NORMAL CLINICAL FEATURES OF THE GINGIVA

By

Dr. Marcel Hallare

COLOR

The color of the attached and marginal gingivae is generally described as coral pink and is produced by the vascular supply, the thickness and degree of keratinization of the epithelium, and the presence of pigment-containing cells

PHYSIOLOGIC PIGMENTATION (MELANIN)

Melanin, a non-hemoglobin-derived brown pigment is responsible for the normal pigmentation of the skin, gingiva, and remainder or the oral mucous membrane

SIZE

Size of gingiva corresponds to the sum total of the bulk of cellular elements and their blood supply Alteration in size is a common feature of gingival disease

CONTOUR

The marginal gingiva envelops the teeth in collar-like fashion and follows a scalloped outline on the facial and lingual surfaces It forms a straight line along teeth with relatively flat surfaces On teeth with pronounced mesiodistal convexity of teeth in labioversion, the normal arcuate contour is accentuated and the gingiva is located further apically On teeth in linguoversion, the gingiva is horizontal and thickened

SHAPE

The shape of the interdental gingiva is governed by the contour of the proximal tooth surfaces and the location and shape of gingival embrasures

CONSISTENCY

The gingiva is firm and resilient and, with exception of the movable free margin, tightly bound to the underlying bone

SURFACE TEXTURE

The gingiva presents a textured surface like that of an orange peel and is referred to as being stippled The attached gingiva is stippled; the marginal gingiva is not The central portion of the interdental papillae is usually stippled, but the marginal borders are smooth

Stippling varies with age. It is absent in infancy, increases until adulthood , and frequently begins to disappear in old age. Microscopically, stippling is produced by alternate rounded protuberances and depressions in the gingival surface The papillary layer of the connective tissue projects into the elevations, and both the elevated and the depressed areas are covered by stratified squamous epithelium

Stippling is a form of adaptive specialization or reinforcement for function. It is a feature of healthy gingiva, and reduced or loss of stippling is a common sign of gingival disease When the gingiva is restored to health following treatment, the stippled appearance returns

The surface texture of the gingiva is also related to the presence and degree of epithelial keratinization Keratinization is considered to be a protective adaptation to function. It increases when the gingiva is stimulated by toothbrushing

PERIODONTAL LIGAMENT

The periodontal ligament is the connective tissue structure that surrounds the root and connects it with bone It is continuous with connective tissue of the gingiva and communicates with the marrow spaces through vascular channels in the bone

Dense fibrous connective tissue attaching the tooth to the alveolar bone
Functionto support the tooth in the alveolus & to maintain the physiologic relation between the cementum and bone

NORMAL MICROSCOPIC FEATURES

The most important elements of the periodontal ligament are the principal fibers, which are collagenous, arranged in bundles, and follow a wavy course when viewed in longitudinal section Terminal portions of the principal fibers that insert into cementum and bone are termed Sharpeys fibers

PRINCIPAL FIBERS
Transseptal Group extend interproximally over the alveolar crest and are embedded in the cementum of adjacent teeth Alveolar Crest Group extend obliquely from the cementum just beneath the Junctional epithelium to the alveolar crest and their function is to counterbalance the coronal thrust of the more apical fibers, thus helping to retain the tooth within the socket and resists Horizontal Group their fibers extend at right angles to the long axis of the teeth from the cementum to the alveolar bone and function is similar to alveolar crest group Oblique Group largest group in the periodontal ligament, extends from the cementum in a coronal direction obliquely to the bone and bears the brunt of vertical masticatory stresses and transform them into tension on the alveolar bone Apical Group they radiate from the cementum to the bone at the fundus of the socket and not present in incompletely formed roots

Other Fibers

Elastic fibers - this group of fibers are scarce and are confined to the loose connective tissue surrounding neurovascular channels Oxytalan - is found interspersed among the collagen fibers, and is morphologically similar to those in gingiva and run in an occluso-apical direction associated with blood vessels and nerve fibers. They are found more often on the cemental than on the bony side of the ligament Indifferent fiber plexus - appears to course parallel to the root surface, forming a loose intersecting network and may also be incorporated into the mineralized matrices

CELLS

The main function of periodontal ligament cells is to maintain the normal organization of the fiber system by synthesizing new fibers and remove old ones Generally the cellular density in periodontal ligament is greatest in young individuals and decrease with age Cellular density also increases with heavy function and decreases with lack of function

FIBROBLAST

They make up the major cellular population of the ligament principal cells of the periodontal ligament Their function is to synthesize collagen, which aggregates into fibrils and fibers extracellularly

CEMENTOPROGENITOR AND OSTEOPROGENITOR CELLS

CEMENTOBLASTS Are observed during active deposition of cellular cementum OSTEOBLASTS Found in the peripheral part of the periodontal ligament adjacent to bone and seen where alveolar bone is deposited OSTEOCLASTS and ODONTOCLASTS Osteoclasts work with osteoblasts to remodel existing alveolar bone. Odontoclasts can resorb mineralized dental tissue, including cementum

EPITHELIAL CELLS They are commonly found in the ligament close to cementum. They originate from Hertwigs epithelial root sheath Undifferentiated mesenchymal cells OR PROGENITOR CELLS -- These cells have a perivascular location within 5 micrometers of blood vessels and a source of new cells for the periodontal ligament

MACROPHAGES In the ligament are important defense cells because of their phagocytic activity and mobility (take up bacteria, dead cells and foreign bodies) LEUCOCYTES Individual leukocytes, specially small lymphocytes and plasma cells may appear in periodontium when it is stressed by disease

VASCULAR SUPPLY

Compared with other connective tissues, the periodontal ligament is exceptionally well vascularized, which reflects the high rate of turnover of its cellular constituents Its main blood supply is from the SUPERIOR AND INFERIOR ALVEOLAR ARTERIES

NERVES

The periodontal ligament contains both sensory and autonomic nerve endings The sensory nerve endings are able to identify pain and pressure The mechanoreceptors for pressure are extremely sensitive and are able to detect minute particles between occluding tooth surfaces The autonomic innervation that originates from the superior cervical ganglion is primarily responsible for the control of smooth muscles associated with the periodontal vasculature

FUNCTIONS OF THE PERIODONTAL LIGAMENT

PHYSICAL FORMATIVE NUTRATIVE AND SENSORY

PHYSICAL

Transmission occlusal forces to the bone attachment of teeth to bone maintenance of the gingival tissues in their proper relationship to the teeth resistance to the impact of occlusal forces (shock absorption) provision of soft tissue casing to protect the vessels and nerves from injury by mechanical forces

FORMATIVE

Periodontal ligament serves as the periosteum for cementum and bone Cells of the periodontal ligament participate in the formation and resorption of cementum and bone which occur in physiologic tooth movement In the accommodation of the periodontium to occlusal forces and in the repair of injuries

NUTRATIVE

The periodontal ligament supplies nutrients to the cementum, bone, and gingiva by way of the blood vessels and provides lymphatic drainage

SENSORY

The innervation of the periodontal ligament provides proprioceptive and tactile sensitivity which detects and localizes external forces acting upon the individual teeth and serves an important role in the neuromuscular mechanism controlling the masticatory musculature