Dr.

Nael Al Masri
periodontist

Periodontium
The tissues that surround and support the teeth are

known as the periodontium.

Periodontium: peri = around . odontous = tooth

It includes:
1. Gingiva
Tooth supporting structurs:
1. Periodontal ligament
2. Alveolar bone
3. Cementum

Oral Mucosa

Masticatory
mucosa

(keratinized
epithelium)
in gingiva &
hard palate)

Specialized
mucosa

(specifically in
the regions of
the taste
buds on the
dorsum of the
tongue)

Lining
mucosa
nonkeratinized
epithelium)

Lips, cheeks,
floor of the
mouth.

GINGIVA
The gingiva is the part of the oral mucosa that covers the alveolar

processes of the jaws and surrounds the necks of the teeth

Histologically:
Composed of a thin outer layer of epithelium and an underlying
core of connective tissue

Gingiva:
The gingiva is divided anatomically into:
Free (marginal) gingiva
Attached gingiva
Interdental gingiva

Function?
All types are specifically structured to function against

the mechanical & microbial damage

Marginal Gingiva
free Gingiva

Unattached Gingiva

Terminal edge or border

of gingiva .
in 50% cases it is
Demarcated by free
gingival groove.(3)
It forms the soft tissue
wall of the Gingival
Sulcus.

gingival groove

Gingival Groove :
A shallow line or depression Separate free
gingival from attached gingiva

Gingival sulcus:
It is a shallow v shaped space between
epithelial lining of marginal gingiva and
the enamel or cementum on the other
side
The base of the sulcus is formed by the
junctional epithelium.
Clinically normal sulcus measured by a
periodontal probe is 1 to 3 mm

Depth of gingival sulcus is important

clinical parameter

Attached gingiva
Definition: It is firm & resilient gingiva, tightly bound to
the underlying periosteum of alveolar bone
Clinically :
It is located between the free gingiva and the alveolar
mucosa demarcated by mucogingival junction
It should not be confused with the width
of the keratinized gingiva because
the latter also includes the marginal gingiva

Attached gingiva

mucogingival junction
alveolar mucosa

Attached Gingiva
It prevent free gingiva from

pulling
Withstand mechanical forces
Prevent recession
Improves esthetics, patient
comfort and ease of hygiene

Copyright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Width of attached Gingiva?

Definition:
The distance between the mucogingival junction and the
external surface of the bottom of gingival sulcus or the
periodontal pocket.
Different width
It is widest in the incisor and molar regions(3.5-4.5 in
maxilla, 3.3-3.9 in mandible).
Least in premolar area (1.9 mm in maxilla, 1.8 in mandible).
The width of attached gingiva increases with age.

Measuring the width of attached gingiva

Attached Gingiva
The attached gingiva is
NOT measured on
palate because it is
difficult to distinguish
it from the palatal
mucosa.
Copyright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Interdental Gingiva
It is the portion of

gingiva that fills

the area between
two adjacent
teeth apical to the
contact area.

Copyright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

It consists of two interdental papillae:

facial and lingual

Papilla
The tissue that occupy the interproximal embrasure is called
the papilla.
Shape : The shape of this papilla varies from triangular and

knife-edge in the anterior regions due to point sized

contacts of the teeth to broader and more square shaped
tissue in the posterior sextants due to the teeth having
broad contact areas.
facial papilla

Lingual papill

Interdental Gingiva
Shape :
The interdental can be pyramidal or have a "col" shape.
Col is a valley-like

depression in the
interdental gingiva
that lies directly
apical to the contact
area.

The col is absent if teeth are missing or

recession is present

 If a space is present between teeth like diastema, the

gingiva is firmly bound over the interdental bone and

forms a smooth, rounded surface without interdental
papillae

Gingival Epithelium
The gingival tissue is comprised of thin protective layer of the
epithelial tissue(stratified squamous epithelium), that
covers the underlying connective tissue
The principal cells of the gingival epithelium, is the
keratinocyte.(90%)

Other cells found in the epithelium are :

1. Langerhans cells.
2. Merkel cells
3. Melanocytes.

The main function of the gingival epithelium is to protect the deep

structures against oral environment. This is achieved by
proliferation and differentiation of the keratinocyte and produce
protective keratin layer

The main morphologic changes

during keratinization is:

progressive flattening of the cell
increasing prevalence of tonofilaments
production of keratohyaline granules
the disappearance of the nucleus

Production of keratin layer

Anatomical Areas of the Gingival Epithelium

Oral epitheliumcovers

the free and attached

gingiva
Sulcular epithelium

lines the sulcus

Junctional epithelium

located at the base of the

sulcus
Copyright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Oral Epithelium (OE)

Epithelial covering of the

outer surface of the free and

attached gingiva
Thickness 0,2-0,3 mm

Extends from the crest of the

gingival margin to the

mucogingival junction

Copyright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Sulcular Epithelium (SE)

Epithelial lining of the gingival

sulcus
Thin, nonkeratinized

epithelium; making it less

resistant to stresses
The junction of the SE with the

connective tissue is smooth in

health

Semi permeable, allowing fluid

to flow from the gingival
connective tissue into the sulcus
gingival crevicular fluid.
Copyright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Junctional Epithelium (JE)

coronal margin of junctional

epithelium forms the base of the

gingival sulcus and located in
healthy periodontium at CEJ or
slightly coronal to it
Nonkeratinized
Rapid turn over rate(5-7 days)
Permeable

Copyright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Junctional Epithelium (JE)

Length = 0.25 mm to 1.35 mm
It is triangular in cross

section,

15 to 30 cells thick at the

coronal zone
4 to 5 cells thick at the apical

zone

Copyright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Junctional epithelium

Connective Tissue:
Is known as the lamina propria. Divided into two layers:
The papillary layer adjacent to epithelium
The reticular layer, contiguous with the periosteum.
Lamina propria consist of:
1-Cells
Fibroblasts synthesize collagen
and elastic fibers and ground substance
(glycoprotien )
Mast cells, Neutrophils ,Plasma cells
2-extracellular matrix
Collagen fibers
Intercellular ground substance
3- Blood vessels
4- Nerves

Functions of gingival fibers

Brace the free gingiva firmly

against the tooth

Reinforce attachment of the

junctional epithelium to the

tooth

Provide rigidity to withstand

mastication

Gingival collagen fibers

Fiber Groups
DGgingivodental
Ccircular

AGalveologingival
PGperiostogingival
Transseptal
Copyright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Dentogingival Unit
Junctional epithelium and
gingival fibers are considered
a functional unit
(Dentogingival Unit)

Copyright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Clinical Features of Healthy Gingiva

Colour: The gingiva is typically coral pink in color, but

may vary due to physiologic pigmentation among

some races.
Factors affecting Color of Gingiva

Vascular supply

Thickness of epithelium

Degree of keratinization

Presence of melanin pigmentation

Gingival color:
melanin pigmentation.
The color of pigmentation
ranges from light brown to
black

Gingival Consistency:
Usually resilient and firm because of the dense collagenous
nature of the gingival connective tissue.
Gingival Surface Texture:
Being stippled like an orange peel or smooth .
Stippling usually on attached gingiva and central part of
papilla, in contrast marginal gingiva not stippled
Stippling is caused by the gingival connective tissue fibers
that attach the gingival epithelium to the cementum and
bone.

Shape and contour

The shape varies from triangular and knife-edge in the anterior

regions due to point sized contacts of the teeth to broader and

more square shaped tissue in the posterior sextants due to the
teeth having broad contact areas.

Factors affecting the shape :

Contours depends on :
Shape of the tooth.
Alignment of teeth in arch.
Location & size of the area of proximal contact.
Dimension of facial & lingual embrasure.

size and position

The size of the gingiva depend on cellular and

intercellular elements
Alteration in size is a common feature of gingival
disease.

Instruments required for practical

course

Periodontal probes
mirrors
Explorers
Sickle scalers (anterior +posterior)
periodontal Curates(universal ,gracey, Colombia)
Rubber cups and soft brushes for low speed handpiece
Plastic model
2 protecting eye glasses
polishing paste and
mouthwash(chlorehexidiene,lestrine)