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. Specialized mucosa makes around 15% of the total oral mucosa. They perform distinct functions and are capable of adapting to the changes in the environment around them. By the fifth week of development, a horseshoe-shaped band of thickened epithelium (dental lamina) forms on the developing maxillary and mandibular bones. © 2021 American Academy of Periodontology, I have read and accept the Wiley Online Library Terms and Conditions of Use. 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. 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). It covers the dorsal surface of the tongue and composed of cornified epithelial papillae. They contain nuclei with clefts, lysosomes, centrioles, Golgi vesicles, a small amount of endoplasmic reticulum, and moderate numbers of mitochondria. • In 40% of adults Gingiva show stippling. epithelium except for the lack of stratum corneum and it does not contain clearly defined stratum granulosum. Polson AM, Greenstein G, Caton J. 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. In their classical studies Glickman et al. Lining mucosa expresses K4/K13 pair which is associated with elasticity, whereas the masticatory mucosa expresses K1/K10 pair which is associated with rigidity. They concluded that the oxygen quotient (QO ) of the normal gingiva is 1.6 ± 2 0.37. 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. Odland bodies are small sub-cellular structures of size 200-300 nm. about 60% of the total oral mucosa. The cell surface adhesion molecules belong to the immunoglobulin class. They have protective action against ultraviolet irradiation and have also been shown to be responsive to many immunological mediators 73. 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. Number of times cited according to CrossRef: Gingival stippling in dogs: Clinical and structural characteristics. This is a normal situation, and as the tooth erupts the free gingival margin will ultimately move apically. They have a protective role due to their ability to interact with active oxygen species (O 2-, H O , RO, ROO, etc.) 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. It is found in the skin and may also be seen in the gingival epithelium. The dendritic cells in the epithelium are known as Langerhan’s cells. The oral gingival epithelium expresses K5, K14, K1, K2, K10, K11, K6, K8, K16, K18, and K19. Sinai Hospital, Cleveland, Ohio. It does not function during mastication and therefore is non-keratinized, soft and pliable. A shallow space between the marginal gingiva and the external tooth surface is termed as gingival sulcus. During gingival inflammation, the sulcular epithelium is densely infiltrated with PMN’s and lymphocytes. The normal appearance of healthy gingiva is shown in Figure 6-1. cementum, periodontal ligament, and bone; invested in the gingiva. Critical Reviews in Oral Biology & Medicine. Gingival Crevice The gingival crevice is the space between the free gingiva and the tooth surface and is lined by nonkeratinized stratified squamous epithelium. 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. In normal periodontal tissues, it extends approximately 2 mm coronal to the cementoenamel junction (CEJ). The consumption of the oxygen in the healing gingiva varies according to the nature of the microscopic tissue changes. It covers the dorsal surface of the tongue and composed of cornified epithelial papillae. K4 and K13 expressions are observed in the suprabasal layers of non-keratinized and para-keratinized epithelia 84,85. It is relatively loosely bound to the adjacent structures by the connective tissue that is rich in elastin. 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 dimensions of the col are determined by the width of the contact area between adjoining teeth. Gingival tissues surrounding both the maxillary detention and the mandibular dentition may be affected. ICAM-1 molecule interacts with the leukocyte function associated with antigen-1 and is involved in the transmigration of neutrophil through the epithelium. The shape of the interdental gingiva is determined by the contact areas of the adjoining teeth and their mesiobuccal, mesiolingual, distobuccal and distolingual line angles. 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. All basal cells in stratified epithelia express keratins K5 and K14. Apically, it is bounded by the junctional epithelium and coronally it meets the outer gingival epithelium at the height of the free gingival margin. Histological sulcus depth is considered as the exact sulcus depth. The development of teeth takes place in three distinct phases based on the characteristics of the developing teeth, the bud, bell and cap stages. Type 2: These are spherical in shape and show fewer dendrites, a more electron-dense cytoplasm with fewer Birbeck granules. 5 In puberty and pregnancy, gingival hyperplasia can be due to poor oral hygiene, inadequate nutrition, or systemic variation in hormonal stimulation. 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. Stippling of the gingival tissue. Journal of periodontal research. Cytokeratins as molecular markers in the evaluation of the precise differentiation stage of human gingival epithelium reconstituted in vitro. The normal depth of the gingival sulcus and the corresponding width of the marginal gingiva is variable. These cells are associated with the development of Merkel cell carcinoma (MCC), which is a very aggressive small cell tumor of neuroendocrine origin, usually arising on sun-exposed parts of the skin. 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. 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… A characteristic feature of these cells is the presence of. These cells lack desmosomes and tonofilaments. 6 Gingival … The expressions of TLRs have been reported in healthy as well as diseased periodontal tissues. In the posterior teeth, the apex of the interdental gingiva is blunted with buccal and lingual peaks. The lack of keratinization makes this area particularly susceptible to influences from microorganisms. The lack of keratinization makes this area particularly susceptible to influences from microorganisms. The keratin expression of gingival epithelium cells changes with their maturation. There are a large number of biologically active substances that may stimulate or suppress, It is the epithelium which lines the gingival sulcus. They observed that during healing after gingivectomy, the maximum QO is achieved on the 2 fourteenth postoperative day. Journal of periodontal research. 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. Achieving predictable gingival stippling . The older cells are continuously replaced by new cells so that the integrity of the tissue can be maintained. Abstract: The texture of the gingival surface may be similar to orange peel and is referred to gingival stippling. Various disease processes around the teeth result in the destruction of periodontal tissues, thus making them mobile. 1981 Dec;52(12):743-6. ICAM-1 molecule interacts with the leukocyte function associated with antigen-1 and is involved in the transmigration of neutrophil through the epithelium. In 1972, Lang and Löe16 in a study reported that ………………….Content available in the hard-copy of the website……………………………. 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 exact function of these granules is not clear, however, they have been associated with antigen trapping and presentation. If the destructive process continues, the tooth/teeth are ultimately lost. Inner: Tooth surface which may be the enamel, cementum, or a part of each, depending on the position of the junctional epithelium. The normal/thin periodontal biotype is found in around 75% of the patients, whereas thick biotype is found in approximately 25%. Learn about our remote access options, Chairman Periodontal Research, Mt. in 1961 80. K1, K2, K10, and K11 are expressed in the suprabasal layers of keratinized stratified squamous epithelia 83. 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. A variation of 1-9 mm in the width of attached gingiva has been reported in humans 16. The term biotype has been replaced by the term phenotype in the recent (2017) world workshop classification system. 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. 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. Its absence or reduction indicates … gingival stippling … The nucleus of the cells becomes flattened. 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. Microscopically, the gingiva can be studied under three headings. The information presented in this website has been collected from various leading journals, books and websites. in labial flanges of gingival veneers and . Search for more papers by this author 1994 Mar;29(2):81-94. The mucogingival junction is a stable landmark which is probably genetically determined 12. Expression of ELAM-1 by endothelial cells is increased under the influence of cytokines such as TNF-α, IL-1, and bacterial lipopolysaccharides. and you may need to create a new Wiley Online Library account. 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. As the cells move from the basal layer to the surface, they show many biochemical and morphological changes. Along with acting as a physical barrier, the gingival epithelium also plays an important role in the innate immune response 61. The basic to neutral keratins have been numbered from K1 to K8 whereas the acidic keratins have been numbered from K9 to K19. It exhibits no exudate in periodontal health. Ortho-keratinization is characterized by a complete disintegration of the nucleus and cytoplasmic organelles. It constitutes around 25% of the total oral mucosa and is present as gingiva (free, attached and interdental) and covers the hard palate. The unique functions that these tissues carry out are. Cell and tissue research. A small number of cells remain in the proliferative compartment of the basal layer, participating in the formation of new cells. 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 gingival epithelium is firmly attached to the underlying connective tissue and is nonpermeable to water-soluble substances. Lamina densa consists of anchoring fibers made up of collagen Type VII, which binds to the collagen Type I and III of the extracellular matrix 49, 50. Thus, these receptors actively participate in host-microbial interactions in periodontal diseases. The principal cells of the gingival epithelium are the keratinocytes. In gingival health, the gingival … Junctional epithelium mostly expresses K5, K14, K13, and K19. Please check your email for instructions on resetting your password. Stratum spinosum consists of 10-20 layers of cells typically large in size, resembling spines. Morphologically, they become more flattened as they move from basal layer towards the surface. FIGURE H. Nearly normal gingival tissue four weeks after cessation of gum chewing. Generally, the papillary surface is keratinized. In different areas of the mouth, the width of attached gingiva varies. 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. 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. The boundaries of the gingival sulcus are. The mean width of attached gingiva increases from the primary dentition to permanent dentition 23. 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. The dental lamina is comprised of cells that proliferate at a faster rate as compared to the adjacent epithelial cells. The “bell stage” is characterized by the formation of two principal hard tissues of the tooth, enamel, and dentin (Figure 1.2a, 1.2b). Introduction: Stippling is a feature of healthy gingiva, which is a form of adaptive specialization or reinforcement of function. The book is usually delivered within one week anywhere in India and within three weeks anywhere throughout the world. These cells then migrate to the suprabasal layers and differentiate to form mature keratinocytes. FIGURE 6-1 Normal gingiva. It is typically coral pink in color, but its color may vary due to physiologic pigmentation among some races. Some persistence of stippling. The dental follicle gives rise to cementoblasts, osteoblasts, and fibroblasts which are responsible for the formation of the tooth-supporting structures. Because of this clinical … 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. Unhealthy gums, conversely, will show bleeding on probing (BOP) and/or purulent exudate. Excessive pigmentation of the gingiva is an esthetic problem and is treated by gingival depigmentation procedures. Others have reported sulcus depth of 1.12 to 2.91 mm 9 and 0.69 mm 10. Epithelium of the Gingiva. 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. FIGURE I.Typical cheilitis showing maceration at commissure with atrophy and crusting of … 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 primordium of the brain. 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 proliferation of the keratinocytes takes place by mitosis primarily in the basal layer and to some extent in the suprabasal layers. • Stippling returns when gingiva is restored to health. In the stratum corneum, the cells become flattened and show signs of nucleus disintegration. 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. epithelium except for the lack of stratum corneum and it does not contain clearly defined stratum granulosum. Following expression of keratins is observed in stratified squamous epithelium. Under absolutely ideal conditions, the sulcus depth is 0 or close to 0 mm 5. 2010). It is usually given its due importance when the gingival … Squier CA, Kammeyer GA. Attachment: They attach the teeth to their bony housing and also to one another. Content available in the hard-copy of the website……….. Working off-campus? It is a feature of healthy gingiva, and reduction or loss ot stippling is a common sign of gingival disease. Karring T, Lang NP, Löe H. The role of gingival connective tissue in determining epithelial differentiation. The hyperplasic gingiva usually presents a normal color and has a firm consistent with abundant stippling … 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). Type 1: They are pyramidal in shape and are highly dendritic with an electron-lucent cytoplasm. Stippling is (/ form of adaptive specie dilution or reinforcement for function. The term periodontal phenotype is used inter-changeably with the term periodontal biotype. Seibert and Lindhe (1989) 26 later used the term periodontal biotype to describe gingival forms and classified gingiva as thin scalloped or thick-flat. Due to infiltration by the immune cells, there is a loss of desmosomal attachment and widening of the intercellular spaces 96, 97. 2010 Sep 1;16(9):2891-9. Hence, this epithelium is non-keratinized. It covers the floor of the mouth, ventral (underside) tongue, alveolar mucosa, cheeks, lips, and soft palate. 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. This shape is referred to as “Col”. 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. On the basis of electron microscopic appearance, Langerhan’s cells have been divided into two types. References are available in the hard-copy of the website. The depth of gingival sulcus is an important indicator of periodontal status. They observed that flat gingival anatomy was found in patients having square teeth while the highly scalloped gingival form was found in patients with a tapered tooth form. The cells of the sulcular epithelium rarely show keratohyalin granules and membrane coating granules. 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 gingival epithelium can be further divided into three functional compartments: outer gingival epithelium, sulcular epithelium, and junctional epithelium. The prevalence of gingival and periodontal disease is manifold and has not been highlighted much due to its asymptomatic and milder symptoms. 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. During gingival inflammation, the sulcular epithelium is densely infiltrated with PMN’s and lymphocytes. 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 significance of gingival stippling in the diagnosis of PD in dogs is limited (Kyllar et al. 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. 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. The oral mucosa has been traditionally divided into three categories: lining mucosa, specialized mucosa, and masticatory mucosa. 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. Periodontal maintenance (Supportive periodontal therapy), Orthodontic-periodontal interrelationship, Piezosurgery in periodontics and oral implantology. 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. The gene coding for neutral-basic keratins are found on chromosome 12 (12q13.13), while the acidic keratins are found on chromosome 17 (17q21.2). Its expression has been shown to be increased in gingival inflammation 64, 65, 68. The interdental gingiva occupies the interproximal spaces between the adjoining teeth. This … The human face begins to form during the 4th week of embryonic development and by the 6th week, the external face is completed. Specialized mucosa makes around 15% of the total oral mucosa. It does not function during mastication and therefore is non-keratinized, soft and pliable. During the fourth week of development, this membrane breaks down in order to form the opening between the future oral cavity (primitive mouth or stomodeum) and the foregut. The Journal of the American Dental Association. 1990 Jan 1;35:S217-21. As the cells move from the basal layer to the cornified layer, their morphological characters change. This condition can only be achieved in germfree animals or after prolonged and stringent plaque control 6, 7. These patients are less likely to have gingival recession, but more likely to have exostoses and intrabony defects during periodontitis 27. These are attached to each other with desmosomes and contain many keratin filament bundles known as tonofibrils. Normal gingiva covers the alveolar bone and tooth root to a level just … The anatomical width of attached gingiva increases slightly with the increasing age because of tooth eruption to compensate for occlusal wear 12. The consistency of the normal gingiva is firm and resilient. The word ‘Periodontium’ is derived from the Greek words peri-, meaning “around” and -odons, meaning “tooth”. The cementoblasts derived from the dental follicle deposit cementum on the root surface and fibroblasts give rise to the periodontal ligament. 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. The cell surface adhesion molecules belong to the immunoglobulin class. The histological studies have reported the sulcus depth of 1.8 mm in healthy periodontium with a variation of 0-6 mm 8. 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 renewal time or the turnover time is the time taken for complete renewal of the tissue. It is usually keratinized. 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). Learn more. • Reduction of stippling – common sign of Gingival disease. It is relatively loosely bound to the adjacent structures by the connective tissue that is rich in elastin. Eventually, mature tooth structure is formed which is supported by the supporting tissues, i.e. 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. 2004 May;15(3):165-75. These cells lack desmosomes and tonofilaments. 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). 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. Histological Characteristics of Stippling in Children, https://doi.org/10.1902/jop.1962.33.2.176. Periodontium comprises of root cementum, periodontal ligament, bone lining the tooth socket (alveolar bone), and the part of gingiva facing the tooth surfaces (dentogingival junction). 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. Periodontal biotype refers to the hereditary thickness of periodontal tissue. A thick periodontal biotype displays a thick and wide gingiva, wider teeth and thicker bone. Rete pegs are not present in the sulcular epithelium. There is a dramatic reduction in cell organelles as the cells move from the basal layer to the stratum granulosum. 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. Resistance: These tissues resist and resolve the forces produced during mastication, speech, and deglutition. In 1969, Ochsenbein and Ross 25 described two types of gingival forms: flat and highly scalloped. Trackman PC, Kantarci A. Connective tissue metabolism and gingival overgrowth. In the, The oral mucosa has been traditionally divided into three categories: lining mucosa, specialized mucosa, and masticatory mucosa. Gingival description: Location, degree and … Melanocytes are melanin pigment-producing cells. Defense: They have an internal defense mechanism that protects them against the noxious stimuli present in the oral cavity. Numerous small electron-dense granules, also known as membrane coating granules or “Odland bodies”, are also observed in the cells of this layer. The structural integrity and interactions between the tooth-supporting structures are the fundamental requirements for a healthy periodontium. Gosselin F, Magloire H, Joffre A, Portier MM. The epithelium is organized into four layers which are distinguishable microscopically. From the fourteenth day onwards till the twenty-first day, there is a decline in QO 2 to approximately the level of normal gingiva. Reduction or loss of stippling is a common sign of gingival disease. Magnusson I, Nyman S, Karring T, Egelberg J. Connective tissue attachment formation following exclusion of gingival connective tissue and epithelium during healing. These protuberances give rise to deciduous teeth. Rete pegs are not present in the sulcular epithelium. 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. Epithelium cells changes with their maturation: the texture of the patients, thick! Squamous epithelium the maximum QO is achieved on the basis of electron microscopic,. Corneum reduces with age and with the sense of light touch discrimination.... In host-microbial interactions in periodontal diseases ” role in the suprabasal layers and differentiate to form mature keratinocytes migration... Begins to form mature keratinocytes the melanin pigmentation of the basement membrane with hemidesmosomes and reduction or ot... 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