PERIODONTIUM

 defined as those tissues

supporting and investing the
tooth, consists of PDL, alveolar
bone, cementum as supporting
tissues and gingiva as
investing tissue. (R Ten cate)

 Perio means around

Odontos means teeth
(Jan
Lindhe)
 ZONES OF ORAL MUCOSA
(Bodecker 1944, Orban & Sicher 1945)

ORAL MUCOSA

MASTICATORY MUCOSA LINING MUCOSA

(subjected to high (not subject to high
compression and friction levels of friction as in
as in gingiva and other areas of mouth)
covering of hard palate)

SPECIALIZED MUCOSA
dorsum of the tongue
 Definition
Gingiva is the part of oral
mucosa that covers the
alveolar processes of the
jaws and surrounds the
necks of the teeth. JP
Fiorellini, DM Kim, SO
Ishikawa
 Clinical Features
 The gingiva is divided
anatomically into:
 Marginal / Unattached

or free gingiva
 Attached gingiva

 Interdental gingiva

 All types are specifically

structured to function
appropriately against
mechanical and
microbial damage.
(Ainamo J and Talari A,
1976)
 Marginal gingiva
 Marginal / Unattached or free gingiva
is the terminal edge or border of the
gingiva surrounding the teeth in a
collar like fashion.

 Limits:
 Coronally: the gingival margin about
1.5 to 2mm coronal to CEJ.
 Apically: In about 40 to 50% of the
cases, it is demarcated from the
adjacent attached gingiva by a
shallow linear depression known as
the free gingival groove (FGG).
(Ainamo J and Loe H, 1966)
■ FGG is often most pronounced on the vestibular aspect of
the teeth, occurring most frequently in the incisor and
premolar regions of mandible and least frequently in
mandibular molar and maxillary premolar region.

■ MG is usually about 1 mm wide.

■ It forms the soft tissue wall of the gingival sulcus.

■ It may be separated from the tooth surface with a periodontal

probe.
 Gingival sulcus / Gingival crevice /
Gingival pocket
 Is the shallow crevice or
space around the teeth
bounded by the surface
of the tooth on one side
and the epithelium lining
the free margin of the
gingiva on the other.

 It is V shaped and barely

permits the entrance of a
periodontal probe.
 Depth of gingival sulcus:
 Under absolutely normal or ideal conditions, close to
or equal to 0mm. Such strict conditions can be
produced experimentally only in germ free animals or
after intense, prolonged plaque control. (Gottlieb B
and Orban B, 1933)
 In clinically healthy gingiva in humans, a sulcus of
some depth can be found.
 Biologic or histologic depth:

 1.8mm, with variation from 0-6 mm (Orban B

and Kohler J, 1924)
 1.5mm (Weski O, 1922) and 0.69mm (Gargiulo
AW et al, 1961).
 ■ Clinical or probing depth:
determined by the introduction of a
metallic instrument, the periodontal
probe. The probing depth of a
clinically normal gingival sulcus in
humans is 2-3mm.

The histologic depth of a sulcus need

not be exactly equal to the depth of
penetration of the probe.
 In newly-erupted permanent teeth, the sulcus depth
often reaches 5 to 7 mm in the early stages of eruption.
(Tenenbaum H, 1986)

 Sulcus depth deminishes steadily as the tooth erupts,

and at a rate proportionate to the increase in clinical
crown height. (Smith 1982)
 Attached Gingiva
■ Glossary of periodontal terms (1977) has
defined attached gingiva, “as the portion of
the gingiva extending from the base of the
gingival crevice to the MGJ. It is firm,
dense, stippled and tightly bound down to
the underlying periosteum and tooth”.
■ Extent:
 Coronally: continuous with the marginal
gingiva being demarcated by the FGG,
or when such a groove is not present,
by a horizontal plane placed at the level
of CEJ.
 Apically: to the MGJ where it becomes
continuous with the alveolar (lining)
mucosa.
■ The MGJ particularly on the vestibular aspect can be
localized
■ Functionally – by passive movement of lips and cheek
(Hilming,1970)
■ Anatomically – by differences of colour and surface
characteristics. (Orban, 1948)
■ Histochemically – by application of Schiller’s iodine solution
to reveal the glycogen stored in the epithelium of the lining
mucosa.(Fasske E, 1958)
■ Roll technique– MGJ blanches

■ Normally, MGJ resides about 3-5 mm below the level of

the alveolar crest.

■ By functional method, the MGJ is about 0.5 mm apical to

that found with a histochemical method (Bernimoulin et al
1971)
■ Width of AG : an important clinical parameter
 the distance between the MGJ and the projection on the
external surface of the bottom of the gingival sulcus or the
periodontal pocket.
Width of AG= gingival margin to MGJ-sulcus depth
 Because the MGJ remains stationary throughout adult life,
changes in the width of the AG are caused by the
modification in the position of its coronal end.
The width of AG increases with age and in supraerupted
teeth.
 The AG on lingual aspect of mandible terminates at the
junction with the lingual alveolar mucosa.
The palatal surface of the AG in maxilla blends
imperceptibly with the equally firm and resilient palatal
mucosa.
 onthe facial aspect:
 generally greatest in the

incisor region (3.5 – 4.5

mm in the maxilla and
3.3 to 3.9 mm in the
mandible)
 less in the posterior
Vestibular gingiva
segments
 least width in the 1st

premolar area (1.9 mm

– maxillary premolar
and 1.8mm-mandibular
premolar). Ainamo and
Loe, 1966
Lingual gingiva
of mandible
 Width of AG in deciduous and transition dentition:
 In the anterior region, this height increases from the
primary to the permanent dentition, more so in the
maxilla than in the mandible. (Bimstein E,1988)
 The mean width of the attached gingiva increased
from the deciduous to the permanent dentition.
(Bowers 1963) whereas it did not show an increase
from the deciduous to the permanent dentition.
(Tenenbaum H, 1986)
 The width of the attached gingiva in the primary
dentition increased with age. (Rose & App 1973,
Bimstein & Eidelman 1983)
 For many years the presence of an adequate zone of AG
was considered critical for maintenance of marginal
tissue health and for prevention of continuous loss of
connective tissue attachment. (Nabers,1954;
Ochsenbein, 1960; Friedman and Levine, 1964; Hall,
1981). However, this traditional dogma was not
scientifically supported.

 Gingival health can be maintained independent of its

dimensions. (Lindhe & Nyman 1980, Kennedy et al
1986, Freedman et al 1999)
 Interdental Gingiva (IDG)
 occupies the gingival embrasure which is
the interproximal space beneath the area
of tooth contact.

 The shape of IDG

 determined by
 the contact relationships between

the teeth
 the width of the approximal tooth

surfaces
 the course of the CEJ

 Presence or absence of recession

 Pyramidal in the anteriors, where
the tip of one papilla is located
immediately beneath the contact
point.
 Site of extraction showing the
facial and palatal interdental
papillae and intervening col

Histologic view of col

■ If diastema is present or when a tooth is
missing from the arch, the gingiva is
firmly bound over the interdental bone
and forms a smooth rounded surface
without IDP or “col”.
 The gingiva consists of a central core of
connective tissue covered by stratified
squamous epithelium.
 GINGIVAL EPITHELIUM
 Provides the protective integument of the periodontium.
 Regional morphological variations of gingival epithelium
that are a reflection of tissue adaptation to tooth and
alveolar bone:
 Development of gingival epithelium
 Gingiva evolves as the crown enters the oral cavity by
breaking through the oral epithelium. The development of
gingiva prior to tooth eruption into the oral cavity has not
been studied. (Schroeder, 1986)
 The nonkeratinized junctional epithelium originates from the
enamel organ, while the nonkeratinized sulcular and the
keratinized gingival epithelium originate from the oral
mucosa.
 General aspects of gingival epithelium
 Functions:
 Physical barrier to infection and underlying gingival
attachment, while allowing a selective interchange with
the oral environment.
 Participates actively in responding to infection,
signalling further host reactions, integrating innate and
acquired immune responses. Dale BA,2002
 Cells:
 Keratinocyte: principal cell type (90%)
 Nonkeratinocytes (10%)
 Nonkeratinocytes are also known as clear cells
because the zone around their nuclei appears lighter
than that in the keratinocytes due to shrinkage of
cytoplasm during histologic processing owing to the
lack of desmosomal attachments except the merkel
cells. These include:
 Langerhans cells

 Merkel cells

 Melanocytes

 Inflammatory cells
 GINGIVAL EPITHELIUM: Cell types
dead

Keratinocytes Melanocyte to
make & transfer
alive pigment

Langerhans Merkel cell

APC cell sensory
immunity

Nerve cell represented

by its axon
 The epithelium maintains its structural integrity by a
process of continuous cell renewal by proliferation and
differentiation:

Proliferation takes place in the basal layer by mitosis

Some cells migrate towards the surface

Undergo series of morphologic & biochemical

changes
i) progressive flattening of cell
ii) increase in tonofilaments
iii) production of keratohyaline granules
iv) disappearance of nucleus and other organelles
Schroeder, 1981