The Normal Periodontium 1-Gingiva
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Transcript of The Normal Periodontium 1-Gingiva
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The Normal Periodontium I:The Gingiva
Periodontology 1
DENT 371
Dr. Hisham Al-Shorman, PhD
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Periodontium:
Around the Tooth
The functional system of
tissues that surrounds the
teeth and attaches them to
the bone
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The Periodontium
GINGIVA
PERIODONTAL LIGAMENTS
CEMENTUM
ALVEOLAR BONE
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THE GINGIVA
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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
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Mucogingival Junction
The junction between the gingiva and the
lining oral mucous membrane
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The Gingiva
Anatomically, consists of 3 parts:
Free gingiva
Attached gingiva
Interdental gingiva
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Free Gingiva
Extends from the gingivalmargin to the free gingival
groove (FGG) at the level ofthe CEJ
Can be separated form thetooth by a probe
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The space between thefree gingiva and the tooth
surface is gingival sulcus
The base of the sulcus isformed by the junctionalepithelium.
Depth of normal gingivalsulcus (crevice) : 0-3 mm
Copyright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Gingival Sulcus
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Copright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Forms soft tissue wall
of the gingival sulcus
The margin of the freegingiva follows the
contours of the teeth,creating a wavy outline
Free Gingiva
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Attached Gingiva
Extends from the FGG toMGJ
On the palate, the wholemucosa is keratinisedand there is no MGJ
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Attached Gingiva
Firmly attached to the
underlying bone to:
Withstand masticatoryforces
Withstand tooth brushing Prevent movement of
marginal gingiva
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Width varies in differentparts of the mouth,
For example:Maxilla, buccally:
widest around incisors,
narrowest aroundpremolars
Mandible, lingually:narrowest aroundincisors,
widest around molars
Attached Gingiva
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The portion of
gingiva that fillsthe area betweentwo adjacent teethapical to thecontact area
Copyright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Interdental Gingiva
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Interdental Gingiva (Papilla)
Shape determined by:
Contact relationship between
teeth Width of proximal surfaces
Shape of the CEJ
Anterior : PyramidalMolars : Flattened in a
buccolingual direction
Between buccal & lingual
papillae COL
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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
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Coral Pink Gingiva Pigmentation
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Stippling of the Attached Gingiva
Caused by the
connective tissuefibers that attach
the gingival
tissue to thecementum and
bone Copyright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
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Histology
The gingiva consists of 2 main types of
tissue: Epithelium
Connective tissue
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Epithelium: Stratified Squamous
(parakeratinized)
Epithelium is attached to the underlying connective
tissue by a basement membrane
Ortho-keratinized Para-keratinized
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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)
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Structure
The oral mucosa is mostly parakeratinized
Ortho- Vs para-keratinization
Epithelial cells contain a specific protein
called cytokeratin (K1-K19), in addition toother proteins such as keratolinin,
involucrin and filaggrin
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Structure
Other cell types within gingival epithelium:
Langerhans cells: modified monocytes playing a
role in immunity
Merkel cells: contain nerve endings
Melanocytes: contain melanin
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Oral epithelium (OE)
Sulcular epithelium (SE)
Junctional epithelium (JE)
Anatomic Parts of Epithelium
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The epithelial ridges of
the OE extend downinto the underlying
connective tissue
A dense network ofcollagen fibers tightly
anchors the epithelium
Oral Epithelium (OE)
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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
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Gingival Crevicular Fluid (GCF)
Functions:
Cleansing
adhesion of epithelium to the tooth (plasma
proteins)
Antimicrobial properties
Antibody activity
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Epithelial lining of the gingival
sulcus
Thin, nonkeratinized epithelium;
making it less resistant to
stresses
The SE is permeable, allowingfluid to flow from the gingival
connective tissue into the
sulcusgingival crevicular fluidCopyright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Sulcular Epithelium (SE)
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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
zoneCopyright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Junctional Epithelium (JE)
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Connective Tissue
Lies beneath epithelium
Gingival CT is largelyfibrous
Major component: Collagen
Cellular component and ground
substance
Contains the vascular, lymphatic
and nerve supply/drainage to/
from the gingival tissues
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Arrangement of Gingival Fibers
Arranged in groups:
DG
dentogingival Circular
AGalveologingival
PG
periostogingival Transseptal:
between teeth
Copyright 2011 W olters Kluwer Health | Lippincott Williams & Wilkins
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Functions of Gingival Fibers
To brace firmly marginal gingiva to
the tooth
Rigidity against mastication without
deflection
Unite marginal gingiva withcementum and attached gingiva
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Thank you