It consists of an epithelial layer and an underlying connective tissue layer called the lamina propria.
determined by histological sections sulcus depth reading provided by periodontal probe
As the mucogingival junction remains stationary throughout adult life, changes in the width of the attached gingiva are caused by modifications in the position of its coronal end. The width of the attached gingiva increases with age and in supraerupted teeth. On the lingual aspect of the mandible the attached gingiva terminates at the junction with lingual alveolar mucosa, which is continuous with the mucous membrane lining floor of the mouth. The palatal surface of the attached gingiva in the maxilla blends imperceptibly with the equally firm, resilient palatal mucosa.
Anterior segment Pyramidal because the tip of the papilla is located immediately beneath the contact point. The shape of the gingiva in a given interdental space depends on the contact point between the two adjoining teeth and the presence or absence of some degree of recession The facial and lingual surfaces are tapered toward the interproximal contact area, the mesial and distal surfaces are slightly concave. Lateral border and tips of the interdental papillae are formed by a continuation of the marginal gingiva from adjacent teeth, the intervening portion consists of attached gingiva. If a diastema is present, the gingiva is firmly bound over the interdental bone and forms a smooth, rounded surface without interdental papillae
Histologic features and turnover-rate of the epithelium in the col region are similar to those of the rest of the gingival epithelium. Clinical studies supported the hypothesis that gingivitis starts interdentally because of plaque accumulation and not because of histologic origin.
Orthokeratinization Superficial horny layer similar to that of skin with no nuclei in the stratum corneum and a well-defined stratum granulosum. -Only some areas of the outer gingival epithelium are orthokeratinized the other gingival areas are covered by Para keratinized or nonkeratinized epithelium.
Para keratinization The stratum corneum retains pyknotic nuclei and the keratohyaline granules are dispersed, not giving rise to stratum granulosum.
Non-keratinized epithelium has neither granulosum nor corneum strata and superficial cells have viable nuclei.
At the coronal part of the junctional epithelium, the DAT cells typically express a high density of transferrin receptors, which supports the idea of their active metabolism and high turnover .
Semicircular fibers Which attach at the proximal surface of a tooth, immediately below the cementoenamel junction, go around the facial or lingual marginal gingiva of the tooth and attach on the proximal surface of the same tooth.
Transgingival fibers Attach in the proximal surface of one tooth traverse the interdental space diagonally, go around the facial or lingual surface of the adjacent tooth, again traverse diagonally the interdental space and attach in the proximal surface of the next tooth.
Edward technique or tattooing technique
along the facial and lingual surfaces of the alveolar bone, from which capillaries extend along the sulcular epithelium and between the retepegs of the external gingival surface. Occasional branches of the arterioles pass through the alveolar bone to the periodontal ligament or run over the crest of the alveolar bone. and extend parallel to the crest of the bone to anastomose with vessels of the periodontal ligament, with capillaries in the gingival crevicular areas and vessels that run over the alveolar crest
This device uses pulse echo principle with aids of pulse generator and measurement frequency of 5MHz, a piezoelectric crystal is allowed to oscillate. Ultrasonic pulses are transmitted through the sound permeable gingiva. On reaching bone or teeth surface, it is reflected. A transducer probe of 4mm diameter moistened with saliva is applied to measure site with slight pressure to produce acoustic coupling. By timing received echo with respect to transmission of pulse, thickness is digitally displayed.
In disease: Both chronic and acute inflammations produce changes in the normal firm and resilient consistency of the gingiva. In patients with chronic gingivitis, both destructive (edematous) and reparative (fibrotic) changes coexist, and the consistency of the gingiva is determined by their relative predominance.
reduction or loss of stippling may indicate but does not convincingly signify disease (Feneis, 1952; Zwarych and Quigley, 1965; Loesche, 1994). Moreover, mild inflammation is not necessarily resulting in the loss of stippling (Ainamo and Löe, 1966).
Gingiva in health and disease
Dr. Lakkireddy Vasavi reddy
Gingiva in health and disease
Blood supply, lymphatics and nerve supply
Changes in disease
Correlation of clinical and microscopic features
• Masticatory mucosa- gingiva and
covering of the hard palate.
• Specialized mucosa- dorsum of
• Lining mucosa- lining the
remainder of the oral cavity.
The oral cavity is lined
by a mucous
membrane that is
with the skin of the lip
& posteriorly with the
mucosa of the soft
The oral mucosa
consists of three zones:
The gingiva is that part of the masticatory
mucosa which covers the alveolar process
and surrounds the cervical portion of the
The fibrous tissue, covered by keratinized
epithelium that immediately surrounds a
tooth and is contiguous with its
periodontal ligament and with the
mucosal tissues of the mouth. (GPT 2001)
The gingiva is divided
• Interdental areas.
• It is unattached gingiva, which is the
terminal edge or border of the gingiva
surrounding the teeth in collar like
• It is about 1mm wide, it forms the soft
tissue wall of the gingival sulcus
Free gingival groove -In about 50% cases,
marginal gingiva is demarcated from the
adjacent, attached gingiva by a shallow
linear depression, runs parallel to & at a
distance of 0.5 to 2mm from the margin of
• It may be separated from the tooth
surface with a periodontal probe.
• “It is shallow crevice or space around the
tooth bounded by the surface of the tooth
on one side and the epithelium lining the
free margin of the gingiva on the other.”
• It is “V” shaped and barely permits the
entrance of a periodontal probe.
• Histological depth- 1.8mm with variations
from 0 to 6mm, other studies have reported
1.5mm and 0.69mm, respectively.
• Probing depth - normal gingival sulcus is 2 to
• Ideal condition- 0mm
• It is firm resilient and tightly bound to the
underlying periosteum of alveolar bone.
• Width of attached gingiva
“It is the distance between the mucogingival
junction and the projection on the external
surface of the bottom of the gingival sulcus or
the periodontal pocket.”
• Greatest in the incisor region -3.5to4.5mm
in maxilla, 3.3to3.9mm in mandible
• Least in first premolar area -1.9mm in
maxilla , 1.8mm in mandible
• Dissipates functional and
• Provides a resistant barrier to
plaque induced inflammation.
• Prevents deflection of marginal
gingiva due to effects of frena &
• Aids in plaque maintenance &
ease of oral hygiene maintenance.
• Improves aesthetics.
Bowers (1963) measured the
widths of the facial attached
gingiva in the primary and
permanent dentitions of 240
Width of the attached gingiva was
determined by subtracting the
sulcus probing depth (free gingiva)
from the total width of the
keratinized tissue (gingival margin
Extremes of the width of attached
gingiva ranged from 1 to 9 mm.
Values were greatest in the incisor
regions (especially the lateral
incisor) and the least in the canine
and first premolar sites
confirmed the pattern of facial keratinized tissue widths in longitudinal
observations of children.
Increases in widths of facial attached and keratinized tissue were
noted in primary and permanent teeth over 2 years
Facially-positioned teeth had narrower zones of attached and
keratinized tissue than well-aligned or lingually-positioned teeth.
As teeth moved lingually, an increase in the width of attached and
keratinized tissue and a slight decrease in clinical crown height were
Voigt et al.
Measurements of the width of lingual attached
gingiva were performed by Voigt et al. (1978) on
clinically normal subjects ranging in age from 3
to 36 years
Greatest widths were recorded on the first and
second molars (4.7 mm), decreasing at premolar
and third molar sites. The smallest widths were
observed on the incisors and canines (1.9 mm).
Friedman* - Said that ‘‘inadequate’’ zone of gingiva would
facilitate Subgingival plaque Formation because of
improper pocket closure resulting from the movability of
the Marginal tissue. The amount of attached gingiva is
generally considered to be insufficient when stretching of
the lips or cheeks induce movement of free gingival margin
Lang* and loe - Reported a study on the relationship
between the gingival width and inflammation, in an effort
to determine the adequate amount. They concluded that
2mm of keratinized gingiva, with less than 1mm of attached
gingiva is adequate to maintain gingival health.
Eager divided attached gingiva based on periodontal type:
Shallow thin gingiva with slender crown formation.
Wide thick gingiva with quadrant crown formation.
TISSUE BARRIER CONCEPT: Goldman and Cohen outlined a “tissue
barrier” concept for mucogingival surgery. They postulated that a dense
Collagenous band of connective tissue retard or obstruct the spread of
inflammation better than does the loose fiber arrangement of the
alveolar mucosa. They recommended increasing the zone of keratinized
tissue to achieve an adequate tissue barrier
Goaslind et al. (1977) measured the thickness of the free and attached
facial gingiva in a population consisting of 10 males (age 25 to 36) with
clinically healthy gingiva
Free gingival thickness averaged 1.56 mm ± 0.39 mm, increased from
anterior to posterior and was directly proportional to sulcus depth.
Thickness of the attached gingiva averaged 1.25 mm ± 0.42 mm, increased
from anterior to posterior in the mandibular arch, remained relatively
constant in the maxillary anterior, and was inversely proportional to
attached gingival width.
The overall mean thickness for all areas was 1.41 mm.
• The interdental gingiva occupies the gingival embrasure, which is the
interproximal space beneath the area of the tooth contact.
Col shape is because it represents the valley like depression that connects a
facial & lingual papilla and conforms to the shape of the interproximal
• In a study using Rhesus monkeys, McHugh (1974) confirmed that the interdental
area is col-shaped.
• This area consists of soft tissue residing between papillary peaks on the buccal and
• Histological analysis of sections through the actual col showed that it is always
lined by squamous epithelium, 5 or more cell-layers thick. Ameloblasts were not
• Gingival epithelium:
0.2-0.3mm in thickness
different layers on the
basis of degree of
1.Basal layer (stratum basale)
2. Prickle cell layer (stratum
3. Granular layer (stratum
4. keratinized cell layer (stratum
• Major cell type of the gingival
• Proliferation: by mitosis in basal
layer; less frequently in supra
• Differentiation: involve process
• Progressions of biochemical and
morphological events that occur
as cell migrate from basal layer to
• Present in basal and spinous layers.
• Stellate cells with numerous dendritic processes.
• Synthesise melanin in premelanosomes or melanosomes.
• Attached neither to the subjacent basal lamina nor to
adjacent cells of the stratum basale.
• Contain tyrosinase which hydroxylates tyrosine to
dihydroxy-phenylalanine (DOPA ) which in turn is
converted to melanin. Melanin granules are phagocytosed
and contained within melanophages or melanophores.
• Dendritic cells located among
keratinocytes at all suprabasal
levels belong to mononuclear
phagocyte system (R.E system).
• Considered macrophages with
possible antigenic properties,
important role in immune
reaction as antigen-presenting
cells for lymphocytes.
• Contain g-specific
granules(Birbeck’s granules) and
have marked adenosine
• Found in oral epithelium of
normal gingiva and in smaller
amounts in the sulcular
epithelium probably absent from
the junctional epithelium of
• Located in the deeper layers
of the epithelium, harbour
nerve endings and are
connected to the adjacent
cells by desmosomes.
• They have been identified as
• The epithelium covering the gingiva may be
differentiated as follows:
• oral epithelium (OE), which faces the
• oral sulcular epithelium (OSE), which faces
the tooth without being in contact with
the tooth surface.
• junctional epithelium (JE), which
provides the contact between
the gingiva and the tooth.
• Covers crest & outer surfaces of marginal gingiva & surface of
attached gingiva .
• Keratinized or parakeratinized or various combinations with
prevalence toward parakeratinization.
• Keratinization varies in following order:
Palate(Most keratinized)> Gingiva>Ventral aspect of Cheek(Least
•the cells – cylindrical / cuboidal
•Attached to underlying
and to each other by
and gap junctions.
•Cells have ability to undergo
•Also called as stratum
( progenitor cell compartment of
•Consists of keratinocytes,
• Uppermost layers contains Odland
bodies or keratinosomes.
• Contain fewer cell organelles and
• Expression of K1 & K10
• Expression of K5 & K14
• Keratin bundles increase in
• Cell to cell attachment -
• Gap junctions - high numbers.
• Langerhans cells are present
• Cells become flattened.
• Named because of
• They are 1 to 0.1 µm in
diameter round or irregular
and electron dense, present in
cytoplasm and stain with acid
• Nuclei shows signs of
• Tonofibrils more prominent.
• Sythesizes protein.
• Desmosomes becomes
• 300 – 400 Å thick.
• Approx. 400 Å beneath basal layer of
• Permeable to fluids.
• Barrier to particulate.
• It is a thin, nonkeratinized stratified squamous epithelium without retepegs
and extends from coronal limit of the junctional epithelium to the crest of
the gingival margin.
• It lacks granulosum & corneum strata and normally does not contain
• It has potential to keratinize if -exposed to oral cavity
-bacterial flora is eliminated.
• It suggests that local irritation of sulcus prevents sulcular keratinization.
• It may act as a semipermeable membrane though which injurious bacterial
products pass into the gingiva and tissue fluid from gingiva seeps into the
A single or multiple layer of non-keratinizing cells adhering to
the tooth surface at the base of the gingival crevice. Formerly
called epithelial attachment.
• Length : 0.25 to 1.35mm
• Thickness: 3 – 4 cell layer in early life.
10 – 29 cell layers – coronal
1 - 2 cell layers – apical
Gottlieb (1921) first coined the term epithelial
attachment and proposed that the oral epithelium
(OE) fused with the outer enamel epithelium (OEE) of
the erupting tooth at the base of the sulcus.
Waerhaug (1952) suggested that the tooth/epithelial
interface which extends to the CEJ was a potential
space maintained tightly against the tooth by vascular
pressure. This concept became known as the
Orban (1960) inserted steel blades into the sulci of
dogs and monkeys and demonstrated a firm
attachment of epithelial cells to the teeth. The author
agreed with Gottlieb's concept of a firm epithelial
Schroeder & Listgarten
• Prior to eruption, the surface of the enamel is
covered by the REE which comprises the
reduced ameloblasts and the former stratum
• These cells produce a basal lamina called the
epithelial attachment lamina, which is in
contact with the hard tissue structure. It is to this
lamina that the epithelial cells attach, via
hemidesmosomes, to form the primary
epithelial attachment in unerupted teeth.
• As tooth erupts, the reduced ameloblasts and
some cells of the stratum intermedium get
converted into junctional epithelial cells. As the
tooth erupts through the oral mucosa, the
attachment of soft to hard tissue is termed the
secondary epithelial attachment, which may
consist simply of a basal lamina (the epithelial
attachment lamina) anhemidesmosomes
• Turnover is very high protective &
• Earlier thought epithelial cells facing external
basal lamina divide rapidly.
• proteoglycans , hyaluronan , decorin , syndecan
and CD-44…on epithelial cell surfaces and
within intercellular spaces.
• β1 integrin family and intercellular adhesion
molecule-1….. Cell adhesion
• Evidence DAT cells high mitotic activity
• DAT cells Role in tissue dynamics &
reparative capacity of JE.
• Daughter cells replace degenerating cells on tooth surface
• Daughter cells enter exfoliation pathway & gradually
migrate coronally between basal cells & DAT cells
• Epithelial cells move in coronal direction along tooth
Renewal of gingival epithelium:
• Skougaard and Beagrie (1962) investigated renewal time in the
gingival epithelium of marmosets using injections of tritiated
thymidine and autoradiography.
• Epithelial cells in the attached gingiva exhibited a renewal rate of 10.4
days, whereas the corresponding rate for the epithelial cuff was 5.8
Cuticular structures of tooth:
• Cuticle describes a thin acellular structures with homogenous matric that is
sumtimes enclosed within clearly demarcated linear borders.
• Listgarten divided the as:
• Acquired – saliva, bacteria, calculus and surface stains
• Developemtal origin- REE, coronal epithelium, dental cuticle
Gingival connective tissue:
• 60% - collagen fibres, 5%- fibroblasts, 35%- vessels, nerves & matrix.
• Also known as LAMINA PROPRIA.
Papillary layer Reticular layer
Sub adjacent to epithelium;
consists of papillary projections
between epithelial rete pegs.
Density - 120+30/mm2
Contiguous with the
periosteum of the alveolar
• 65% of cells of gingival C.T.
• Ovoid/spindle shaped with branching processes;
• Pale staining elongated/disc like nucleus with basophilic
• Well developed RER, Mitochondria and Golgi complex.
• Fibrocytes- Produce ECM components of developing CT.
• Lamellar / pyriform shaped – immature cells
• Spindle/ fusiform – intermediate cells
• Stellate/ star shaped – mature cells
• To secrete collagen and elastin, glycoproteins and GAG’s.
• Secrete active collagenase & MMP’s .
• Secrete number of growth factors, cytokines and inflammatory mediators like IL-
1, IL-6, IL-8, TNF-α, PDGF, keratinocyte growth factor etc.
• Role in developmental processes, wound healing and tissue re-modelling.
• In health: produce & maintain ECM, role in homeostasis and modification of
parts of matrix they created.
• In disease: enlarged, cytopathically altered due to dispersion of chromatin,
formation of surface blebs, enlargement and dilation of mitochondria, breaks in
• Derived from monocytes.
• Also known as tissue
• Spindle/irregularly shaped
with oval nuclei.
• Short projections -
• There are tissue
macrophages and wandering
• In health: less well defined. Role in homeostasis.
• In disease: produce powerful hydrolytic enzymes: act as scavengers dispensing
with the bacteria, toxins & debris.
• Release neutrophil chemotactic factors, PG’s , IL-1 that regulate immune
• Activated macrophages can regulate C.T turnover (potent substances – stimulate
fibroblast proliferation – enhanced collagen production).
• Represent the first line of host defence
• Omnipresent in gingival tissues and
likely to play major role in periodontal
homeostasis in health.
• Migrate rapidly from blood to enter the
C.T as a result of immune response and
• Play a role in phagocytosis by release of
certain intracellular enzymes like
myeloperoxidase, lysozyme, lactoferrin,
collagenase-2 or PMN type collagenase
or MMP-8 and alkaline phosphatase.
• In gingiva: Decorin, biglycan,
versican and syndecan.
• Bind growth factors, cytokines and
other biologically active molecules.
• GAG’s in supra-alveolar fiber
apparatus, loose connective tissue and
• Major - fibronectin, laminin, tenascin ,
• Fibronectin: binds fibroblasts to fibres;
mediate cell adhesion and migration
• Laminins: attach basal lamina to
• Collagen fibres
• Elastic fibres – Oxytalin, elastin, elaunin
• Reticular fibres
• To brace the marginal gingiva firmly against the tooth.
• To provide the rigidity necessary to withstand the forces of mastication without being deflected
away from the tooth surface.
• To unite the free marginal gingiva with the cementum of the root and the adjacent attached gingiva.
• Three groups of fibers:
• On the facial, lingual and interproximal surface embedded in
the cementum just beneath the epithelium at the base of the
• They extend externally to the periosteum of the facial and
lingual alveolar bones and terminate in the attached gingiva or
blend with the periosteum of the bone.
• Course through the connective tissue of the marginal and
interdental gingiva and encircle the tooth in ring like fashion.
• Form horizontal bundles that extend between the cementum
of approximating teeth into which they are embedded.
According to Bartold:
• Interpapillary group
• Inter gingival
• Inter circular
• Semi circular
Page and co workers:
• Semicircular and
Clinical importance of gingival fibres:
• Circumferential supracrestal fiberotomy( pericision)
• Gingivoplasty of thick interdental papilla
• The boundary between the oral epithelium OE and
the underlying (CT) has a wavy course. The
connective tissue portions which project into the
epithelium are called connective tissue papillae
(CTP) and are separated from each other by
epithelial ridges — so-called rete pegs (ER).
• In normal gingiva, a characteristic morphologic
feature of the oral epithelium and the oral sulcular
epithelium is the presence of rete pegs, while these
structures are lacking in the junctional epithelium.
Blood supply of gingiva:
• Three sources of blood supply to the gingiva are as follows
1. Supraperiosteal arterioles
2. Vessels of periodontal ligament, which extend into the gingiva
and anastomose with capillaries in the sulcus area.
3. Arterioles which emerge from the crest of the interdental
• Nuki and Hock (1974) studied the organization
of the gingival vasculature noting that the
subepithelial vasculature consisted of a series
of interconnecting capillary units made up of
at least 2 terminal arterial capillaries, 4
primary venular capillaries, and numerous
• The capillary units were among the first
vessels affected by inflammation as evidenced
by an increase in vessel width (5 to 10 m)
and length (400 to 1,000 ^im as well as
alteration of vessel morphology
• Lymphatic drainage
• Lymphatics beneath the junctional epithelium extend
into the periodontal ligament and accompany the blood
• Gingival innervation
• It is derived from fibers arising from nerves in the
periodontal ligament and from the labial buccal and
• The following nerve structures are present in the
connective tissue, a meshwork of terminal argyrophilic
fibers some of which extend into the epithelium.
• Meissner type- tactile corpuscles
• Krause-type end bulbs- temperature receptors
• Encapsulated spindles
• Epithelial permeability increases.
• The intercellular spaces of the J/E widen and
serve as a primary pathway for the progress of
the inflammatory exudate from the gingiva to
the gingival sulcus.
• There is a significant influx of neutrophils that
the intercellular spaces of the junctional
epithelium become pathologically altered, with
disruption to the intercellular junctions and
increasing widening of the intercellular spaces.
• Once this level of infiltration has occurred, and if the driving stimulus (dental plaque) remains, then the
normal rapid turnover of the junctional epithelium is insufficient to restore health and the pathway to
ongoing tissue damage is established.
• With continuing plaque accrual, neutrophil migration and early activation of macrophages and
lymphocytes within the gingival connective tissue, the junctional epithelium can be seen to commence
migration in an apical direction and result in the earliest formation of a periodontal pocket.
• Communicative pathways may be established through a variety of cells known to reside in the
epithelium. For example, Langerhans cells, which act as antigen-presenting cells, have been noted to
increase in number with increasing inflammation.
Connective tissue changes:
• Subsequent to the initial inflammatory response, CT destruction occurs within 3-4 days after
plaque accumulation and begins at perivascular collagen bundles.
• As the inflammatory process continues, destruction expand deeper towards pdl and alveolar bone –
• Simultaneously with destruction, fibrosis and scarring may coexist.
• Qualitative and quantitative changes occur to the gingival collagens, gingival proteoglycans .
• The glomerular nature of gingival plexus increases with increase in the number and size of the
• During this process, the post capillary venules adopt the appearance of high endothelial venules
which facilitates emigration of lymphocytes.
• Pioneers: Ochsenbein and Ross
• Most prevalent.
• Consists of flat soft tissue.
• Thick bony architecture.
• Dense & fibrotic with large zone of
• More resistant to recession
• Highly scalloped soft tissue.
• Thin bony architecture.
• Characterized by fenestration and
• More prone to recession, bleeding
Correlation of clinical and
Normally coral pink in color.
Depends on the thickness and degree of the keratinisation of
the epithelium and the presence of pigment producing cells.
Alveolar mucosa is red, smooth and shiny.
Epithelium is thinner, non keratinised
and contains no rete pegs.
• Melanin pigmentation – can occur as
early as 3hrs after birth and often is
the only evidence of pigmentation.
According to Dummett: In Blacks
• Gingiva : 60%
• Hard palate : 61%
• Mucous membrane : 22%
• Tongue : 15%
LEAD TOXICITY COPPER PIGMENTATION MINOCYCLINE
AMALGAM TATOO HEAVY METAL POISONING
The size of the gingiva corresponds with the sum total of
the bulk of cellular & intercellular elements & their
• Size of the gingiva is enlarged and is called as gingival
Inflammatory- increase in cells and decrease in fibres.
Non-inflammatory - decrease in cells and increase in
• The gingiva is firm and resilient with exception of the movable free
• The collagenous nature of the lamina propria and its contiguity with
the mucoperiosteum of the alveolar bone determines the firmness of
the attached gingival margin.
• The normal consistency of the gingiva can be checked by palpation
either with a blunt instrument or digital pressure.
• Pitting on pressure indicates soft and oedematous gingiva.
• Anteriors :Triangular to knife-edged
• Posteriors : broader and more square shaped
Factors affecting shape:
• Contour of proximal teeth.
• Location and shape of embrasure.
• In disease:
• Facial & lingual surfaces:
• Teeth with relatively flat surfaces:
• Pronounced MD convexity,
labially placed teeth: accentuated
• Linguo-version teeth: horizontal
• Shape of teeth and their alignment
• Location and size of area of
• Dimensions of facial and lingual
Thickened shelf like
contour of gingiva on tooth
in lingual version
aggravated by local
irritation caused by plaque
• Chronic gingivitis- marginal gingiva
becomes rolled or rounded and interdental
papilla becomes blunt and flat.
• ANUG- Punched-out crater like
depressions at the crest of interdental
• Chronic desquamative gingivitis-
irregularly-shaped denuded appearance of
• Gingival recession- exaggerated
scalloping of the gingiva.
• Stillmans clefts: apostrophe shaped
indentation extending from the gingival
• Mc calls festoons: life-saver like
enlargement on the marginal gingiva,
most commonly seen on the canine and
premolar facial surface.
• The gingiva presents a textured surface similar to an orange peel and is
referred to as being stippled.
• Best viewed by drying the gingiva. Attached gingiva is stippled but not
• Stippling is absent in infancy, appears in some children at about 5years
age, increases until adulthood and frequently begins to disappear in
• Form of adaptive specialisation or reinforcement for function
• In Chronic inflammation
Smooth and shiny gingival surface
firm and nodular
• Smooth surface texture is also produced by epithelial atrophy in
atrophic gingivitis and peeling of the surface occurs in Chronic
• Hyperkeratosis-leathery texture
• Drug induced gingival overgrowth- nodular surface.
The normal position of the gingiva is 1mm above the cemento enamel junction.
Position of the teeth in the arch.
Mesio-distal curvature of tooth surface.
High frenal attacment.
Friction from soft tissue.
• Physical injuries
• Chemical injuries
• Thermal injuries.
• In acute cases, the appearance of the slough (necrotising epithelium),
erosion or ulceration and the accompanying erythema are the common
• In chronic cases, permanent gingival defects are usually present in the
form of gingival recession
Continuous tooth eruption
Eruption does not cease when teeth meet their functional antagonists but
continues throughout life.
• Active tooth eruption is the movement of the teeth in the direction of the
Occlusal plane, whereas passive tooth eruption is the exposure of the tooth
by apical migration of the gingiva. This concept distinguishes between the
anatomic crown and between the clinical crown and clinical root .
Gottlieb and Orban believed that active and passive eruption proceed
• Originally, passive eruption was thought to be a physiological process.
Now, it is considered as a pathologic process.
Effect of aging:
On Gingival Epithelium
Thinning & decreased keratinization.
Flattening of rete pegs & altered cell density.
Width of the AG increases.
Gingival connective tissue
coarser & more dense gingival CT.
changes in collagen :
-increased rate of conversion of soluble to insoluble collagen.
-increased mechanical strength.
-increased denaturing temperature.
• Knowing the normal gingival architecture in health is important to
differentiate between health and disease state of an individual.
• Hence it is significant to understand the morphological and clinical
alterations in the gingiva during disease state which helps us to
identify the intensity and prognosis of a particular disease.
• Newman,Takei,Klokkevold,Carranza.Clinical Periodontlogy.9th edition, Elsevier pub,2002.
• Newman,Takei,Klokkevold,Carranza.Clinical periodontology 10th edition, Elsevier
• Lang NP, Lindhe J. Clinical Periodontology and implant dentistry.5thedition.Blackwell
• Nanci A , Bosshardt D. Structure of periodontal tissues in health and disease. Periodontol 2000
• I Glickman, Manhold, John H. The Oxygen Consumption of Healing Gingiva J DENT RES August
1950 29: 429-435.
• Mundeja N, Baiju CS, Khashu H, Jain D, Gupta A. Gingival biotype: A key determinant in
periodontal treatment. Int J Dent Health Sci 2014; 1(4);552-565
• Esfahrood ZR, Kadkhodazadeh M, Talebi Ardakani MR. Gingival biotype: a review. Gen Dent.
• Shah R, Sowmya NK, Thomas R, Mehta DS. Periodontal biotype: Basics and clinical
considerations. J Interdiscip Dentistry 2016;6:44-9.