corelation between microscopic and macroscopic features of gingiva- dr harshavardhan patwal

Presented by ,Dr Harshavardhan Patwal

OMM consist of 3 zones:

a.Masticatory mucosa-25%

b.Specialized mucosa-15%

c. Lining mucosa-60%

DEFINITION: It is that part of the oral mucous membrane that covers the alveolar process and the cervical portions of the teeth.

CLINICAL FEATURES:

gingiva is anatomically divided into:

a.Marginal gingivab.Attached gingivac.Interdental gingiva

INTERDENTAL GINGIVA

Interdental gingiva

Gingiva is histologically divided into:

Epithelium

Connective tissue

Various portions are seen to orginate from distinct portions of odontogenic sequence and developing oral mucosal tissues.

Non-keratinized junctional epi Enamel organ.

Non- keratinized sulcular epithelium & keratinized gingival epi oral mucosa.

PROTECTIVE BARRIER.

FORMS AN ATTACHMENT APPARATUS TO THE TOOTH SURFACE.

BIDIRECTIONAL MOVEMENT OF SUBSTANCES.

CAPABLE OF REACTING TO EXTERNAL STIMULI.

PRODUCES POTENT ANTIMICROBIAL PEPTIDES

gingival epithelium is an important initiator, mediator, regulator of host responses..

3 DIFFERENT FORMS OF STRATIFIED SQUAMOUS EPITHELIA ARE:

a. Orthokeratinized epitheliumb. Non-keratinized epitheliumc. Parakeratinized epithelum

2 MOST IMPORTANT PROCESS RESPONSIBLE FOR FORMATION OF SUPERFICIAL LAYER OF EPITHELIUM ARE:

Epithelial proliferation.

Epithelial maturation. Maturation in the oral cavity follows two main pattern:

Keratinization(Cornification). Non-keratinization.

DEPENDING ON THE LOCATION OF GINGIVAL EPITHELIUM

Oral or outer epithelium

Sulcular epithelium

Junctional epithelium

covers the crest and outer surface of marginal gingiva and surface of attached gingiva.

0.2-0.3mm in thickness.

Either keratinized or parakeratinized.

Keratinized epithelim shows 4 distinct layers- - Stratum Basale - Stratum Spinosum - Stratum Granulosum - Stratum Corneum

Keratinised epithelium non-keratinised epithelium

SULCULAR EPITHELIUMlines the gingival sulcus. thin, non-keratinized stratified squamous epithelium without rete pegs.Extends from the coronal limit of the junctional epithelium to the crest of gingival margin.

JUNCTIONAL EPITHELIUM consist of a collar like band of stratified squamous Non-keratinizing epithelium. It is formed by the confluence of oral epithelium and reduced enamel epithelium.Dentogingival unit: Junctional epithelium along with gingival fibres forms the dentogingival unit.

Tonofilaments and Desmosomes are what distinguishes them as epithelial cell. Tonofilaments- fibrous proteins, synthesized by ribosomes, appr 8nm, chemically they represent a class of intercellular proteins known as Cytokeratins.Keratins-are a family of related proteins that are the predominant cytoskeletal proteins in all epithelia.C1, C2, C10, C11, C12- seen in most keratinized epithelia.C5-C14- Stratification specific cytokeratins.C6-C16- Highly proliferative epithelium.C4-C13- Eosophageal type Cytokeratin.C19- Non-keratinized, Parakeratinized. An important property of the epithelium is its ability to function as a barrier, and this depends on its cohsiveness. Cohisiveness is provided through-viscous intercellular material,Desmosomes, Hemidesmosomes, Tonofilaments.

DESMOSOME

HEMIDESMOSOMES

GAP AND TIGHT JUNCTIONS

MelanocytesMerkels cellsInflammatory cellsLangerhans cells

The connective tissue supporting the oral epithelium is termed Lamina propria.Divided into •The superficial papillary-Collagen fibres are loosely arranged.•The deeper reticular layer

Lamina propria consist of cells, Blood vessels, neural elements, fibres embedded in Ground substance (matrix).

o Fibroblasts.o Macrophages.

Melanophage Siderophage

o Mast cells.o Inflammatory cells

PMNs Lymphocytes Plasma cells

Collagen fibres. Reticulin Fibres. Oxytalan Fibres. Elastic Fibres

Main constituent of connective tissue matrix are protein carbohydrate macromolecules.

They are divided as Proteoglycans and Glycoproteins.

•Coral pink/pigmentation.

• Knife -like margin.

• Papilla fill to contacts.

•Firm and resilient.

•Attached gingiva stippled.

•Free gingival margin 1-3mm coronal to CEJ.

• Scalloped to follow bone contours.

Color:

Size:

Size –can change with increase in connective tissue and/or inflammatory components

Contour:

Contour maybe related to the tooth positioning

Shape- Correlated with the shape of the teeth and contacts/embrasures

Consistency-Firm,resilient and bound to the bone.

Surface texture-Attached gingiva is stippled (orange peel appearance).This is due to the normal protruberances and depression in the gingiva.

Position-Level at which gingiva is attached to the tooth.Changes as the teeth erupts.

Elevations and depressions are responsible for stippled appearence

Active- Coronal movement of the teeth.Passive- Apical migration of gingiva

Thank you