© 2021 American Academy of Periodontology, I have read and accept the Wiley Online Library Terms and Conditions of Use. Use the link below to share a full-text version of this article with your friends and colleagues. Pitaru S, McCulloch CA, Narayanan SA. In gingival health, the gingival … Adaptation: These tissues have the capability to adapt to the changes in the external environment and wear associated with aging through a continuous process of remodeling and regeneration. The oral gingival epithelium expresses K5, K14, K1, K2, K10, K11, K6, K8, K16, K18, and K19. and you may need to create a new Wiley Online Library account. … If you do not receive an email within 10 minutes, your email address may not be registered, In general, sulcular depth less than 2 to 3 mm in humans and animals is considered as normal 11. It covers the floor of the mouth, ventral (underside) tongue, alveolar mucosa, cheeks, lips, and soft palate. It is a feature of healthy gingiva, and reduction or loss ot stippling is a common sign of gingival disease. It does not function during mastication and therefore is non-keratinized, soft and pliable. However, it must be remembered that the depth of a sulcus histologically (histological sulcus depth) is not necessarily the same as the depth which could be measured with a periodontal probe (clinical sulcus depth). These are modified lysosomes, which contain ………………….Content available in the hard-copy of the website……………………………. The term biotype has been replaced by the term phenotype in the recent (2017) world workshop classification system. In the “bud stage”, also referred to as primordia of enamel organ, two types …………………..Content available in the hard-copy of the website…………………………….Content available in the hard-copy of the website……….. In the posterior teeth, the apex of the interdental gingiva is blunted with buccal and lingual peaks. Conclusion: Gingival stippling was seen as a normal characteristic in both male and female. Periodontal maintenance (Supportive periodontal therapy), Orthodontic-periodontal interrelationship, Piezosurgery in periodontics and oral implantology. There are a large number of biologically active substances that may stimulate or suppress ……………………Content available in the hard-copy of the website……………………………. The oral mucosa has been traditionally divided into three categories: lining mucosa, specialized mucosa, and masticatory mucosa. Research has shown increased expression of integrins 62, intercellular adhesion molecule-1 (ICAM-1), It has been demonstrated that expression of integrins especially those functioning as fibronectin receptors is increased in gingival epithelial cells during inflammation 66. Tissue Engineering Part A. Stratum spinosum consists of 10-20 layers of cells typically large in size, resembling spines. gingival stippling the presence of a minutely lobulated surface on the gingiva, like that of an orange peel; it is a normal adaptive process, varying from one person to another. Gingival tissues surrounding both the maxillary detention and the mandibular dentition may be affected. ICAM-1 molecule interacts with the leukocyte function associated with antigen-1 and is involved in the transmigration of neutrophil through the epithelium. Karring T, Lang NP, Löe H. The role of gingival connective tissue in determining epithelial differentiation. This … In conclusion, gingival stippling was found to be a normal characteristic in 56.3% of 3 to 10-year-old children, without significant differences in prevalence related to arch, gender or age. The normal appearance of healthy gingiva is shown in Figure 6-1. The attached gingiva is usually ‘stippled’, with small regularly spaced depressions on its surface, giving it an “orange peel appearance” 13, 14. If the destructive process continues, the tooth/teeth are ultimately lost. epithelium except for the lack of stratum corneum and it does not contain clearly defined stratum granulosum. The inflammation in the periodontal tissues due to plaque accumulation results in the conversion of normal sulcus into a pathological pocket. In normal periodontal tissues, it extends approximately 2 mm coronal to the cementoenamel junction (CEJ). It is relatively loosely bound to the adjacent structures by the connective tissue that is rich in elastin. Col is a depression between the buccal and lingual papillae which conforms to the interproximal contact area 24. Generally, the papillary surface is keratinized. They contain nuclei with clefts, lysosomes, centrioles, Golgi vesicles, a small amount of endoplasmic reticulum, and moderate numbers of mitochondria. Because it represents the area of fusion of junctional epithelium of two adjoining teeth, it is non-keratinized and is more susceptible to damage from plaque and other noxious stimuli as compared to the keratinized gingiva. In the edentulous infant, the gingival tissues present with thick gingival mucosa and segmentations that correspond with the primary buds (Figure 18-1).A high labial frenum attachment is a normal finding in almost 85% of infants, which may diminish in size with normal development. In the absence of inflammation and pocket formation, the gingival groove runs somewhat parallel to and about 0.5 to 1.5 mm from the gingival margin 4, and it is approximately at the level of the bottom of the gingival sulcus. Periodontal biotype refers to the hereditary thickness of periodontal tissue. The absence of stippling in anterior segment is usually associated with gingivitis unlike its regular absence in posterior segment which is considered as a normal feature. The cell surface adhesion molecules belong to the immunoglobulin class. These cells are of ectodermal origin migrating into mesenchymal tissue; therefore are also referred to as ectomesenchymal cells. They observed that during healing after gingivectomy, the maximum QO is achieved on the 2 fourteenth postoperative day. The older cells are continuously replaced by new cells so that the integrity of the tissue can be maintained. Many methods 28-45 have been used to determine the gingival thickness including injection needles, transgingival probing, histologic sections, cephalometric radiographs, probe transparency, ultrasonic devices, CBCT and conventional histology on cadaver jaws. It is the epithelium which lines the gingival sulcus. Content available in the hard-copy of the website……….. These are essentially the primordial dental arches. They are usually located in the basal layer. K6 and K16 are expressed in highly proliferative epithelia. K1, K2, K10, and K11 are expressed in the suprabasal layers of keratinized stratified squamous epithelia 83. As the root formation continues, the osteoblasts deposit bone around the root of the tooth. The cementoblasts derived from the dental follicle deposit cementum on the root surface and fibroblasts give rise to the periodontal ligament. 1994 Mar;29(2):81-94. The basal cells show a large number of hemidesmosomes firmly attaching to the lamina densa of the basal lamina. Stefan A. Hienz, Sašo Ivanovski, in Functional Occlusion in Restorative Dentistry and Prosthodontics, 2016. Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username. Rete pegs are not present in the sulcular epithelium. The Three-Dimensional Concept of the Epithelium-Connective Tissue Boundary of Gingiva. Para-keratinization is usually observed in the oral gingival epithelium which is characterized by an incomplete disintegration of the nucleus and cytoplasmic organelles. Stippling is (/ form of adaptive specie dilution or reinforcement for function. After appropriate pretreat- showed either no or very delicate signs of stippling. The lining mucosa constitutes about 60% of the total oral mucosa. On the basis of electron microscopic appearance, Langerhan’s cells have been divided into two types. Prevalence of gingival stippling in children. The keratin expression of gingival epithelium cells changes with their maturation. Oxygen consumption of gingiva: Working off-campus? Defense: They have an internal defense mechanism that protects them against the noxious stimuli present in the oral cavity. Periodontium comprises of root cementum, periodontal ligament, bone lining the tooth socket (alveolar bone), and the part of gingiva facing the tooth surfaces (dentogingival junction). Sinai Hospital, Cleveland, Ohio. Apically, it is bounded by the junctional epithelium and coronally it meets the outer gingival epithelium at the height of the free gingival margin. Attachment: They attach the teeth to their bony housing and also to one another. Periodontics is that specialty of dentistry which encompasses the prevention, diagnosis, and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes; the maintenance of the health, function, and esthetics of these structures and tissues; and the replacement of lost teeth and supporting structures by grafting or implantation of natural and synthetic devices and materials 1. These patients are less likely to have gingival recession, but more likely to have exostoses and intrabony defects during periodontitis 27. Its absence or reduction indicates … This condition can only be achieved in germfree animals or after prolonged and stringent plaque control 6, 7. In the following discussion, we shall discuss in detail various tooth-supporting structures, their development, structural organization, function and their ability to adapt to the changes in the surrounding environment. Journal of periodontal research. The proliferation of the keratinocytes takes place by mitosis primarily in the basal layer and to some extent in the suprabasal layers. In their classical studies Glickman et al. Various disease processes around the teeth result in the destruction of periodontal tissues, thus making them mobile. The sulcular epithelium is relatively less permeable to water soluble substances as compared to junctional epithelium but is more permeable as compared to the oral epithelium. Morphologically, they become more flattened as they move from basal layer towards the surface. It is found in the skin and may also be seen in the gingival epithelium. 6 Gingival … A thick periodontal biotype displays a thick and wide gingiva, wider teeth and thicker bone. The renewal time or the turnover time is the time taken for complete renewal of the tissue. They have a protective role due to their ability to interact with active oxygen species (O 2-, H O , RO, ROO, etc.) Specialized mucosa makes around 15% of the total oral mucosa. Content available in the hard-copy of the website……….. It has been demonstrated that expression of integrins especially those functioning as fibronectin receptors is increased in gingival epithelial cells during inflammation 66. The histological studies have reported the sulcus depth of 1.8 mm in healthy periodontium with a variation of 0-6 mm 8. These cells have synaptic contacts with somatosensory afferents and are associated with the sense of light touch discrimination 82. Content available in the hard-copy of the website……….. They have protective action against ultraviolet irradiation and have also been shown to be responsive to many immunological mediators, Dendritic cells are potent antigen-presenting cells and may be the only cells capable of initiating the adaptive immune response. Type 1: They are pyramidal in shape and are highly dendritic with an electron-lucent cytoplasm. They perform distinct functions and are capable of adapting to the changes in the environment around them. The first step in our journey to understand Periodontology starts with a thorough understanding of the normal periodontium and structure of periodontal tissues in health. Archives of oral biology. Following expression of keratins is observed in stratified squamous epithelium. They have numerous Birbeck granules and are usually found in the suprabasal layers. It is relatively loosely bound to the adjacent structures by the connective tissue that is rich in elastin. The gingival epithelium can be further divided into three functional compartments: outer gingival epithelium, sulcular epithelium, and junctional epithelium. Ortho-keratinization is characterized by a complete disintegration of the nucleus and cytoplasmic organelles. The unique functions that these tissues carry out are. epithelium except for the lack of stratum corneum and it does not contain clearly defined stratum granulosum. Merkel cells, Tactile cells, or Merkel-Ranvier cells are oval-shaped receptor cells found in the deeper layers of the epithelium. Excessive keratohyalin bodies and tonofibrils are seen in the cells. In different areas of the mouth, the width of attached gingiva varies. It constitutes around 25% of the total oral mucosa and is present as gingiva (free, attached and interdental) and covers the hard palate. In the later stages of the bell stage (also referred to as advanced bell stage), the growth of cervical loop cells into the deeper tissues forms Hertwig’s epithelial root sheath, which determines the root shape of the tooth. The anatomical width of attached gingiva increases slightly with the increasing age because of tooth eruption to compensate for occlusal wear 12. It covers the floor of the mouth, ventral (underside) tongue, alveolar mucosa, cheeks, lips, and soft palate. In the spinous layer, these cells show numerous contacts via desmosomes which are almost double in number as compared to the cells in the basal layer. 2010 Sep 1;16(9):2891-9. In the posterior areas, it is less with the least width in the first premolar area (1.9 mm in the maxilla and 1.8 mm in the mandible) 3. Junctional epithelium mostly expresses K5, K14, K13, and K19. The marginal gingiva or unattached gingiva forms the coronal border of the gingiva which surrounds the tooth but is not adherent to it. From the fourteenth day onwards till the twenty-first day, there is a decline in QO 2 to approximately the level of normal gingiva. Introduction: Stippling is a feature of healthy gingiva, which is a form of adaptive specialization or reinforcement of function. Reduction or loss of stippling is a common sign of gingival disease. The sulcular epithelium is relatively less permeable to water soluble substances as compared to junctional epithelium but is more permeable as compared to the oral epithelium. Cellular origins and differentiation control mechanisms during periodontal development and wound healing. The dental lamina is comprised of cells that proliferate at a faster rate as compared to the adjacent epithelial cells. (adsbygoogle = window.adsbygoogle || []).push({}); The basal layer makes the proliferation compartment of the epithelium, whereas the remaining layers make the differentiation compartment. It has been observed that thick gingiva has coarse and diffuse stippling whereas thin gingiva has fine and scanty stippling. The cells of the sulcular epithelium rarely show keratohyalin granules and membrane coating granules. Resistance: These tissues resist and resolve the forces produced during mastication, speech, and deglutition. The gingival connective tissue is composed of collagen fibers … Periodontium refers to a group of specialized tissues that surround and support the teeth, maintaining them in the maxillary and mandibular bones. It extends from the base of the free gingiva to the mucogingival junction (Figure 1.5) where the keratinized epithelium of attached gingiva abruptly merges with the non-keratinized epithelium of the alveolar mucosa, In different areas of the mouth, the width of attached gingiva varies. The epithelium is organized into four layers which are distinguishable microscopically. These cells lack desmosomes and tonofilaments. Toll-like receptors (TLRs) are important components of innate immunity. Melanocytes are melanin pigment-producing cells. Critical Reviews in Oral Biology & Medicine. Under absolutely ideal conditions, the sulcus depth is 0 or close to 0 mm, The attached gingiva is continuous with the oral epithelium of the free gingiva and is firmly bound to the underlying periosteum of the alveolar bone. A small number of cells remain in the proliferative compartment of the basal layer, participating in the formation of new cells. These are essentially the primordial dental arches. It does not function during mastication and therefore is non-keratinized, soft and pliable. The mandibular arch gives rise to a pair of mandibular processes (actually the pharyngeal arch itself), and a pair of the outgrowths of the arch- the maxillary processes (that later give rise to a pair of palatal processes). The cells of the sulcular epithelium rarely show keratohyalin granules and membrane coating granules. The word ‘Periodontium’ is derived from the Greek words peri-, meaning “around” and -odons, meaning “tooth”. Expression of ELAM-1 by endothelial cells is increased under the influence of cytokines such as TNF-α, IL-1, and bacterial lipopolysaccharides. These protuberances give rise to deciduous teeth. Thus, these receptors actively participate in host-microbial interactions in periodontal diseases. Learn about our remote access options, Chairman Periodontal Research, Mt. They have protective action against ultraviolet irradiation and have also been shown to be responsive to many immunological mediators 73. These layers are basal cell layer (stratum basale), spinous cell layer (stratum spinosum), granular cell layer (stratum granulosum), and the cornified /keratinized cell layer (stratum corneum). Number of times cited according to CrossRef: Gingival stippling in dogs: Clinical and structural characteristics. As the cells move from the basal layer to the cornified layer, their morphological characters change. Keratins are fibrous proteins which take part in cornification of the stratified squamous epithelial tissue. cementum, periodontal ligament, and bone; invested in the gingiva. It is typically coral pink in color, but its color may vary due to physiologic pigmentation among some races. The lack of keratinization makes this area particularly susceptible to influences from microorganisms. Lamina densa consists of anchoring fibers made up of collagen Type VII, which binds to the collagen Type I and III of the extracellular matrix 49, 50. It extends from the base of the free gingiva to the mucogingival junction (Figure 1.5) where the keratinized epithelium of attached gingiva abruptly merges with the non-keratinized epithelium of the alveolar mucosa 3.