The Gingiva

Embryology, Anatomy, Histology & Biochemistry

Dr. Khansa Ababneh

Periodontium

Tissues which surround & support the teeth.

Periodontium
Gingiva Periodontal
ligament

Alveolar bone

Cementum

Tooth Development & Eruption

Periodontal tissues develop during tooth development

Development of the periodontium

role of epithelial-mesenchymal interactions

Oral epithelium

Ectomesenchyme
(dental follicle)

Gingival epithelium

PDL Alveolar bone Cementum Gingival CT

Oral mucosa

Masticatory mucosa Lining mucosa

Specialised mucosa

GINGIVA

Part of masticatory mucosa Fibrous mucosa surrounding necks of teeth covers the coronal portion of the alveolar process

GINGIVA
3 main parts:
1.

Free gingiva

2.

Attached gingiva
Interdental gingiva

3.

Free gingiva

From gingival margin to the free gingival groove (FGG) at the level of the CEJ.

Can be separated form the tooth by a probe

Depth of gingival sulcus (crevice) : 0-3 mm.

Attached gingiva
Extends from the FGG to the mucogingival junction (MGJ)

Attached gingiva

On the palate, the whole mucosa is keratinised and there is

No MGJ

Attached gingiva

Firmly attached to underlying bone to:

withstand

masticatory forces

withstand
prevent

forces of tooth brushing

movement of marginal gingiva

Width varies in different parts of the mouth;

between right & left sides between different people with age (increases)

For example

Maxilla, buccally:
widest around incisors, narrowest around premolars

Mandible, lingually
narrowest around incisors, widest around molars.

Is the width of the attached gingiva important? Which is more important; width or thickness?

Keratinised Vs Attached
Attached gingiva Keratinised gingiva

FG + AG

KG

Interdental gingiva

Also: interdental papilla. Shape determined by:

Contact relationship between teeth width of proximal surfaces shape of the CEJ.

Anterior : Pyramidal

Molars : Flattened in a buccolingual direction.

Between buccal & lingual papillae

COL

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 bleeding on probing (BOP).

HISTOLOGY

The gingiva consists of 2 main types of tissue:

1. 2.

Epithelium Connective tissue Epithelium is attached to the underlying connective tissue by a basement membrane.

Epithelium

Stratified squamous epithelium (parakeratinised) Function:

Protection of underlying structures while permitting

selective interchange with the oral environment

Active production of cytokines, adhesion molecules, growth factors and enzymes Examples: -defensins, IL-1 , IL-8, EGF

 Main cell type :

keratinocyte
1. stratum basale (basal cell layer) 2. stratum spinosum (spinous cell layer)
3.

Structure

4 layers of cells:

stratum granulosum (granular cell layer)

4. stratum corneum (corneal or horny cell layer)

The oral mucosa is mostly parakeratinised: stratum corneum retains pyknotic nuclei

Difference between ortho- & parakeratinisation

Cytokeratin (K1-K19)

Other proteins: keratolinin, involucrin & filaggrin.

within the gingival epithelium

Langerhans

Other cell types

cells: modified monocytes found

in the suprabasal layer, playing a role in

immunity
Merkel

cells: in deeper layer of epitheium,

contain nerve endings

Melanocytes:

in basal and spinous cell layer,

contain melanin

Types of Gingival Epithelium

Oral epithelium Sulcular epithelium Junctional epithelium

Oral epithelium
Faces the oral cavity, is parakeratinised, shows rete pegs and connective tissue papillae (responsible for the stippled texture). Turnover rate 1012 days.

Sulcular epithelium
Faces the tooth without contacting it. Thin nonkeratinised stratified squamous epithelium (no granulosum and corneum layers), extends from the coronal end of the junctional epithelium to the crest of the gingival margin. Acts as a semipermeable membrane.

Junctional epithelium

Provides contact between gingiva & tooth. Stratified squamous nonkeratinised epithelium. 3-4 cells thick in early life, increasing to 10-20 later. Basal and suprabasal layers. Length = 0.25-1.35 mm. No rete pegs.

Derived from the reduced enamel epithelium

Junctional Epithelium

Attachment to tooth: inner basal lamina

Attachment to gingival connective tissue: outer basal lamina Lamina densa & lamina lucida
Large cells; wide intercellular spaces

ECM of Epithelium

Not abundant in gingival epithelium PG: CD44, HA, syndecan, decorin

Glycoproteins: integrin family, e.g.: 21, and ICAM-1 (in Jep & Oep)

Differences between gingival epithelia

Cell size/tissue volume in JE is > in OE

Intercellular spaces in JE are > in OE

No of desmosomes in JE is < in OE Difference in cytokeratin expression & cell surface markers JE originates from REE; OSE & OE originate from oral mucosa

Renewal of gingival epithelium

Cell division Cell shedding

The Dentogingival junction

Enamel + cementum (CEJ) + junctional

epithelium + gingival fibres + adhesion

proteins.

Dentogingival epithelium

Gingival Crevicular fluid (GCF)

In gingival sulcus Cleaning & antimicrobial effects Increases adhesion of gingiva to tooth.

Connective Tissue
1.

Cells:

fibroblasts, mast cells, macrophages, neutrophils, lymphocytes, plasma cells.

2. 3. 4.

5.
6.

Collagen fibres Extracellular matrix (ECM) Nerves Blood vessels Lymphatics

Fibres

Collagen, elastin,

reticulin & oxytalan

fibres.

Provide structure,
framework, increase elasticity and resiliency

of gingiva.

Fibres

Arranged in groups :

Transseptal Circular Dentogingival Dentoperiosteal

Medium in which all other components are embedded. Consists of: water, proteins, glycoproteins, proteoglycans & growth factors:
Collagen type I , III, V & VI Proteoglycans: decorin, biglycan, versican Integrins Fibronectin

ECM