GINGIVA

Parts, Clinical
Features/Microscopic Features

Department of Periodontics &

Implantology
VSPM Dental College, Nagpur
 Purpose statement

 The students should understand the

anatomic and microscopic features of
Gingiva and should be able to differentiate
between healthy and diseased gingival
tissue.
 Learning objectives
Sr LO Domain Level
no
1 Explain the Anatomic Landmarks of Gingiva Psychomoto Must know
r

2 Explain the Width of Attached gingiva Cognitive Must know

3 To explain the Microscopic features of gingiva Cognitive Must know

4 Write Structural and metabolic characteristics Psychomoto Must know

of the different areas of gingival epithelium r

5 Explain the structure of gingival connective Cognitive Nice to

tissue. know
 Introduction

The oral mucosa consists of three zones:

 Masticatory mucosa - gingiva and covering of the hard
palate.
 Specialized mucosa - dorsum of the tongue.
 Lining mucosa - lining the remainder of the oral
cavity.
As far as periodontium is concerned consists of
 Gingiva -main function is protection of underlying tissues.
 Periodontal ligament
 Cementum }--forms attachment apparatus
 Alveolar bone
 Definition

 Gingiva: “Gingiva is the part of the oral mucosa that

covers the alveolar processes of the jaws and surrounds
the neck of the teeth.”

The gingival is divided anatomically into

 [Link]
 [Link]
 [Link] areas.
Marginal Gingiva
It is unattached gingiva, which is the terminal edge or border of
the gingiva surrounding the teeth in collar like fashion.

Free gingival groove

In about 50% cases, marginal gingiva is demarcated from
the adjacent, attached gingiva by a shallow linear
depression, runs parallel to & at a distance of 0.5 to 2mm
from the margin of gingiva.
Gingival sulcus
 “It is 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.” It is “V” shaped and
barely permits the entrance of a periodontal probe.
Histological depth- determined by
histological sections
1.8mm with variations from 0 to 6mm,
other studies have reported 1.5mm and
0.69mm, respectively.

Probing depth - sulcus depth reading

provided by periodontal probe normal
gingival sulcus is 2 to 3 mm.
Attached Gingiva
 The attached Gingiva is continuous with the marginal gingiva.
 It is firm resilient and tightly bound to the underlying
periosteum of 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.”
 As the mucogingival junction remains stationary throughout
adult life, changes in the width of the attached gingiva are
caused by modifications in the position of its coronal end.
 Absence of Interdental
papillae and col where
Proximal tooth contact
is missing
Interdental gingiva
 The interdental gingiva occupies the gingival embrasure, which
is the interproximal space beneath the area of the tooth contact.
Shape
Anterior segment
 Pyramidal because the tip of the papilla is located
immediately beneath the contact point.
Posterior segment
 Col shape because it represents the valley like depression that
connects a facial & lingual papilla and conforms to the shape of
the interproximal contact.
 Shape depends on the contact point between the two adjoining
teeth and the presence or absence of some degree of recession
Microscopic features
 Gingiva consists of a central core of connective tissue covered
by stratified squamous epithelium
Gingival epithelium
General aspects of gingival epithelium biology
Three different areas morphologically & functionally
1. Oral or outer epithelium
2. Sulcular epithelium
3. Junctional epithelium
Cell types
Principal cell- keratinocytes
Other cells, nonkeratinocytes or clear cells, which include
Langerhans cells, Merkel cells , Melanocytes
 I. Keratinocyte
Function - Protecting deep
structures.
- Allowing a
selective interchange with
oral environment.

It may be

 Orthokeratinization

 Parakeratinization

 Non-keratinized Diagram showing representative

epithelium cells from the various layers
Of stratified squamous
epithelium as seen by electron
microscopy
 Nonkeratinocyte cells
 Melanocytes
Dendritic cells located in the basal and
spinous layer of the gingival epithelium
synthesize melanin in organelles called
premelanosomes or melanosomes.
 Langerhans cells
Dendritic cells located among
keratinocytes at all suprabasal levels
belong to mononuclear phagocyte
system (R.E system).
 Merkel cells
Located in the deeper layers of the
epithelium, harbour nerve endings and Human gingival epithelium
have been identified as tactile Myoloperoxidase technique
perceptors. showing Langerhans cells
 Basal Lamina
The epithelium is joined to the underlying connective tissue by
a basal lamina 300-400 Ả thick, lying approximately 400 Ả
beneath the epithelial basal layer.
It consists of
Lamina lucida
Lamina densa
 Hemidesmosomes of the basal epithelial cells abut the
lamina lucida. The complex of basal lamina and fibrils is
the Periodic acid- Schiff (PAS) positive and argyrophilic line
observed at the optical level.
 The basal lamina is permeable to fluids but acts as a barrier
to particulate matter
Structural and metabolic characteristics of the different
areas of gingival epithelium

Oral or outer epithelium

 Covers crest & outer surfaces of marginal gingiva & surface of
attached gingiva .
Keratinized or parakeratinized or various combinations with
prevalence toward parakeratinization.
Keratinization varies in following order
Palate (Most keratinized)
↓
Gingiva
↓
Ventral aspect of tongue
↓
Cheek (Least keratinized)
Sulcular epithelium
 It is a thin, nonkeratinized stratified
squamous epithelium without
retepegs and extends from coronal
limit of the junctional epithelium to
the crest of the gingival margin.
 It has potential to keratinize if -
exposed to oral cavity
- bacterial flora is eliminated.
 Suggests that local irritation of
sulcus prevents sulcular
keratinization.
Importance
 It may act as a semi permeable
membrane through which injurious
bacterial products pass into the
gingiva and tissue fluid from
gingiva seeps into the sulcus.
Junctional epithelium
 The junctional epithelium consists of a
collar like band of stratified squamous
non-keratinized epithelium.
 It is 3-4 layers thick in early life, the
number of layers increase with age to
[Link] cells is grouped in two strata
basal and suprabasal
 The length ranges from 0.25 to 1.35mm.
 It attaches to tooth surface by means of
an internal basal lamina and to the
connective tissue by an external basal
lamina.
 The internal basal lamina consists of a
lamina densa and lamina lucida to which
hemidesmosomes are attached.
Dentogingival Unit

The attachment of the junctional epithelium to the tooth is

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

Therefore the junctional epithelium and gingival fibers are

considered a functional unit called as dentogingival unit.
Gingival connective tissue
 Known as the lamina propria
 Consists of Papillary layer subjacent to the epithelium.
 Reticular layer contiguous with the periosteum of the alveolar
bone
Connective tissue consists of 1. Cellular elements
2. Extra cellular compartment
1. Cellular elements
 Preponderant cell is fibroblast, synthesizes & degrade fibers.
 Glycoproteins & glycosaminoglycan is also formed by fibroblasts.
 Other cells 1. Mast cells 2. Fixed macrophages & histiocytes.
3. Adipose cells 4. Eosinophils
5. Plasma cells 6. Lymphocytes
7. Neutrophils
2. Extracellular compartment
Fibers
Three types collagen, reticular & elastic.
 Collagen type-I forms bulk of lamina propria & provides
tensile strength to gingival tissue.
 Collagen type IV-branches between collagen type-I bundles &
is continuous with fibers of the basement membrane and blood
vessel walls.
 The elastic fiber system is composed of oxytalan, elaunin, and
elastin fibers distributed among collagen fibers.
Gingival Fibers
Consists of type I collagen
Functions of gingival fibers
 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.
Three groups of fibers
 Gingivodental group
 Circular group
 Transseptal group
Gingival epithelium
Biochemical characteristic of different areas of gingival
epithelium.
Oral or outer epithelium.
Keratin K1, K2 and K10 to K12
-Specific for epidermal type differentiation.
-Expressed with high intensity in orthokeratinized
areas & less intensity in parakeratinized areas.
K6 and K16 -Characteristic of highly proliferative epithelia.
K5 and K14 -Stratification specific cytokeratines
-Both are present in outer epithelia.
K19 -Absent in orthokeratinized areas.

●Glycogen can accumulate intracellularly when not degraded

completely. Its concentration inversely related to degree of
keratinization & inflammation.
Sulcular epithelium
-Lacks K1, K2 & K10-K12.
-It contains K4 & K13-eosophageal type cytokeratines.
-It also expresses K19.
●Lower degree of enzyme activity than in outer epithelium.
●G-6PD-Homogenous and faint in all strata unlike increasing
gradient toward surface in cornified epithelia.
●Acid phosphatase -Negative

Junctional epithelium
It expresses
K19 - Absent in keratinized epithelia.
K5 & K14 - Stratification type specific.
K4 & K13 - Not synthesized in junctional epithelium
- Sudden change from sulcular epithelia to junctional.
K6 & K16 - Linked to highly proliferative epithelia.
- Absent in junctional epithelia though its turnover is
high.
 Ground substance
●Fills the space between fibers &cells, amorphous with high
water content.
●It is composed of [Link]
2. Glycoproteins.
1. Proteoglycans
●Mainly hyaluronic acid & chondroitin sulphate.
●Responsible for maintaining wide variety of tissue &
cellular function.

2. Glycoproteins
Mainly fibronectin, gives faint paS positive reaction to ground
substance.
 Major functions are
- Mediate attachment of fibroblast to collagen fibers present in
the matrix.
- Helps in wound healing and tissue regeneration
Another glycoprotein laminin found in basal lamina
-Binds specifically to type IV collagen complex.
-It serves to attach to epithelial cell.
Blood supply
Three sources of blood supply to the gingiva are as follows

1. Supraperiosteal
2. Vessels of periodontal ligament.
3 Arterioles which emerge from the crest of the interdental septa and
extend parallel to the crest of the bone.
Diagram of arteriole penetrating the interdental alveolar bone to
supply the interdental tissue (left) and the supraperiosteal arteriole
overlying the facial alveolar bone sending branches to surrounding
tissue (right)
Summary
•Gingiva is anatomically divided into marginal, attached gingiva
and interdental gingiva.

•Microscopically, gingiva is divided into epithelium and connective

tissue.

•Gingival epithelium is of three types namely oral, sulcular and

junctional epithelium.

•Oral epithelium is keratinized and sulcular and junctional

epithelium are non keratinized.

•Non keratinocytes present in the epithelium are langerhans cells,

melanocytes, merkel cells and inflammatory cells.
 Applied Aspect
T h e he a l t h o f g i ng i va i s a n i mp o r t a nt f act or i n
d e t e r mi ni n g t he o v er al l h eal t h of the
p e r i od o nt i u m . M ai nt e n an ce o f g i n gi v al he al t h i s
c r uc i a l f o r a l l f o r ms o f p e r i o do nt al t he r a p y b o t h
n o n - s u rg i c a l & s u rg i c a l .
H e al t h y gi n gi va h el p s i n mai n t ai ni n g t h e s up p o r t t o
t e e t h a n d t h u s p r e s e r ve s t he i nt e gr i t y a n d f u nct i o n
of teeth in the dental arch.
 Expected Questions

 Gingival fibres and Junctional epithelium. (10 marks)

 Importance of attached gingiva. (2 marks)

 Non Keratinocytes/clear cells. (2 marks)

 Types of gingival epithelium. (2 marks)

 Blood supply of gingiva.(2 marks)

 REFERENCES

✓ Clinical peridontology, 10th & 11th edition – Carranza F.A.,

Michael G. Newman.
✓ Oral Histology, Development, structure and function – A.R.
Tencate, 5th & 6th edition.
✓ Orbans Oral Histology and Embryology – S.N. Bhaskar, 11th
edition.
✓ Clinical Periodontology and Implant Dentistry – Jan Lindhe, 4th
edition.