Dr.

Nithin Mathew
 Introduction
Definition
Macroscopic anatomy
1. Marginal gingiva
2. Gingival sulcus
3. Attached gingiva
4. Interdental gingiva

Dr. Nithin Mathew –Gingiva

 Periodontium
peri = around
odontos = tooth

i.e structures surrounding the tooth

Comprises
Gingiva
Periodontal ligament
Cementum
Alveolar bone

Dr. Nithin Mathew –Gingiva

 Oral mucosa - three zones:
•the gingiva and the covering of the hard
palate :masticatory mucosa

•the dorsum of the tongue, covered by

specialized mucosa

•the oral mucous membrane lining the

remainder of the oral cavity.

Dr. Nithin Mathew –Gingiva

 Gingiva is that part of oral mucosa that covers the
alveolar processes of the jaws and surrounds the necks
of the teeth.

Dr. Nithin Mathew –Gingiva

  Marginal gingiva
 Gingival sulcus
 Attached gingiva
 Interdental gingiva

Dr. Nithin Mathew –Gingiva

 Marginal, or unattached

The terminal edge or border of the gingiva

surrounding the teeth in collarlike fashion

Demarcated from the adjacent, attached gingiva by a

shallow linear depression, the free gingival groove

Usually 1 mm wide

Dr. Nithin Mathew –Gingiva

 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

V shaped

Clinical determination of the depth of the gingival

sulcus is an important diagnostic parameter

Dr. Nithin Mathew –Gingiva

 Depth of this sulcus, as determined in histologic
sections, has been reported as 1.8 mm,

The clinical maneuver used to determine the depth of

the sulcus is the introduction of the periodontal
probe-and the estimation of the distance it penetrates.

The histologic depth of a sulcus need not be exactly

equal to the depth of penetration of the probe.

The so-called probing depth of a clinically normal

gingival sulcus in humans is 2 to 3 mm

Dr. Nithin Mathew –Gingiva

 It is the distance between the mucogingival junction
and the projection on the external surface at the
bottom of the gingival sulcus or the periodontal
pocket

The attached gingiva is continuous with the marginal

gingiva.

It is firm, resilient and tightly bound to the underlying

periosteum of alveolar bone.

Dr. Nithin Mathew –Gingiva

 The facial aspect of the attached gingiva extends to the
relatively loose and movable alveolar mucosa from
which it is demarcated by the mucogingival junction.

The width of the attached gingiva is another important

clinical parameter.

It is the distance between the mucogingival junction

and the projection on the external surface of the
bottom of the gingival sulcus or the periodontal
pocket

Dr. Nithin Mathew –Gingiva

 greatest in the incisor region :
 3.5 to 4.5 mm in the maxilla
 3.3 to 3.9 mm in the mandible

less in the posterior segments with the least width in

the first premolar area :
 1.9 mm in the maxilla
 1.8 mm in the mandible

Width of the attached gingiva increases with age' and in

supraerupted teeth

Dr. Nithin Mathew –Gingiva

 Lingual aspect of the mandible, the attached gingiva
terminates at the junction with the lingual alveolar
mucosa, which is continuous with the mucous
membrane lining the floor of the mouth.

The palatal surface of the attached gingiva in the maxilla

blends imperceptibly with the equally firm, resilient
palatal mucosa.

Dr. Nithin Mathew –Gingiva

 Occupies the gingival embrasure
Can be pyramidal or have a "col" shape

Shape depends on the contact point and the presence

or absence of some degree of recession

Dr. Nithin Mathew –Gingiva

 ‘col’ it presents a valley like depression that connects
the facial and lingual papilla and conforms to the shape
of interproximal contact.

Dr. Nithin Mathew –Gingiva

 Measurement approach
By using Schiller’s potassium iodide solution
Tensiontest
Roll test

Dr. Nithin Mathew –Gingiva

 Broadly speaking gingiva is made up of epithelium and
connective tissue.

The gingival epithelium can be studied under three

headings:
 Outer or oral epithelium
 Sulcular epithelium
 Junctional epithelium

Dr. Nithin Mathew –Gingiva

 Function
Mechanical, chemical, water and microbial barrier
Signalling function

Major cell type : keratinocyte

Other cells :langerhan cells, merkel cells, melanocytes.

Cell to cell attachments :desmosomes, tight jn, gap jn.

Dr. Nithin Mathew –Gingiva

 Covers the crest and the outer surface of marginal gingiva
and surface of attached gingiva.

4 layers
 Stratum basale:- cuboidal cells
 Stratum spinosum:- large polyhedral cells
→Desmosomes
 Stratum granulosum
 Stratum corneum:- superficial most layer Large, wide,
flat and lacking nucleus.

0.2 – 0.3mm thickness

keratinization varies
Dr. Nithin Mathew –Gingiva
 Lines the gingivalsulcus

Non keratinized stratified squamous epithelium

It is not keratinized due to constant irritation of

plaque

Extends from the coronal area of the junctional

epithelium to the free margin of the gingival.

Epithelium lacks heavy ridges and papillae.

Dr. Nithin Mathew –Gingiva
 Collar-like band

0.25 – 1.35mm

Formed by the confluence of oral epithelium and reduced

enamel epithelium.

Epithelial attachment – internal basal laminae

3-4 layers thick in early life, but the number of layers increases
with age to 10 or even 20 layers

Junctional epithelium + gingival fibres = dento-gingival unit

Dr. Nithin Mathew –Gingiva
 Attached to the tooth surface (epithelial attachment) by
means of an internal basal lamina and to the gingival
connective tissue by an external basal lamina

The attachment of the junctional epithelium to the tooth is

reinforced by the gingival fibers, which brace the marginal
gingiva against the tooth surface

Junctional epithelium + gingival fibres = dento-gingival

unit

Dr. Nithin Mathew –Gingiva

 The gingival sulcus is the shallow, V-shaped space or
groove between the tooth and gingiva that encircles the
newly erupted tip of the crown.

In the fully erupted tooth, only the junctional epithelium

persists.

Sulcus consists of the shallow space that is coronal to the

attachment of the junctional epithelium and bounded by
the tooth on one side and the Sulcular epithelium on the
other.

The coronal extent of the gingival sulcus is the gingival

margin
Dr. Nithin Mathew –Gingiva
 Undergoes continuous renewal.

Thickness is maintained by a balance between new cell

formation in the basal and spinous layers and the
shedding of old cells at the surface.

The mitotic activity exhibits a 24-hour periodicity, with

highest and lowest rates occurring in the morning and
evening,respectively.

The mitotic rate is higher in nonkeratinized areas and is

increased in gingivitis
Dr. Nithin Mathew –Gingiva
 The gingival sulcus contains a fluid that seeps into it
from the gingival connective tissue through the thin
Sulcular epithelium.

Functions
 Cleanse debris from the sulcus

 Contain plasma proteins that may improve

adhesion of the epithelium to the tooth
 Possess antimicrobial properties, and exert
antibody activity to defend the gingiva

Dr. Nithin Mathew –Gingiva

 Connective tissue of the gingiva is known as the
Lamina Propria

Consists of two layers:

a papillary layer subjacent to the epithelium, which
consists of papillary projections between the epithelial
rete pegs
a reticular layer contiguous with the periosteum of the
alveolar bone.

Connective tissue has a cellular and an extracellular

compartment composed of fibers and ground
substance
Dr. Nithin Mathew –Gingiva
 The ground substance fills the space between fibers
and cells, is amorphous, and has a high content of
water.

Composed of proteoglycans, mainly hyaluronic acid and

chondroitin sulfate, and glycoproteins, mainly
fibronectin.

Fibronectin binds fibroblasts to the fibers and many

other components of the intercellular matrix, helping
mediate cell adhesion and migration.

Laminin is another glycoprotein found in the basal

laminae, which serves to attach it to epithelial cells

Dr. Nithin Mathew –Gingiva

 The three types of connective tissue fibers are
collagen, reticular, andelastic.

Collagen type I forms the bulk of the lamina propria

and provides the tensile strength to the gingival tissue.

Type IV collagen branches between the collagen type I

bundles and is continuous with fibers of the basement
membrane and blood vessel walls

Dr. Nithin Mathew –Gingiva

 Connective tissue of the marginal gingiva is densely
collagenous, containing a prominent system of collagen
fiber bundles called the gingival fibers

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

Dr. Nithin Mathew –Gingiva

 The gingival fibers are arranged in three groups:
dentogingival, circular and transseptal

Dentogingival

Facial, lingual, and interproximal surfaces.

Embedded in the cementum just beneath the

epithelium at the base of the gingival sulcus.

On the facial and lingual surfaces, they project from the

cementum in fanlike conformation toward the crest
and outer surface of the marginal gingiva, terminating
short of the epithelium
Dr. Nithin Mathew –Gingiva
 They also extend externally to the
periosteum of the facial and lingual
alveolar bones and terminate in th
attached gingiva or e blend
periosteum of the bone. with the

Interproximally, the gingivodental fibers

extend toward the crest of the interdental
gingiva

Dr. Nithin Mathew –Gingiva

Circular Group

The circular fibers course

through the connective tissue
of the marginal and
interdental gingivae and
encircle the tooth in ringlike
fashion
 Transseptal Group

Located interproximally,

Transseptal fibers form horizontal bundles that extend

between the cementum of approximating teeth into
which they are embedded.

Lie in the area between the epithelium at the base of the

gingival sulcus and the crest of the interdental bone

Dr. Nithin Mathew –Gingiva

 Alveologingival group

The fibers run from the crest of the alveolar bone and
interdental septum, radiating coronally into the
overlying lamina propria of the gingiva

Dentoperiosteal group

The fibers only occur in vestibular and lingual gingiva.

They arise from cementum and pass over the alveolar
crest to insert into the periosteum

Dr. Nithin Mathew –Gingiva

 Semicircular group

The fibers emanate from cementum near

the cementenamel junction, cross the free
marginal gingiva, and insert into a similar position on
the opposite side of the tooth.

Transgingival group

The fibers reinforce the circular and semicircular

fibers. The fibers arise from the cervical cementum and
extend into the marginal gingiva of the adjacent tooth,
merging with the circular fibers

Dr. Nithin Mathew –Gingiva

 Longitudinal group

The fibers extend for long distances within the free

gingiva, some possibly for the whole length of the arch.

Interdental group

The fibers pass through the coronal portion of the

interdental gingiva in the buccolingual direction,
connecting buccal and lingual papillae.

Dr. Nithin Mathew –Gingiva

 Vertical group

The fibers arise in alveolar mucosa or

attached gingiva and pass coronally towards the
marginal gingiva and interdental papilla.

Dr. Nithin Mathew –Gingiva

 Three sources of blood supply to the gingiva are
asfollows

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 .

Occasional branches of the arterioles pass through the

alveolar bone to the periodontal ligament or run over
the crest of the alveolar bone

Dr. Nithin Mathew –Gingiva

 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, with capillaries in the gingival
crevicular areas and vessels that run over the alveolar
crest.

Dr. Nithin Mathew –Gingiva

 Maxillary

Nasopalatine nerve
 Supplies facial aspect of anterior teeth

Posterior superior alveolar nerve

 Supplies facial aspect of posterior teeth

Greater palatine nerve

 Supplies lingual aspect of posterior teeth

Anterior palatinenerve
 Supplies lingual aspect of anterior teeth

Dr. Nithin Mathew –Gingiva

 Mandibular

Inferior Alveolar
nerve

Dr. Nithin Mathew –Gingiva

 Color

Healthy gingiva :"coral pink."

Other colours like red, white, and blue can signify
inflammation (gingivitis) or pathology.

Normal racial pigmentation makes the gingiva appear

darker.

Because the color of gingiva varies due to racial

pigmentation, uniformity of color is more important
than the underlying color itself.
Dr. Nithin Mathew –Gingiva
 Produced by vascular supply, the thickness and degree
of keratinization of the epithelium and the presence of
pigment containing cells : melanin

Dr. Nithin Mathew –Gingiva

 Size

Corresponds to the sum total of the bulk of cellular

and intercellular elements and their vascular supply.

Contour

Depends on the shape of the teeth and their alignment

in the arch, the location and size of the area of the
proximal contact and the dimensions of the facial and
lingual embrasures.

Marginal gingiva-scalloped outline on facial and lingual

surfaces, straight line along the teeth with flat surfaces.
Dr. Nithin Mathew –Gingiva
 On teeth with pronounced mesiodistal convexity or
teeth in labial version, the normal arcuate contour is
accentuated and the gingival is located farther apically.

On teeth in lingual version the gingiva is horizontal and

thickened.

Shape

Governed by the contour of the proximal tooth

surfaces and the location and shape of the gingival
embrasures.
The height of the interdental gingival varies with the
location of the proximal contact.
Dr. Nithin Mathew –Gingiva
 Consistency

Firm and resilient because it is bound to the

underlying bone except movable free margin.

Collagenous nature of lamina propria and its contiguity

with the mucoperiosteum of the alveolar bone
determine the firmness of the attached gingiva.

Gingival fibers contribute to the firmness of gingival

margin.

Dr. Nithin Mathew –Gingiva

 Surface Texture

Orange peel-referred to as being stippled.

It is best viewed by drying the gingiva.

Attached gingiva is stippled, marginal is not.

Central portion of interdental papilla is usually stippled

but the marginal borders are smooth.

Stippling is less prominent in lingual surfaces.

Dr. Nithin Mathew –Gingiva

 Position

The position of the gingiva refers to the level at which

the gingival margin is attached to the tooth

Dr. Nithin Mathew –Gingiva