Anatomy, Structure,

and Function of the Periodontium

Part (1)

‫المدرس الدك تور اوس دنان‬

‫استاذ امراض اللثة‬
IUST
 Introduction
• The normal periodontium provides
the support necessary to
maintain teeth in function. It
consists of four principal
components:
gingiva, periodontal ligament,
cementum, and alveolar bone.
• Each of these periodontal
components is distinct in its
location, tissue architecture,
biochemical composition, and
chemical composition, but all of
these components function
together as a single unit.
• Therefore the pathologic changes
that occur in
one periodontal component may
have significant implications for
the maintenance, repair, or
regeneration of other components
of the periodontium.
• 1. The gingiva and the covering of the hard
palate, termed the masticatory mucosa.
• (The gingiva is the part of the oral mucosa that
covers the alveolar processes of the jaws and
surrounds the necks of the teeth).
2. The dorsum of the tongue, covered by
specialized mucosa.
3. The oral mucous membrane lining the
remainder of the oral cavity is called the lining
mucosa.
Clinical Features
In an adult, normal gingiva covers the alveolar bone
and tooth root to a level just coronal to the cemento-
enamel junction (CEJ).
• The gingiva is divided anatomically into marginal,
attached, and interdental areas.
• Although each type of gingiva exhibits considerable
variation in differentiation, histology, and thickness
according to its functional demands, all types are
specifically structured to function appropriately
against mechanical and microbial damage.
Marginal Gingiva
The marginal or unattached gingiva is the terminal edge or border of
the gingiva that surrounds the teeth in collar-like fashion.
In about 50% of cases, it is demarcated from the adjacent attached
gingiva by a shallow linear depression called the free gingival
groove (fgg).
The marginal gingiva is usually about 1 mm wide, and it forms the
soft-tissue wall of the gingival sulcus. It may be separated from the
tooth surface with a periodontal probe.
The most apical point of the marginal gingival scallop is called the
gingival zenith.
Gingival Sulcus
The gingival sulcus is the shallow crevice or
space around the tooth bounded by the
surface of the tooth on one side and the
epithelium lining the free margin of the
gingiva on the other side.
It is V-shaped and barely permits the
entrance of a periodontal probe. The clinical
determination of the depth of the gingival
sulcus is an important diagnostic parameter.
Under absolutely normal or ideal conditions,
the depth of the gingival sulcus is 0 mm or
close to 0 mm. These strict conditions of
normalcy can be produced experimentally
only in germ-free animals or after intense
and prolonged plaque control.
• In clinically healthy human gingiva, a sulcus of
some depth can be found. The depth of this
sulcus, as determined in histologic
sections, has been reported as 1.8 mm; other
studies have reported 1.5 mm and 0.69 mm.
• The clinical evaluation used to determine the
depth of the sulcus involves the introduction of
a metallic instrument (i.e., the periodontal
probe) and the estimation of the distance it
penetrates (i.e., the probing depth). The
histologic depth of a sulcus does not need to
be exactly equal to the depth of penetration of
the probe.
• The penetration of the probe depends on
several factors, such as probe diameter,
probing force, and level of inflammation.
Consequently, the probing depth is not
necessarily exactly equal to the histologic
depth of the sulcus.
• The so-called probing depth of a clinically
normal gingival sulcus in humans is 2 to 3
mm.
Attached Gingiva

The attached gingiva is continuous

with the marginal gingiva. It is firm,
resilient, and tightly bound to the
underlying periosteum of alveolar
bone. The facial aspect of the
attached gingiva extends to the
relatively loose and movable
alveolar mucosa; it is demarcated
by the mucogingival junction.
The width of the attached
gingiva is another important
clinical parameter. It is the
distance between the mucogingival
junction and the projection on the
external surface of the bottom of
the gingival sulcus or the
periodontal pocket. It should not be
confused
with the width of the keratinized
gingiva, although this also
includes the marginal gingiva.
The width of the attached gingiva on the facial aspect
differs in different areas of the mouth. It is generally
greatest in the incisor region (i.e., 3.5 to 4.5 mm in the
maxilla, 3.3 to 3.9 mm in the mandible) and narrower in
the posterior segments (i.e., 1.9 mm in the maxillary first
premolars and 1.8 mm in the mandibular first premolars).
Interdental Gingiva
The interdental gingiva
occupies the gingival
embrasure, which is the
interproximal space beneath
the area of tooth contact. The
interdental gingiva can be
“pyramidal”, or it can have a
“col” shape.
In the former, the tip of one
papilla is located immediately
beneath the contact point; the
latter presents a valley-like
depression that connects a
facial and lingual papilla and
that conforms to the shape of
the interproximal contact.
The shape of the gingiva
in a given interdental
space depends on the
presence or absence of a
contact point between the
adjacent teeth, the
distance between the
contact point and the
osseous crest, and the
presence or absence of
some degree of
recession.
Microscopic examination
reveals that gingiva is
Microscopic
composed of the Features
overlying stratified
squamous epithelium and
the underlying central
core of connective tissue.
Although the epithelium
is predominantly cellular
in nature, the connective
tissue is less cellular and
composed primarily of
collagen fibers and
ground substance.
These two tissues are
considered separately.
 General Aspects of Gingival Epithelium Biology

Historically, the epithelial compartment was thought to

provide only a physical barrier to infection and the
underlying gingival attachment. However, we now
believe that epithelial cells play an active role in innate
host defense by responding to bacteria in an interactive
manner, which means that the epithelium participates
actively in responding to infection, in signaling further
host reactions, and in integrating innate and acquired
immune responses.
The gingival epithelium
consists of a continuous lining of
stratified squamous epithelium.
There are three different areas
that can be defined from the
morphologic and functional
points of view: the oral or outer
epithelium, the sulcular
epithelium, and the junctional
epithelium.

The principal cell type of the

gingival epithelium—as well as of
other stratified squamous
epithelia—is the keratinocyte.
Other cells found in the
epithelium are the clear cells or
non-keratinocytes, which include
the Langerhans cells, the
Merkel cells, and the
melanocytes.
The main function of the gingival epithelium is to protect the deep
structures while allowing for a selective interchange with the oral
environment. This is achieved via the proliferation and differentiation
of the keratinocytes.
The proliferation of keratinocytes takes place by mitosis in the
basal layer and less frequently in the supra-basal layers, in which a
small proportion of cells remain as a proliferative compartment while
a larger number begin to migrate to the surface.

Differentiation involves the process of keratinization, which

consists of progressions of biochemical and morphologic events that
occur in the cell as they migrate from the basal layer.
A complete keratinization process leads to the production of an
orthokeratinized superficial layer similar to that of the skin, with no
nuclei in the stratum corneum and a well-defined stratum granulosum.
Only some areas of the outer gingival epithelium are orthokeratinized;
the other gingival areas are covered by para-keratinized or non-
keratinized epithelium and are considered to be at intermediate stages
of keratinization.
In parakeratinized epithelia, the stratum corneum retains pyknotic
nuclei, and the keratohyalin granules are distributed rather than
giving rise to a stratum granulosum.
The nonkeratinized epithelium (although cytokeratins are the major
component, as in all epithelia) has neither granulosum nor corneum
strata, whereas superficial cells have viable nuclei.
• Q- What is the difference between
Orthokeratinized and Parakeratinized?
• A- In the orthokeratinized epithelium the cell
nuclei disappear in the keratinized layer,
whereas in the parakeratinized epithelium
flattened, highly condensed nuclei remain in
the cell cytoplasm of the keratinized layer until
exfoliation.
Non-keratinocyte cells are present in gingival epithelium
as in other epithelia;
• Melanocytes are dendritic cells located in the basal
and spinous layers of the gingival epithelium. They
synthesize melanin in organelles called pre-
melanosomes or melanosomes .
• Langerhans cells are dendritic cells
located among keratinocytes at all
supra-basal levels. They belong to
the mononuclear phagocyte system
as modified monocytes derived from
the bone marrow. They contain
elongated granules, and they are
considered macrophages with
possible antigenic properties.
Langerhans cells have an important
role in the immune reaction as
antigen-presenting cells for
lymphocytes.
They are found in the oral epithelium
of normal gingiva and in smaller
amounts in the sulcular epithelium;
they are probably absent from the
junctional epithelium of normal
gingiva.
 Let’s talk IMMUNOLGY
Monocytes are a type of white blood cell
(leukocytes) that reside in your blood and tissues to
find and destroy germs (viruses, bacteria, fungi and
protozoa) and eliminate infected cells.
Monocytes invite other white blood cells to help treat
injury and prevent infection.
Monocytes are macrophages in the blood;
macrophages are monocytes in tissue!
Let’s talk IMMUNOLGY

Antigen-presenting cell
• Merkel cells are located in the deeper layers
of the epithelium; they harbor nerve endings,
and they are connected to adjacent cells by
desmosomes. They have been identified as
tactile preceptors.
END OF PART (1)