plane parallel to the gingival surface .
• KERATOHYALINE GRANULES : Associated with keratin formation & are 1
micrometre in diameter , round in shape & appear in the cytoplasm of the cell .
22
23. Stratum corneum :
• Closely packed , flattened cells that have lost most nuclei & other organelles as
they become keratinized .
• The cells are densely packed with tonofilaments
• Clear , rounded bodies clearly representing lipid droplets appear within the
cytoplasm of the cells .
23
24. Proliferation through mitosis occurs in the basal layer , less
frequently in the suprabasal layer and migration occurs.
Differentiation includes keratinisation in which main
morphologic changes seen are:
• Progressive flattening of the cell.
• Increased prevalence of tonofilaments.
• Intercellular junctions coupled
keratohyaline granules.
• Disappearance of the nucleus
to the production of
24
25. • Three types of surface keratinization can occur in the gingival
epithelium:
1. Orthokeratinization
2. Parakeratinization
3. Nonkeratinization
25
26. ORTHOKERATINIZATION:
• Complete keratinization superficial
horny layer.
• No nuclei in stratum corneal layer
.
• Well-defined stratum granulosum.
• Few areas of outer gingival epithelium.
26
27. • 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
rather than giving rise to a stratum
granulosum.
PARAKERATINIZATION:
27
28. • Viable nuclei in superficial layer
.
• Has neither granulosum nor
corneum strata.
• Layers of nonkeratinized
epithelium:
1. Stratum superficiale
2. Stratum intermedia
3. Stratum basale
NON – KERATINIZATION
28
29. ULTRASTRUCTURE OF EPITHELIUM:
• Each epithelial type have characteristic pattern of cytokeratins.
• Keratin proteins are composed of different polypeptide subunits
characterized by their isoelectric points and molecular weights.
• Basal cells begin synthesis of low mol. Wt. keratins.
Ex.: K19 (40kD).
• High mol. Wt. keratins are expressed when they reach superficial
layers.
Ex.: K1 (68kD).
29
30. • Other proteins synthesized during maturation proess:
Keratolinin
Involucrin
Filaggrin
• Corneocyte:
Most differentiated epithelial cell
Composed of bundles of keratin tonofilaments in amorphous
matrix of filaggrin, surrounded by a resistant envelope made of
keratolinin and involucrin.
30
31. 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.
31
32. 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.
32
33. • 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 33
35. • 90% of the total gingival cell population.
• Originate from ectodermal germ layer
.
• Cell organelles: nucleus, cytosol, ribosomes, Golgi apparatus etc
• Melanosomes: Pigment bearing granules
• Proliferation and differentiation of the
keratinocytes helps in the barrier action of
the epithelium.
KERATINOCYTES :
35
36. • 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.
36
37. The various nonkeratinocytes are :
• Langerhans cells,
• Merkel cells,
• Melanocytes,
• Inflammatory cells
NON-KERATINOCYTES/CLEAR CELLS:
37
38. • Dendritics cells - Modified monocytes belonging to RES.
• Paul Langerhans used gold impregnation technique to visualize LCs.
• Reside chiefly in suprabasal layers.
• Act as antigen -presenting cells for lymphocytes.
• Specific elongated g-specific granules called as Birbecks Granules.
• Have marked adenosine triphosphatase activity.
• Only epidermal cells which express receptors for C3 and Fc portion of IgG.
• Can move in and out of the epithelium unlike melanocytes.
LANGERHANS CELLS
38
39. • Located in deeper layers of epithelium.
• Not dendritic cells
• Possess keratin tonofilaments and desmosomes.
• Harbor nerve endings.
• Sensory in nature - respond to touch – Tactile Perceptors
MERKEL CELLS:
39
40. • Originate from neural crest cells.
• Found in the stratum basale.
• Identified in gingiva by Laidlaw and Cahn, 1932.
• Have long dendritic processes, interspersed between the keratinocytes.
• Synthesize melanin, responsible for providing color to gingiva.
• Melanin is synthesized in organelle called premelanosomes/melanosomes,
which are transported along microtubules and actin filaments to the cell
Periphery.
MELANOCYTES
40
41. Oral or outer epithelium
Sulcular epithelium
Junctional epithelium
2mm
TYPES OF GINGIVAL
EPITHELIUM
41
42. ORAL OR OUTER EPITHELIUM
• Covers the crest and outer surface of
the marginal gingiva and the surface
of the attached gingiva.
• 0.2 to 0.3 mm in thickness.
• Keratinized or parakeratinized, or it
may present combinations of these
conditions.
• The oral epithelium is composed of
four layers. 42
43. • K1, K2, K10-12 cytokeratins present are immunohistochemically
expressed with high intensity in orthokeratinized areas and with
less intensity in parakeratinized areas.
• K6 and K16 , characteristic of highly proliferative epithelia.
• K5 and K14, stratification-specific cytokeratins , also are present
43
44. SULCULAR EPITHELIUM
• 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. 44
45. 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.
45
46. JUNCTIONAL EPITHELIUM
• Collarlike 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
termination,
cementoenamel
tissue.
coronal
located at
junction in
end to apical
healthy
• Length: 0.25 to 1.35 mm.
46
47. • These cells can be grouped in two strata:
• The basal layer: that faces the
tissue (External Basal
connective
Lamina)
• The suprabasal layer: that extends to
the tooth surface.– (Internal basal
lamina)
• 3 zones of junctional epithelium:
1. Apical – germination
2. Middle – adhesion
3. Coronal- permeable.
47
48. THE DENTOGINGIVAL UNIT:
• The attachment of the junctional epithelium to the tooth is
reinforced by the gingival fibers, which brace the marginal gingiva
against the tooth surface.
• For this reason, the junctional epithelium and the gingival fibers
are considered together as a functional unit.
48
49. Hypothesis given to explain mode of attachment of epithelium to
tooth surface:
1. Gottlieb: gingiva is organically united to surface of enamel. He
termed it as epithelial attachment. (drawback- did not explain
how exactly it attaches.)
2. Waerhaug : in 1952 presented a concept of epithelial cuff, he
concluded that gingival tissues are closely adapted but not
organically united.
3. Stern: in 1962 showed the attachment to tooth is through
hemidesmosomes, supported by schroeder and listgarten.
49
50. Unique structural and functional features of JE that contribute to
preventing pathogenic bacterial flora from
tooth surface:
First,
Firmly attached to the tooth surface forming
plaque bacteria.
Second,
colonizing the subgingival
an epithelial barrier against
Allows access of gingival fluid, inflammatory cells, and components of the
immunologic host defense to the gingival margin.
Third,
Exhibits rapid turnover contributing to the host–parasite equilibrium and the
rapid repair of damaged tissue.
Have an endocytic capacity equal to that of macrophages and neutrophils and
that this activity may be protective in nature. 50
52. FUNCTIONS:
• Provides attachment to the tooth.
• Forms an epithelial barrier against the plaque bacteria.
• Rapid cell division and funneling of cells towards the sulcus:
Hinder bacterial colonization and
Repair of damaged tissue occurs rapidly.
• Allow GCF:
From connective tissue into crevice – Gingival fluid exudates, PMNs,etc.
From crevice to connective tissue – Foreign material such as carbon particles,
• Produces active antimicrobial substances like defensins, lysosomal enzymes,
calprotectin and cathelicidin.
• Epithelial cells activated by microbial substances secrete chemokines, e.g. IL-1, IL-6, IL-
8 and TNF that attract and activate professional defense cells such as lymphocytes and
PMNs.
52
53. • Represented as either as transudate or an exudate.
• Diagnostic or prognostic biomarker of the biologic state of the
periodontium in health and disease.
• GCF flow increases during inflammation and resembles that of
inflammatory exudates.
• Gingival fluid diffuses through the basement membranes.
GINGIVAL CREVICULAR FLUID
53
54. • Functions:
Cleanse material from the sulcus.
Contain plasma proteins that may improve adhesion of epithelium
to the tooth
Possess antimicrobial properties
Expert antibody activity to defend the gingiva.
54
56. VARIOUS JUNCTIONAL COMPLEXES PRESENT IN
GINGIVA
• Tight junctions/Zonae occludens
• Adhesive junctions:
Cell to cell
– Zonula adherens
– Desmosomes: 30 nm.
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.
56
57. - - - lntercellular
space
..>C l. . .- -Channel
between cells
(formed by
connexons)
(c) Gap junctions: Communicating junctions
allow Ions and small molecules to pass
for intercellular communication.
Interlocking
junctional
proteins
lntercellular
Linker
proteins
(cadherins)
(a) Tight junctions: Impermeable junctions
prevent molecules from passing through
the intercellular space.
Intermediate
filament
(keratin)
(b) Desmosomes: Anchoring junctions bind
adjacent cells together like a molecular
"Velcro" and help form an internal tension
reduclng network of fibers.
57
58. CONNECTIVE TISSUE
• The predominant tissue component of gingiva –
• LAMINA PROPRIA
• Components:
Collagen fibers (60%)
Fibroblasts (5%)
Vessels, Nerves & Matrix (35%)
• Layers of connective tissue:
1. Papillary Layer
2. Reticular Layer
58
59. GROUND SUBSTANCE:
• Fills space between fibers and cells
• Amorphous
• High water content
• Composed of:
Proteoglycans:
Hyaluronic acid
Chondroitin sulphate
Glycoproteins: (PAS positive)
Fibronectin
Laminin 59
60. CELLS:
The different types of cell present in the connective tissue
are:
Fibroblasts
Mast cells
Fixed Macrophages & Histiocytes
Inflammatory cells (Plasma cells, Lymphocytes,
Neutrophils)
Adipose cells
Eosinophils
60
61. FIBROBLASTS:
• Preponderant cellular element in the gingival connective tissue.
• Mesenchymal origin.
• Play a major role in the development, maintenance, and repair of gingival
connective tissue.
• Regulate collagen degradation through phagocytosis and the secretion of
collagenases.
61
62. GINGIVAL FIBERS:
The connective tissue fibers are produced by the
fibroblasts and can be divided into:
• Collagen fibers
• Reticulin fibers
• Oxytalan fibers
• Elastic fibers..
62
63. Collagen type I:
forms the bulk of the lamina propria
provides the tensile strength to the gingival tissue.
Type IV collagen:
branches between the collagen type I bundles
continuous with fibers of the basement membrane and the blood vessel
walls.
Densely packed collagen bundles that are anchored into the acellular
extrinsic fiber cementum just below the terminal point of the junctional
epithelium form the connective tissue attachment.
63
64. Reticulin fibres:
•Have argyrophilic property and are numerous in tissue adjacent to basement
membrane.
• Found in large number in loose CT surrounding blood vessel
Elastic fibres:
•Only present in association with blood vessels.
•Gingiva seen coronal to mucogingival junction has no elastic fibres except in assocation
with blood vessels.
Oxytalan fibers.
• Initially described by Fullmer
.
• Modified type of elastic fibers.
• Scarce in gingiva but more in PDL.
64
65. Gingival Fibers:
• The connective tissue of the marginal gingiva is densely
collagenous, and it contains a prominent system of collagen fiber
bundles called the gingival fibers.
• These fibers consist of type I collagen.
• Functions:
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
65
66. The gingival fibers are arranged in three groups:
1. Gingivodental
2. Circular
3. Transseptal
According Page et.al:
Semicircular fibers:
Transgingival fibers
Lindhe: Dentoperiosteal fibers
66
67. • 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 67
73. • Generally coral pink.
• Color is a result of:
Vascular supply
Thickness
Degree of keratinisation of epithelium,
Presence of pigment containing cells.
• Color to be correlated with cutaneous pigmentation
COLOUR
73
74. PHYSIOLOGIC
PIGMENTATION(MELANIN)
• Melanin (non hemoglobin derived brown pigment)
• Prominent in blacks, diminished in albinos
• Distribution of Oral Pigmentations in blacks:
Gingiva -60%
Hard Palate -61%
Mucous membrane -22%
Tongue -15%
• 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. 74
75. SYNTHESIS OF MELANIN PIGMENTATION
• Tyrosine is hydroxylated into DOPA in presence
of Tyrosinase enzyme.
• DOPA (Dihydroxy Phenylalanine) is converted into
Melanin
• Melanin is phagocytosed to become Melanophage &
Melanophores.
75
76. • Sum total of the bulk of cellular
and intercellular elements and
their vascular supply.
• Alteration in size is a common
feature of gingival disease
SIZE
76
77. CONTOUR
• Marginal gingiva envelops the teeth in collarlike 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) or teeth in labial version
• horizontal and thickened - in lingual version.
77
78. SHAPE
• The shape of the interdental gingiva is governed by the contour
of the proximal tooth surfaces and the location and shape of the
gingival embrasures.
• Anterior region of the dentition, the interdental papilla is pyramidal in
form. the papilla is more flattened in a buccolingual direction in the molar
region.
78
79. • Shape depends on:
Presence/absence of contact
Distance btw contact point and osseous crest
Course of CEJ
Width of the approximate tooth surfaces
Presence/absence of recession.
79
80. CONSISTENCY
• Firm and resilient
• Collagenous nature of the lamina propria and
its contiguity with the mucoperiosteum
determine the firmness of the attached
gingiva.
• The gingival fibers contribute to the firmness
of the gingival margin.
80
81. • Orange peel – stippled,
• Stippling is best viewed by drying Gingiva.
• Attached Gingiva is stippled, marginal gingival is not.
• Central portion of interdental papilla is usually stippled, but marginal
borders are smooth.
• Less prominent on lingual surfaces and may be absent in some.
SURFACE TEXTURE
81
82. • Stippling –produced by alternate round protuberance and
depressions in the gingival surface.
• Low magnification ; a stippled surface,
• Higher magnification; cell micropits
• Aform of adaptive specialization or reinforcement for function
–feature of healthy gingiva
82
83. • Reduction of stippling – common sign of Gingival disease.
• Stippling returns when gingiva is restored to health.
• Keratinisation – protective adaptation , increased by tooth
brushing.
• In 40% of adults Gingiva show stippling.
• Generalized absence of stippling is seen
in: Infancy
Diseased conditions like gingival enlargements, mucocutaneous
lesions affecting gingiva, inflammation etc.,
83
84. POSITION
• 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
• Gottlieb : active and passive eruption go hand in hand.
• Active eruption is coordinated with attrition, to compensate for tooth
substance worn away.
84
86. • Exposure of the tooth via the apical migration of the gingiva is called
gingival recession or atrophy.
• According to the concept of continuous eruption, the gingival sulcus
may be located on the crown, the cementoenamel junction, or the
root, depending on the age of the patient and the stage of eruption.
• Therefore, some root exposure with age would be considered normal
and referred to as physiologic recession.
• Again, this concept is not accepted at present.
• Excessive exposure is termed pathologic recession
86
87. 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.
87
88. AGE CHANGES
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.
b. 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.
88
89. Gingivitis associated with dental
plaque only
Gingival diseases modified by
systemic factors
Gingival diseases modified by
medications
Gingival diseases modified by
malnutrition
DENTAL-PLAQUE–
INDUCED
GINGIVAL
DISEASES
GINGIVAL DISEASES
89
90. Gingival diseases of specific bacterial origin
Gingival diseases of viral origin
Gingival diseases of fungal origin
Gingival lesions of genetic origin
Gingival manifestations of systemic conditions
Traumatic lesions
Foreign-body reactions
Not otherwise specified
NONPLAQUE
INDUCED
GINGIVAL
DISEASES
90
91. • 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
91
92. • They reported the following mean dimensions:
Asulcus depth of 0.69 mm, (a)
an epithelial attachment of 0.97 mm,(b)
connective tissue attachment of 1.07 mm.(c)
The biologic width is commonly stated to be 2.04 mm,(b+c)
which represents the sum of the epithelial and connective tissue
measurements.
92
93. Biologic Width Evaluation:
1. Clinical (discomfort when the restoration margin levels are being assessed
with a periodontal probe)
2. Radiographs (for interproximjal violation but mesiofacial and distofacial line
angle not seen properly)
3. Bone sounding (probing under anesthesia)
Biologic width violation:
• Unpredictable bone loss
• Gingival recession
• Persistence of ginigivitis
93
94. • 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.
• Therefore, Gingiva, a small tissue is a big issue for the fraternity
of periodontics.
CONCLUSION
94
95. • Clinical Periodontology By Carranza, 12th Edition
• Clinical Periodontology And Implant Dentistry By Jan
Lindhe, 4th Edition.
• Biology Of Periodontal Connective Tissue-bartold And
Sampath Narayanan
• Ababneh KT, Hall RC, Embery G: Immunolocalization
of glycosaminoglycans in ageing, healthy and
periodontally diseased human cementum, Arch Oral
Biology 43:235, 1998.
REFERENCES
95
96. • Agnew RG, Fong CC: Histologic studies on experimental transplantation of teeth, J Oral Surg 9:18,
1956.
• Ainamo A: Inluence of age on the location of the maxillary mucogingival junction, J Periodontal Res
13:189, 1978.
• . Ainamo A, Ainamo J: The width of attached gingiva on supraerupted teeth, J Periodontal Res
13:194, 1978.
• Ainamo J, Löe H: Anatomical characteristics of gingiva: a clinical and microscopic study of the free
and attached gingiva, J Periodontol 37:5, 1966.
• Ainamo J, Talari A: The increase with age of the width of attached gingiva, J Periodontal Res 11:182,
1976.
• Ambrosini P, Cherene S, Miller N, et al: A laser Doppler study of gingiva blood low variations
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