The Normal Periodontium I: The Gingiva

Periodontology 1 DENT 371

Dr. Hisham Al-Shorman, PhD

Periodontium:
Around the Tooth

The functional system of tissues that surrounds the teeth and attaches them to the bone

The Periodontium

GINGIVA
PERIODONTAL LIGAMENTS CEMENTUM

ALVEOLAR BONE

THE GINGIVA

 ORAL MUCOSA:
1. Masticatory: gingiva & hard palate 2. Specialized: tongue 3. Lining: other parts

GINGIVA is a part of the masticatory mucosa

Fibrous mucosa surrounding the necks of teeth, covering the coronal portion of the alveolar process

Mucogingival Junction
The junction between the gingiva and the lining oral mucous membrane

The Gingiva
Anatomically, consists of 3 parts: Free gingiva Attached gingiva Interdental gingiva

Free Gingiva
Extends from the gingival margin to the free gingival groove (FGG) at the level of the CEJ Can be separated form the tooth by a probe

Gingival Sulcus
The space between the free gingiva and the tooth surface is gingival sulcus The base of the sulcus is formed by the junctional epithelium. Depth of normal gingival sulcus (crevice) : 0-3 mm
Copyright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Free Gingiva
Forms soft tissue wall of the gingival sulcus The margin of the free gingiva follows the contours of the teeth, creating a wavy outline
Copright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Attached Gingiva
Extends from the FGG to MGJ

On the palate, the whole mucosa is keratinised and there is no MGJ

Attached Gingiva
Firmly attached to the underlying bone to:
Withstand masticatory forces Withstand tooth brushing Prevent movement of marginal gingiva

Attached Gingiva
Width varies in different parts of the mouth, For example:
Maxilla, buccally:

widest around incisors, narrowest around premolars Mandible, lingually: narrowest around incisors, widest around molars

Interdental Gingiva
The portion of gingiva that fills the area between two adjacent teeth apical to the contact area

Copyright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Interdental Gingiva (Papilla)

Shape determined by:
Contact relationship between teeth Width of proximal surfaces Shape of the CEJ Anterior : Pyramidal Molars : Flattened in a buccolingual direction Between buccal & lingual papillae COL

Clinical Features of Normal (Healthy) Gingiva

Colour: pink (physiologic/ racial pigmentation)

Contour: scalloped outline

Margins: thin, knife-edge Surface texture: stippled Consistency: resilient Pointed interdental papillae

Probing depth: 0-3 mm

No BOP

Coral Pink Gingiva

Pigmentation

Stippling of the Attached Gingiva

Caused by the connective tissue fibers that attach the gingival tissue to the cementum and bone

Copyright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Histology
The gingiva consists of 2 main types of tissue:
Epithelium

Connective tissue

Epithelium: Stratified Squamous (parakeratinized)

Ortho-keratinized

Para-keratinized

Epithelium is attached to the underlying connective tissue by a basement membrane

Structure
Main cell type: keratinocyte

4 layers of cells:
1. stratum basale (basal cell layer) 2. stratum spinosum (spinous cell layer) 3. stratum granulosum (granular cell layer) 4. stratum corneum
(corneal cell layer)

Structure
The oral mucosa is mostly parakeratinized Ortho- Vs para-keratinization Epithelial cells contain a specific protein called cytokeratin (K1-K19), in addition to other proteins such as keratolinin, involucrin and filaggrin

Structure
Other cell types within gingival epithelium:
Langerhans cells: modified monocytes playing a role in immunity Merkel cells: contain nerve endings
Melanocytes: contain melanin

Anatomic Parts of Epithelium

Oral epithelium (OE) Sulcular epithelium (SE) Junctional epithelium (JE)

Oral Epithelium (OE)

The epithelial ridges of the OE extend down into the underlying connective tissue A dense network of collagen fibers tightly

anchors the epithelium

Gingival Crevicular Fluid (GCF)

Fluid in the gingival sulcus (sulcular fluid)
In healthy state, its volume is small

With inflammation, its flow increases and

composition changes Source: diffusion through JE

Gingival Crevicular Fluid (GCF)

Functions:
Cleansing adhesion of epithelium to the tooth (plasma proteins) Antimicrobial properties Antibody activity

Sulcular Epithelium (SE)

Epithelial lining of the gingival sulcus Thin, nonkeratinized epithelium; making it less resistant to stresses The SE is permeable, allowing fluid to flow from the gingival connective tissue into the sulcusgingival crevicular fluid

Copyright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Junctional Epithelium (JE)

Epithelium that forms the base of the sulcus Joins the gingiva to the tooth Length = 0.71 mm to 1.35 mm 15 to 30 cells thick at the coronal zone

4 to 5 cells thick at the apical zone

Copyright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Connective Tissue
Lies beneath epithelium Gingival CT is largely fibrous Major component: Collagen

Cellular component and ground substance Contains the vascular, lymphatic and nerve supply/drainage to/ from the gingival tissues

Arrangement of Gingival Fibers

Arranged in groups: DGdentogingival Circular AGalveologingival PGperiostogingival Transseptal: between teeth
Copyright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Functions of Gingival Fibers

To brace firmly marginal gingiva to the tooth Rigidity against mastication without deflection Unite marginal gingiva with cementum and attached gingiva

Thank you