Peridontology, Level 4 , Lec.
1
Seham Abdullah By : T.
Introduction to Periodontics
: Periodontology
Is the branch of dentistry that studies the supporting structures of the
teeth , diseases and conditions that affects them. It deals with the
maintenance of oral health, the diagnosis and treatment of gingival
diseases , as well as the placement of dental implant.
:Periodontist
Is a dentist who is specializes in the prevention, diagnosis , and
treatment of periodontal diseases , and in the placement of dental
implant.
: Periodontium
Refers to specialized tissues that both surround and support the teeth.
The word comes .Maintaining them in maxillary and mandibular bones
from the Greek term peri-,meaning "around " , and –odons, meaning
"tooth". So it means the tissues " around the teeth".
Normal Periodontium
Peridontology, Level 4 , Lec.1
Seham Abdullah By : T.
of The periodontium consists of the investing and supporting tissues
bone. the tooth: gingiva, periodontal ligament, cementum, and alveolar
function of It has been divided into two parts: the gingiva, the main
attachment which is protecting the underlying tissues, and the
cementum, and apparatus, composed of the periodontal ligament,
alveolar bone
Normal Gingiva:
this with the normal features of the gingiva, since This section deals
knowledge is necessary for an understanding of gingival inflammation
.(gingivitis)
alveolar The gingiva is the part of the oral mucosa that covers the
.teeth processes of the jaws and surrounds the necks of the
In an adult, normal gingiva has the following features:
Color
The color of the attached and marginal gingiva is
and is produced by ”coral pink“ as described generally
and supply of lamina properia, the thickness the vascular
.degree of keratinization of the epithelium
brown and pigmentation occurs as a diffuse Melanin
. light-brown patches
This is a normal pigmentation of the skin, gingiva, and remainder of the
oral
mucous membrane.
Contour
and The contour or shape of the gingiva varies considerably
in the on the shape of the teeth and their alignment depends
. contact and size of the area of proximal arch, the location
knife-shaped The gingiva is scalloped in marginal areas with a
¬¬¬¬. pyramidal in form , whereas the interdental papilla is edge
Consistency
The gingiva is firm and resilient and tightly bound to the underlying
movable free gingiva. with the exception of the bone
Surface Texture
an The gingiva presents a textured surface similar to
.and is referred to as being stippled orange peel
It is a feature of healthy gingiva, but may be absent
Peridontology, Level 4 , Lec.1
Seham Abdullah By : T.
in some persons.
The best viewed by drying the gingiva. Stippling is
not. attached gingiva is stippled; the marginal gingiva is
Stipplings of the attached gingiva is indicative feature of healthy
gingiva but it is a reversible feature, i.e. it is lost or disappear in disease
but returns following successful treatment. Theses stipplings formed
by projection of the
elevations and papillary layer of lamina propria into epithelium causing
depressions.
Position
The position of the gingiva refers to the level at which the gingival
margin is attached to the tooth. The normal gingiva is approximately to
enamel junction.-the level of the cemento
is divided into marginal or free , attached, and Anatomically, the gingiva
.interdental papilla
Marginal Gingiva
of the The marginal, or free, gingiva is the terminal edge or border
like fashion. In about 50% of gingiva surrounding the teeth in collar
adjacent attached gingiva by a cases, it is demarcated from the
from gingival groove. It is separated shallow linear depression, the free
.the tooth surface with a gingival sulcus
The gingival sulcus
The gingival sulcus is the shallow , V-shaped space between the tooth
and the gingiva that encircles the clinical crown , it is lined by sulcular
epithelium.
depth of the gingival sulcus Under normal conditions, the clinical
0-3mm.
The biologic or histologic depth of the sulcus is the distance between
the gingival margin and the coronal end of the junctional epithelium.
This can be measured only in carefully prepared histologic section, and
measures about 1.8 mm.
The Gingival Crevicular Fluid (GCF):
It is a fluid that seeps into the sulcus from the gingival connective
tissue through the thin sulcular epithelium. It is a serum transudate
that contains microbial and host products that arise as a result of
inflammatory-host interaction. This fiuid helps in washing of the
Peridontology, Level 4 , Lec.1
Seham Abdullah By : T.
materials from the gingival sulcus, it also has defensive action by
releasing antibacterial agents.
Composition of GCF:
1. cellular elements: bacteria, desquamated epithelial cells, and
neutrophils
2.electrolytes: potassium, sodium, and calssium
3. organic contents: carbohydrates ,proteins , glucose …
fluid can be collected. In strickly normal gingiva little or no
The GCF increases during:
1.inflammation
2. mastication
3. tooth brushing
4. gingival massage
5. pregnancy
6. smoking
7. female sex hormones
8. hormonal contraceptives
9. during healing period after surgery
clinical evaluation used to determine the depth of the sulcus The
involves the introduction of a blunt-end graduated metallic instrument,
the periodontal
probe, and the estimation of the distance it penetrates.
Attached Gingiva
firm, The attached gingiva is continuous with the marginal gingiva. It is
resilient, and tightly bound to the underlying alveolar bone.
The attached gingiva is demarcated from the adjacent alveolar mucosa
on the facial aspect by a clearly defined mucogingival junction. The
alveolar mucosa is red, smooth, and shiny rather than pink and
stippled.
parameter. It is The width of the attached gingiva is important clinical
the free gingival the distance between the mucogingival junction and
sulcus or the periodontal pocket. It groove the bottom of the gingival
the width of the keratinized gingiva should not be confused with
the marginal gingiva . because the latter also includes
The normal or ideal width of the attached gingiva is generally greatest
Peridontology, Level 4 , Lec.1
Seham Abdullah By : T.
region (3.5 to 4.5 mm in maxilla, 3.3 to 3.9 mm in in the incisor
mandible), and
1.8 mm in narrower in the posterior segments (1.9 mm in maxillary and
.mandibular first premolars)
gingiva terminates On the lingual aspect of the mandible, the attached
which is continuous with at the junction of the lingual alveolar mucosa,
of the mouth. The palatal the mucous membrane lining the floor
maxilla blends imperceptibly with surface of the attached gingiva in the
the equally firm and resilient
palatal mucosa.
Normal gingiva in a young adult. Note the demarcation
(mucogingival line) (arrows) between the attached gingiva
Interdental gingiva
The interdental gingiva occupies the gingival embrasure
If a diastema is present, the between two adjacent teeth.
interdental bone and forms gingiva is firmly bound over the
.interdental papillae a smooth, rounded surface without
overlying stratified Histologically, the gingiva is composed of the
core of connective tissue squamous epithelium and the underlying
.((lamina properia
of the gingiva shows regional morphologic The epithelial component
reflect tissue adaptation to the tooth and alveolar bone. variations that
Peridontology, Level 4 , Lec.1
Seham Abdullah By : T.
These
variations include the oral epithelium, sulcular epithelium, and
.junctional epithelium
the crest and outer surface of the The oral, or outer, epithelium covers
of the attached gingiva. On average, marginal gingiva and the surface
0.3 mm in thickness. It is keratinized or the oral epithelium is 0.2 to
parakeratinized
(basal The oral epithelium is composed of four layers: stratum basale
layer), stratum spinosum (prickle cell layer), stratum granulosum
cornified layer).) (granular layer), and stratum corneum
sulcus. It is a thin, The sulcular epithelium lines the gingival
squamous epithelium without rete pegs, and keratinized stratified-non
it extends from the
coronal limit of the junctional epithelium to the crest of the gingival
margin
may act as a The sulcular epithelium is extremely important because it
bacterial products semipermeable membrane through which injurious
gingiva seeps into the pass into the gingival and tissue fluid from the
.sulcus(GCF)
like band of stratified -a collar The junctional epithelium consists of
located It is 3 to 4 layers thick keratinizing epithelium.-squamous non
The length of the junction in healthy tissue. at the cement-enamel
junctional epithelium ranges from 0.25 to 1.35 mm
The biologic width is defined as the physiologic dimention of the
junctional epithelium and connective tissue attachment.
Peridontology, Level 4 , Lec.1
Seham Abdullah By : T.
Histologic appearance of healthy
gingiva.
cementoenamel junction (CEJ).
Oral epithelium (OE).
junctional epithelium (JE)
The connective tissue of the gingiva is known as the lamina propria
which is a thin loose connective tissue . it is formed of :
1. cellular component: fibroblasts are the predominant cells .
Inflammatory cells as lymphocytes ,plasma cells, neutrophils and
eosinophils are present in small amount in normal gingiva. They play
role in host defense mechanism.
2. Gingival fibers: that forms the bulk of the lamina propria and provide
the tensile strength of the gingival tissue.
Remember:
●
= The distance between the base of sulcus and alveolar crest in healthy periodontium
mm 2 -1
.Under absolutely ideal or normal conditions, the depth of gingival sulcus = 0 mm ●
.normal gingival sulcus = 2–3 mm Probing depth of clinically ●
● Histological depth of gingival sulcus = 1.5 -1.8 mm
● The distance between the apical end of the junctional epithelium and the crest of
alveolus is constant and it is 1.07 mm
● The distance between gingival margin and free gingival groove (width of marginal
gingiva) = 0.5–1.5mm
●
width of attached gingiva =
3.9 mm in mandible), - 4.5 mm in maxilla, 3.3-in the incisor region (3.5
in the posterior (1 9 mm in maxillary and 1 8 mm in mandibular first premolars)
