Ginguva

1. Si Dr. Carlos T. Capitan II
na po ang susunod .
Merry Christmas po sa inyong lahat !

2. CONTENTS
 Nerve supply
 Correlation of clinical and microscopic features
 Repair/healing of gingiva
 Age changes
 Gingival diseases
 Oral Mucosa- Alveolar Mucosa
 Clinical considerations
 Conclusion
 References
 Introduction
 Definition
 Development of gingiva
 Macroscopic anatomy
 Microscopic anatomy
 Blood supply
 Lymphaticdrainage

3. The nerve supply of gingiva follows the course of vascular supply. In the
maxilla, the gingiva is supplied by the posterior, middle and the anterior
superior alveolar nerve, branches of the infraorbital nerve, the greater palatine
nerve, and nasopalatine nerve.
NERVE SUPPLY

4. In the mandible, the gingiva is largely supplied by the inferior alveolar nerve.
The buccal nerve supplies the gingiva in relation to the molars and premolars.
The branches of the lingual nerve supply the gingiva on the lingual aspect of
all lower teeth. Most of the nerve endings in the gingiva terminate within the
lamina propria. Only a few nerve endings are present in the epithelium..
Various neural terminal
endings present in gingiva.
Include Meissner
corpuscles, krause type end
bulbs and encapsulated
spindles.

5. CORRELATION OF CLINICAL AND
MICROSCOPIC FEATURES

6. • Generally coral pink.
• Color is a result of:
• - Vascular supply Thickness
- Degree of keratinisation of epithelium,
- Presence of pigment containing cells.
• - Color to be correlated with cutaneous pigmentation
Color

7. Gingival Hyperpigmentation(melanin)
• It results from melanin granules, which are produced by melanoblasts.
Melanin, a non-hemoglobin–derived brown pigment, is the most common
of the endogenous pigments and is produced by melanocytes present in the
basal and suprabasal cell layers of the epithelium
• Prominent in blacks, diminished in albinos
As a diffuse , deep purplish discoloration or as irregularly shaped brown and
light brown patches and may appear as early as 3 hours after birth.

8. • 0.2 mm for marginal gingiva, 0-9 mm
for attached gingiva
Size
CHANGES IN SIZE OF
GINGIVA
- Normal size depends on the
sum of the bulk of cellular and
intercellular elements and their
vascular supply
- Alteration in size is a common feature of
gingival disease
- In disease, the size is increase in
bulk of cellular and intracellular
elements.

9. Contour
• Marginal gingiva envelops the teeth in collarlike fashion and follows a
scalloped outline on the facial and lingual surfaces.
• straight line - along teeth with relatively flat surfaces.
• accentuated - pronounced mesiodistal convexity (e.g., maxillary
canines) or teeth in labial version
• horizontal and thickened - in lingual version.

10. The shape of the interdental gingiva is governed by the contour of the
proximal tooth surfaces and the location and shape of the gingival
embrasures.
Anterior region of the dentition, the interdental papilla is pyramidal in form.
the papilla is more flattened in a buccolingual direction in the molar region.
Shape

11. • Shape depends on:
 Presence/absence of contact
 Distance btw contact point and osseous crest
 Course of CEJ
 Width of the approximate tooth surfaces
 Presence/absence of recession.

12. Consistency
• Firm and resilient
• Collagenous nature of the lamina propria and
its contiguity with the mucoperiosteum
determine the firmness of the attached
gingiva.
• The gingival fibers contribute to the firmness
of the gingival margin.
• If the gingiva is suppressed, the
proteoglycans become deformed and recoil
when the pressure is eliminated.
• Thus, the macromolecules are important for
the resilience of the gingiva.

13. • Healthy gums have stippled, translucent appearance.
• Orange peel appearance.
Surface Texture

14. • Reduction of stippling – common sign of Gingival disease.
• Stippling returns when gingiva is restored to health.
• Keratinisation – protective adaptation , increased by tooth
brushing.
• In 40% of adults Gingiva show stippling.
• Generalized absence of stippling is seen in:
Infancy
Diseased conditions like gingival enlargements, mucocutaneous
lesions affecting gingiva, inflammation etc.,

15. Position
• The level at which the gingival margin is attached to the tooth.
• Continuous eruption, even after meeting their functional antagonists occurs through
out life
Active Eruption :Movement of teeth in the direction of occlusal plane
Passive Eruption: exposure of the tooth by apical migration of Gingiva
• Gottlieb : active and passive eruption go hand in hand.
• Active eruption is coordinated with attrition, to compensate for tooth
substance worn away.
• Attrition reduces the clinical crown and prevents it from becoming disproportionately
long in relation to the clinical root, thus avoiding excessive leverage on periodontal
tissue.
• Rate of active eruption is in pace with tooth wear in order to preserve vertical
dimension.

17. • According to the concept of continuous eruption, the
gingival sulcus may be located on the crown, the
cementoenamel junction, or the root, depending on
the age of the patient and the stage of eruption.
• Therefore, some root exposure with age would be
considered normal and referred to as physiologic
recession.
• Again, this concept is not accepted at present.
• Excessive exposure is termed pathologic recession
GINGIVAL RECESSION OR ATROPHY
Exposure of the tooth via the apical migration of the gingiva is
called gingival recession or atrophy.

18. REPAIR/HEALING
OF GINGIVA
• Turnover rate is 10-12 days.
• It is one of the best healing tissues in the body with
little or no scarring.
• However the reparative capacity is lesser than that of
periodontal ligament and epithelial tissue.

19. AGE
CHANGES
Stippling usually disappears with age.
Width of the attached gingiva increases with age.
a. Gingival epithelium:
• Thinning and decreased keratinization
• Rete pegs flatten
• Migration of junctional epithelium apically.
• Reduced oxygen consumption.
b. Gingival connective tissue:
• Increased rate of conversion of soluble to insoluble collagen
• Increased mechanical strength of collagen
• Increased denaturing temperature of collagen
• Decreased rate of synthesis of collagen
• Greater collagen content.

20. GINGIVAL
DISEASES
Gingivitis associated with dental
plaque only
Gingival diseases modified by
systemic factors
Gingival diseases modified by
medications
Gingival diseases modified by
malnutrition
DENTAL-PLAQUE–
INDUCED
GINGIVAL
DISEASES

21. Gingival diseases of specific bacterial origin
Gingival diseases of viral origin
Gingival diseases of fungal origin
Gingival lesions of genetic origin
Gingival manifestations of systemic conditions
Traumatic lesions
Foreign-body reactions
Not otherwise specified
NONPLAQUE
INDUCED
GINGIVAL
DISEASES

22. CLINICAL
CONSIDERATIONS
• The biological width is defined as
the dimension of the soft tissue,
which is attached to the portion of
the tooth coronal to the crest of
the alveolar bone.
• Gargiulo et al.,:
• Established that there is a definite
proportional relationship between
the alveolar crest, the connective
tissue attachment, the epithelial
attachment, and the sulcus depth.
BIOLOGICAL WIDTH

23. • They reported the following mean dimensions:
 A sulcus depth of 0.69 mm, (a)
 an epithelial attachment of 0.97 mm,(b)
 connective tissue attachment of 1.07 mm.(c)
The biologic width is commonly stated to be 2.04 mm,(b+c)
which represents the sum of the epithelial and connective tissue
measurements.

24. Biologic Width Evaluation:
1. Clinical (discomfort when the restoration margin levels are being assessed
with a periodontal probe)
2. Radiographs (for interproximjal violation but mesiofacial and distofacial line
angle not seen properly)
3. Bone sounding (probing under anesthesia)
If this distance is less than 2 mm or more at one or more locations, a diagnosis
of biologic width violation can be confirmed
Biologic width violation:
• Unpredictable bone loss
• Gingival recession
• Persistence of ginigivitis

25. GINGIVAL BIOTYPE
• Gingival biotype is described as the thickness of the gingiva in the
faciopalatal/ faciolingual dimension.
• Seibert and Lindhe categorized the gingiva into:
1. thick-flat: A gingival thickness of ≥ 2 mm
2. thin scalloped: a gingival thickness of <1.5 mm
• Significant impact on the outcome of the restorative, regenerative and
implant therapy.
• Direct co-relation exists with the susceptibility of gingival recession followed
by any surgical procedure.

26. Thick blunted:
Resists recession
reacts to surgical & restorative
insults with pocket formation
Thin scalloped:
Attached soft tissue is minimal
Bony dehiscence & fenestration defects
Reacts to surgical or restorative
interventions with ST recession, apical
migration of attachment & loss of
underlying alveolar volume .

27. Three primary types of oral mucosa:
1. lining mucosa
2. masticatory mucosa
3. specialized mucosa.
Oral Mucosa
Source: www.icoi.org glossary
Lining mucosa includes the buccal mucosa,
labial mucosa, alveolar mucosa, as well as the
mucosa lining the ventral surface of the tongue, floor
of the mouth, and soft palate. Histologically, lining
mucosa is a type that is associated with
nonkeratinized stratified squamous epithelium
Masticatory Mucosa. A stratified squamous
keratinized epithelium is found on surfaces subject to the
abrasion that occurs with mastication, e.g., the roof of the mouth
(palate) and gums (gingiva). The type of epithelium that covers
the lining mucosa is a non-keratinized stratified squamous
epithelium .
It is the rigid mucosa tightly bound to the underlying bone in the
attached gingiva and hard palate.
Specialized mucosa is found on the dorsal surface
of the tongue, as well as the lateral surface of the tongue, in the
form of the lingual papillae.

28. Alveolar mucosa
is the soft, thin mucous membrane
that sits above the marginal gingiva
and the attached gingiva, and continues
across the floor of the mouth, cheeks, and
lips. It is bright red in color due to being
rich with blood vessels, and is shiny and
smooth in appearance.
it is made up of nonkeratinized stratified squamous epithelium, making it
delicate and sometimes difficult to work with.
In oral implantology, it’s crucial to keep the alveolar mucosa intact, particularly
when implants are done in the front of the mouth. Disruption of the alveolar
mucosa can impact the aesthetic results of the procedure, leading to implant
failure. The buccal flap should be made carefully so as to keep the alveolar
mucosa intact.

29. 99
• Clinical Periodontology By Carranza, 12th Edition
• Clinical Periodontology And Implant Dentistry By Jan
Lindhe, 4th Edition.
• Biology Of Periodontal Connective Tissue-bartold And
Sampath Narayana
• Oral Histology, Development, Structure And Function – A.R.
Tencate, 5th Edition
• PERIODONTICS REVISITED Shalu Bathla, 1st Edition
REFERENCES

30. • Gingival tissues play a key role in the protection of tooth
structures and supporting periodontal tissues against trauma
and/or infection
• Making the gingival health, a very essential component for the
success of all periodontal treatment procedures.
• Therefore, Gingiva, a small tissue is a big issue for the fraternity
of periodontics.
CONCLUSION

31. • Babita Pawar, Pratishtha Mishra, Parmeet Banga, and P. P. Marawar.
Gingival zenith and its role in redefining esthetics: A clinical study. J
Indian Soc Periodontol. 2011 Apr-Jun; 15(2): 135–138.
• Niklaus P. Lang, and Harald Löe. The Relationship Between the Width of
Keratinized Gingiva and Gingival Health. J Periodontol. 1972
Oct;43(10):623-7.
• Gerald M. Bowers. A Study of the Width of Attached Gingiva. Journal of
Periodontology,May 1963, Vol. 34, No. 3, Pages 201-209
• Wennström JL. Lack of association between width of attached gingiva
and development of soft tissue recession. A 5-year longitudinal study. J
Clin Periodontol. 1987 Mar;14(3):181-4

32. • Mehta P, Lim LP. The width of the attached gingiva--much ado about
nothing? J Dent. 2010 Jul;38(7):517-25.
• Molecular and Cell Biology of the Gingiva, Periodontology 2000; Vol 24;
2000; 28-55.