DR.

VISHWAS MADAAN
M.D.S. Part1
Dept. of Periodontics and Oral Implantology
DEFENSE MECHANISMS
OF GINGIVA
GINGIVA : THE COMBINATION OF EPITHELIAL AND
CONNECTIVE TISSUES THAT FORMS A COLLAR OF
MASTICATORY MUCOSA AROUND THE TEETH OF THE
COMPLETE DECIDUOUS OR PERMANENT TEETH AND IS
ATTACHED TO BOTH TEETH AND ALVEOLAR PROCESS.




GINGIVAL TISSUES ARE THE
ARCHITECTURE OF PERIODONTAL
PROTECTION.
ARCHITECTURE IMPLIES A STRUCTURE DESIGNED FOR A
PARTICULAR PURPOSE AND TO ACCOMPLISH A
PARTICULAR TASK.

FOR THE HUMAN GINGIVA THIS TASK IS PROTECTION.



PROTECTION OF WHAT?
THE UNDERLYING PERIODONTIUM,
ALVEOLAR BONE AND ASSOCIATED
CONNECTIVE TISSUE ELEMENTS.



PROTECTION FROM WHAT?
MASTICATORY FORCES,
FOREIGN INVADERS
(MICROORGANISMS)



AS WE KNOW THAT BOTH EXTERNALLY
AND INTERNALLY HUMAN BODY IS
PROTECTED BY A CONTINUOUS LINING,
THE SKIN AND MUCOSA.
BUT THESE SURFACES ARE INTACT
THROUGHOUT LIFE UNTIL AND UNLESS
BREACHED BY ANY PATHOLOGICAL
PROCESS.

HUMAN GINGIVAL TISSUES ARE DIFFERENT FROM THESE
LINING SURFACES WHEREBY A BREACH IN CONTINUITY IS
PRESENT PHYSIOLOGICALLY DUE TO THE ERUPTION OF
DECIDUOUS AND PERMANENT TEETH, THEREBY
COMPROMISING ITS PROTECTIVE QUALITY.
For this reason tissues surrounding the teeth have been
designed in a specialized manner.


Epithelium


Connective
tissue

GCF




Epithelium
two different stratified
epithelia :
the oral epithelium
the junctional epithelium
ORAL EPITHELIUM IS KERATINIZED
KERATINIZATION BEGINS FROM MUCOGINGIVAL
JUNCTION TILL THE GINGIVAL MARGIN UPTO THE TIP OF
THE INTERDENTAL PAPILLA EXCLUDING THE SULCUS , J.E.,
COL AREA.

KERATINIZATION OFFERS SOME PROTECTION AGAINST
MASTICATORY FORCES
JUNCTIONAL EPITHELIUM
SURROUNDS THE TEETH LIKE A CUFF
ATTACHED TO TOOTH VIA HEMIDESMOSOMES
CONTAINS WIDE INTERCELLULAR SPACES THAT HARBOR
DEFENSE CELLS (NEUTROPHILS)

FLUID EXERTED OUT FROM THE
GINGIVAL SULCUS
HIGH CELL TURNOVER RATE. RENEWS
ITSELF IN 1-5 DAYS

PRESENCE OF THESE DEFENSE CELLS
AND THE MOVEMENT OF GINIGVAL
CREVICULAR FLUID PROTECTS
AGAINST INVADING
MICROORGANISMS







Connective tissue

supragingival fiber
apparatus


on the basis of preferential orientation, architectural arrangement and sites
of insertion these bundles have been classified as :
1. Dento-gingival
2. Dento-periosteal
3. Alveolo-gingival
4. Circular
5. Semi circular
6. Transgingival
7. Intercircular
8. Interpapillary
9. Periosteo-gingival
10. Interginigval
11. Trans-septal

THE SUPRAGINGIVAL FIBRE APPARATUS NOT ONLY
ATTACHES THE GINGIVA TO TEETH AND BONE, BUT
ALSO PROVIDES A DENSE FRAMEWORK THAT
ACCOUNTS FOR THE RIGIDITY AND BIOMECHANICAL
RESISTANCE OF THE GINGIVA.

GINGIVA IS MADE RESILIENT IN NATURE DUE TO THE
PRESENCE OF FIBRE BUNDLES.
HENCE GINGIVA IS ABLE TO WITHSTAND FRICTIONAL
FORCES AND PRESSURES THAT RESULT FROM
MASTICATION.
THE FIBRE APPARATUS ALSO CONTROLS THE POSITION
OF THE TOOTH IN THE ARCH.







GINGIVAL CREVICULAR FLUID
Gingival crevicular
fluid

Brill & Krasse in 1958 first described
the passage of a tissue fluid
(crevicular or sulcus or pocket fluid)
from gingival blood vessels to the
gingival sulcus.

Volume of GCF secreted per day=
0.5-2.4ml/ day

From where does the
gingival crevicular fluid arise
?

It arises as an ultrafiltrate
from the gingival plexus of
blood vessels within the
lamina propria adjacent to
j.e.
Gingival crevicular fluid
Functions :
1) Cleanse material from the sulcus

2) Contain plasma proteins that may improve
adhesion of the epithelium to the tooth.

3) Possess antimicrobial properties.

4) Exert antibody activity in defense of the
gingiva.
COMPOSITION OF GCF
Cellular
Elements
Electrolytes
Organic
Compounds
Metabolic
and Bacterial
products
Enzyme and
enzyme
Inhibitors
Epithelial cells
Leucocytes
Bacteria
Sodium
Potassium
Fluoride
Others

1. Carbohydrates
2. Proteins
Immunoglobulins
Compliment
Components
other proteins
3. Lipids

1. Lactic acid
2. Hydroxyproline
3. Prostaglandins
4. Urea
5. Endotoxin
6. Cytotoxic substances
7. Antibacterial factors



1. Acid phosphatase
2. Alkaline phosphatase
3. Pyrophosphotase
4. B-glucoronidase
5. Lysosome
6. Hyaluronidase
7. Lactic dehydrogenase
8. Proteolytic enzymes
Proteinases

Mammalian
Proteinases

Bacterial
Proteinases

1. Cathepsin D
2. Elastase
3. Cathepsin G
4. Plasmogen activator
5. collagenases
22
Why it is important to study gcf?

Gingival crevicular fluid (GCF) is
regarded as a window for non-
invasive analysis of periodontal
conditions, including markers of
connective tissue and bone
destruction.

METHODS OF COLLECTION AND MEASUREMENT OF
THE VOLUME OF GCF

1. Gingival washing methods
2. Capillary tubing or micropipettes
3. Absorbent filter paper strips
4. Twisted threads
5. Other Methods


Gingival washing methods
Two different techniques have been used
(Skapski & Lehner 1976)
Involved the instillation and
re-aspiration of 10ml of
Hanks balanced salt solution
at the interdental papilla
26
Gingival washing methods
This method involved the construction of a customized
acrylic stent which isolated the gingival tissues from the
rest of the mouth. The tissues were then irrigated for
15min, with a saline solution, using a peristaltic pump, and
the diluted GCF was removed.
(Oppenhein 1960)
Apparatus for collection of
washing in the mouth
Connections to the peristaltic
pump
27
Advantage - The washing technique is particularly valuable for
harvesting cells from the gingival crevice region.

Disadvantage
1. The production of customized acrylic stents is complicated and
technically demanding.

2. The major disadvantage of this technique is that all fluid may not be
recovered during the aspiration and re-aspiration procedure. Thus
accurate quantification of GCF volume or composition is not
possible.
Gingival washing methods
28
Capillary tubing or micropipettes
Isolation and drying of a site
Capillary tubes of known internal diameter are
inserted into the entrance of the gingival
crevice
Capillary action
Migration of GCF into the tube
29
Capillary tubing or micropipettes
Because the internal diameter is known the volume of fluid collected can
be accurately determined by measuring the distance which the GCF has
migrated.
This technique appears to be ideal as it provides an undiluted sample of
native GCF whose volume can be accurately assessed.
Disadvantages
However, it is difficult to collect an adequate volume of GCF in a short
period, unless the sites are inflamed and contain large volumes of GCF.

It is difficult to conceive that holding a capillary tube at the entrance to a
gingival crevice for such lengthy periods ensures an atraumatic collection.

A further complication of this technique is the difficulty of removing the
complete sample from the tubing.
Advantages
30
Intracrevicular and the Extracrevicular techniques
These strips are placed within the sulcus (Intrasulcular method) or at
its entrance (Extrasulcular method). The placement of filter paper
strip in relation to the sulcus or pocket is important.

Absorbent filter paper strips

The Brill technique places it into the pocket until resistance is
encountered.
Disadvantage: This method introduces a degree of irritation of the
sulcular epithelium than can, by itself trigger the oozing of fluid.

To minimize this irritation, Loe and Holm Pedersen placed the
filter paper strip just at the entrance of the pocket or over the pocket
entrance. In this way, fluid seeping out is picked up by the strip, but
the sulcular epithelium will not be in contact with the paper.

Absorbent filter paper strips
31
32
Absorbent filter paper strips
The advantages of the technique
are that it is quick and easy to use,
can be applied to individual sites
and, possibly, is the least
traumatic when correctly used.
Twisted threads

Pre weighing the threads before and after GCF
collection
Other Methods
Plastic transparent strips
Platinum Loops or microspatules
33
34
Methods of estimating the volume collected
The distance the fluid had migrated up the strip

Assessing the area of filter paper wetted by the GCF
sample.

Staining the strips with ninhydrin

Weighing of strips before and after sample collection

Electronic measuring device, the Periotron

PERIOTRON
35
An electronic method has been devised for measuring gingival fluid absorbed on
paper strips by Harco electronics called Periotron (Dental product division
Winnipeg, Manitoba, Canada).
Mechanism of action : Measures the electric current flow through a wetted paper
strip.

It allows accurate determination of the GCF volume and subsequent laboratory
investigation of the sample composition.
36
PERIOTRON





?
Lets revise





?
What are three main domains
of gingiva by which it acts to
protect the periodontium?


Epithelium


Connective
tissue

GCF






?
WHAT IS THE MAIN CHARACTERISTIC
OF ORAL EPITHELIUM?
Keratinization





?
What are the two main
characteristic of j.e.?
Defense cells (neutrophils)
Gingival crevicular fluid





?
What is the main defense
function of gingival fibres?
Rigidity -ability to
withstand frictional
forces





?
What is the volume of
g.c.f. secreted daily under
normal conditions?
0.5-2.4ml/ day





?
What are the 4 functions
of g.c.f.?



FUNCTIONS :
1) CLEANSE MATERIAL FROM THE SULCUS

2) CONTAIN PLASMA PROTEINS THAT MAY
IMPROVE ADHESION OF THE EPITHELIUM TO
THE TOOTH.

3) POSSESS ANTIMICROBIAL PROPERTIES.

4) EXERT ANTIBODY ACTIVITY IN DEFENSE OF
THE GINGIVA.





?
What are the various
methods for collection of
g.c.f. ?
METHODS OF COLLECTION AND MEASUREMENT OF
THE VOLUME OF GCF

1. Gingival washing methods
2. Capillary tubing or micropipettes
3. Absorbent filter paper strips
4. Twisted threads
5. Other Methods