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The Gingiva
Embryology, Anatomy, Histology & Biochemistry
Dr. Khansa Ababneh
Periodontium Tissues which
surround & support the teeth.
Periodontium• Gingiva
• Periodontal ligament
• Alveolar bone
• Cementum
Tooth Development & Eruption
Periodontal tissues develop during tooth development
Development of the periodontium role of epithelial-mesenchymal interactions
Oral epithelium
Gingival epithelium
Ectomesenchyme (dental follicle)
PDLAlveolar bone
CementumGingival CT
Oral mucosa Masticatory
mucosa
Lining mucosa
Specialised mucosa
GINGIVA Part of masticatory
mucosa
Fibrous mucosa surrounding necks of teeth
covers the coronal portion of the alveolar process
GINGIVA
3 main parts:
1. Free gingiva
2. Attached gingiva
3. Interdental gingiva
Free gingivaFree gingiva From gingival margin
to the free gingival groove (FGG) at the level of the CEJ.
Can be separated form the tooth by a probe
Depth of gingival sulcus (crevice) : 0-3 mm.
Attached gingivaAttached gingivaExtends from the FGG to the mucogingival junction (MGJ)
Attached gingiva
On the palate, the whole mucosa is keratinised and there is No MGJ
Attached gingiva
Firmly attached to underlying bone to:
withstand masticatory forces
withstand forces of tooth brushing
prevent movement of marginal gingiva
Width varies in different parts of the mouth;
between right & left sides
between different people
with age (increases)
For example
Maxilla, buccally:widest around incisors, narrowest around
premolars
Mandible, linguallynarrowest around incisors, widest around molars.
Is the width of the attached gingiva important?
Which is more important; width or thickness?
Keratinised Vs Attached
Attached gingiva Keratinised gingiva
FG + AG
KG
Interdental gingiva Also: interdental
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 bleeding on probing
(BOP).
HISTOLOGYHISTOLOGY The gingiva consists of 2 main types of
tissue:
1. Epithelium2. Connective tissue
• Epithelium is attached to the underlying connective tissue by a basement membrane.
EpitheliumEpithelium Stratified squamous epithelium (parakeratinised) Function:
Protection of underlying structures while permitting
selective interchange with the oral environment
Active production of cytokines, adhesion molecules,
growth factors and enzymes
Examples: β-defensins, IL-1 β, IL-8, EGF
StructureStructure 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 or horny cell layer)
• The oral mucosa is mostly
parakeratinised: stratum corneum
retains pyknotic nuclei
• Difference between ortho- & para-
keratinisation
• Cytokeratin (K1-K19)
• Other proteins: keratolinin,
involucrin & filaggrin.
Other cell types within the gingival epithelium
Langerhans cells: modified monocytes
found in the suprabasal layer, playing a
role in immunity
Merkel cells: in deeper layer of
epitheium, contain nerve endings
Melanocytes: in basal and spinous cell
layer, contain melanin
Types of Gingival Epithelium
Oral epithelium
Sulcular epithelium
Junctional
epithelium
Oral epitheliumFaces the oral cavity, is parakeratinised, shows rete pegs and connective tissue papillae (responsible for the stippled texture). Turnover rate 10-12 days.
Sulcular epithelium Faces the tooth without contacting it. Thin non-keratinised stratified squamous epithelium (no granulosum and corneum layers), extends from the coronal end of the junctional epithelium to the crest of the gingival margin. Acts as a semi-permeable membrane.
Junctional epithelium Provides contact between
gingiva & tooth.
Stratified squamous non-keratinised epithelium.
3-4 cells thick in early life, increasing to 10-20 later.
Basal and suprabasal layers.
Length = 0.25-1.35 mm. No rete pegs.
Junctional Epithelium Derived from the
reduced enamel epithelium
Attachment to tooth: inner basal lamina
Attachment to gingival connective tissue: outer basal lamina
Lamina densa & lamina lucida
Large cells; wide intercellular spaces
ECM of Epithelium
Not abundant in gingival epithelium
PG: CD44, HA, syndecan, decorin
Glycoproteins: integrin family, e.g.: α2β1, and ICAM-1 (in Jep & Oep)
Differences between gingival epithelia Cell size/tissue volume in JE is > in OE
Intercellular spaces in JE are > in OE
No of desmosomes in JE is < in OE
Difference in cytokeratin expression & cell surface markers
JE originates from REE; OSE & OE originate from oral mucosa
Renewal of gingival
epithelium Cell sheddingCell division
The Dentogingival junction
Enamel + cementum (CEJ) +
junctional epithelium + gingival
fibres + adhesion proteins.
Dentogingival epithelium
Gingival Crevicular fluid (GCF)
In gingival sulcus
Cleaning & antimicrobial effects
Increases adhesion of gingiva to
tooth.
Connective Tissue
1. Cells: fibroblasts, mast cells, macrophages,
neutrophils, lymphocytes, plasma cells.
2. Collagen fibres3. Extracellular matrix (ECM)4. Nerves5. Blood vessels6. Lymphatics
Fibres Collagen, elastin,
reticulin & oxytalan
fibres.
Provide structure,
framework, increase
elasticity and
resiliency of gingiva.
Fibres Arranged in groups : :
Transseptal
Circular
Dentogingival
Dentoperiosteal
ECM Medium in which all other
components are embedded.
Consists of: water, proteins, glycoproteins, proteoglycans & growth factors:
Collagen type I , III, V & VI Proteoglycans: decorin, biglycan,
versican Integrins Fibronectin