CLINICAL AND

HISTOLOGICAL FEATRUES
OF
GINGIVA AND
PERIODONTAL LIGAMENT
SWATI Y. RAWAL, BDS, MDS, MS
9/9/15
IMU
GENERAL CHRACTERISTICS
OF ORAL MUCOUS
MEMEBRANES
•PROTECTION - Varies with permeability and
function
•SECRETION - Minor salivary glands in
most areas; none in gingiva
• PROLIFERATION - Epithelium & connective
tissue
•ABSORPTION- Through most mucous
membranes, especially the
floor of the mouth and the
gingival sulcus
TYPES OF ORAL MUCOSA

 Lining Mucosa – vestibule, alveolar mucosa

 Specialized Mucosa - dorsum of the tongue

 Masticatory Mucosa –
 Gingiva
 Hard palate
LINING MUCOSA
SPECIALIZED MUCOSA
MASTICATORY MUCOSA
Gingiva and Hard Palate
MASTICATORY MUCOSA: GINGIVA
MASTICATORY MUCOSA – ALVEOLAR MUCOSA
(GINGIVA) (LINING)
MASTICATORY MUCOSA
SURFACE CHARACTERISTICS OF
GINGIVA
 Color
 Contour
 Surface Texture
 Consistency/Density
 Sulcus
 Distributional Patterns
 Frenal Attachment/Tissue Elements
SURFACE CHARACTERISTICS OF
GINGIVA:
COLOR
SURFACE CHARACTERISTICS OF GINGIVA:
COLOR
SURFACE CHARACTERISTICS OF GINGIVA:
COLOR
SURFACE CHARACTERISTICS OF GINGIVA:
Contour-Surface Texture-Consistency-
Distributional Patterns
MASTICATORY MUCOSA: GINGIVAL
Facial Distributional Patterns

Range: 1- 9mm: Bowers, G. M.: JOP 1963

GINGIVAL DISTRIBUTION
PATTERNS
MASTICATORY MUCOSA:
GINGIVAL
Lingual Distributional Patterns

Range: 1- 5mm: Voight, J.: JOP 1977

GINGIVAL DISTRIBUTION
PATTERNS/FEATURES
MASTICATORY MUCOSA/GINGIVAL
DISTRIBUTION PATTERNS
FRENAL ATTACHMENTS/TISSUES
FACIAL
FRENAL ATTACHMENTS/TISSUES
LINGUAL
FRENAL ATTACHMENT TISSUES

Frenal Attachments Contain:

Connective Tissue Fibers
Fatty Tissues
Nerves
Blood Vessels

Frenal Attachments DO NOT Contain:

Muscles Fibers
SURFACE CHARACTERISTICS OF
GINGIVA:
Probing Patterns
SULCUS: DEPTH AND EXUDATIONS

- Normal sulcus depth = 1-3 millimeters

- Deeper in mesial and distal areas than mid tooth
- A principle criteria of health is the absence of bleeding or suppuration
- Probe penetrates into the junctional epithelium
- Depth of penetration is related to state of health and probing force
THE COL AREA: “A valley between two
peaks”
HISTOLOGICAL
FEATRUES OF THE
NORMAL
PERIODONTIUM
GINGIVAL EPITHELIUM

 ORAL
 Basal

 Spinous

 Granular
cell
 Cornified
BL- basal layer
PL- Spinous
layer
GL- Granular
layer
KL- Keratinized
layer
GINGIVAL EPITHELIUM – BASAL LAYER
GINGIVAL EPITHELIUM – SPINOUS LAYER
GINGIVAL EPITHELIUM – GRANULAR LAYER
GINGIVAL EPITHELIUM – CORNIFIED LAYER
PARA vs. ORTHO KERATINIZATION
 DENTOGINGIVAL JUNCTION

• Histologic Sulcus
• Junctional Epithelium
• Cemento-Enamel Junction
• Gingival Fiber Groups
• Attachment Apparatus
– Cementum
– PDL
– Alveolar Bone
GINGIVAL CONNECTIVE
TISSUES

 TYPES OF FIBERS  FIBER GROUPS

 COLLAGEN  DENTOGINGIVAL

 TYPE I, III, IV  DENTOPERIOSTEAL

 ELASTIC (DENTOALVEOLAR)
 OXYTALAN  TRANSEPTAL

 ELASTIN (ACCESSORY)
 CIRCULAR
 GINGIVAL CONNECTIVE
TISSUES
 FIBER GROUPS
 DENTOGINGIVAL

 DENTOPERIOSTEAL

(DENTOALVEOLAR)
 TRANSEPTAL

(ACCESSORY)
 CIRCULAR
 GINGIVAL CONNECTIVE TISSUES

 FIBER GROUPS
 DENTOGINGIVAL

 DENTOPERIOSTEAL

- DENTOALVEOLAR
 TRANSEPTAL

- ACCESSORY
 CIRCULAR
GINGIVAL CONNECTIVE TISSUES
 FIBER GROUPS
 TRANSEPTAL/ACCESSORY
GINGIVAL CONNECTIVE TISSUES
 FIBER GROUPS
 Circular Fibers ?
GINGIVAL CONNECTIVE TISSUES
 FIBER GROUPS
 Circular Fibers!!!

Arnim, S. & Hagerman, D.: JADA 1953

THE EPITHELIAL-CONNECTIVE
TISSUE INTERFACE
 THE EPITHELIAL-CONNECTIVE
TISSUE INTERFACE

Three Levels of Interdigitation:

1) Epithelial Rete Pegs-C.T. Papillae
2) Basal Cell “Undulations”
3) Anchoring Fibrils
• THE BASAL LAMINA – is a “Trilaminar” structure
consisting of a:
- Lamina Densa, Lamina Lucida and Hemi-
desmosomes
- The Lamina Densa will face enamel, cementum
or the
underlying connective tissues
- The Hemidesmosomes always face the
epithelium
- The epithelium is identified by the presence of
Tonofilamen and Desmosomes
TTOU
CHOU
CH
BIOLOGIC
WIDTH
CONCEPT

Histologic Sulcus 0.69mm

Epithelial Attachment 0.97mm
C.T. Attachment 1.07mm

BIOLOGIC WIDTH 2.04mm

FOCUS AREAS FOR SUGGESTED STUDY

 Surface Characteristics of Gingiva

 Clinical: distribution and measurement methods
 Gingival Epithelial Layers
 Important Differences between Gingiva and Alveolar
mucosa
 Dentogingival Junction – Light and EM
 Gingival Connective Tissue Fibers and Groups
 Blood and Nerve Supply
 Clinical Significance
PERIODONTAL
ANATOMY AND
HISTOLOGY
THE ATTACHMENT
APPARATUS
 PERIODONTAL LIGAMENT

 CEMENTUM

 ALVEOLAR BONE
THE PERIODONTAL LIGAMENT
(PDL)
ORIGIN AND DEVELOPMENT
 Principal fibers are white, inelastic fibers,
consisting of primarily Type I collagen
 Due to their configuration they allow for
slight tooth movement within the socket
 The average width is 0.25mm, but varies
with location apico-coronally, and
function
 Insert into cementum or bone via
Sharpey’s Fibers
THE PERIODONTAL LIGAMENT (PDL)

 FIBER GROUPS

1. ALVEOLAR CREST
2. HORIZONTAL
3. OBLIQUE
4. APICAL
5. INTER-RADICULAR
PDL: FIBER GROUPS

1. ALVEOLARCREST
2. HORIZONTAL
3. OBLIQUE
4. APICAL
5. INTER-
RADICULAR
FIBER GROUPS - ALVEOLAR CREST

PROPOSED FUNCTION: MAINTAIN ALVEOLAR BONE HEIGHT

FIBER GROUPS - HORIZONTAL

PROPOSED FUNCTION: RESIST LATERAL FORCES

FIBER GROUPS - OBLIQUE

PROPOSED FUNCTION: RESIST VERTICAL FORCES

FIBER GROUPS - OBLIQUE

PROPOSED FUNCTION: RESIST VERTICAL FORCES

 FIBER GROUPS - APICAL

UNCLEAR – NOT FOUND IN ERUPTING OR RESORBING TEETH ROOTS

 THE PERIODONTAL LIGAMENT (PDL)
 FUNCTIONS OF THE PERIODONTAL LIGAMENT

1. ATTACHMENT

1. SENSORY

2. FORMATIVE/REGENERATIVE
FUNCTIONS OF THE PDL:

1. ATTACHMENT
FUNCTIONS OF THE PDL:

1. ATTACHMENT
FUNCTIONS OF THE PDL:
1. ATTACHMENT
FUNCTIONS OF THE PDL:
1. ATTACHMENT
FUNCTIONS OF THE PERIODONTAL LIGAMENT:

2. SENSORY

a. Rich nerve complex

b. Proprioception
FUNCTIONS OF THE PDL:
3. FORMATIVE - HEALING AND REGENERATION

Interstitial Spaces contain Undifferentiated Mesenchymal cells

PDL - Structure and Components:
Epithelial Rests of Malassez
PDL - Structure and Components:
Epithelial Rests of Malassez

EM of
Proliferating
epithelial rest as
found in older
adults

Degenerative rests
are found in 30-40
y-o age groups
1. Through alveolar
bone

2. Along the
periosteal surface

3. Terminal branches
forming
anastomoses and
terminal loops