Dendritic cells are potent antigen-presenting cells and may be the only cells capable of initiating the adaptive immune response. 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. 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. Therefore, epithelial melanin pigmentation provides a defense barrier by acting as a binder for toxic products such as free radicals and polycyclic compounds 75. These cells are of ectodermal origin migrating into mesenchymal tissue; therefore are also referred to as ectomesenchymal cells. The oral gingival epithelium expresses K5, K14, K1, K2, K10, K11, K6, K8, K16, K18, and K19. This shape is referred to as “Col”. 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. about 60% of the total oral mucosa. 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. Seibert and Lindhe (1989) 26 later used the term periodontal biotype to describe gingival forms and classified gingiva as thin scalloped or thick-flat. The gingiva can be anatomically divided into marginal, attached and interdental gingiva. It has been demonstrated that pathogen-associated molecular patterns (PAMPs), shared by many different periodontopathogenic bacteria, stimulate the resident gingival epithelial cells to initiate inflammatory responses in a TLR-dependent manner 69. The information presented in this website has been collected from various leading journals, books and websites. These cells have synaptic contacts with somatosensory afferents and are associated with the sense of light touch discrimination 82. 1983 Apr 1;230(3):615-30. The oral sulcular epithelium mostly expresses K5, K14, K4, K13, K6, K16, and K19. In 1969, Ochsenbein and Ross 25 described two types of gingival forms: flat and highly scalloped. Content available in the hard-copy of the website……….. 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). Journal of periodontal research. Histological Characteristics of Stippling in Children, https://doi.org/10.1902/jop.19126.96.36.199. Following expression of keratins is observed in stratified squamous epithelium. It is found in the skin and may also be seen in the gingival epithelium. FIGURE 6-1 Normal gingiva. Odland bodies are small sub-cellular structures of size 200-300 nm. Rete pegs are not present in the sulcular epithelium. Karring T, Lang NP, Löe H. The role of gingival connective tissue in determining epithelial differentiation. 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. • Reduction of stippling – common sign of Gingival disease. They contain nuclei with clefts, lysosomes, centrioles, Golgi vesicles, a small amount of endoplasmic reticulum, and moderate numbers of mitochondria. Masticatory mucosa is the load-bearing mucosa during mastication. Conclusion: Gingival stippling was seen as a normal characteristic in both male and female. The depth of gingival sulcus is an important indicator of periodontal status. In different areas of the mouth, the width of attached gingiva varies. Relationships between epithelium and connective tissue in inflamed gingiva. In other words, it is the time taken for the exfoliation of a number of cells corresponding to the total number of cells in the tissue, and the formation of the same number of cells through mitotic cell division. 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. It covers the dorsal surface of the tongue and composed of cornified epithelial papillae. Stippling is (/ form of adaptive specie dilution or reinforcement for function. In the stratum corneum, the cells become flattened and show signs of nucleus disintegration. The clinical appearance of healthy gingiva: tissue is pink and uniform in color, stippling can be seen, and the papillae fill the interdental spaces. The gingival connective tissue is composed of collagen fibers … Eventually, mature tooth structure is formed which is supported by the supporting tissues, i.e. The gingival epithelium can be further divided into three functional compartments: outer gingival epithelium, sulcular epithelium, and junctional epithelium. The word ‘Periodontium’ is derived from the Greek words peri-, meaning “around” and -odons, meaning “tooth”. These cells lack desmosomes and tonofilaments. The dendritic cells in the epithelium are known as Langerhan’s cells. 1990 Jan 1;35:S217-21. The marginal gingiva or unattached gingiva forms the coronal border of the gingiva which surrounds the tooth but is not adherent to it. 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. Cellular origins and differentiation control mechanisms during periodontal development and wound healing. In the anterior teeth, the interdental gingiva assumes the conical shape and is referred to as interdental papilla. 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. The term periodontal phenotype is used inter-changeably with the term periodontal biotype. 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. 1975 Feb;10(1):1-1. These are modified lysosomes, which contain ………………….Content available in the hard-copy of the website……………………………. Histologically, the marginal gingiva is made up of oral gingival epithelium coronal to the gingival groove, oral sulcular epithelium, junctional epithelium and subjacent connective tissue of the lamina propria. In the, The oral mucosa has been traditionally divided into three categories: lining mucosa, specialized mucosa, and masticatory mucosa. 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. epithelium except for the lack of stratum corneum and it does not contain clearly defined stratum granulosum. The hyperplasic gingiva usually presents a normal color and has a firm consistent with abundant stippling … References are available in the hard-copy of the website. They have a protective role due to their ability to interact with active oxygen species (O 2-, H O , RO, ROO, etc.) A shallow space between the marginal gingiva and the external tooth surface is termed as gingival sulcus. Research has shown increased expression of integrins 62, intercellular adhesion molecule-1 (ICAM-1) 63, endothelial leukocytes adhesion molecule 1 (ELAM-1)64, 65 and vascular cell adhesion molecule (VCAM)-1 in the inflamed gingiva 62. 5 In puberty and pregnancy, gingival hyperplasia can be due to poor oral hygiene, inadequate nutrition, or systemic variation in hormonal stimulation. 1981 Dec;52(12):743-6. The older cells are continuously replaced by new cells so that the integrity of the tissue can be maintained. They observed that during healing after gingivectomy, the maximum QO is achieved on the 2 fourteenth postoperative day. Journal of periodontal research. ICAM-1 molecule interacts with the leukocyte function associated with antigen-1 and is involved in the transmigration of neutrophil through the epithelium. Masticatory mucosa is the load-bearing mucosa during mastication. The renewal time or the turnover time is the time taken for complete renewal of the tissue. Because of this clinical … Thus, these receptors actively participate in host-microbial interactions in periodontal diseases. Base: Coronal margin of the attached tissues. Some persistence of stippling. The cells of the sulcular epithelium rarely show keratohyalin granules and membrane coating granules. The epithelium is organized into four layers which are distinguishable microscopically. Stratum spinosum consists of 10-20 layers of cells typically large in size, resembling spines. A healthy periodontium is required to adequately support the teeth in function. The lining mucosa constitutes. The dental lamina is comprised of cells that proliferate at a faster rate as compared to the adjacent epithelial cells. 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. 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. 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). A thesis submitted in partial fulfillment of the requirements for the degree Master of Science (Periodontics) at the Ohio State University. 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. They contain nuclei with clefts, lysosomes, centrioles, Golgi vesicles, a small amount of endoplasmic reticulum, and moderate numbers of mitochondria. The basal cells show a large number of hemidesmosomes firmly attaching to the lamina densa of the basal lamina. Specialized mucosa makes around 15% of the total oral mucosa. The outer gingival epithelium consists of keratinized stratified squamous epithelium, which covers the attached gingiva and the crest and outer surface of the marginal gingiva. Type 2: These are spherical in shape and show fewer dendrites, a more electron-dense cytoplasm with fewer Birbeck granules. The Journal of the American Dental Association. In their classical studies Glickman et al. Its absence or reduction indicates … The basic to neutral keratins have been numbered from K1 to K8 whereas the acidic keratins have been numbered from K9 to K19. These patients are less likely to have gingival recession, but more likely to have exostoses and intrabony defects during periodontitis 27. The consumption of the oxygen in the healing gingiva varies according to the nature of the microscopic tissue changes. The basal layer consists of one or two layers of cuboidal cells, which are undifferentiated cells. Magnusson I, Nyman S, Karring T, Egelberg J. Connective tissue attachment formation following exclusion of gingival connective tissue and epithelium during healing. 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. The sulcular epithelium is similar to the outer gingival. A variation of 1-9 mm in the width of attached gingiva has been reported in humans 16. All basal cells in stratified epithelia express keratins K5 and K14. A small number of cells remain in the proliferative compartment of the basal layer, participating in the formation of new cells. If the destructive process continues, the tooth/teeth are ultimately lost. Polson AM, Greenstein G, Caton J. This website is a small attempt to create an easy approach to understand periodontology for the students who are facing difficulties during the graduation and the post-graduation courses in our field. May not have BOP. The lack of keratinization makes this area particularly susceptible to influences from microorganisms. Achieving predictable gingival stippling . On the basis of electron microscopic appearance, Langerhan’s cells have been divided into two types. Periodontal maintenance (Supportive periodontal therapy), Orthodontic-periodontal interrelationship, Piezosurgery in periodontics and oral implantology. Apically, it is bounded by the junctional epithelium and coronally it meets the outer gingival epithelium at the height of the free gingival margin. The boundaries of the gingival sulcus are. The dimensions of the col are determined by the width of the contact area between adjoining teeth. Critical Reviews in Oral Biology & Medicine. Introduction: Stippling is a feature of healthy gingiva, which is a form of adaptive specialization or reinforcement of function. Working off-campus? The development of teeth takes place in three distinct phases based on the characteristics of the developing teeth, the bud, bell and cap stages. 1994 Mar;29(2):81-94. It does not function during mastication and therefore is non-keratinized, soft and pliable. Type 1: They are pyramidal in shape and are highly dendritic with an electron-lucent cytoplasm. 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. FIGURE H. Nearly normal gingival tissue four weeks after cessation of gum chewing. 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 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 … The cells of the sulcular epithelium rarely show keratohyalin granules and membrane coating granules. Reduction or loss of stippling is a common sign of gingival disease. Histological sulcus depth is considered as the exact sulcus depth. Prevalence of gingival stippling in children. The nucleus of the cells becomes flattened. In health, the rate of renewal of the epithelial cells equals to the rate of cell exfoliation, so that the total number of the cells remains constant. In gingival health, the gingival … 2010). Hence, this epithelium is non-keratinized. In 1972, Lang and Löe16 in a study reported that ………………….Content available in the hard-copy of the website……………………………. Use the link below to share a full-text version of this article with your friends and colleagues. There are 20 keratin polypeptides which have been divided into acidic and basic subfamilies. These are essentially the primordial dental arches. The gingival epithelium is firmly attached to the underlying connective tissue and is nonpermeable to water-soluble substances. 2 2, 74. 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. 1985 Mar;20(2):201-8. The anatomical width of attached gingiva increases slightly with the increasing age because of tooth eruption to compensate for occlusal wear 12. The histological studies have reported the sulcus depth of 1.8 mm in healthy periodontium with a variation of 0-6 mm 8. cementum, periodontal ligament, and bone; invested in the gingiva. It is relatively loosely bound to the adjacent structures by the connective tissue that is rich in elastin. 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. 58 During the primary dentition stage, the normal … Periodontology is the scientific study of the periodontium in health and in disease 1. A thick periodontal biotype displays a thick and wide gingiva, wider teeth and thicker bone. Content available in the hard-copy of the website……….. The human face begins to form during the 4th week of embryonic development and by the 6th week, the external face is completed. Attachment: They attach the teeth to their bony housing and also to one another. These protuberances give rise to deciduous teeth. The dental follicle gives rise to cementoblasts, osteoblasts, and fibroblasts which are responsible for the formation of the tooth-supporting structures. It does not function during mastication and therefore is non-keratinized, soft and pliable. It is usually keratinized. and you may need to create a new Wiley Online Library account. Sinai Hospital, Cleveland, Ohio. It constitutes around 25% of the total oral mucosa and is present as gingiva (free, attached and interdental) and covers the hard palate. Resistance: These tissues resist and resolve the forces produced during mastication, speech, and deglutition. 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. Melanocytes are melanin pigment-producing cells. 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. These are essentially the primordial dental arches. 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 attached gingiva is usually ‘stippled’, with small regularly spaced depressions on its surface, giving it an “orange peel appearance” 13, 14. After appropriate pretreat- showed either no or very delicate signs of stippling. Apically, it is bounded by the junctional epithelium and coronally it meets the outer gingival epithelium at the height of the free gingival margin. Junctional epithelium mostly expresses K5, K14, K13, and K19. Microscopically, the gingiva can be studied under three headings. 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. Periodontium refers to a group of specialized tissues that surround and support the teeth, maintaining them in the maxillary and mandibular bones. Toll-like receptors (TLRs) are important components of innate immunity. The dental lamina is comprised of cells that proliferate at a faster rate as compared to the adjacent epithelial cells. Under absolutely ideal conditions, the sulcus depth is 0 or close to 0 mm 5. Cytokeratins as molecular markers in the evaluation of the precise differentiation stage of human gingival epithelium reconstituted in vitro. The cell surface adhesion molecules belong to the immunoglobulin class. Due to infiltration by the immune cells, there is a loss of desmosomal attachment and widening of the intercellular spaces, Periobasics A Textbook of Periodontics and Implantology, Text Book of Basic Sciences for MDS Students. The book is usually delivered within one week anywhere in India and within three weeks anywhere throughout the world. In general, sulcular depth less than 2 to 3 mm in humans and animals is considered as normal 11. 2010 Sep 1;16(9):2891-9. 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). Now, let us discuss in detail the components of the periodontium. in 1961 80. They have numerous Birbeck granules and are usually found in the suprabasal layers. The “bell stage” is characterized by the formation of two principal hard tissues of the tooth, enamel, and dentin (Figure 1.2a, 1.2b). The normal depth of the gingival sulcus and the corresponding width of the marginal gingiva is variable. 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). 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. Squier CA, Kammeyer GA. 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 development of teeth takes place in three distinct phases based on the characteristics of the developing teeth, the bud, bell and cap stages. The expressions of TLRs have been reported in healthy as well as diseased periodontal tissues. These cells then migrate to the suprabasal layers and differentiate to form mature keratinocytes. Search for more papers by this author Generally, the papillary surface is keratinized. 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. gingival stippling … A characteristic feature of these cells is the presence of. Defense: They have an internal defense mechanism that protects them against the noxious stimuli present in the oral cavity. 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. Unhealthy gums, conversely, will show bleeding on probing (BOP) and/or purulent exudate. The authors also discouraged the assumption that introduction of external oxygen could hasten the natural process of healing. The degree of keratinization of stratum corneum reduces with age and with the onset of menopause 60. In normal periodontal tissues, it extends approximately 2 mm coronal to the cementoenamel junction (CEJ). •In chronic inflammation: The gingiva may appear enlarged, pink/ pale in color with normal or deepened stippling and a fibrotic consistency. It is composed of the ectoderm externally and the endoderm internally. As the root formation continues, the osteoblasts deposit bone around the root of the tooth. Normal or exaggerated TNF-α, IL-1, and bacterial lipopolysaccharides description: Location, degree and … of... Normal disturbance such as brushing or periodontal et al to physiologic pigmentation among some races on (... 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