Se ha denunciado esta presentación.
Utilizamos tu perfil de LinkedIn y tus datos de actividad para personalizar los anuncios y mostrarte publicidad más relevante. Puedes cambiar tus preferencias de publicidad en cualquier momento.

Gingiva

Gingiva

Audiolibros relacionados

Gratis con una prueba de 30 días de Scribd

Ver todo
  • Sé el primero en comentar

Gingiva

  1. 1. Dr. Nithin Mathew
  2. 2. Dr. Nithin Mathew – Gingiva  Introduction  Definition  Macroscopic anatomy 1. Marginal gingiva 2. Gingival sulcus 3. Attached gingiva 4. Interdental gingiva
  3. 3. Dr. Nithin Mathew – Gingiva  Periodontium peri = around odontos = tooth i.e structures surrounding the tooth  Comprises  Gingiva  Periodontal ligament  Cementum  Alveolar bone
  4. 4. Dr. Nithin Mathew – Gingiva  Oral mucosa - three zones: • the gingiva and the covering of the hard palate : masticatory mucosa • the dorsum of the tongue, covered by specialized mucosa • the oral mucous membrane lining the remainder of the oral cavity.
  5. 5. Dr. Nithin Mathew – Gingiva  Gingiva is that part of oral mucosa that covers the alveolar processes of the jaws and surrounds the necks of the teeth.
  6. 6. Dr. Nithin Mathew – Gingiva  Marginal gingiva  Gingival sulcus  Attached gingiva  Interdental gingiva
  7. 7. Dr. Nithin Mathew – Gingiva  Marginal, or unattached  The terminal edge or border of the gingiva surrounding the teeth in collarlike fashion  Demarcated from the adjacent, attached gingiva by a shallow linear depression, the free gingival groove  Usually 1 mm wide
  8. 8. Dr. Nithin Mathew – Gingiva  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  V shaped  Clinical determination of the depth of the gingival sulcus is an important diagnostic parameter
  9. 9. Dr. Nithin Mathew – Gingiva  Depth of this sulcus, as determined in histologic sections, has been reported as 1.8 mm,   The clinical maneuver used to determine the depth of the sulcus is the introduction of the periodontal probe-and the estimation of the distance it penetrates.  The histologic depth of a sulcus need not be exactly equal to the depth of penetration of the probe.  The so-called probing depth of a clinically normal gingival sulcus in humans is 2 to 3 mm
  10. 10. Dr. Nithin Mathew – Gingiva  It is the distance between the mucogingival junction and the projection on the external surface at the bottom of the gingival sulcus or the periodontal pocket  The attached gingiva is continuous with the marginal gingiva.  It is firm, resilient and tightly bound to the underlying periosteum of alveolar bone.
  11. 11. Dr. Nithin Mathew – Gingiva  The facial aspect of the attached gingiva extends to the relatively loose and movable alveolar mucosa from which it is demarcated by the mucogingival junction.  The width of the attached gingiva is another important clinical parameter.  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
  12. 12. Dr. Nithin Mathew – Gingiva  greatest in the incisor region :  3.5 to 4.5 mm in the maxilla  3.3 to 3.9 mm in the mandible  less in the posterior segments with the least width in the first premolar area :  1.9 mm in the maxilla  1.8 mm in the mandible  Width of the attached gingiva increases with age' and in supraerupted teeth
  13. 13. Dr. Nithin Mathew – Gingiva  Lingual aspect of the mandible, the attached gingiva terminates at the junction with the lingual alveolar mucosa, which is continuous with the mucous membrane lining the floor of the mouth.  The palatal surface of the attached gingiva in the maxilla blends imperceptibly with the equally firm, resilient palatal mucosa.
  14. 14. Dr. Nithin Mathew – Gingiva  Occupies the gingival embrasure  Can be pyramidal or have a "col" shape  Shape depends on the contact point and the presence or absence of some degree of recession
  15. 15. Dr. Nithin Mathew – Gingiva  ‘col’ it presents a valley like depression that connects the facial and lingual papilla and conforms to the shape of interproximal contact.
  16. 16. Dr. Nithin Mathew – Gingiva  Measurement approach  By using Schiller’s potassium iodide solution  Tensiontest  Roll test
  17. 17. Dr. Nithin Mathew – Gingiva  Broadly speaking gingiva is made up of epithelium and connective tissue.  The gingival epithelium can be studied under three headings:  Outer or oral epithelium  Sulcular epithelium  Junctional epithelium
  18. 18. Dr. Nithin Mathew – Gingiva  Function  Mechanical, chemical, water and microbial barrier  Signalling function  Major cell type : keratinocyte  Other cells : langerhan cells, merkel cells, melanocytes.  Cell to cell attachments : desmosomes, tight jn, gap jn.
  19. 19. Dr. Nithin Mathew – Gingiva  Covers the crest and the outer surface of marginal gingiva and surface of attached gingiva.  4 layers  Stratum basale:- cuboidal cells  Stratum spinosum:- large polyhedral cells →Desmosomes  Stratum granulosum  Stratum corneum:- superficial most layer Large, wide, flat and lacking nucleus.  0.2 – 0.3mm thickness  keratinization varies
  20. 20. Dr. Nithin Mathew – Gingiva  Lines the gingival sulcus  Non keratinized stratified squamous epithelium  It is not keratinized due to constant irritation of plaque  Extends from the coronal area of the junctional epithelium to the free margin of the gingival.  Epithelium lacks heavy ridges and papillae.
  21. 21. Dr. Nithin Mathew – Gingiva  Collar-like band  0.25 – 1.35mm  Formed by the confluence of oral epithelium and reduced enamel epithelium.  Epithelial attachment – internal basal laminae  3-4 layers thick in early life, but the number of layers increases with age to 10 or even 20 layers  Junctional epithelium + gingival fibres = dento-gingival unit
  22. 22. Dr. Nithin Mathew – Gingiva  Attached to the tooth surface (epithelial attachment) by means of an internal basal lamina and to the gingival connective tissue by an external basal lamina  The attachment of the junctional epithelium to the tooth is reinforced by the gingival fibers, which brace the marginal gingiva against the tooth surface  Junctional epithelium + gingival fibres = dento-gingival unit
  23. 23. Dr. Nithin Mathew – Gingiva  The gingival sulcus is the shallow, V-shaped space or groove between the tooth and gingiva that encircles the newly erupted tip of the crown.  In the fully erupted tooth, only the junctional epithelium persists.  Sulcus consists of the shallow space that is coronal to the attachment of the junctional epithelium and bounded by the tooth on one side and the Sulcular epithelium on the other.  The coronal extent of the gingival sulcus is the gingival margin
  24. 24. Dr. Nithin Mathew – Gingiva  Undergoes continuous renewal.  Thickness is maintained by a balance between new cell formation in the basal and spinous layers and the shedding of old cells at the surface.  The mitotic activity exhibits a 24-hour periodicity, with highest and lowest rates occurring in the morning and evening, respectively.  The mitotic rate is higher in nonkeratinized areas and is increased in gingivitis
  25. 25. Dr. Nithin Mathew – Gingiva  The gingival sulcus contains a fluid that seeps into it from the gingival connective tissue through the thin Sulcular epithelium.  Functions  Cleanse debris from the sulcus  Contain plasma proteins that may improve adhesion of the epithelium to the tooth  Possess antimicrobial properties, and exert antibody activity to defend the gingiva
  26. 26. Dr. Nithin Mathew – Gingiva  Connective tissue of the gingiva is known as the Lamina Propria  Consists of two layers:  a papillary layer subjacent to the epithelium, which consists of papillary projections between the epithelial rete pegs  a reticular layer contiguous with the periosteum of the alveolar bone.  Connective tissue has a cellular and an extracellular compartment composed of fibers and ground substance
  27. 27. Dr. Nithin Mathew – Gingiva  The ground substance fills the space between fibers and cells, is amorphous, and has a high content of water.  Composed of proteoglycans, mainly hyaluronic acid and chondroitin sulfate, and glycoproteins, mainly fibronectin.  Fibronectin binds fibroblasts to the fibers and many other components of the intercellular matrix, helping mediate cell adhesion and migration.  Laminin is another glycoprotein found in the basal laminae, which serves to attach it to epithelial cells
  28. 28. Dr. Nithin Mathew – Gingiva  The three types of connective tissue fibers are collagen, reticular, and elastic.  Collagen type I forms the bulk of the lamina propria and provides the tensile strength to the gingival tissue.  Type IV collagen branches between the collagen type I bundles and is continuous with fibers of the basement membrane and blood vessel walls
  29. 29. Dr. Nithin Mathew – Gingiva  Connective tissue of the marginal gingiva is densely collagenous, containing a prominent system of collagen fiber bundles called the gingival fibers  Functions:  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
  30. 30. Dr. Nithin Mathew – Gingiva  The gingival fibers are arranged in three groups: dentogingival, circular and transseptal Dentogingival  Facial, lingual, and interproximal surfaces.  Embedded in the cementum just beneath the epithelium at the base of the gingival sulcus.  On the facial and lingual surfaces, they project from the cementum in fanlike conformation toward the crest and outer surface of the marginal gingiva, terminating short of the epithelium
  31. 31. Dr. Nithin Mathew – Gingiva  They also 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.  Interproximally, the gingivodental fibers extend toward the crest of the interdental gingiva
  32. 32. Circular Group The circular fibers course through the connective tissue of the marginal and interdental gingivae and encircle the tooth in ringlike fashion
  33. 33. Dr. Nithin Mathew – Gingiva Transseptal Group  Located interproximally,  Transseptal fibers form horizontal bundles that extend between the cementum of approximating teeth into which they are embedded.  Lie in the area between the epithelium at the base of the gingival sulcus and the crest of the interdental bone
  34. 34. Dr. Nithin Mathew – Gingiva Alveologingival group  The fibers run from the crest of the alveolar bone and interdental septum, radiating coronally into the overlying lamina propria of the gingiva Dentoperiosteal group  The fibers only occur in vestibular and lingual gingiva. They arise from cementum and pass over the alveolar crest to insert into the periosteum
  35. 35. Dr. Nithin Mathew – Gingiva Semicircular group  The fibers emanate from cementum near the cementenamel junction, cross the free marginal gingiva, and insert into a similar position on the opposite side of the tooth. Transgingival group  The fibers reinforce the circular and semicircular fibers. The fibers arise from the cervical cementum and extend into the marginal gingiva of the adjacent tooth, merging with the circular fibers
  36. 36. Dr. Nithin Mathew – Gingiva Longitudinal group  The fibers extend for long distances within the free gingiva, some possibly for the whole length of the arch. Interdental group  The fibers pass through the coronal portion of the interdental gingiva in the buccolingual direction, connecting buccal and lingual papillae.
  37. 37. Dr. Nithin Mathew – Gingiva Vertical group  The fibers arise in alveolar mucosa or attached gingiva and pass coronally towards the marginal gingiva and interdental papilla.
  38. 38. Dr. Nithin Mathew – Gingiva Three sources of blood supply to the gingiva are asfollows  Supraperiosteal arterioles along the facial and lingual surfaces of the alveolar bone, from which capillaries extend along the sulcular epithelium and between the rete pegs 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
  39. 39. Dr. Nithin Mathew – Gingiva  Vessels of the periodontal ligament, which extend into the gingiva and anastomose with capillaries in the sulcus area.  Arterioles, which emerge from the crest of the interdental septa 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.
  40. 40. Dr. Nithin Mathew – Gingiva Maxillary  Nasopalatine nerve  Supplies facial aspect of anterior teeth  Posterior superior alveolar nerve  Supplies facial aspect of posterior teeth  Greater palatine nerve  Supplies lingual aspect of posterior teeth  Anterior palatine nerve  Supplies lingual aspect of anterior teeth
  41. 41. Dr. Nithin Mathew – Gingiva Mandibular  Inferior Alveolar nerve
  42. 42. Dr. Nithin Mathew – Gingiva Color  Healthy gingiva : "coral pink."  Other colours like red, white, and blue can signify inflammation (gingivitis) or pathology.  Normal racial pigmentation makes the gingiva appear darker.  Because the color of gingiva varies due to racial pigmentation, uniformity of color is more important than the underlying color itself.
  43. 43. Dr. Nithin Mathew – Gingiva  Produced by vascular supply, the thickness and degree of keratinization of the epithelium and the presence of pigment containing cells : melanin
  44. 44. Dr. Nithin Mathew – Gingiva Size  Corresponds to the sum total of the bulk of cellular and intercellular elements and their vascular supply. Contour  Depends on the shape of the teeth and their alignment in the arch, the location and size of the area of the proximal contact and the dimensions of the facial and lingual embrasures.  Marginal gingiva-scalloped outline on facial and lingual surfaces, straight line along the teeth with flat surfaces.
  45. 45. Dr. Nithin Mathew – Gingiva  On teeth with pronounced mesiodistal convexity or teeth in labial version, the normal arcuate contour is accentuated and the gingival is located farther apically.  On teeth in lingual version the gingiva is horizontal and thickened. Shape  Governed by the contour of the proximal tooth surfaces and the location and shape of the gingival embrasures.  The height of the interdental gingival varies with the location of the proximal contact.
  46. 46. Dr. Nithin Mathew – Gingiva Consistency  Firm and resilient because it is bound to the underlying bone except movable free margin.  Collagenous nature of lamina propria and its contiguity with the mucoperiosteum of the alveolar bone determine the firmness of the attached gingiva.  Gingival fibers contribute to the firmness of gingival margin.
  47. 47. Dr. Nithin Mathew – Gingiva SurfaceTexture  Orange peel-referred to as being stippled.  It is best viewed by drying the gingiva.  Attached gingiva is stippled, marginal is not.  Central portion of interdental papilla is usually stippled but the marginal borders are smooth.  Stippling is less prominent in lingual surfaces.
  48. 48. Dr. Nithin Mathew – Gingiva Position  The position of the gingiva refers to the level at which the gingival margin is attached to the tooth

×