Gingiva

1. Name-PARTHA PROTIM SINGHA
(BDS FINAL YEAR)

2. CONTENTS
 Introduction
 Macroscopic Features
 Marginal Gingiva
 Attached Gingiva
 Interdental Gingiva
 Microscopic Features
 Cells
 Fibers
 Blood and Lymphaties supply
 Never supply to Gingiva

3. INTRODUCTION
 INTRODUCTION
 The Gingiva is the part of oral mucosa that cover
the alneolar proceses of the Jaw and surrounds
the neck of the teeth.

4. MACROSOPIC FEATURES
 Anatomically,the gingiva is divided into three parts, it includes:
 Marginal.
 Attached.
 Interdental gingival.

 Marginal Gingiva/Free Gingiva/Unattached Gingiva
 The marginal or unattached gingival is the terminal edge or border of
the gingival surrounding the teeth in collar-like fashion.
 In about 50% of cases it is demarcated from the adjacent, attached
gingival by shallow linear depression, the free gingival groove.
 Usually about 1mm wide, it forms the soft tissue wall of the gingival
sulcus. It may be separated from the tooth surface with a periodontal
probe.

6. Gingival Sulcus
 The gingival sulcus is defined as the space or shallow crevice between
the tooth and the free gingival. The tooth bounded by the surface of the
tooth on one side and the epithelial lining the free margin of the gingiva
on other.
 It is V-shape and barely permits the entrance of a periodontal probe.
 Under absolutely normal or ideal condition, the depth of the gingival
sulcus is or about 0 mm.
 In clinically healthy gingiva in humans a sulcus of some depth can be
found. The depth of this sulcus is 1.8 mm.
 The clinical maneuver used to determine the depth of the sulcus is the
introduction of a metallic instrument –the periodontal probe- and the
estimation of the distance it penetrates.
 The histologic depth of a sulcus need to be exactly equal to the depth of
penetration of periodontal probe then so called probing depth of a
clinically normal gingival sulcus in human is 2 to 3 mm.

7. Attached Gingiva
 The attached gingiva is continuous with the marginal
gingival. It is firm, resillent and tightly bounded to the
underlying periosteum of the alveolar bone.
 The facial aspect of the attached gingival extend to the
relatively loose and movable alveolar mucosa, from which
it is demarcated by the mucogingival junction.
 The width of attached gingiva on the facial aspect differ
indifferent areas of the mouth. It is generally greater in
incisor region (3.5 to 4.5 mm in maxilla and 3.3 to 3.9 in
mandible) and less in posterior segment . Least width in 1st
premolar area (1.9 mm in maxilla and 1.8 mm in mandisble)
 The width of attached gingiva increase with age and in
supraerupted teeth.

8. Methods to measure the width of attached gingiva :-
 There are four different method used to find the
width of attached gingival.
 Measurement approach :-
 In this method first the pocket depth or the
sulcus depth is measured and then the total width
of gingiva is measured, i.e. from gingival margin
to mucogingival line. Thus by subtracting these
two measurements, we get the attached gingiva
can acquire.
 Total gingival width-pocket depth= width
of attached gingival.

9. By using Schiller’s potassium iodide solution :-
 It is similar to measurement approach.
Potassium iodide (KI) solution only stains the
keratinized epithelium, i.e. marginal gingiva,
attached gingiva and interdental papilla. After
application of this solution, the total width of
gingiva is measured that is from gingival margin
to mucogingival line and later the sulcus depth or
pocket depth is measured.
 Then by subtracting the total gingival width from
pocket depth, we get the width of attached
gingival. Stained total gingival width- pocket
depth = width of attached gingiva.

10. Tension test:-
 This is done by stretching the lip or cheek to
demarcate the mucogingival line and to see for any
movement of the free gingival margin. And if the free
gingiva margin moves during stretching of lips then
the attached gingiva is considered to be inadequate.
 Roll test :-
 It is done by pushing the adjacent mucosa
coronally with a dull instrument. If the gingiva moves
with the instrument then the width od attached
gingiva is considered inadequate. In adequate width,
the gingiva dose not move because the attached
gingiva is firmly attached to the underlying bone.

11. Interdental Gingiva
The interdental gingiva occupies the embrasure which is the inter
proximal space beneath the area of tooth contact. The interdental
gingiva can be pyramidal or have a “col” shape.
In pyramidal the tip of one papilla is located immediately beneath
the contact point. The lather presents a valley like depression that
connect a facial and lingual papilla and conforms to the shape of the
interproximal contact.
The shape of the gingiva in given interdental shape depends on the
contact point between the two adjoining teeth and the presence or
absence of some degree of the recession
If a diastema is present the gingiva is firmly bound over the
interdental bone and forms a smooth rounded surface without
interdental papilla.

13. MICROSCOPIC FEATURES
 Gingiva consist of a central core of connective tissue covered by
stratified squamous epithelium.
 Three types of epithelium exist in gingiva :-
 The oral or outer epithelium/keratinized epithelium
 The sulcular epithelium
 The junction epithelium/non-keratinized epithelium
 Keratinized Epithelium:-
 In the keratinized epithelium the principal cell type is Keratinocyte
which can synthesis Keratin the process of Keratinization involves a
sequence of biochemical and morphological events that occur in a cell as
it migrates from the basal layer toward the cell surface.
 Non-Keratinized Epithelium:-
 The non-keratinized epithelium contain clear cells, which include
melanocytes, Langerhans cells, Merkel cells and lymphocytes.

14. Oral Epithelium
 Oral epithelium has the following cell layers:-
 Basal layer (stratum basale or stratum germinativum).
 Spinous layer (stratum spinosum ).
 Granular layer (stratum granulosum ).
 Keratinized cell layer (stratum corneum ).
 There are three distinct differences between the oral
sulcular epithelium , oral epithelium and the junction
epithelium:
 The size of the cell in the junctional epithelium is relative
to the tissue volume , layer than in the oral sulcular
epithelium.
 The intercellular space in the junctional epithelium is
comparatively wider than in the oral epithelium.
 Granular layer which is seen in the oral epithelium is
absent in sulcular and junctional epithelium.

16. Morphologic Characteristics of the
Different Areas of Gingival Epithelium
 Oral or Outer epithelium:-
 It cover the crest and outer surface of the
marginal gingiva and the surface of the attached
gingiva. It is keratinized oe parakeratinized or
combination of both. Keratinization varies in
different areas in the following order :
palate(most keratinized ), gingiva, ventral aspect
of the tongue and cheek (least keratinized ). The
keratinized epithelium of the gingival consists of
four layers, namely :-

18.  Stratum basale:-
 The cells of basal layer are either cylindrical or
cuboidal and are in contact with the basement
membrane. The basal layer have ability to divie thatwhy
also known as stratum germinativum. When two
daughter cells have been formed by cell division, an
adjacent ‘older’ basal cell is pused into the spinous cell
layer and starts as a keratinocyte, to traverse the
epithelium. It takas approximately 1 month for a
keratinocyte to reach the outer epithelial surface.
 The basal cells are separated from connective tissue by
a basement membrane. In light microscopy this
membrane appear as zone approx 1 micrometer wide
and reacts positively to a PAS strain.

19.  Immediately beneath the basal cell there is zone
called as lamina lucida and beneath this electron
dense zone called as lamina densa
 The epithelial cells facing the lamina lucida contain
no electron dense zone called as hemidesmosomes
 The hemidesmosomes are involves in attachement of
epithelium to underline basement membrane
 Stratum spinosum
 It consist of large cells with short cytoplasmic
processes resembling spine arrange that regular
intervals, give the cells a prickled appearence

20.  Stratum granulosum
 Electron dense keratohyalin bodies began to occur ;
these granules are believed to be related to the
synthesis of keratin.
 Stratum corneum
 The soft tissue wall of gingival sulcus is lined
coronally with sulcular epithelium extending from
gingival margin to the junctional epithelium.
 The sulcular epithelium resembles the oral
epithelium in all respect except that is dose not
become fully keratinized.
 Although it contain keratinocytes ,they do not
undergo keratinization

21.  Junctional Epithelium
 Denotes the tissue that joins to the tooth on one side and to the
sulcular epithelium and C.T on the other
 It form the base of sulcus
 General Structrual Features of Junctional Epithelium
 It consist of collar like band of stratified squamous non-
keratinized epithelium.
 The length of junctional epithelium ranges from 0.25 to 1.35 mm.
 Three zone in junctional epithelium is described:
 Apical for germination
 Middle for adhesion
 Coronal or permeable

 Non-Keratinocytes or clear cell
 Non-keratinocytes are melanocytes, langerhans cells, merkel cells
and inflammatory cells. They together make up to 10% of the cell
population in oral epithelium.


22.  MELANOCYTES:-
 These are highly specialized dendritic cells of neural crest
origin located in the basal and spinous layer of gingival
epithelium.
 It synthesizes melanin pigment
 They are packed with numerous melanosomes, which
contain tyrosinase that hydroxylates tyrosine to
dihydroxphenylalanine (DOPA ),which gets converted to
melanin.
 Gingiva, buccal mucosa, hard palate and tougue
 Langerhans cells
 They are dendritic cells located among the keratinocytes at
all suprabasal levels.
 They have immunologic function
 They contain g-specific granules which are rod or flask
shaped granules.
 Found in oral epithelium of normal gingiva and in smaller
amounts in sulcular epithelium.

23.  Merkel cells
 Theyare located in the basal cell layer of gingival
epithelium.
 Identified as tactile receptors.
 Merkel cells are sensory and respond to touch.
 Contains small membrane bound vesicles in the
cytoplasm sometimes situated adjacent to a nerve
fiber associated with the cells.
 Inflammatory cells
 Commonly seen in the nucleated cell layers.
 Mostly lymphocytes are seen.


24.  Supra Alveolar Connective tissue
 The connective tissue supporting the oral epithelium is formed as
lamina propria and for descriptive purpose it can be divided into two layer.
 Superfical papillary layer:-associated with epithelial ridger
 Deeper reticular layer:-that lies between the papillary layer and underlying
structures.
 The lamina propria consist of cells ,fibers ,B.V,embedded in amorphous
ground substance
 CELLS – Fibroblast Macrophage
 Mast cells inflammatory cells
 FIBRES – The C.T fibers are produced by fibroblast and can be divided into
 Collagen fibers oxytalan fibers
 Reticulin fibers Elastin fibers
 Collagen types 1 form the bulk of the lamina propria and provide the tensile
strength to the gingival tissue
 Collagen types 2 seen in basement membrane
 The function of gingival fibers
 It braces the marginal gingival firmily against the tooth
 It helps to withstand the forces exected by mastication
 It units the free gingiva to the root cementum and the adjacent attached
gingiva

26. PRINCIPAL GROUP FIBERS
 Dentogingival fibers
 They protect the cementum in a fan like conformation towards the crest
and outer surface of marginal gingiva.
 Alveolar gingival fiber
 They extend from the periorteum of the alveolar crest coronally into
the lamina propria .Their function in to attach the gingiva to the alveolar
bone.
 Dentoperiosteal fibers
 They arise from the cementum near the cementoenamel junction and
insert into the periostum of the alveolar bone and protect the
periodontal ligament
 Circular fibers
 Surrounds the tooth in a cuff or ring like fashion and course through
the C.T of marginal and attached gingival.
 Transseptal fibers
 Located interproximally, they extend from cementum of one tooth to
other there function is to protect the interproximal bone and maintain
tooth to tooth contact .

27. Fibers of secondary group
 Periosteogingival fibers
 They extend from the periosteum of the alveolar
bone to the attached gingiva . They help to attach
gingiva to the alveolar bone.
 Interpapillary fibers
 Seen in interdental gingiva extending in a facio
lingual direction and support the
gingival papilla
 Transgingival fibers
 They are seen in and around the teeth with in the
attached gingiva. They maintain the alignment of
teeth in the arch


28.  Intercircular firbers
 They extend from cementum on distal surface of tooth
splaying buccally and lingually around the next tooth and are
inserted on the
 mesial surface.
 Intergingival fibers
 They are seen within the attached gingiva adjacent to the
basement membrane extending mesiodistally. They provide
support and contour for the attached gingiva.
 Semicircular fibers
 They extend from the mesial surface of a tooth to the distal
surface of the same tooth in a half circle.
 Oxytalan fibers
 They are present in all connective tissue structures of the
periodontium. The function of these fiber is , yet unknown.
 Elastin fibers
 The elastin fibers are only present in connective tissue of
the gingiva and periodontal ligament. They are also seen in
connective tissue of alveolar mucosa in large number.

29. Blood and lymphatics supply
 There are three major sources of blood supply to
the gingiva
 Supraperiosteal arterioles:-overlying the alveolar
bone along the facial and lingual surfaces several
branches to surrounding tissue
 Vessels of periodontal ligament
 Arterioles emerging from the crest of interdental
septa
 Lymphatic drainage of the gingiva brings in the
lymphatics of the connective tissue papillae

30. Never supply to gingiva
 Receptor are seen as free ending within papillary
layers of lamina propria. The following never
structure are present in the connective tissue
which are basically a mesh work of terminal
argyrophilic fiber which sometimes extend into
the epithelium
 Meissner type tactile corpuscles :- touch receptor
 Krause type of end bulb :- temperature receptor
 Fine fibers in the papilla:- pain receptor

31. REFERENCES
 Carranza’s Clinical Periodontology – 11th edition
 Essentials of Clinical Periodontology &
Periodontics-by Shantipriya Reddy

32. Thank you