DENTOGINGIVAL

UNIT
By- Dr Rohit Rai

Content
Junctional epithelium
Gingival fiber
Clinical importance of dentogingival unit

JUNCTIONAL
EPITHELIUM

In 1921, Gottlieb discovered that the epithelium of

the gingiva is in organic connection with the enamel
surface and therefore only a shallow crevice exists
at the free border of the gingiva. Gottlieb called the
relation between epithelium and enamel, "Epithel
Ansatz"epithelial attachment. The word
"Ansatz"attachment was used to connote a
relation similar to that existing between a muscle or
tendon to a bone.
.

. Orban (1956) suggested that the attachment of

the epithelium to the tooth should be considered as
part of the dento-gingival junction.
And term, "attached epithelial cuff" should be used
instead of the term epithelial attachment.
(Journal of Periodontology 1956 Jul (167 - 180): The Epithelial Attachment (The Attached
Epithelial Cuff) by Balint J. Orban)

 Attached epithelial cuff extends from the apical

aspect of the gingival sulcus to the cemento-enamel
junction. It is widest in its coronal portion (about 1520 cell layers), but becomes thinner towards the
cemento enamel junction (CEJ)
Consists of a collar-like band of stratified squamous
nonkeratinized epithelium.
it is 3 to 4 layers thick in early life, but the number of
layers increases with age to 10 or even 20; these cells
can be grouped in two strata; basal and suprabasal
Length of the junctional epithelium ranges from 0.25
to 1.35mm

 Expresses K19 (which is absent from keratinized

epithelia) and the stratification specific cytokeratins K5
and K14.
Morgan et al reported that reactions to demonstrate K4 or
K13 reveal a sudden change between sulcular and
junctional epithelium, with the junctional area being the
only stratified non keratinized epithelium in the oral
cavity that does not synthesize these specific polypeptides
Lack of expression of K6 and K16 (proliferation
specific keratins), although the turnover of the cells is
very high.

 Similar
to
sulcular
epithelium,
junctional
epithelium exhibits less
glycolytic enzyme activity
than outer epithelium and
lacks acid phosphatase
activities.

 There are relatively few intercellular junctions and

distensible intercellular spaces,and the adhesion
between the epithelial cells thereby is reduced as
compared with other gingival epithelia.
The spaces enable diffusion of tissue fluids from the
connective tissue through epithelium into the gingival
sulcus.It also explains its susceptibility to tearing
during probing.
The unkeratinized surface,the orientation of cells with
their long axis parallel to the tooth and the
intercellular spaces permit the passage of bacterial
products from the gingival sulcus to the connective
tissue.

Cell layers which are not juxtaposed to the tooth exhibit numerous free ribosomes and
prominent membrane-bound structures such as Golgi complexes and cytoplasmic
vacuoles,presumably phagocytic.
* Langerhans cells are present.
* Lysosome-like bodies are also present .
* Keratinosomes are absent.
* Lacks acid phosphatase activity
.
* The borderline between the junctional epithelium and the underlying connective
tissue doesnot present epithelial retepegs except when inflamed.

 Junctional epithelium attaches :to the

1.The tooth surface (epithelial

attachment) by
internal basal lamina
2.The gingival connective tissue by
external basal lamina

Area of greater permeability and

Numerous intercellular spaces

Area of greater attachment with

Greater number of
hemidesmosomes
Fewer hemidesmosomes &
Cells with Germinative
characteristics

Listgarten (1972) has

calculated that the rate
of cellular exfoliation
from a unit surface of
JE.it has been found
that JE is 50-100 times
faster than that of oral
gingival epithelium.

Dento
Gingival
Junction

TOOTH ERUPTION AND FORMATION OF JUNCTIONAL

EPITHELIUM

Functions of dentogingival unit :

1. Provide additional support for the teeth
2. Protect the underlying alveolar bone
It has:- a cellular compartment

+
Extracellular compartment composed of fibers and
ground substance.
Lamina propria consists of 2 layers :1) Papillary layer subjacent to the epithelium which consists of
papillary projections between epithelial rete pegs.
2) Reticular layer contiguous with the periosteum of alveolar
bone.

Connective tissue of gingiva

Collagen Fibroblasts
fibres
(5%)
(60%)

Vessels,
nerves
and
matrix
(35%)

 connective tissue is produced mainly by fibroblasts,

although some constituents are produced by mast cells
and other components are derived from blood.
It facilitates cell movement and the diffusion of
various biologically active substances including gases,
minerals, nutrients, waste products,hormones,enzymes
etc.

Glycoprote
in

Proteoglyc
an

fibronectin
laminin
osteonectin
tenascin
elastin.

hyaluronic acid
Chondroitin sulfate
heparan sulfate
dermatan sulfate
Decorin
Biglycan
Versican
Syndecan

* The name collagen comes from Greek meaning glue

producer.When collagen is heated in water,it gradually
breaks down to produce soluble derived protein i.e.
gelatin or animal glue.
* Collagen type I forms the bulk of lamina propria and
provides the tensile strength to gingival tissue.
Basic structure of type I collagen is a rod-like molecule
approximately 300nm long and 1.5nm in
diameter,composed of 3 polypeptide chains ( chains)
wrapped together in a right-handed helix.

* Type IV collagen is found in basement

membrane.
* Electron micrograph of collagen shows
crossbanding with a periodicity of 700 between
the individual dark bands.

* Type III collagen (argyrophilic reticulum

fibers known so because they readily take
up silver stain) branches between the
collagen type I bundles and is continuous
with fibers of the basement membrane and
blood vessel walls.Molecular structure
[1(III)]3.

Type V collagen has a parallel filamentous pattern and coats collagen type I and
III fibers.
*Type VII collagen forms the anchoring fibrils,which are part of subepithelial
basement membrane
collagen type VI is present as diffuse microfibrils around blood vessels and near
epithelial basement membrane and nerves.

Functions of gingival fibers :1) To brace the marginal gingiva firmly against the tooth.
2) To provide the rigidity necessary to withstand the forces of mastication
without being deflected away from the tooth surface.
3) To unite the free marginal gingiva with the cementum of the root and the
adjacent attached gingiva.

STRUCTURE OF A COLLAGEN FIBER

TYPES OF GINGIVAL
FIBERS

1) Circular fibers
3) Intercircular fibers
5) Transseptal fibers
7) Interpapillary fibers

2) Dentogingival fibers
4) Intergingival fibers
6) Transgingival fibers

ORIENTATION OF DIFFERENT GROUPS OF GINGIVAL FIBERS

Connective tissue fibers

Collag
en

Reticuli
n

Fibre
s

Elastic

Oxytal
an

* Tractional forces in the extracellular matrix produced by fibroblasts are

believed to be the forces responsible for generating tension in the
collagen.This keeps the teeth tightly bound to the alveolar bone.

Reticulin Fibers
Exhibit argyrophilic-staining properties
Numerous in the tissue adjacent to the basement membrane.
Also occur in large numbers in the loose connective tissue surrounding
the blood vessels. Thus, reticulin fibers are present at the epitheliumconnective tissue and the endothelium-connective tissue interfaces.

Oxytalan fibers
Present in the gingiva and the periodontal ligament and seen to be
composed of long thin fibrils with a diameter of approximately 150A0.
Can be demonstrated light microscopically only after previous
oxidation with peracetic acid.
Function - yet unknown.

Elastic fibers (Elaunin & oxytalan)

Elauni
n

represent another form

of elastic tissue
consisting of bundles
of microfibrils
embedded with in a
small quantity of
elastin

Oxytalan fibers
run more or less vertically form the cementum surface of the root apically,
forming a three-dimensional branching meshwork that surrounds the root and
terminates in the apical complex of arteries, veins and lymphatics
also affiliated with neural elements.
numerous and dense in the cervical region of the ligament, where they run
parallel to the gingival group of collagen fibers
function -not been fully determined, they are thought to regulate vascular flow in
relation to tooth functions.
Because they are elastic, they can expand in response to tensional variations,
with such variations then registered on the walls of the vascular structure

1) Fibroblasts found between fiber bundles.

- Constitute the preponderant cellular element in gingival
connective tissue (65% of total cell population).
- Mesenchymal in origin.
Functions :a) Synthesize collagen and elastic fibers.
b) Synthesize glycoproteins and glycosaminoglycans of the
amorphous intercellular substance.
c) Regulate collagen degradation through phagocytosis and
secretion of intercellular substance.

d) They exhibit contractility and motility.

* In this manner,they play a major role in the development,maintenance and repair of
gingival connective tissue.
* They are spindle-shaped or stellate cells with an oval-shaped nucleus.
* Cytoplasm contains well-developed RER,Golgi complex,mitochondria and many fine
tonofilaments.
* Adjacent to the cell membrane,all along the periphery of the cell,a large number of
vesicles can be found.

* They reside in a network of connective

tissue fibers.The intervening space is filled
with matrix which constitutes the
environment of the cell.
* Are the Architect builder and caretaker of
connective tissue.

fibroblast

Ultrastructure of fibroblast

Mast cell
2) Mast cells are responsible for production of certain components of the matrix.
- Also produce vasoactive substances which can affect the function of the microvascular
system and control the flow of blood through the tissue.
- Cytoplasm is characterized by the presence of a large number of vesicles of varying
size.These vesicles stain with certain basic dyes such as methylene blue and contain
biologically active substances such as proteolytic enzymes, histamine and heparin.
(Oral Histology-Ten Cate)

- Heparin regulates rate of bone resorption.

- Well developed Golgi complex,scarce RER.

- They decrease in mild inflammation and increase in chronic inflammation.
(Periodontics-Grant,Listgarten)

- A large number of small cytoplasmic projections i.e. microvilli can be seen

along the periphery of the cell.

Mast cell

3) Fixed macrophages and histiocytes are components of the mononuclear

phagocyte system (reticulo-endothelial system).
- Derived from circulating blood monocytes which migrate into the tissue.
- Nucleus is characterized by numerous invaginations of varying size.A zone of
electron-dense chromatin condensations can be seen along the periphery of the nucleus.
- Well developed Golgi complex.
- Numerous vesicles of varying size present in the cytoplasm.

- Scarce RER but a certain number of free ribosomes are evenly distributed in the
cytoplasm.
- Remnants of phagocytosed material are often found in lysosomal vesiclesphagosomes.
- A large number of microvilli of varying size can be seen in the periphery of the cell.
- They are particularly numerous in inflamed tissue.

4) Inflammatory cells
a) Neutrophils can be seen in relatively high
number in both the gingival connective tissue and the
sulcus.
- Nucleus is lobulate.
- Numerous lysosomes containing lysosomal enzymes are
found in the cytoplasm.
b) Lymphocytes- are characterized by an oval to
spherical nucleus containing localized areas of electrondense chromatin.

- Cytoplasm contains lysosomes,numerous free ribosomes,few mitochondria and in

localized areas endoplasmic reticulum with fixed ribosomes.
- Lymphocytes are absent when gingival normalcy is judged by strict clinical criteria
or under special experimental conditions;but they are practically constant in healthy
normal gingiva,even before the complete tooth eruption.
- Immunohistochemical studies using monoclonal antibodies have identified the
different lymphocyte subpopulations:-

a) T lymphocytes (helper,cytotoxic,suppressor and natural killer) present

in the infiltrate in the area below the junctional epithelium of healthy
gingiva in newly erupted teeth in children.
- thus interpreted as a normal lymphoid tissue involved in the early defense
recognition system.
b) B lymphocytes appear as time elapses.
c) Plasma cells contain an eccentrically located spherical nucleus with
radially deployed electron-dense chromatin.

* Endoplasmic reticulum with numerous ribosomes is found

randomly distributed in the cytoplasm.
- Cytoplasm contains numerous mitochondria and a well
developed Golgi complex.
- Elaborate specific antibodies against already recognized antigens
are always present in the sulcus of clinically normal gingiva.
plasma cell

5) Adipose cells and eosinophils may also be found in low number.

* The cellular activities in connective tissue are widely mediated by growth

factors and cytokines released from the cells in the periodontal
environment.Other mediating functions rely on extracellular matrix
components.The cells may be triggered to release mediators,which results in
either catabolic or anabolic processes.

The lamina propria of the gingiva has properties that distinguish it from the
connective tissue of the PDL :-Fibroblasts lack alkaline phosphatase,have less contractile proteins
and can release more prostaglandins in response to histamine.
- Extracellular matrix has less ground substance,less type III collagen,is
hyaluronan- rich and has a lower turnover rate.
(Oral Histology-Berkovitz)

Clinical significance
Repair of gingival connective tissue :* Because of the high turnover rate,the connective tissue of the gingiva has
remarkably good healing and regenerative capacity.
* It is one of the best healing tissues in the body and generally shows little
evidence of scarring after surgical procedures.This is caused by rapid
reconstruction of the fibrous architecture of the tissues.
* However,the reparative capacity of the gingival connective tissue is not as
great as that of the PDL or the epithelial tissue.

* Dental procedures such as root planing, subgingival restorative procedures

and crown and bridge gingival retraction techniques all damage both the
epithelium and gingival connective tissue.
* It is essential that dental procedures should be as atraumatic as possible so
that sufficient volume of gingival collagen fibers are maintained to hold the
healing gingiva close to the roots.This allows a new,intact epithelial lining of
the gingival sulcus to be quickly reconstituted and thus heal without any loss
of attachment.

Conclusion

References
Carranzas Clinical periodontology 10th edition
Carranzas Clinical periodontology 9th edition