GINGIVA

R. RESHMAA
PG 1ST YEAR
CONTENTS
• INTRODUCTION
• DEFINITION
• DEVELOPMENT OF GINGIVA
• MACROSCOPIC FEATURES
– MARGINAL GINGIVA
– GINGIVAL SULCUS PART I
– ATTACHED GINGIVA
– INTERDENTAL GINGIVA

• MICROSCOPIC FEATURES
– GENERAL ASPECTS
– EPITHELIUM
– CONNECTIVE TISSUE

• CO RELATION OF CLINICAL AND MICROSCOPIC FEATURES OF GINGIVA

• FUNCTIONS OF GINGIVA
• AGE CHANGES OF GINGIVA
• HISTOCHEMICAL ASPECTS OF GINGIVA
• SUMMARY
• CONCLUSION
INTRODUCTION
• The healthy periodontium provides the support necessary to maintain teeth in
adequate function.
• It is comprised of four principal components: namely the gingiva, periodontal
ligament, cementum and alveolar bone.
• Each of these components is distinct in its location, tissue architecture,
biochemical and cellular components and yet they function together as a single
unit.
 ORAL MUCOUS MEMBRANE

KERATINIZED MUCOSA OR NON KERATINIZED MUCOSA

SPECIALISED MUCOSA
MASTICATORY MUCOSA OR LINING MUCOSA

HARD PALATE SOFT PALATE TASTE BUDS

DORSAL
FLOOR OF THE
GINGIVA LINGUAL
MOUTH
MUCOSA

LIPS AND
CHEEKS

ALVEOLAR
MUCOSA
DEFINITION
GINGIVA:
– GRANT: It is the part of oral mucous membrane attached to the teeth and the alveolar
processes.

– SCHROEDER – AAP IN 1972: It is a combination of epithelium and connective tissue and is

defined as that portion of oral mucous membrane, which in complete post-eruptive dentition of
a healthy young individual, surrounds and is attached to the teeth and the alveolar processes.

– LINDHE 4TH EDITION: It is the part of masticatory mucosa covering the alveolar processes and
the cervical portion of the tooth.

– CARANZA 11TH EDITION: The gingiva is the part of oral mucosa that covers the alveolar
processes of jaw and surrounds the neck of the teeth.
DEVELOPMENT OF GINGIVA (Cho and Grant in 2000)

After enamel • REE is

formation, formed

When tooth • REE + oral

penetrates epithelium
unites into JE
oral mucosa

Developmen • Shallow space

coronal to the
t of gingival attachment of
sulcus JE
MACROSCOPIC FEATURES
• ANATOMICALLY DIVIDED INTO

– Marginal Gingiva

– Attached Gingiva

– Interdental Gingiva
MARGINAL GINGIVA
• Unattached gingiva or free gingiva
• The terminal edge or border of the gingiva surrounding the teeth in collar-like
fashion.
• Free gingival groove:
– Shallow linear depression that demarcates from the adjacent attached gingiva
– 50% cases (Ainamo and Loe in 1966)

• After complete tooth eruption, the free gingival margin is located on the enamel
surface approximately 1.5 to 2 mm coronal to the cemento-enamel junction.
GINGIVAL SULCUS
• Shallow crevice or space around the tooth
• V – shaped
• Depth of gingival sulcus – important diagnostic parameter
• 1.8mm (0 to 6mm) – Histological sections (Orban in 1924)
• 0mm depth – absolutely normal or ideal condition – only in germ free animals
(Gnotobiotic) – experimentally (Atstrom in 1975 and Caffesse in 1980)
• 2-3mm – clinically normal gingival sulcus
ATTACHED GINGIVA
• The attached gingiva is a region between the free gingival groove and the
alveolar mucosa or the mucogingival junction.
• It is a continuation of the marginal gingiva but is firm, resilient and tightly bound
to the underlying periosteum of the alveolar bone
WIDTH OF ATTACHED GINGIVA
• 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.
• WIDTH OF KERATINIZED GINGIVA – Includes marginal gingiva

ANTERIORS POSTERIOR

MAXILLA 3.5-4.5mm 1.9mm

Bowers in 1963
MANDIBLE 3.3-3.9mm 1.8mm
In the maxilla, the vestibular gingiva is generally widest in the area of the incisors and
most narrow adjacent to the premolars. In the mandible, the gingiva on the lingual aspect
is particularly narrow in the area of the incisors and wide in the molar region
Adequate width of attached gingiva
• More than 1mm of attached gingiva is considered adequate – Bowers in 1963
• Minimum 2mm of keratinized gingiva and minimum 1mm attached gingiva is
considered adequate – Lang and Loe in 1968

• The width of attached gingiva increases with age 4 (JPR Ainamo 1978)
• The width of attached gingiva increases in supra-erupted teeth (JPR Ainamo et al
1978)
MEASUREMENT OF WIDTH OF ATTACHED GINGIVA
• Width of attached gingiva = Total width of gingiva – Sulcus or pocket depth
(Halls)
• Methods to determine Mucogingival junction:
– Visual method
– Functional method
– Visual method using staining (iodine solution)
THICKNESS OF GINGIVA
• To determine the gingival biotype
• Kan et al, used visual method
– If periodontal probe is visible through gingiva – thin biotype
– If not visible – thick biotype

• Greenberg et al, first used TRANSGINGIVAL PROBING to determine the

thickness of attached gingiva
– <1.5mm- thin
– >1.5mm – thick

• Ultrasound technique (KYDD et al 1974)

ATTACHED GINGIVA ALVEOLAR MUCOSA

COLOR – PINK RED

STIPPLED SMOOTH

MOSTLY PARAKERATINIZED NON KERATINIZED, THIN

RETE PEGS PRESENT NO RETE PEGS PRESENT

NUMEROUS BLOOD VESSELS

INTERDENTAL GINGIVA
• Occupies gingival embrasure which is the interproximal space beneath the area
of tooth contact
• Pyramidal or col shape
• Col – valleylike depression that connects a facial and lingual papilla and
conforms to the shape of the interproximal contact (Cohen in 1959)
• Thin non keratinized stratified epithelium - Mostly prone for tissue destruction
(Kohl in 1961)
Microscopic features
Microscopic
features

Epithelium Connective tissue

Outer epithelium

Sulcular
epithelium

Junctional
epithelium
GENERAL ASPECTS OF GINGIVAL EPITHELIUM
• Principle cell of gingival epithelium: KERATINOCYTE
• FUNCTIONS:
– Protect the deep structures
– Active role in innate host defense
– Selective interchange with oral environment
– By proliferation and differentiation
 KERATINOCYTES

LANGERHAN
CELLS OF GINGIVAL CELLS
EPITHELIUM

NON KERATINO
MELANOCYTES
CYTES

MERKEL CELLS
KERATINOCYTES
• PROLIFERATION:

– Takes by mitosis in the basal layer

• DIFFERENTATION:

– Progression of biochemical and morphological events that

occur in the cell as they migrate from the basal layer

– Changes:
• Progressive flattening of the cell

• Intercellular junctions coupled to the production of

keratohyalin

• Disappearance of the nucleus.

 MELANOCYTES
• Dendritic cells
• Found in basal and spinous layer
• Synthesized in Pre melanosomes or melanosomes

TYROSINASE
TYROSINE DIHYDROXY PHENYLALANINE (DOPA) MELANIN

MELANOPHAGES
LANGERHAN CELLS
• Dendritic cells
• Modified monocytes
• Suprabasal layer
• G-specific granules (Birbeck granules) – adenosine triphosphatase activity
• Found in oral epithelium and sulcular epithelium
• Not found in junctional epithelium
• Antigen presenting cells – role in immune response.
MERKEL CELLS
• Deeper layer
• Harbour nerve endings
• Tactile perception
OUTER (ORAL) EPITHELIUM
• Covers the crest and outer surface of marginal gingiva and surface of attached
gingiva
• Mostly – parakeratinized (Weinmann in 1959)
• 0.2-0.3mm thickness
• Degree of keratinization: decreases with age and menopause (Papic et al in 1950)
• Ortho keratinized area – K1, K2, K10, K11, K12
• Para keratinized area – K19
LAYERS OF ORAL EPITHELIUM
STRATUM • KERATINISED CELL LAYER
CORNEUM

STRATUM • GRANULAR LAYER

GRANULOSUM

STRATUM • PRICKLE CELL LAYER

SPINOSUM

STRATUM BASALE • BASAL LAYER

STRATUM BASALE
• Single layer of cuboidal cells
• Undergoes mitosis
• Basal cells + parabasal spinous cells are referred to as stratum germinativum
• Shows ribosomes and RER  protein synthesis
STRATUM SPINOSUM
• Irregular polyhedral cells larger than basal cells
• Spiny or prickle cell appearance
• Intercellular bridges
• Most active in protein synthesis indicating keratinization
STRATUM GRANULOSUM
• Larger and flatter cells
• Nucleus – degeneration and pyknosis
• Contains keratohyalin granules
• Keratinosome  Odland bodies  contains acid phosphatase
STRATUM CORNEUM
• Outermost layer
• Larger and flatter cells
• No keratohyalin granules
• Acidophilic and amorphous layer
SULCULAR EPITHELIUM
• Lines the gingival sulcus
• Thin non keratinized stratified squamous epithelium
• Extent – coronal limit of the junctional epithelium to crest of gingival margin
• Semi permeable but less permeable than junctional epithelium
• K4, K13 (oesophageal type cytokeratins)
• Potential to keratinize if,
– Exposed to oral cavity
– Bacterial flora is eliminated.
JUNCTIONAL EPITHELIUM
• Junctional epithelium consist of collar like band of stratified squamous non
keratinized epithelium
• Epithelium tapers from coronal end (10 to 29 cells wide) to its apical end – CEJ (3
to 4 cell layer)
• 2 strata
– Basal layer – facing the connective tissue
– Supra basal layer – extending into the tooth surface

• Length of junctional epithelium – 0.25 to 1.35mm

• Absence of keratinosomes
• Numerous migrating PMN’s
• Epithelial attachment  internal basal lamina + hemidesmosomes connecting JE
to tooth surface (Gottleib 1921)
• Junctional Epithelium + Gingival fibres  DENTOGINGIVAL UNIT
• FUNCTIONS OF JE:
– Rapid turnover rate
– Access to gingival fluid inflammatory cells to gingival margin
– Firmly attached to tooth surface forming epithelial barrier
BIOLOGICAL WIDTH
• Biological width is the combined width of connective tissue and epithelial
attachment superior to the crestal bone.
- Gargnilo et al in 1961

• He reported
– Mean junctional epithelium = 0.97mm
– Mean supracrestal connective tissue attachement = 1.07mm
– Biological width = JE + Connective tissue attachment = 0.97+1.07 = 2.04mm
SIGNIFICANCE OF BIOLOGICAL WIDTH
• Fellipe et al 2003

– Acts as a barrier and prevents penetration of micro organisms into the periodontium

– Biological width is essential for preservation of periodontal health and to remove

irritation that may damage periodontium
SEQUALAE OF BIOLOGICAL WIDTH VIOLATION

• Gingival inflammation
• Gingival tissue recession
• Bleeding on probing
• Pocket formation
• Clinical attachment loss
• Minimal bone loss
STEPS TO CORRECT BIOLOGICAL WIDTH
• Crown lengthening
• Apical repositioning flap
• Orthodontic tooth extrusion
• Bone resection
GINGIVAL CONNECTIVE TISSUE
• Known as Lamina Propria

Lamina propria

Papillary layer Reticular layer

• Subjacent to
epithelium • Continuous with
• Consists of papillary periosteum of
projection between alveolar bone
epithelial rete pegs
 Fibroblast

Cellular Mast cells

Macrophages

Connective
Collagen
tissue

Reticulin

Fibres
Extra cellular Elastin
Ground
substances
Oxytalan
GROUND SUBSTANCE (MATRIX)
• Fills the space between fibres and cells
• Amorphous and contains high amount of water
• Proteoglycans, hyaluronic acid, chondroitin sulfate and glycoproteins
• Glycoproteins:
– Fibronectin – binds fibroblast to fibres – cell to cell adhesion and migration
– Laminin – found in basal lamina – attaches epithelial cell to it
COLLAGEN FIBRES
• 60% volume
• Type I forms the bulk of lamina propria
• Type IV branches between collagen type I and is continuous with fibres of
basement membrane
TROPOCOLLAGE COLLAGEN COLLAGEN
PROTOFIBRIL
N FIBRILS FIBRES
RETICULAR FIBRES
• Argyrophilic staining
• Numerous in tissue adjacent to basement membrane
• Present at epithelium-connective tissue interface.
ELASTIC FIBRES
• Composed of
– Oxytalan
– Elaunin
– Elastin fibres

• Present in blood vessels of gingiva

GINGIVAL FIBRES
• Prominent system of collagen fiber
bundles
• Functions:
– To brace marginal gingiva firmly against
the tooth
– Provide rigidity  to withstand force of
mastication
– Unite free gingiva with cementum of the
root and adjacent attached gingiva
PRINCIPLE FIBRES:
• DENTOGINGIVAL FIBRES
• ALVEOLOGINGIVAL FIBRES
• DENTO PERIOSTEAL FIBRES
• CIRCULAR FIBRES
• TRANS SEPTAL FIBRES
PRINCIPLE GROUP
• DENTOGINGIVAL FIBRES:
– From the cementum in a fan-like conformation towards the crest and outer surface of the
marginal gingiva.

• ALVEOLO GINGIVAL FIBRES:

– From the periosteum of the alveolar crest coronally into the lamina propria.

• DENTO PERIOSTEAL FIBRES:

– From the cementum near the cementoenamel junction and insert into the periosteum of the
alveolar bone

• CIRCULAR FIBRES:
– They surround the tooth in a cuff or ring like fashion

• TRANS SEPTAL FIBRES:

– They are located interproximally, they extend from cementum of one tooth to the
cementum of neighbouring tooth.
SECONDARY FIBRES:
• INTERGINGIVAL FIBRES
• TRANSGINGIVAL FIBRES
• SEMI CIRCULAR FIBRES
SECONDARY GROUP
• INTERGINGIVAL:
– They are seen within the attached gingiva adjacent to the basement membrane
extending mesiodistally

• TRANSGINGIVAL:
– These are seen in and around the teeth with in the attached gingiva

• SEMICIRCULAR:
– They extend from the mesial surface of a tooth to the distal surface of same tooth in a
half circle
CELLS OF GINGIVAL CONNECTIVE TISSUE
FIBROBLAST
• Mesenchymal in origin
• Major role in development, maintenance and
repair of gingival connective tissue
• Synthesises – collagen, elastic fibres,
glycoproteins, GAG
• Regulates collagen degradation through
phagocytosis and secretion of collagenases
MAST CELLS
• A cell filled with basophilic granules
• Found in connective tissue
• It releases histamine, and other substances
during inflammatory and allergic reactions.
• Type of granulocyte derived from myeloid stem
cells.
MACROPHAGES
• Type of WBC
• Responsible for detecting, engulfing,
destroying pathogens and apoptotic cells
• Produced from differentiation of monocytes
which turn into macrophage when they leave
the bloodstream
BLOOD SUPPLY OF GINGIVA
• Supra periosteal arterioles: Facial and lingual surfaces of the alveolar bone
• Vessels of periodontal ligament: which extends into the gingiva
• Supra crestal arterioles: arises from the crest of interdental septum.
• Normal – the vascular network is arranged in a regular repetitive and layered
pattern
• Diseased – exhibits irregular vascular plexus pattern with the microvessels
exhibiting a looped, dilated and convoluted appearance
LYMPHATIC DRAINAGE
• Drains into
• Mandibular anteriors – submental lymph nodes
• Mandibular posteriors – submandibular lymph
nodes
• Maxillary – pre auricular and deep cervical
lymph nodes
NERVE SUPPLY OF GINGIVA
• Fibres arising from the nerves of the periodontal ligament and from the labial,
buccal and lingual nerves
• Nerve receptors: Meissner type, merkel cells, Krause type end bulbs
CONCLUSION
• The gingival tissues, with their specialized relationship to the tooth surface,
constitute the major peripheral defense against microbial infections that may lead
to periodontal disease.
• Both the epithelial and connective tissue components play major roles in this
defense.
• Although the keratinized oral gingival epithelium provides effective protection
against both mechanical trauma and bacterial invasion, the nonkeratinized
junctional epithelium is only partly effective in its protective role, because its
attachment function to the tooth is incompatible with good resistance to trauma.
• However, with the assistance of leukocytes residing in the intercellular spaces
and its high turnover rate, it provides a fairly effective barrier to bacterial
penetration.
REFERENCES
• Carranza – Clinical Periodontology 11th Edition
• Jan Lindhe – Clinical Periodontology And Implant Dentistry 4th Edition
• Orban’s – Textbook Of Oral Histology
THANK YOU
GINGIVA – II
• CO RELATION OF CLINICAL AND MICROSCOPIC FEATURES OF GINGIVA
• HISTOCHEMICAL ASPECTS OF GINGIVA
• FUNCTIONS OF GINGIVA
• AGE CHANGES OF GINGIVA
CORRELATION OF CLINICAL AND MICROSCOPIC
FEATURES OF GINGIVA
COLOR
• Coral pink
• Factors:
– Vascular supply
– Degree of keratinization
– Presence of pigmented cells
PHYSIOLOGIC PIGMENTATION
• Melanin pigmentation – non haemoglobin derived brown pigment
• Diffuse deep purplish discoloration or as irregularly shaped brown and light
brown patches.
• According to Dummet et al
– Gingiva 60%
– Hard palate 61%
– Mucous membrane 22%
– Tongue 15%
• Color of gingiva may change to red, bluish red to pale pink in disease
• Systemically absorbed heavy metals may also cause gingival pigmentation –
bismuth, arsenic, mercury, lead and silver
• Abnormal melanin pigmentation of the gingiva may be observed in conditions
like Addison’s disease, Peutz-jeghers disease
CONTOUR
• Normal – marginal gingiva – scalloped and knife edges
• Interdental papilla – anterior-pyramidal and posterior-tent shaped.
• Factors – shape of the teeth, alignment in the arch, location and size of the
proximal contact dimensions of the facial and lingual gingival embrasures.
• In disease – marginal gingiva becomes rounded or rolled, whereas interdental
papilla becomes flat
• STILLMAN’S CLEFT – apostrophe shaped indentations extending from and into
the gingival margin varying distance on the facial surface
• MCCALL’S FESTOON – life preserver shaped enlargement of gingiva, most
commonly seen on the facial surface of canine and premolar
CONSISTENCY
• Normal gingiva is firm and resilient
• Factors – cellular and fluid content and collagenous nature of lamina propria
• In disease – soggy, soft, edematous or firm fibrotic leathery consistency
SIZE
• The size of the gingiva corresponds with the sum total of the bulk of cellular and
intracellular elements
• Alteration in size is seen in gingival diseases
SURFACE TEXTURE
• Orange peel appearance (Orban in 1948)
• Attached gingiva; central portion of interdental papillae – stippled; marginal
gingiva is not.
• Absent in infancy; appears in 5yrs of age; increases until adulthood; disappears
in old age
• Produced by alternate rounded protuberances and depressions in the gingival
surface. The papillary layer of the connective tissue projects into the elevations,
and the elevatd and depressed areas are covered by eepithelium
• Form of adaptive specialization or reinforcement of function
POSITION
• The position of the gingiva refers to the level at which the gingival margin is
attached to the tooth.
• In disease, the position can be shifted either coronally (as in pseudo pocket) or
apically (gingival recession).
CONTINUOUS TOOTH ERUPTION
• ACTIVE ERUPTION – Active eruption is the movement of the teeth in the
direction of the occlusal plane.
• PASSIVE ERUPTION – The exposure of the teeth by apical migration of the
gingiva.
• Gottlieb and Orban – Active and passive eruption proceed together; attrition;
FUNCTIONS OF GINGIVA
• Defense mechanism
HISTORY
G.V.Black in 1899 – DENTAL COSMOS
Loops of glands running lengthwise to the root and
anastomosing freely and ceasing in a thick mass before reaching
the ginigival border
WAERHAUG IN 1952
• Focused on the anatomy of the sulcus and its transformation into a
gingival pocket during the course of periodontitis

BRILL AND KRAUSSE IN 1958

• Introduced filter paper into the gingival sulci of dogs previously
injected with fluorescein intramuscularly; within 3minutes the
fluorescent material was recovred on the paper strips.
• This indicated the passage of fluid from the blood stream through
the tissues and exiting through gingival sulcus.

Löe et al. IN 1965

• Explored the use of GCF as an indicator of periodontal diseases
EGELBERG IN 1966
• Analyzed GCF and focused his studies on the dentogingival blood vessels and
their permeability as they relate to GCF flow.

CIMASONI IN 1969
• Analysed proteins in GCF
GINGIVAL VASCULARITY
EGELBERG IN 1966
• Found that gingival vasculature is found as loop of capillary units which forms
network below crevicular epithelium – referred to as cervical plexus.
• Cervical plexus arranged in a flat layer
• Diameter of blood vessels – 7 r 40 µm
GINGIVAL PERMEABILITY
• Brill And Krausse – 1958 – Fluoroscein
• Ratcliff – 1966 – India Ink
• Cimasoni – 1983 – Saccharated Iron Oxixde
• MOLECULAR WEIGHT UPTO 1000kd – PERMEABLE
– SUBTANCES LIKE
• Histamine (Egelberg In 1964)
• Albumin (Ranney Et Al 1970)
• Endotoxin (Ranney Et Al 1973)
• Thymidine
• Phenytoin

• The mechanism of penetration through intact epithelium is movemet of molecules and ion
through intercellular spaces and do not traverse the cell membranes (Johnson et al 1973)
PRODUCTION OF GCF
• Brill and Krausse (1958) and Egelberg (1966)
– GCF is produced due to increased vascular permeability of vessels
underlying the sulcular and junctional epithelium after irritation
Alfano hypothesis (1974)
• GCF is a osmotically mediated
• Pre inflammatory fluid
• Accumulation of macromolecules in basement membrane causes an
osmotic gradient and flow of gingival fluid is created.
PASHLEY’S HYPOTHESIS
• NORMALLY,
– Fluid from capillary  Enters tissue  removed by Lymph
– If capillary fluid increases than the Lymphatic uptake  oedema/ GCF Production
METHODS OF COLLECTION OF GCF

• Gingival crevicular washing

• Capillary tube

• Absorbent paper strips

• Pre-weighted twisted threads

GINGIVAL CREVICULAR WASHING

Two different techniques have been used:

• The simplest (Skapsi and Lehner 1967) involved the instillation and re-aspiration of 10ml
of Hanks’ balanced salt solution at the interdental papilla using Hamilton’s microsyringe

• This process was repeated 12 times to allow thorough mixing of the transport solution
and GCF.

• This technique could therefore be applied either to individual interdental units or

multiple units which were then pooled.
• A more complicated method (Oppenheim 1970) involved the construction of a
customized acrylic stent which isolated the gingival tissues from the rest of
the mouth.

• The tissues were then irrigated for 15min, with a saline solution, using a
peristaltic pump, and the diluted GCF was removed.
• ADVANTAGES:
– Valuable for harvesting cells

– Simpler technique can be used for individual site as well as group of teeth.

• DISADVANTAGES:
– Acrylic stent – production is technically demanding

– Mandibular stents are difficult to produce

– Restricted to only few individuals

– All fluid may not be recovered – accurate quantification of GCF is not possible

– Composition of GCF is also not known

CAPILLARY TUBING OR MICROPIPETTES
Isolation and drying of the site

Capillary tubes of known internal diameter – inserted into

the entrance of the gingival crevice
Brill et al 1960

GCF from the crevice migrates into the tube by capillary

action

Volume of the fluid collected can be determined by

measuring the distance which GCF has migrated.
• ADVANTAGES:
– Volume can be accurately assessed.

– Undiluted native sample can be collected.

• DISADVANTAGES:
– Difficult to collect adequate sample because sometimes the procedure may exceed 30minutes

– Difficulty in atraumatic collection

– Difficulty of removing the sample from the capillary tube – forcing the sample by jet of air or
by centrifuging it or by diluting with larger fixed volume of a solution.
ABSORBENT PAPER STRIPS
• Collection of GCF from absorbent paper can be in two ways:

Methods

Intra crevicular Extra crevicular

Entrance of the
crevice or pocket
(Loe et al 1965)

Base of the pocket

(Brill’s technique
1962)
PRE WEIGHED TWISTED THREADS
• Used by Weinstein et al 1967.

• Threads were placed in the gingival crevice around the teeth and
the amount of fluid collected was estimated by weighing the sample
thread.
• ADVANTAGES OF ABSORBENT PAPER STRIPS:

– Quick to use

– Individual sites can be assessed easily

– Least traumatic

• DISADVANTAGES OF STAINING:

– Not efficient for chair side

– Evapouration of gcf volume

– Staining interferes with analysis of components of gcf

 Methods Of Estimating The Amount Of GCF
• The amount of GCF collected on a strip was assessed by the distance the
fluid had migrated up the strip. This was often taken as a simple linear
measurement, but a more accurate value was achieved by assessing the area
of filter paper wetted by the GCF sample.

• Further accuracy was achieved by staining the strips with ninhydrin to

produce a purple color in the area where GCF had accumulated (20).

• It was found that fluorescein labeling was 100 times more sensitive than
ninhydrin for staining protein.
PERIOTRON
• The introduction of an electronic measuring device, the Periotron, has allowed
accurate determination of the GCF volume and subsequent laboratory
investigation of the sample composition.
• 3 models:
– Periotron 600
– Periotron 6000
– Periotron 8000
AGE CHANGES IN GINGIVA
GINGIVAL EPITHELIUM
• Thinning and decreased keratinization of the gingival epithelium (Shklar et al in 1966)
• Epithelial permeability to bacterial antigens, a decreased resistance to functional trauma
or both.
• Flattening of rete pegs and altered cell density. (Shklar et al 1966)
• But no age related differences in gingival epithelium of human or dogs.(Berglundh et al
1991)
• Migration of junctional epithelium from its position to a more apical position with
gingival recession.
• But the WAG does not decrease with age due to passive eruption to compensate for
attrition. (Ainamo et al in 1976)
CONNECTIVE TISSUE:
• Coarser and denser gingival connective tissue with increasing age. (Wentz et al in
1952)
• Rate of conversion of soluble collagen to insoluble collagen (Schier et al in 1976)
• Lower rate of collagen synthesis (Claycomb et al 1967)