JUNCTIONAL EPITHELIUM

Dr.M.Satya Post graduate

Contents
• • • • • • • • • • Introduction Development of the Junctional epithelium Structure of the Junctional epithelium Epithelial attachment apparatus Turnover of the Junctional epithelial cells Dynamic aspects of the junctional epithelium Expression of various molecules and their functions Junctional epithelium adjacent to oral implants Regeneration of the Junctional Epithelium Role of junctional epithelium in the initiation of pocket formation. • Long junctional epihelium

Gingival Epithelium .

.

.

in the males . J.1955. . Periodont. A. and wienmann : A sex difference in epithelial cells of human gingiva. a similar but smaller particle is present in 1 to 2 % of the cells.The gingival epithelium is similar to epidermis in that it shows a distinct sex difference.26:11. In the female.S. Marwah. a large Feulgen-positive particle has been found adjacent to the nuclear membrane ..

leaving a cuticle adherent to the tooth surface and forming a V-shaped space. the reduced enamel epithelium that covers the crown fuses with the oral epithelium and becomes the Epithelial attachment. the superficial portion of the attachment progressively separates from the enamel.the Gingival sulcus . As the tooth erupts.Development of Junctional epithelium According to Gottlieb.

Gottlieb .

Euler and wodehouse • contended that the gingival sulcus is formed by a split in the Epithelial attachment rather than by separation from the tooth.Weski. . Gross.

Wearhaug .

Orban Gottlieb .

Stern .

.

Dento-gingival junction Schroeder and Listergarten first clarified the anatomy and histology of the dentogingival junction in their monograph“Fine structure of developing epithelial attachment of human teeth” .

JE CT Enamel space Internal basal lamina External basal lamina .

25 – 1.35mm • Stratified squamous non-keratinized epithelium that is made up of two strata only i.. Apically: narrows to 1-3 cells • Length: 0. a basal layer(stratum basale) and a suprabasal layer(stratum suprabasale) .e.• Coronally: 15-30 cells thick.

Cytokeratins in JE • JE expresses simple keratin markers such as K8 and K4 which demarcates the SE from JE.and 9 are typical of that of simple.less differentiated epithelia. .6.7.rapidly proliferting. • JE does not express K1 & K10 • K19 is present in all layers of JE in monomeric state which is expressed more in proliferative cell layers • JE attached to tooth through the K5 and 14hemidesmosomes assembly • K5.

Non-keratinzed Junctional epithelium ? .

Junctional epithelium is unique as it possess 2 basement membranes – the internal and external basal lamina Enamel Lamina propria Hemidesmosomes Internal Basal Lamina External Basal Lamina .

1981 Schroeder and listgarten 1977 Yamasaki et al 1979 Schroeder and Munzel-ppedrazzoli 1970 .Remarcable permeability Junctional epithelium ? Schroeder 1969.

particularly its basal cell layers.• The junctional epithelium. is well – innervated by sensory nerve fibers Byers and Holland 1977 Kondo et al 1992 Maeda et al 1994 .

• It consists of hemidesmosomes at the plasma membrane of the cells Directly Attached to Tooth(DAT cells)and a basal lamina-like extracellular matrix.on the tooth surface . termed the internal basal lamina.Epithelial attachment apparatus • The attachment of the junctional epithelium to the tooth is mediated through an ultramicroscopic mechanism defined as the epithelial attachment apparatus.

• The epithelium- tooth interface is a unique structure wherein epithelial cells adhere by means of bonafide hemidesmosomes to an epithelium derived extracellular matrix lacking most of the common BM components. Moreover, TF cells differ from connective tissue facing cells and their production of extracellular matrix, but also by their cytoskeletal architecture.
Marketta Horrnia et al: The dento- epithelial junction:cell adhesion by Type 1 hemidesmosomes in the absence of a true basal lamina. J Periodontol 2001;72:788-797

DAT cells
• Salonen coined the term DAT cells.(1989) • Innermost suprabasal cells. • They form and maintain the internal basal lamina that faces the tooth surface

• DAT cells possess stress fibers arranged in parallel to the tooth axis and to the presumable cervical-line in the cytoplasm, and microvilli-like structures on their enamel surfaces.
J Periodontal Res. 2005 Aug;40(4):354-63.

Cytoskeleton and surface structures of cells directly attached to the tooth in the rat junctional epithelium.
Ishikawa H, Hashimoto S, Tanno M, Ishikawa T, Tanaka T, Shimono M.

.

The epithelial attachment is not static but DYNAMIC .

• Extracellular protiens.laminin-5 • Intracellular protiens. forming the site of attachment between the basal surface of the cell and the basement membrane.Hemidesmosomes • a structure representing half of a desmosome.plectin and BP . found on the basal surface of some epithelial cells.

• Hemidesmosomes are transmembrane cell-matrix junctional complexes that are intracellularly connected to the cytoskeleton filaments of epithelial cells .

.

511 and 111 Laminin-332 .Laminin Laminin.

The daughter cells enter the exfoliation pathway and gradually migrate coronally between basal cells and the DAT cells to eventually break off into the sulcus. The daughter cells produced by dividing DAT cells replace degenerating cells on the tooth surface. 2. or 3.Turnover of the junctional epithelial cells • The mechanism of DAT cell turnover is not fully understood. Epithelial cells move/migrate in the coronal direction along the tooth surface and are replaced by basal cells migrating round the apical termination of the junctional epithelium . 1. Considering the fact that the DAT cells are able to divide and migrate. three possible mechanisms were proposed.

.

the DAT cells typically express a high density of transferrin receptors.which supports the idea of their active metabolism and high turnover .• At the coronal part of the JE.

Junctional epithelium in the antimicrobial defense JE consists of active population of cells and antimicrobial functions which together form the 1st line of defense against microbial invasion into tissue .

g. Laterally. interleukin. interleukins -1 and -6. . cause further activation of the junctional epithelial cells (5). such as lymphocytes (LC) and polymorphonuclear leukocytes (PMN). Their secreted product. in turn.g. the (external) basement membrane forms an effective barrier against invading microbes (3). These include defensins and lysosomal enzymes (4). In the coronal part of the junctional epithelium quick cell exfoliation (1) because of rapid cell division (2) and funnelling of junctional epithelial cells towards the sulcus hinder bacterial colonization. e. Active antimicrobial substances are produced in junctional epithelial cells.8 and cytokines. e.• • Several antimicrobial mechanisms exist in the junctional epithelium. and tumour necrosis factor-a that attract and activate professional defense cells. Epithelial cells activated by microbial substances secrete chemokines.

.

Junctional epithelium adjacent to oral implants .

Regeneration of the junctional epithelium .

Location and functions of molecular factors associated with the junctional epithelium .

.

.

.

Obviously .the conditions for DAT cell survival and adequate function at the coronal part of the JE are different and more susceptible of compromises than those for the basal cells living in the vicinity of the connective tissue(CT) and the blood circulation. At the gingival margin the GCF may become contaminated so that agents from the oral cavity and/or the plaque bacteria challenge the most coronal DAT cells.Role of the GCF • The GCF passing through the junctional epithelium determines the environmental conditions and provides sufficient nutrients for the DAT cells to grow. • .

cathepsin D. aspartate aminotranfearases and collagen peptides. The degeneration and detachment of DAT cells exposes the tooth surface and creates a subgingival niche suitable for the colonization of anareobic gram –ve bacteria and apical growth of dental plaque Antimicrobial agents and leukocyte-derived enzymes such as lysozyme. and products of tissue breakdown such as lactate dehydrogenase. elastin .bacterial collagenases and variety of enzymes.hydrogen sulfide.such as hyaluronidases and neuraminidases.collagenase and lactoferrin.prostaglandins.β-glucoronidase.Bacterial agents -endotoxins.complement factors. butyric and propionic acids. intracellular enzymes. . alkaline phosphatase. different cytokines. Host derived agents .

Role of the PMN’s • Myeloperoxidase • Elastase • Lysozyme • Cathepsin G • Urokinase • Acid hydrolases and • defensins Primary granules/azurophilic granules • Lactoferrin • Elastase • lysozyme Secondary granules .

glucose metabolism and macromaolecular synthesis . and thus reduction in bacterial cell division rate.lactoferrin • It has high affinity for iron and it acts on bacteria by causing iron depletion.

The molecule may have a role in delaying the repair of the JE/DAT cell population during severe inflamation.health High conc of lactoferrin hamper epithelial cell growth by interfering with their adhesion and spreading . disease 600μg/ml 1500μg/ml .

stromelysins.gelatinases Plasminogen activator Cathepsin elastase .Role of host proteinases and inflammatory mediators • • • • Collagenases.

Role of bacterial products .

Gingipains Disturbs the ICAM-1-dependent adhhesion of PMNs. Tada et al 2003 .

short chain fatty acid containing and annaerobic conditions in the sub-gingival space.• Short chai fatty acids • Hydrogen sulfide • ammonia The protien rich. .HS appaers to be a potential candidate to cause significant damage to JE/DAT cells.

Role of risk factors for periodontal disease .

.

A functional epithelial seal must be re-established at the most coronal portion of the tissues and be no more than 2 mm in length. Thank you .

• Fragments of fibronectin are thought to be chemotactic to various periodontal subtypes and are thought to play an important role in the formation of Long Junctional Epithelium .• The long junctional epithelium is formed by the keratinocytes of the oral epithelium repopulating the wound and migrating over the root surface.

• The formation and organization of the wound clot over the root surface is a property of the fibronectin molecules that are expressed in the early phases of wound healing. • The oral keratinocytes express integrins such as α5β1 that are normally present in the epithelium when they come into contact with fibronectin. . • These integrins promote the migration of these keratinocytes over the root surface and form the long junctional epithelium.

Removal of junctional and pocket epithelium curettage Chemical agents Surgical techniques .

Glickman and Prichard have advocated performing a gingivectomy to the crest of the alveolar bone and debriding the defect .

The Modified Widman flap Ramfjord and Nissle .

Prevention or impeding of Epithelial Migration • Elimination of junctional or pocket epithelium may not be sufficient because .

1st approach RST .

2nd approach CORONALLY DISPLACED FLAPS .

GUIDED TISSUE REGENERATION .

IRVING GLICKMAN : 3rd edition • ORBAN.Jukka I.11th edition • CLINICAL PERIODONTOLOGY –CARRANZA’S.REFERENCES • Clinical periodontology.2005.2003. Thank you . • Marja T.P. Bosshardt and N.D.s Oral histology and Embryology.vol 31. lang :The junctional epithelium: from health to Disease :J Dent Res(1):9-20.Salonen:structure and function of the toothepithelial interface in health and disease.10TH EDITION • D. • Periodontology 2000.