The dendritic cells in the epithelium are known as Langerhan’s cells. 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. It plays an important role in the trans-endothelial migration of leukocytes during inflammation. The non-keratinocytes associated with the gingival epithelium are melanocytes, Langerhans cells, and Merkel cells 46-48. Trackman PC, Kantarci A. Connective tissue metabolism and gingival overgrowth. gingival stippling … It is a feature of healthy gingiva, and reduction or loss ot stippling is a common sign of gingival disease. It is demarcated from the attached gingiva by a shallow linear depression, the free gingival groove in approximately 50% of cases 3. 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. Because it represents the area of fusion of junctional epithelium of two adjoining teeth, it is non-keratinized and is more susceptible to damage from plaque and other noxious stimuli as compared to the keratinized gingiva. Inner: Tooth surface which may be the enamel, cementum, or a part of each, depending on the position of the junctional epithelium. It is found in the skin and may also be seen in the gingival epithelium. Excessive keratohyalin bodies and tonofibrils are seen in the cells. K1, K2, K10, and K11 are expressed in the suprabasal layers of keratinized stratified squamous epithelia 83. Neural crest cells, which are derived from the neural tube play an important role in the development of teeth. There are 20 keratin polypeptides which have been divided into acidic and basic subfamilies. Thus, these receptors actively participate in host-microbial interactions in periodontal diseases. During gingival inflammation, the sulcular epithelium is densely infiltrated with PMN’s and lymphocytes. This … A characteristic feature of these cells is the presence of g-specific granules or Birbeck granules (100 nm to 1 μm in size) first described by Birbeck et al. The normal/thin periodontal biotype is found in around 75% of the patients, whereas thick biotype is found in approximately 25%. The Journal of the American Dental Association. The histological studies have reported the sulcus depth of 1.8 mm in healthy periodontium with a variation of 0-6 mm 8. References are available in the hard-copy of the website. 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. A variation of 1-9 mm in the width of attached gingiva has been reported in humans 16. 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. Merkel cells, Tactile cells, or Merkel-Ranvier cells are oval-shaped receptor cells found in the deeper layers of the epithelium. The gingival epithelium is firmly attached to the underlying connective tissue and is nonpermeable to water-soluble substances. Toll-like receptors (TLRs) are important components of innate immunity. It covers the dorsal surface of the tongue and composed of cornified epithelial papillae. 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). ICAM-1 molecule interacts with the leukocyte function associated with antigen-1 and is involved in the transmigration of neutrophil through the epithelium. All basal cells in stratified epithelia express keratins K5 and K14. Conclusion: Gingival stippling was seen as a normal characteristic in both male and female. Masticatory mucosa is the load-bearing mucosa during mastication. This is a normal situation, and as the tooth erupts the free gingival margin will ultimately move apically. During gingival inflammation, the sulcular epithelium is densely infiltrated with PMN’s and lymphocytes. The consistency of the normal gingiva is firm and resilient. •In chronic inflammation: The gingiva may appear enlarged, pink/ pale in color with normal or deepened stippling and a fibrotic consistency. The expressions of TLRs have been reported in healthy as well as diseased periodontal tissues. Hence, this epithelium is non-keratinized. The gingiva is palpated with a blunt instrument to check for its consistency. The mean width of attached gingiva increases from the primary dentition to permanent dentition 23. The basal cells show a large number of hemidesmosomes firmly attaching to the lamina densa of the basal lamina. Polson AM, Greenstein G, Caton J. The dimensions of the col are determined by the width of the contact area between adjoining teeth. The nucleus of the cells becomes flattened. The lack of keratinization makes this area particularly susceptible to influences from microorganisms. 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. 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. A thesis submitted in partial fulfillment of the requirements for the degree Master of Science (Periodontics) at the Ohio State University. Periodontology is the scientific study of the periodontium in health and in disease 1. 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. The word ‘Periodontium’ is derived from the Greek words peri-, meaning “around” and -odons, meaning “tooth”. 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. In normal periodontal tissues, it extends approximately 2 mm coronal to the cementoenamel junction (CEJ). They perform distinct functions and are capable of adapting to the changes in the environment around them. (1949, 1950) 98, 99 estimated the oxygen consumption by normal and healing gingiva using Warburg technique. 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 prevalence of gingival and periodontal disease is manifold and has not been highlighted much due to its asymptomatic and milder symptoms. 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. Stippling of the gingival tissue. Therefore, epithelial melanin pigmentation provides a defense barrier by acting as a binder for toxic products such as free radicals and polycyclic compounds 75. The keratin expression of gingival epithelium cells changes with their maturation. 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 inflammation in the periodontal tissues due to plaque accumulation results in the conversion of normal sulcus into a pathological pocket. The normal appearance of healthy gingiva is shown in Figure 6-1. Gosselin F, Magloire H, Joffre A, Portier MM. The cells of the sulcular epithelium rarely show keratohyalin granules and membrane coating granules. The basic to neutral keratins have been numbered from K1 to K8 whereas the acidic keratins have been numbered from K9 to K19. The degree of keratinization of stratum corneum reduces with age and with the onset of menopause 60. 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. In their classical studies Glickman et al. Some persistence of stippling. The lining mucosa constitutes about 60% of the total oral mucosa. Term phenotype in the suprabasal layers and differentiate to form mature keratinocytes to K19 of gingiva... An esthetic problem and is nonpermeable to water-soluble substances surface of the periodontium they an. To 2.91 mm 9 and 0.69 mm 10 excessive keratohyalin bodies and are. Smoking also stimulates melanin production, leading to exceedingly evident intraoral pigmentation 78,.. Immune cells, Tactile cells, or Merkel-Ranvier cells are potent antigen-presenting cells and may also seen. 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