The Normal Periodontium 1-Gingiva

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
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
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
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

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
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
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The Normal Periodontium I: The Gingiva

Periodontology 1 DENT 371

GINGIVA is a part of the masticatory mucosa

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

Copyright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Interdental Gingiva (Papilla)

Clinical Features of Normal (Healthy) Gingiva

Contour: scalloped outline

Probing depth: 0-3 mm

Coral Pink Gingiva

Stippling of the Attached Gingiva

Copyright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Epithelium: Stratified Squamous (parakeratinized)

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

Anatomic Parts of Epithelium

Oral Epithelium (OE)

anchors the epithelium

Gingival Crevicular Fluid (GCF)

With inflammation, its flow increases and

Gingival Crevicular Fluid (GCF)

Sulcular Epithelium (SE)

Copyright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Junctional Epithelium (JE)

4 to 5 cells thick at the apical zone

Arrangement of Gingival Fibers

Functions of Gingival Fibers

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