Gingiva is the part of oral mucosa that covers the alveolarprocesses of jaws and surrounds the necks of teeth

1. 10/12/201
GOOD MORNING !

2. Guide:
Assoc. Prof. Dr. Bhageshwar Dhami
Presenter:
Dr. Arjun Hari Rijal
PG Resident (1st year)
Department of Periodontics
Kantipur Dental College and Hospital

3. Content
• Introduction
• Definition
• Macroscopic anatomy
• Correlation Of Clinical and Microscopic Features
• Age Changes
• Clinical Considerations
• Microscopic anatomy
• Blood supply
• Lymphatic drainage
• Nerve supply
• Conclusion
• References
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4. Introduction
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• Oral mucosa (mucous membrane) continuous with the skin
of the lips and the mucosa of the soft palate and pharynx
• The oral mucosa consists of
(1) the masticatory mucosa, which includes the gingiva and
the covering of the hard palate
(2) the specialized mucosa, which covers the dorsum of
the tongue
(3) the remaining part, called the lining mucosa

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• The periodontium (peri =
around, odontos =
tooth)comprises the following
tissues
(1) gingiva (G)
(2)periodontal ligament (PL)
(3) root cementum (RC)
(4) alveolar bone proper (ABP)
AP= Alveolar process

6. Definitions
• Gingiva is the part of oral mucosa that covers the alveolar
processes of jaws and surrounds the necks of teeth
- Carranza
• Part of masticatory mucosa covering the alveolar processes of
the cervical portions of teeth
-Lindhe
• The fibrous investing tissue, covered by keratinized
epithelium, that immediately surrounds a tooth and is
contiguous with its periodontal ligament and with the mucosal
tissues of the mouth
Glossary Of Periodontics (AAP)
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7. It is a combination of epithelium and connective tissue and it
defined as that portion of oral mucous membrane, which in
complete post eruptive dentition of a healthy young individual
surrounds and is attached to the teeth and the alveolar
processes
-Schroeder
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8. Gingiva is that part of oral mucous membrane that covers the
alveolar processes of the cervical portions of the teeth
-Genco
Gingiva is the part of oral mucous membrane attached to the
teeth and the alveolar processes
-Grant
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9. 10/12/2019
9Macroscopic Anatomy
Interdental gingiva
Marginal gingiva
Attached gingiva
Schluger et al, 1990

10. • 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
• The specific structure of different types of gingiva reflects
each one’s effectiveness as a barrier to the penetration by
microbes and noxious agents into the deeper tissue
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11. Marginal/Unattached Gingiva
• Terminal edge surrounding the
tooth in collar-like fashion
• 1mm wide, forms the soft-tissue
wall of the gingival sulcus
• Demarcated from the adjacent
attached gingiva by a shallow linear
depression called the
free gingival groove- 50% cases
• Position: 1.5-2mm coronal to CEJ
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12. • Most apical point of the marginal
gingival scallop gingival
zenith
• Apicocoronal and mesiodistal
dimensions vary between
0.06 and 0.96 mm (Mattos &
Santana; JP 2008)
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13. Gingival sulcus
• Gingival crevice – Orban &
Mueller,1929
• 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
• V- shaped
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14. • Significance:
• Imp. Diagnostic parameter
• Ideal conditions: 0/ close to
0mm
• Biologic /Histological depth :
1.8mm(0-6mm)
• Probing depth: 2-3 mm
• Strict conditions of normalcy can be
produced
• Experimentally only
in germ-free animals
• After intense and prolonged
plaque control
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15. Interdental Papilla
• Occupies gingival embrasure, interproximal space beneath the
area of tooth contact
• Formed by:
Lateral borders & tip – marginal gingiva
Central intervening portion – attached gingiva
• Shape:
Pyramidal - Anteriors
Col – Posteriors
• Diastema: gingiva is firmly bound over bone forming a
smooth, rounded surface without interdental papilla
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16. Interdental Papilla
• Shape of the gingiva in a given interdental space depends
• presence or absence of a contact point between the
adjacent teeth
• the distance between the contact point and the osseous
crest
• the presence or absence of some degree of recession
• Facial and lingual surfaces are tapered toward the
interproximal contact area
• Mesial and distal surfaces are slightly concave
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Gingival col : Normal Gingiva
Gingival col : After Gingival recession
A valley-like depression that
connects a facial and lingual
papilla and that conforms to
the shape of the interproximal
contact
col is covered with nonkeratinized
stratified squamous epithelium

19. Attached Gingiva
• Firm, resilient and tightly bound to the underlying periosteum
of alveolar bone by connective tissue fibers
• Coronally: marginal gingiva
• Apically:
Palatally -palatal mucosa
Facially -alveolar mucosa
• Mucogingival junction
• Stippling
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20. Facial:
Widest in incisor region
Maxilla: 3.5 – 4.5 mm
Mandible: 3.3 – 3.9 mm
Most narrow adjacent to premolar
Maxilla: 1.9 mm
Mandible: 1.8 mm
Lingual:
• Wider in molar region
• Narrow in incisor region
Increases: by the age of 4yrs
Supra-erupted teeth
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21. Measuring the Width of Attached Gingiva
• HALL WB, 1981: the width of attached gingiva is determined
by subtracting the sulcus or pocket depth from total width of
gingiva
• Total width of gingiva: from MGJ to crest of marginal gingiva
• Methods to determine mucogingival junction:
1. Visual method
2. Functional method
3. Visual methods after histochemistry staining
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Hall WB. Present status of soft tissue grafting. Journal of periodontology. 1977 Sep
1;48(9):587-97.

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Visual methods
Roll Technique
Visual methods after
histochemistry
staining

23. How much zone of attached gingiva is necessary to
maintain the health of Periodontium?
• Bowers GM,1963: It is possible to maintain clinically healthy
gingiva despite a very narrow zone of attachment (less than 1
mm)
• Lang & Loe,1972: suggested that 2 mm of keratinized gingiva
(corresponding to 1 mm attached gingiva) is adequate to
maintain gingival health
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Lang NP, Lo¨e H. The relationship between the width of keratinized gingiva and gingival
health. Journal of Periodontology 1972;43:623–7.
Bowers GM. A study of the width of attached gingiva. The Journal of Periodontology.
1963 May 1;34(3):201-9.

24. • Maynard and Wilson 1979 – 5mm of keratinized gingiva with
3mm attached gingiva when subgingival restorations are
planned
• Kennedy 1985 – over a 6 year period, in patients with
inconsistent oral hygiene saw recession with thin tissue
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25. • Wennstorm, 1987: the lack of minimum amount of
attached Gingiva does not necessarily result in a soft
tissue recession. Proper plaque control prevents soft tissue
recession, even when it is out of adequate width
• Miyasato et al reported that, even in areas of minimal
attached gingiva, periodontal health can be preserved
provided that good plaque control is practiced
• Kennedy et al: there is no evidence that a narrow zone of
attached gingiva is more prone to inflammation than a
wide zone
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Miyasato M, Crigger M, Egelberg J. Gingival condition in areas of minimal and appreciable
width of keratinized gingiva. J Clin Periodontol 1977: 4: 200–209
Kennedy J, Bird WC, Palcanis KG, Dorfman HS. A longitudinal evaluation of varying widths
of attached gingiva. J Clin Periodontol 1985: 12: 667–675
Wennstro¨m JL, Lindhe J, Sinclair F, Thilander B. Some periodontal tissue reactions to
orthodontic tooth movementin monkeys. Journal of Clinical Periodontology
1987;14:121–9

26. • Attached gingiva around teeth is important to minimize the
risk of gingival recession when preparing esthetic margins and
to increase patient comfort when performing oral-hygiene
procedures
• Mehta P et al,2010: width of attached gingiva is not
significant to maintain periodontal health in the presence of
adequate oral hygiene
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Goldberg P, Higginbottom FL, Wilson TG. Periodontal considerations in restorative and
implant therapy. Periodontol 2000 2001: 25: 100–109
Mehta P, Lim LP. The width of the attached gingiva—Much ado about nothing?. Journal of
dentistry. 2010 Jul 1;38(7):517-25.

27. Inadequate width of Attached
Gingiva
• Friedman - Said that ‘‘inadequate’’ zone of gingiva would
facilitate Subgingival plaque Formation because of improper
pocket closure resulting from the movability of the Marginal
tissue
• Amount of attached gingiva considered to be insufficient
when stretching of the lips or cheeks induce movement of
free gingival margin
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Friedman M.T. Barber PM, Mordan NJ, Newman HN. The ‘‘plaque-free zone’’In health and
disease: a scanning electron microscope study. J Periodontol. 1992; 63:890–896

28. • Born without sufficient attached gingiva,
which results in muscles of alveolar
mucosa to pull the gingiva down - Gingival
recession as well as bone loss
• Abnormal free attachment, which
exaggerates the pull on
gingival margin
• Vigorous brushing
• Deep pockets that reaches the level of
mucogingival junction
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29. • Hall mentioned few critical factors to be considered in
determination of adequate attached gingiva
>Patients age
>Level of oral hygiene practice
>Teeth involved any – Tooth Malposition
>Existing recession with esthetics or sensitivity problem
>Patients’ dental needs – Dehiscence
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30. Clinical significances of Attached
Gingiva
• Dissipates functional and masticatory stresses
• Provides a resistant barrier to plaque induced
inflammation
• Prevents Recession
• Deepens vestibule to provide better access for tooth
brushing
• Improves esthetics, patient comfort and ease of hygiene
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31. Attached Gingiva around
Implants
• Absence of keratinized mucosa increases the susceptility of
peri-implant lesions and plaque induced destruction
• Keratinized gingiva around implant has more
hemidesmosomes
• Orientation of collagen fiber in the connective tissue zone of
an implant often appear perpendicular to implant surface,
but in mobile non keratinized tissue these fiber run parallel to
surface of the implant
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James RA, Schultz RL: Hemidesmosome and the adhesion of junctional epithelial
cells to metal implants a preliminary report, J Oral Implantology; 1974; 4:294.

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33. • Adell et al – Attached mucosa is necessary to
prevent movement of mucosa around an exposed
cover screw from inflecting trauma upon to marginal
soft tissue
• Meffert et al. prefer to obtain keratinized tissue
before implant placement
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AdellR, LekholmU, RocklerB, Branemark P-I, Lindhe J, Eriksson B, Sbordone L. Marginal tissue
recession at osseointegrated titanium fixture (I).A 3-year longitudinal prospective study. Int J
oral maxillofacial surgery.1986; 15: 53-61
Meffert RM, Langer B, Fritz ME: Dental implant: a review, J Periodontol.1992; 63: 859-870

34. • Schrodder et al - mobile mucosa may disrupt the implant
epithelial attachment zone and contribute to an increased
risk of inflammation from plaque
• Mehdi Adibrad et al there is a significant
influence of width of keratinized mucosa on health of the
peri-implant tissues
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Schroeder, H.E. &Listgarten, M.A. (1997). The gingival tissues: the architecture of
Periodontal protection. Periodontology 2000; 13: 91–120
Mehdi Adibrad, Mohammad Shahabu, MahastiSahabi, significance of the Width of
Keratinized mucosa on the health status of the supporting tissue Around implants Supporting
overdentures journal of Oral Implantology. 2009; 35(5)

35. • Inadequate keratinized mucosa decreased cleansibility
of implant sites and increased mucosal inflammation.
There is a possibility that plaque accumulation in implant
sites caused more pronounced inflammatory response
compared to contralateral tooth
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Ueno D, Nagano T, Watanabe T, Shirakawa S, Yashima A, Gomi K. Effect of the keratinized
mucosa width on the health status of periimplant and contralateral periodontal tissues: a
cross-sectional study. Implant dentistry. 2016 Dec 1;25(6):796-801.

36. Clinical significance of attached
gingiva around implants
• Prevent spread of inflammation
• Prevents recession of marginal tissue
• Provides tight collar around implants
• Enable patients to maintain good oral hygiene
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37. Correlation Of Clinical And
Macroscopic Features
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38. Color
• Generally coral pink
• Color is a result of:
Vascular supply
Thickness
Degree of keratinization of epithelium
Presence of pigment containing cells
• Color to be correlated with cutaneous pigmentation
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39. Physiologic
Pigmentation(melanin)
• Melanin (non hemoglobin derived brown pigment)
• Prominent in blacks, diminished in albinos
• Distribution of Oral Pigmentations in blacks
Gingiva -60%
Hard Palate -61%
Mucous membrane -22%
Tongue -15%
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40. • As a diffuse , deep purplish discoloration or as irregularly
shaped brown and light brown patches and may appear as early
as 3 hours after birth
Synthesis of Melanin pigmentation
• Tyrosine is hydroxylated into DOPA in presence of
Tyrosinase enzyme
• DOPA (Dihydroxy Phenylalanine) is converted into
Melanin
• Melanin is phagocytosed to become Melanophages or
Melanophores
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41. Size
• Sum total of the bulk of cellular and intercellular elements
and their vascular supply
• Alteration in size is a common feature of gingival disease
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42. Contour
• Marginal gingiva envelops the teeth in collarlike fashion and
follows a scalloped outline on the facial and lingual surfaces
• straight line - along teeth with relatively flat surfaces
• accentuated - pronounced mesiodistal convexity (e.g.,
maxillary canines) or teeth in labial version
• horizontal and thickened - in lingual version
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43. Contour
• The contour or shape of the gingiva varies considerably
and depends on:
the shape of the teeth and their alignment in the arch
the location and size of the area of proximal contact
the dimensions of the facial and lingual gingival
embrasures
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45. Shape
• The shape of the interdental gingiva is governed by the
contour of the proximal tooth surfaces and the location and
shape of the gingival embrasures
• Anterior region of the dentition  pyramidal in form
• More flattened in a buccolingual direction in the molar region
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46. • Shape depends on:
>Presence/absence of contact
>Distance btw contact point and osseous crest
>Course of CEJ
>Width of the approximate tooth surfaces
>Presence/absence of recession
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47. Consistency
• Firm and resilient
• Firmness of the attached gingiva: Collagenous nature of the
lamina propria and its contiguity with the mucoperiosteum
• Firmness of the gingival margin: Gingival fibers
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48. • If the gingiva is suppressed, the proteoglycans become
deformed and recoil when the pressure is eliminated
• Macromolecules are important for the resilience of the
gingiva
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49. Surface Texture
• Orange peel – stippled
• Best viewed by drying Gingiva
• Attached Gingiva, central portion of the interdental
papillae  stippled
• Marginal gingival is not
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50. • Central portion of interdental papilla is usually stippled, but
marginal borders are smooth
• Less prominent on lingual surfaces and may be absent in some
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51. • Stippling –produced by alternate round protuberance and
depressions in the gingival surface
• Low magnification  a stippled surface, 50 µm deep
• Higher magnification  cell micropits
• A form of adaptive specialization or reinforcement for
function –feature of healthy gingiva
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52. • Reduction of stippling – common sign of Gingival disease
• Stippling returns when gingiva is restored to health
• Keratinisation – protective adaptation , increased by
toothbrushing
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53. • In 40% of adults Gingiva show stippling
• Generalized absence of stippling is seen in:
>Infancy
>Diseased conditions like gingival enlargements
>Mucocutaneous lesions affecting gingiva, inflammation etc
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54. Position
• The level at which the gingival margin is attached to the tooth
• Continuous eruption, even after meeting their functional
antagonists occurs through out life
Active Eruption :Movement of teeth in the direction of occlusal
plane
Passive Eruption: exposure of the tooth by apical migration of
Gingiva
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55. • Gottlieb : active and passive eruption go hand in hand
• Active eruption is coordinated with attrition, to compensate
for tooth substance worn away
• Attrition reduces the clinical crown and prevents it from
becoming disproportionately long in relation to the clinical root,
thus avoiding excessive leverage on periodontal tissue
• Rate of active eruption is in pace with tooth wear in order to
preserve vertical dimension
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57. • Exposure of the tooth via the apical migration of the gingiva is
called gingival recession or atrophy
• According to the concept of continuous eruption, the gingival
sulcus may be located on the crown, the cementoenamel
junction, or the root, depending on the age of the patient and
the stage of eruption
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58. • Therefore, some root exposure with age would be considered
normal and referred to as physiologic recession
• Again, this concept is not accepted at present
• Excessive exposure is termed pathologic recession
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59. Repair/Healing Of Gingiva
• Turnover rate is 10-12 days
• It is one of the best healing tissues in the body with little or no
scarring
• However the reparative capacity is lesser than that of
periodontal ligament and epithelial tissue
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60. Age Changes
• Stippling usually disappears with age
• Width of the attached gingiva increases with age
a. Gingival epithelium:
• Thinning and decreased keratinization
• Rete pegs flatten
• Migration of junctional epithelium apically.
• Reduced oxygen consumption
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61. Gingival connective tissue:
• Increased rate of conversion of soluble to insoluble collagen
• Increased mechanical strength of collagen
• Increased denaturing temperature of collagen
• Decreased rate of synthesis of collagen
• Greater collagen content
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62. Clinical
Considerations
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63. Biological Width
• The biological width is defined as the dimension of the soft
tissue, which is attached to the portion of the tooth coronal to
the crest of the alveolar bone
Gargiulo et al
• Established that there is a definite
proportional relationship between
the alveolar crest
the connective tissue attachment
the epithelial attachment
the sulcus depth
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64. • They reported the following mean
dimensions:
>A sulcus depth of 0.69 mm, (a)
>an epithelial attachment of 0.97 mm,(b)
>connective tissue attachment of 1.07
mm.(c)
>The biologic width is commonly stated to
be 2.04 mm,(b+c) which represents the sum
of the epithelial and connective tissue
measurements
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65. Biologic Width Evaluation
1. Clinical (discomfort when the restoration margin levels are
being assessed with a periodontal probe)
2. Radiographs (for interproximal violation but mesiofacial and
distofacial line angle not seen properly)
3. Bone sounding (probing under anesthesia)
If this distance is less than 2 mm or more at one or more
locations, a diagnosis of biologic width violation can be
confirmed
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66. Gingival Biotype
• Gingival biotype is described as the thickness of the gingiva in
the faciopalatal/ faciolingual dimension
• Seibert and Lindhe categorized the gingiva into:
1. Thick-flat: A gingival thickness of ≥ 2 mm
2. Thin scalloped: a gingival thickness of <1.5 mm
• Significant impact on the outcome of the restorative,
regenerative and implant therapy
• Direct co-relation exists with the susceptibility of gingival
recession followed by any surgical procedure
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67. Thick blunted:
>Resists recession
>Reacts to surgical & restorative
insults with pocket formation
Thin scalloped:
>Attached soft tissue is minimal
>Bony dehiscence & fenestration defects
>Reacts to surgical or restorative
interventions with ST recession, apical
migration of attachment & loss of
underlying alveolar volume
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68. • Eager divided attached gingiva based on periodontal type
>Shallow thin gingiva with slender crown formation.
>Wide thick gingiva with quadrant crown formation.
>Unknown combination
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70. Questions 70
1. Stippling:
Absent in Acute gingivitis
Infancy
Older age
2. How to identify firm and fibrotic/firm and resilient?
If we press the gingiva with blunt end of instrument,
Firm/resilient proteoglycan deform and recoil back to
original position after releasing pressure
Firm/ fibrotic absent

71. Questions
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3. Why there is more stippling on facial gingiva than lingual
gingiva?
4. Increase in width of attached gingiva with increasing age?
Since the mucogingival junction remains stable throughout life in
relation to the lower border of the mandible, the increasing
width of the gingiva may suggest that the teeth, as a result of
occlusal wear, erupt slowly throughout life.
In the absence of concurrent retraction of the gingival margin
this results in an increase of the width of attached gingiva with
advancing age(J. AINAMO AND A. TALARI)

72. 725. What is bone sounding, why is it called so?
Bone sounding is done to determine the level of underlying
bone by transgingival probing
6. Different methods of assessing mucogingival junction?
 Visual method
 Histochemical staining( Lugol’s Iodine/ Shiller’s Iodine)
 Functional methods
 Roll Technique
7. Variation in size?
Firm and resilient
Firm and fibrotic
Edematous
Enlarged

73. Questions
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8.What is scalloped margin?
9. Reverse architecture of gingiva?

74. Questions
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Wennstorm, 1987 minimum attached gingiva is sufficient if
there is good plaque control
Miyasato et al
Kennedy et al
Mehta P et al,2010
Maynard and Wilson 1979 Some amount of attached gingiva
is necessary
Kennedy 1985
Bowers GM,1963
Lang & Loe,1972

75. Gingival Epithelium
• Continuous lining of stratified squamous epithelium
Function:
• Physical barrier to Infection
• Participate actively in responding to infection in signaling
further host reactions in integrating innate and acquired
immune responses
• To protect deep structures
• Allow a selective interchange with the oral environment
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Dale BA. Periodontal epithelium: a newly recognized role in health and disease.
Periodontology 2000. 2002 Oct;30(1):70-8.

77. • Layers of stratified squamous epithelium as seen by
electron microscopy
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78. Stratum basale
• Cells: cylindric or cuboid
• Found immediately adjacent to the connective tissue
separated by a basement membrane
• Germinative layer: having the ability to divide
• It takes approximately 1 month for a keratinocyte to reach the
outer epithelial surface, where it is shed from the stratum
corneum
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79. Stratum spinosum:
• Prickle cell layer
• Large polyhedral cells with short cytoplasmic processes
• Keratinosomes or Odland bodies:
Modified lysosomes
Present in the uppermost part of the stratum spinosum
Contain a large amount of acid phosphatase
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80. Stratum granulosum:
• Flattened cells, in a plane parallel to the gingival surface
• Keratohyaline granules
• Associated with keratin formation are 1 μm in diameter)
round in shape and appear in the cytoplasm of the cell
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81. Stratum corneum:
• Closely packed, flattened cells that have lost nuclei and most
other organelles as they become keratinized
• Cells densely packed with tonofilaments
• Clear, rounded bodies probably representing lipid droplets
appear within the cytoplasm of the cell
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82. • Proliferation through mitosis occurs in the basal layer , less
frequently in the suprabasal layer and migration occurs
• Differentiation includes keratinisation in which main
morphologic changes seen are:
• Progressive flattening of the cell
• Increased prevalence of tonofilaments
• Intercellular junctions coupled to the production of
keratohyaline granules
• Disappearance of the nucleus
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84. • Three types of surface keratinization can occur in the gingival
epithelium:
1. Orthokeratinization
2. Parakeratinization
3. Nonkeratinization
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85. Orthokeratinization:
• Complete keratinization 
superficial horny layer
• No nuclei in stratum corneal layer
• Well-defined stratum granulosum
• Few areas of outer gingival epithelium
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86. Parakeratinization
• Intermediate stage of keratinization
• Most prevalent surface area of the gingival
epithelium
• Can progress to maturity or dedifferentiate
under different physiologic or pathologic
conditions
• Stratum cornea retains Pyknotic Nuclei
• Keratohyalin granules are dispersed rather
than giving rise to a stratum granulosum
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87. Nonkeratinization
• Viable nuclei in superficial layer
• Has neither granulosum nor
corneum strata
• Layers of nonkeratinized epithelium:
1. Stratum superficiale
2. Stratum intermedia
3. Stratum basale
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88. Ultrastructure Of Epithelium
• Each epithelial type have characteristic pattern of cytokeratins
• Keratin proteins  composed of different polypeptide
subunits characterized by their isoelectric points and molecular
weights
• Basal cells begin synthesis of low mol. Wt. keratins
Ex.: K19 (40kD)
• High mol. Wt. keratins are expressed when they reach
superficial layers
Ex.: K1 (68kD)
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89. • Other proteins synthesized during maturation process:
Keratolinin
Involucrin
Filaggrin
• Corneocytes
Most differentiated epithelial cell
Composed of bundles of keratin tonofilaments in amorphous
matrix of filaggrin, surrounded by a resistant envelope made
of keratolinin and involucrin
• Histochemical patterns change under normal or pathologic
stimuli, thereby modifying the keratinization process
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90. Epithelial Cell Connections
• Together with intercellular protein-carbohydrate complexes,
cohesion between cells is provided by numerous structures
called “Desmosomes”
• Desmosomes:
• Located between the cytoplasmic processes of adjacent
cells
• Two hemidesmosomes facing each other
• Large number of desmosomes gives a solid cohesion
between cells
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91. • A desmosome comprises the following structural components:
1. the outer leaflets (OL) of the cell membrane of two
adjoining cells
2. the thick inner leaflets (IL) of the cell membranes
3. the attachment plaques (AP), which represent granular and
fibrillar material in the cytoplasm
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92. • Tonofilaments:
Cytoskeleton of keratin proteins which radiate in
brush like fashion from the attachment plaques into
cytoplasm of the cells
• Tight Junctions (Zonae Occludens):
Rarely observed forms of epithelial cell connections
where the membranes of the adjoining cells are believed to be
fused
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93. Ultrastructure Of Epithelial Cell
• Cytoplasmic organelle concentration varies among different
epithelial layers
• Mitochondria, endoplasmic reticulum, golgi complexes etc are
more numerous in deeper strata and decrease towards the
surface
• Cytokeratins increase in number from basale to corneal
layers
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94. Cells Present In Gingival
Epithelium
• Keratinocytes
• Nonkeratinocytes/Clear Cells
Langerhans cells
Merkel cells
Melanocytes
Inflammatory cells
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95. Keratinocytes
• 90% of the total gingival cell population
• Originate from ectodermal germ layer
• Cell organelles: nucleus, cytosol, ribosomes, Golgi apparatus
etc
• Melanosomes: Pigment bearing granules
• Proliferation and differentiation of the keratinocytes
helps in the barrier action of the epithelium
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97. Non-keratinocytes/Clear Cells
• The various non-keratinocytes are :
• Langerhans cells,
• Merkel cells,
• Melanocytes,
• Inflammatory cells
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98. Non-keratinocytes/Clear Cells……
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99. Langerhans cells
• Dendritics cells - Modified monocytes belonging to
reticuloendothelial system
• Paul Langerhans used gold impregnation technique to
visualize LCs
• Reside chiefly in suprabasal layers
• Act as antigen -presenting cells for lymphocytes
• Specific elongated g-specific granules called as Birbecks
Granules
• Have marked adenosine triphosphatase activity
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100. Merkel Cells
• Located in deeper layers of epithelium
• Not dendritic cells
• Possess keratin tonofilaments and desmosomes
• Harbor nerve endings
• Sensory in nature - respond to touch – Tactile Perceptors
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101. Melanocytes
• Originate from neural crest cells
• Found in the stratum basale
• Identified in gingiva by Laidlaw and Cahn, 1932
• Have long dendritic processes, interspersed between the
keratinocytes
• Lack tonofilaments and desmosomal connections
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102. • Synthesize melanin, responsible for providing color to gingiva
• Melanin is synthesized in organelle called
premelanosomes/melanosomes,which are transported along
microtubules and actin filaments to the cell periphery
• Melanophores/Melanophages
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103. Types Of Gingival Epithelium
• Oral or outer epithelium
• Sulcular epithelium
• Junctional epithelium
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104. Oral Or Outer Epithelium
• Covers the crest and outer surface of the
marginal gingiva and the surface of the
attached gingiva
• 0.2 to 0.3 mm in thickness
• Keratinized or parakeratinized, or it
may present combinations of these
conditions(prevalent : parakeratinized)
• The oral epithelium is composed of four
layers
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105. Oral Or Outer Epithelium
• The oral epithelium is composed of four layers
Stratum basale (basal layer)
Stratum spinosum (prickle cell layer)
Stratum granulosum (granular layer)
Stratum corneum (cornified layer)
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106. • K1, K2, K10-12 cytokeratins present are
immunohistochemically expressed with high intensity in
orthokeratinized areas and with less intensity in parakeratinized
areas
• K6 and K16 , characteristic of highly proliferative epithelia
• K5 and K14, stratification-specific cytokeratins , also are
present
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107. Sulcular Epithelium
• Lines the gingival sulcus
• Thin, nonkeratinized stratified squamous epithelium
• No rete pegs
• Extends from the coronal limit
of the junctional epithelium to
the crest of the gingival
margin
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108. Hydropic degeneration of cells
Contains K4 and K13, K19
Don’t have merkel cells
Sulcular epithelium has the potential to keratinize:
• If it is reflected and exposed to the oral cavity
• If the bacterial flora of the sulcus is totally eliminated
Outer epithelium loses its keratinization:
• When it is placed in contact with the tooth
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109. Junctional Epithelium
• Collar like band of stratified squamous
non-keratinizing epithelium
• 3 to 4 layers thick in early life, but the
number increases with age to 10 or even
20 layers
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110. • Tapers from its coronal end to apical termination, located at
the cementoenamel junction in healthy tissue: 10-20 cell wide
to 1-2 cell wide
• Length: 0.25 to 1.35 mm
• Formed by the confluence of the oral epithelium and the
reduced enamel epithelium during tooth eruption
• Junctional epithelium is completely restored after pocket
instrumentation or surgery, and it forms around an implant
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111. • These cells can be grouped in two strata:
• the basal layer: that faces the
connective tissue (External Basal Lamina)
• the suprabasal layer: that extends to
the tooth surface– DAT CELLS
(Internal basal lamina)
• Internal basal lamina consists of
a lamina densa (adjacent to the enamel)
a lamina lucida to which
hemidesmosomes are attached
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1. Electron dense zone
2. Electron lucent zone
3. AF: Anchoring fibres
4. LD: Lamina densa
5. LL: Lamina lucida
6. HD: Hemidesmosomes
7. E: Enamel

113. • 3 zones of junctional epithelium:
1. Apical – germination
2. Middle – adhesion
3. Coronal- permeable
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114. The Dentogingival Unit
• The attachment of the junctional epithelium to the tooth is
reinforced by the gingival fibers, which brace the marginal
gingiva against the tooth surface
• For this reason, the junctional epithelium and the gingival
fibers are considered together as a functional unit
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115. • Hypothesis given to explain mode of attachment of epithelium
to tooth surface:
1. Gottlieb: gingiva is organically united to surface of enamel.
He termed it as epithelial attachment. (drawback- did not
explain how exactly it attaches.)
2. Waerhaug : in 1952 presented a concept of epithelial cuff, he
concluded that gingival tissues are closely adapted but not
organically united
3. Stern: in 1962 showed the attachment to tooth is through
hemidesmosomes, supported by schroeder and listgarten
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116. • Unique structural and functional features of Junctional
epithelium that contribute to preventing pathogenic bacterial
flora from colonizing the subgingival tooth surface:
First,
Firmly attached to the tooth surface forming an epithelial
barrier against plaque bacteria
Second,
Allows access of gingival fluid, inflammatory cells, and
components of the immunologic host defense to the gingival
margin
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117. • Third,
Exhibits rapid turnover contributing to the host–parasite
equilibrium and the rapid repair of damaged tissue.
Have an endocytic capacity equal to that of macrophages and
neutrophils and that this activity may be protective in nature
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118. Development/Origin Of
Junctional Epithelium
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123. 10/12/201
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Oral Sulcular Junctional
1. Keratinization Keratinized Non
keratinized
Nonkeratinized
2. Rete pegs Present Absent Absent
3. Strata granuloma and
corneum
Present Lacking Lacking
4.Merkel cells Present Absent Absent
5. Langerhans cells Present Few Absent
6. Type IV collagen in basal
lamina
Present Absent Absent
7. Tight junctions More Few Few
8. Acid phosphatase activity Present Lacking Lacking
9. Glycolytic enzyme activity High Lower Lower
10. Intercellular space Narrower Narrower Wider

124. Epithelium—Connective Tissue
Interface
• Ultrastructurally the interface is composed of 4 elements:
• Basal cell plasma membrane
• Lamina lucida: 25 to 45 nm wide
• Lamina densa: 40 to 60 nm thickness
• Reticular layer
• From the lamina densa so called
anchoring fibrils project in a
fanshaped fashion into the
Connective tissue
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125. Various junctional complexes
present in gingiva
• Tight junctions/Zona occludens
• Adhesive junctions:
• Cell to cell
– Zonula adherens
– Desmosomes: 30 nm.
• Cell to matrix
– Focal adhesions
– Hemidesmosomes
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126. • Gap junctions:
• Intercellular pipes/channels bridge both adjacent
membranes and intercellular space
• Intercellular space in gap junction is approx. 3 nm
• Major pathway for direct intercellular communication
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127. Connective Tissue
• The predominant tissue component of gingiva – Lamina
Propria
• Components:
• Collagen fibers (60%)
• Fibroblasts (5%)
• Vessels, Nerves & Matrix (35%)
• Layers of connective tissue:
1. Papillary Layer
2. Reticular Layer
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128. Ground Substance
•Produced mainly by the fibroblasts, although some
constituents are produced by mast cells and others are
derived from the blood
• Transportation of water, electrolytes, nutrients,
metabolites, etc., to and from the individual connective
tissue cells occurs within the matrix
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129. Ground Substance
• Fills space between fibers and cells
• Amorphous
• High water content
• Composed of:
• Proteoglycans:
• Glycosaminoglycans
• Hyaluronic acid
• Chondroitin sulphate
• Glycoproteins: (PAS positive)
• Fibronectin
• Osteonectin
• Laminin
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130. Cells
• The different types of cell present in the connective tissue
are:
• Fibroblasts
• Mast cells
• Fixed Macrophages & Histiocytes
• Inflammatory cells (Plasma cells, Lymphocytes,
Neutrophils)gingival connective tissue and the sulcus
• Adipose cells( In lamina propria)
• Eosinophils(In Lamina Propria)
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131. Fibroblasts
• Predominant cellular element in the gingival connective
tissue(65% of total)
• Mesenchymal origin
• Play a major role in the development, maintenance, and
repair of gingival connective tissue
Mainly matrix
• Synthesize :
• Collagen
• Elastic fibers
• Glycoproteins and glycosaminoglycans
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132. Structure
1.Spindle‐shaped or stellate cell with an oval‐shaped nucleus
containing one or more nucleoli
2.Cytoplasm contains a well‐developed granular endoplasmic
reticulum with ribosomes
3.Golgi complex considerable size and the mitochondria are
large and numerous
4.Cytoplasm contains many fine tonofilaments
5.Adjacent to the cell membrane, all along the periphery of the
cell, a large number of vesicles can be seen
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133. Structure
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1
1. Mitochondria
2. Golgi complex
3. Endoplasmic reticulum
4. Vesicles

134. Mast cells
•Responsible for the production of certain components of
the matrix
• Produces vasoactive substances, which can affect the
function of the microvascular system and control the flow
of blood through the tissue
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135. Mast Cells…..
• Cytoplasm presence of a large
number of vesicles (V) of varying
size
• Vesicles contain biologically active
substances such as proteolytic
enzymes, histamine, and heparin
• Golgi complex (G) well developed
• Granular endoplasmic reticulum
scarce
• Microvilli (MV)seen along the
periphery of the cell
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136. Macrophages
• Has a number of different phagocytic and synthetic functions
in the tissue
• Nucleus numerous invaginations of varying size, zone of
electron‐ dense chromatin condensations along periphery
• Golgi complex (G) well developed and numerous vesicles
(V) of varying size are present in the cytoplasm
• Granular endoplasmic reticulum (E) scarce
• Certain number of free ribosomes (R) are evenly distributed in
the cytoplasm
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137. Macrophages…..
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1. V= Vesicles
2. G= Golgi complex
3. M= Mitochondria
4. E= Endoplasmic
reticulum
5. R= Ribosomes
6. PH= Phagosomes

138. Gingival Fibers
• The connective tissue fibers are produced by the
fibroblasts and can be divided into:
• Collagen fibers
• Reticulin fibers
• Oxytalan fibers
• Elastic fibers
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139. Collagen fibres
• Collagen type I:
• forms the bulk of the lamina propria
• provides the tensile strength to the gingival tissue.
• Type IV collagen:
• branches between the collagen type I bundles
• continuous with fibers of the basement membrane and the
blood vessel walls
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140. • Reticulin fibres:
• Have argyrophilic property and are numerous in tissue
adjacent to basement membrane
• Found in large number in loose CT surrounding blood
vessel
• Found in endothelial-CT and epithelium-CT interface
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141. Elastic fibres
• Only present in association with blood vessels
• Gingiva seen coronal to mucogingival junction has no
elastic fibres except in association with blood vessels
• Alveolar mucosa may have many elastic fibres
Oxytalan fibres
• Initially described by Fullmer
• Modified type of elastic fibres
• Scarce in gingiva but more in PDL
• Have thin fibrils with 150 A0 diameter
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142. Gingival Fibers
• Connective tissue of the marginal gingiva densely
collagenous, and it contains a prominent system of collagen
fiber bundles k/a gingival fibers
• Consist of type I collagen
• Functions:
>To brace the marginal gingiva firmly against the tooth
>To provide the rigidity necessary to withstand the forces of
mastication without being deflected away from the tooth
surface
>To unite the free marginal gingiva with the cementum of
the root and the adjacent attached gingiva
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143. • The gingival fibers are arranged in
three groups:
1. Dentogingival
2. Circular
3. Transseptal
According Page et.al:
Semicircular fibers
Transgingival fibers
Lindhe: Dentoperiosteal fibers
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144. Principle Gingival Fibers
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146. Secondary Gingival Fibers
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148. 1
5
8
1. Dentogingival fibersP
2. Alveologingival fibersP
3. Interpapillary fibersS
4. Transgingival fibersS
5. Circular and semicircular
fibersP/S
6. Dentoperiosteal fibersP
7. Transseptal fibersP
8. Periostogingival fibersS
9. Intercircular fibersS
10.Intergingival fibers S
A. Collagen fiber bundles represents
the major component of free and
attached gingiva
B. Periodontal ligament space
contains discrete collagen fiber
groups
C. Many collagen fibers  embedded
on the external aspect of alveolar
bone

149. 10/12/201
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A. Dentogingival
fibre
B. Longitudinal
fibres
C. Circular fibres
D. Alveogingival
fibres
E. Dentoperiosteal
fibres
F. Transseptal fibres
G. Semicircular
fibres
H. Transgingival
fibres
I. Interdental fibres
J. Vertical fibres

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151. Blood Supply
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A. Dentoginival fibres
B. Subepithelial plexus

152. Blood Supply
• Supraperiosteal arterioles along the facial and lingual
surfaces of the alveolar bone from which capillaries extend
along the sulcular epithelium and between the rete pegs of
the external gingival surface
• Vessels of the periodontal ligament, which extend into the
gingiva and anastomose with capillaries in the sulcus area
• Arterioles, which emerge from the crest of the interdental
septa and extend parallel to the crest of the bone to
anastomose with vessels of the periodontal ligament
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153. Lymphatic Drainage
• Lymphatic drainage of the gingiva brings in the
lymphatics of the connective tissue papillae
• Progresses into the collecting network external to the
periosteum of the alveolar process and then moves to
the regional lymph nodes, particularly the submaxillary
group
• Lymphatics just beneath the junctional epithelium
extend into the periodontal ligament and accompany the
blood vessels
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154. Nerve Supply
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• Meissner type tactile corpuscles
Krause –type end bulbs
Encapsulated spindles

155. Conclusion
• Gingival tissues play a key role in the protection of tooth
structures and supporting periodontal tissues against
trauma and/or infection
• Making the gingival health, a very essential component
for the success of all periodontal treatment procedures
• Therefore, Gingiva, a small tissue is a big issue for the
fraternity of periodontics
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156. References
• Newman MG, Takei H, Klokkevold PR, Carranza FA. Newman
and Carranza's Clinical Periodontology E-Book. Elsevier Health
Sciences; 2018 May 29.
• Lang NP, Lindhe J, editors. Clinical periodontology and implant
dentistry, 2 Volume Set. John Wiley & Sons; 2015 Mar 25.
• Nanci A. Ten Cate's Oral Histology-E-Book: Development,
Structure, and Function. Elsevier Health Sciences; 2017 Aug
15.
• Kumar GS. Orban's oral histology & embryology. Elsevier
Health Sciences; 2014 Feb 10.
• Mehta P, Lim LP. The width of the attached gingiva—Much ado
about nothing?. Journal of dentistry. 2010 Jul 1;38(7):517-25.
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157. References
• Bartold PM, Walsh LJ, Narayanan AS. Molecular and cell
biology of the gingiva. Periodontology 2000. 2000
Oct;24(1):28-55.
• Babita Pawar, Pratishtha Mishra, Parmeet Banga, and P. P.
Marawar. Gingival zenith and its role in redefining esthetics: A
clinical study. J Indian Soc Periodontol. 2011 Apr-Jun; 15(2):
135–138.
• Niklaus P. Lang, and Harald Löe. The Relationship Between the
Width of Keratinized Gingiva and Gingival Health. J
Periodontol. 1972 Oct;43(10):623-7.
• Gerald M. Bowers. A Study of the Width of Attached Gingiva.
Journal of Periodontology, May 1963, Vol. 34, No. 3, Pages
201-209
• Wennström JL. Lack of association between width of attached
gingiva and development of soft tissue recession. A 5-year
longitudinal study. J Clin Periodontol. 1987 Mar;14(3):181-4
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