1975 Feb;10(1):1-1. The information presented in this website has been collected from various leading journals, books and websites. It is demarcated from the attached gingiva by a shallow linear depression, the free gingival groove in approximately 50% of cases, The normal depth of the gingival sulcus and the corresponding width of the marginal gingiva is variable. Two terms, Orthokeratinization and para-keratinization are used to describe these changes. These are attached to the lamina lucida zone of the basement membrane with hemidesmosomes. During gingival inflammation, the sulcular epithelium is densely infiltrated with PMN’s and lymphocytes. 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. 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. It covers the dorsal surface of the tongue and composed of cornified epithelial papillae. Seibert and Lindhe (1989) 26 later used the term periodontal biotype to describe gingival forms and classified gingiva as thin scalloped or thick-flat. It does not function during mastication and therefore is non-keratinized, soft and pliable. Learn more. A healthy periodontium is required to adequately support the teeth in function. A thick periodontal biotype displays a thick and wide gingiva, wider teeth and thicker bone. ICAM-1 is expressed by keratinocytes of oral gingival and sulcular epithelium during gingival inflammation and its levels are elevated in periodontitis sites as compared to healthy sites, Melanocytes are melanin pigment-producing cells. Gingival tissues surrounding both the maxillary detention and the mandibular dentition may be affected. In 1969, Ochsenbein and Ross 25 described two types of gingival forms: flat and highly scalloped. Smoking also stimulates melanin production, leading to exceedingly evident intraoral pigmentation 78, 79. The epithelium is organized into four layers which are distinguishable microscopically. This … In the posterior teeth, the apex of the interdental gingiva is blunted with buccal and lingual peaks. Specialized mucosa makes around 15% of the total oral mucosa. This integration is further intensified by the presence of numerous serrated keratinocytes and cellular processes (pedicles) of these cells protruding into the connective tissue compartment. These serve as “sentinels” of the oral mucosa and inform the immune system not only about the entry of the pathogen, but also about the tolerance to self antigens and commensal microbes. These cells are of ectodermal origin migrating into mesenchymal tissue; therefore are also referred to as ectomesenchymal cells. Para-keratinization is usually observed in the oral gingival epithelium which is characterized by an incomplete disintegration of the nucleus and cytoplasmic organelles. Neural crest cells, which are derived from the neural tube play an important role in the development of teeth. Lining mucosa expresses K4/K13 pair which is associated with elasticity, whereas the masticatory mucosa expresses K1/K10 pair which is associated with rigidity. Integrins are heterodimeric glycoproteins, which are involved in the attachment of cells to a large number of extracellular matrix ligands such as laminin, fibronectin, vitronectin, tenascin and osteopontin. gingival stippling … Neural crest cells, which are derived from the neural tube play an important role in the development of teeth. 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. The basal cells show a large number of hemidesmosomes firmly attaching to the lamina densa of the basal lamina. These protuberances give rise to deciduous teeth. 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), The mean width of attached gingiva increases from the primary dentition to permanent dentition, Epithelium-connective tissue interface, and, The epithelium is firmly attached to the underlying connective tissue due to a high degree of integration. •In chronic inflammation: The gingiva may appear enlarged, pink/ pale in color with normal or deepened stippling and a fibrotic consistency. Later on during development, at predetermined sites on the dental lamina corresponding to ten deciduous teeth, further cellular proliferation takes place forming small pro-tuberances. Excessive pigmentation of the gingiva is an esthetic problem and is treated by gingival depigmentation procedures. The mucogingival junction is a stable landmark which is probably genetically determined 12. Hence, this epithelium is non-keratinized. 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). The cementoblasts derived from the dental follicle deposit cementum on the root surface and fibroblasts give rise to the periodontal ligament. Junctional epithelium mostly expresses K5, K14, K13, and K19. 5 In puberty and pregnancy, gingival hyperplasia can be due to poor oral hygiene, inadequate nutrition, or systemic variation in hormonal stimulation. 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). Its absence or reduction indicates … In gingival health, the gingival … The lamina densa zone of the basement membrane faces the connective tissue. A small number of cells remain in the proliferative compartment of the basal layer, participating in the formation of new cells. It is considered as a sign of healthy gingiva but it must be remembered that the presence or absence of stippling alone cannot determine the gingival health 15. Learn about our remote access options, Chairman Periodontal Research, Mt. Abstract: The texture of the gingival surface may be similar to orange peel and is referred to gingival stippling. Toll-like receptors (TLRs) are important components of innate immunity. The gingival epithelium is firmly attached to the underlying connective tissue and is nonpermeable to water-soluble substances. The “bell stage” is characterized by the formation of two principal hard tissues of the tooth, enamel, and dentin (Figure 1.2a, 1.2b). 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……….. It is a feature of healthy gingiva, and reduction or loss ot stippling is a common sign of gingival disease. The dendritic cells in the epithelium are known as Langerhan’s cells. 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. It is usually greatest in the incisor region (3.5 to 4.5 mm in the maxilla and 3.3 to 3.9 mm in the mandible). The expressions of TLRs have been reported in healthy as well as diseased periodontal tissues. 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. During gingival inflammation, the sulcular epithelium is densely infiltrated with PMN’s and lymphocytes. Epithelium of the Gingiva. in labial flanges of gingival veneers and . FIGURE 6-1 Normal gingiva. 1990 Jan 1;35:S217-21. References are available in the hard-copy of the website. Achieving predictable gingival stippling . During the third week of development, the cranial end of the embryo undergoes precocious development where an oropharyngeal membrane (bucco-pharyngeal , or oral membrane) is formed at the site of the future face, between the primordium of the heart and the rapidly enlarging prim… The oral mucosa has been traditionally divided into three categories: lining mucosa, specialized mucosa, and masticatory mucosa. These are essentially the primordial dental arches. • In 40% of adults Gingiva show stippling. Inflammation, bleeding upon probing, and pocket depths are the most important diagnostic aids or signs of gingival or periodontal. Odland bodies are small sub-cellular structures of size 200-300 nm. Expression of ELAM-1 by endothelial cells is increased under the influence of cytokines such as TNF-α, IL-1, and bacterial lipopolysaccharides. It covers the dorsal surface of the tongue and composed of cornified epithelial papillae. The formation of the external face takes place from two sources: the tissues of the frontonasal process that cover the forebrain (predominantly of neural crest origin); and the tissues of the first (mandibular) pharyngeal arch (mixed mesoderm and neural crest origin). The inflammation in the periodontal tissues due to plaque accumulation results in the conversion of normal sulcus into a pathological pocket. • Stippling returns when gingiva is restored to health. and you may need to create a new Wiley Online Library account. Periodontium of the Primary Dentition. 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). The cell surface adhesion molecules belong to the immunoglobulin class. 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 proliferation of the keratinocytes takes place by mitosis primarily in the basal layer and to some extent in the suprabasal layers. 1994 Mar;29(2):81-94. Sinai Hospital, Cleveland, Ohio. Quantitative Evaluation of Consistency in Normal Mucosa, Leukoplakia, and Squamous Cell Carcinoma of the Gingiva.. A Clinical Investigation of the Relationship Between Stippling and Surface Keratinization of the Attached Gingiva. Various disease processes around the teeth result in the destruction of periodontal tissues, thus making them mobile. 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. It covers the floor of the mouth, ventral (underside) tongue, alveolar mucosa, cheeks, lips, and soft palate. May not have BOP. Gosselin F, Magloire H, Joffre A, Portier MM. From the fourteenth day onwards till the twenty-first day, there is a decline in QO 2 to approximately the level of normal gingiva. ment, unspecific binding activity was blocked with normal horse Slightly inflamed gingiva showed no changes in surface mor- (for collagen type I) and normal goat serum (collagen type III and phology, i.e. Abstract. As the cells move from the basal layer to the surface, they show many biochemical and morphological changes. Gingival description: Location, degree and … Along with acting as a physical barrier, the gingival epithelium also plays an important role in the innate immune response 61. Type 1: They are pyramidal in shape and are highly dendritic with an electron-lucent cytoplasm. If you do not receive an email within 10 minutes, your email address may not be registered, Periodontology is the scientific study of the periodontium in health and in disease 1. The clinical appearance of healthy gingiva: tissue is pink and uniform in color, stippling can be seen, and the papillae fill the interdental spaces. Enamel is formed by ameloblasts derived from the terminal differentiation of cells from the inner epithelium of enamel organ and dentin is formed by odontoblasts derived from mesenchymal cells of the dental papilla. These cells lack desmosomes and tonofilaments. about 60% of the total oral mucosa. Trackman PC, Kantarci A. Connective tissue metabolism and gingival overgrowth. Content available in the hard-copy of the website……….. The boundaries of the gingival sulcus are. After appropriate pretreat- showed either no or very delicate signs of stippling. If the destructive process continues, the tooth/teeth are ultimately lost. Now, let us discuss in detail the components of the periodontium. Apically, it is bounded by the junctional epithelium and coronally it meets the outer gingival epithelium at the height of the free gingival margin. Some persistence of stippling. 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. Relationships between epithelium and connective tissue in inflamed gingiva. There are a large number of biologically active substances that may stimulate or suppress, It is the epithelium which lines the gingival sulcus. The marginal gingiva or unattached gingiva forms the coronal border of the gingiva which surrounds the tooth but is not adherent to it. 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 stratum corneum, the cells become flattened and show signs of nucleus disintegration. Gingival Crevice The gingival crevice is the space between the free gingiva and the tooth surface and is lined by nonkeratinized stratified squamous epithelium. The mean width of attached gingiva increases from the primary dentition to permanent dentition 23. It is usually keratinized. Merkel cells, Tactile cells, or Merkel-Ranvier cells are oval-shaped receptor cells found in the deeper layers of the epithelium. It has been observed that thick gingiva has coarse and diffuse stippling whereas thin gingiva has fine and scanty stippling. The nucleus of the cells becomes flattened. The so-called probing depth of a clinically normal gingival sulcus in humans is 2 to 3 mm • The depth of this sulcus, as determined in histologic sections, has been reported as 1.8 mm, with … Some of these granules may be seen associated with the cell membrane. Base: Coronal margin of the attached tissues. Gingiva is that portion of the oral mucosa which covers the tooth-bearing part of the alveolar bone and the cervical neck of the teeth. 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. These are rod-shaped and if the terminal vesicle is present, they assume the classic tennis-racket-like shape 81. Periodontal biotype refers to the hereditary thickness of periodontal tissue. They contain nuclei with clefts, lysosomes, centrioles, Golgi vesicles, a small amount of endoplasmic reticulum, and moderate numbers of mitochondria. Defense: They have an internal defense mechanism that protects them against the noxious stimuli present in the oral cavity. The histological studies have reported the sulcus depth of 1.8 mm in healthy periodontium with a variation of 0-6 mm 8. The dental lamina is comprised of cells that proliferate at a faster rate as compared to the adjacent epithelial cells. 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. epithelium except for the lack of stratum corneum and it does not contain clearly defined stratum granulosum. Oxygen consumption of gingiva: The older cells are continuously replaced by new cells so that the integrity of the tissue can be maintained. It does not function during mastication and therefore is non-keratinized, soft and pliable. It plays an important role in the trans-endothelial migration of leukocytes during inflammation. In the anterior teeth, the interdental gingiva assumes the conical shape and is referred to as interdental papilla. K4 and K13 expressions are observed in the suprabasal layers of non-keratinized and para-keratinized epithelia 84,85. The sulcus depth determined by probing may be more than the histological depth if the periodontal probe penetrates the connective tissue, especially when it is inflamed or it may be less when the periodontal probe does not reach the bottom of the sulcus. Others have reported sulcus depth of 1.12 to 2.91 mm 9 and 0.69 mm 10. Due to infiltration by the immune cells, there is a loss of desmosomal attachment and widening of the intercellular spaces 96, 97. FIGURE I.Typical cheilitis showing maceration at commissure with atrophy and crusting of … The interdental gingiva occupies the interproximal spaces between the adjoining teeth. 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 principal cells of the gingival epithelium are the keratinocytes. The normal/thin periodontal biotype is found in around 75% of the patients, whereas thick biotype is found in approximately 25%. Generally, the papillary surface is keratinized. • Reduction of stippling – common sign of Gingival disease. Conclusion: Gingival stippling was seen as a normal characteristic in both male and female. Working off-campus? … A detailed description of TLRs and their role in host-microbial interactions has been discussed in “Host-microbial interactions in periodontal diseases”. Histological Characteristics of Stippling in Children, https://doi.org/10.1902/jop.1962.33.2.176. Type 2: These are spherical in shape and show fewer dendrites, a more electron-dense cytoplasm with fewer Birbeck granules. Tissue Engineering Part A. These are attached to each other with desmosomes and contain many keratin filament bundles known as tonofibrils. This study was supported in part by a U. S. Public Health Service Teacher Training Grant. Therefore, epithelial melanin pigmentation provides a defense barrier by acting as a binder for toxic products such as free radicals and polycyclic compounds 75. Numerous small electron-dense granules, also known as membrane coating granules or “Odland bodies”, are also observed in the cells of this layer. This condition can only be achieved in germfree animals or after prolonged and stringent plaque control 6, 7. Introduction: Stippling is a feature of healthy gingiva, which is a form of adaptive specialization or reinforcement of function. The unique functions that these tissues carry out are. After fertilization of the egg, there occurs a precisely coordinated cascade of developmental processes involving cell migration, growth, differentiation and apoptosis which results in the development of craniofacial structures. A thesis submitted in partial fulfillment of the requirements for the degree Master of Science (Periodontics) at the Ohio State University. The oral sulcular epithelium mostly expresses K5, K14, K4, K13, K6, K16, and K19. Number of times cited according to CrossRef: Gingival stippling in dogs: Clinical and structural characteristics. © 2021 American Academy of Periodontology, I have read and accept the Wiley Online Library Terms and Conditions of Use. Journal of periodontal research. All of these tooth-supporting structures are different in terms of tissue architecture, biochemical and chemical composition. Under absolutely ideal conditions, the sulcus depth is 0 or close to 0 mm 5. Fournier BP, Ferre FC, Couty L, Lataillade JJ, Gourven M, Naveau A, Coulomb B, Lafont A, Gogly B. Multipotent progenitor cells in gingival connective tissue. 2004 May;15(3):165-75. Journal of periodontology. Along with acting as a physical barrier, the gingival epithelium also plays an important role in the innate immune response 61. In 1972, Lang and Löe16 in a study reported that ………………….Content available in the hard-copy of the website……………………………. In their classical studies Glickman et al. In the, The oral mucosa has been traditionally divided into three categories: lining mucosa, specialized mucosa, and masticatory mucosa. They are usually located in the basal layer. A characteristic feature of these cells is the presence of. Squier CA, Kammeyer GA. The dimensions of the col are determined by the width of the contact area between adjoining teeth. Archives of oral biology. The prevalence of gingival and periodontal disease is manifold and has not been highlighted much due to its asymptomatic and milder symptoms. A variation of 1-9 mm in the width of attached gingiva has been reported in humans 16. Periodontology is the scientific study of the periodontium in health and in disease 1. These serve as “sentinels” of the oral mucosa and inform the immune system not only about the entry of the pathogen, but also about the tolerance to self antigens and commensal microbes. Specialized mucosa makes around 15% of the total oral mucosa. Because of this clinical … They have a protective role due to their ability to interact with active oxygen species (O 2-, H O , RO, ROO, etc.) The frontonasal process gives rise to a pair of medial nasal processes (that later contribute to a single globular [intermaxillary] process), and a pair of lateral nasal processes. ICAM-1 molecule interacts with the leukocyte function associated with antigen-1 and is involved in the transmigration of neutrophil through the epithelium. A shallow space between the marginal gingiva and the external tooth surface is termed as gingival sulcus. It is usually given its due importance when the gingival … After fertilization of the egg, there occurs a precisely coordinated cascade of developmental processes involving cell migration, growth, differentiation and apoptosis which results in the development of craniofacial structures. The basal cells show a large number of hemidesmosomes firmly attaching to the lamina densa of the basal lamina. Periodontics ) at the Ohio State University gums usually have no reaction to normal disturbance such as TNF-α,,... Wide gingiva, and K11 are expressed in highly proliferative epithelia the age. Ideal Conditions, the gingiva is that portion of the patients, whereas thick biotype found. 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