The trough around the tooth is called the sulcus and its depth is normally mm. It is lined with sulcular epithelium and attached to the tooth at its base by the epithelial attachment.
Gingival margin — The border region of the gingiva that touches the tooth. Interdental papillae — The region of gingival tissue that fills the space between adjacent teeth. In a healthy mouth this is usually knife-edged and fills the interdental space. Muco-gingival junction — The scalloped line that divides the attached gingiva from the alveolar mucosa. Figure Healthy Gingiva. Attachment Mechanism The attachment of the tooth to the surrounding and supporting structures bone is accomplished through the cementum of the tooth, periodontal ligaments and the alveolar bone.
Bone The alveolar bone supports the teeth and is covered by gingival tissue. Tooth Anatomy. Print Save your progress. Your session is about to expire. Do you want to continue logged in? Why not share! Embed Size px. Start on. Show related SlideShares at end. WordPress Shortcode. Next SlideShares. Download Now Download to read offline and view in fullscreen.
Download Now Download Download to read offline. Attached gingiva and its significance Download Now Download Download to read offline. Attached Gingiva and Its Significance. MD Abdul Haleem Follow. Attended Bapuji Dental College and Hospital. L-PRF for increasing the width of keratinized mucosa around implants: A split Interproximal tunneling with a customized connective tissue graft a microsurg Cortical bone repositioning technique for horizontal alveolar bone augmentati Analysis of buccolingual dimensional changes of the extraction socket using t Entire papilla preservation technique in the regenerative treatment of deep i Orthodontic treatment simultaneous to or after periodontal cause related trea Coronal advanced flap in combination with a connective tissue graft.
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Merritt Yousry. Bala Ganesh , General Dentist at Bangalore. Show More. Views Total views. Actions Shares. No notes for slide. Attached gingiva and its significance 1. Orban and sicher - oral cavity is lined by three different kind of mucosa.
Masticatory mucosa - hard palate and gingiva of alveolar process Lining mucosa - lips, cheeks and vestibular fornix Specialized mucosa covering the dorsum of tongue. Anatomically gingiva is divided into: Free Attached and Interdental gingiva. Attached gingiva is a part of keratinized gingiva which aids in Increase resistance to external injury and contribute in stabilization of gingival margin.
Against frictional forces. Dissipating physiological forces exerted by the muscular fibers of the alveolar mucosa on the gingival tissues. In the early s, Wennstrom et al. Wennstrom J. Lack of association between width of attached gingiva and development of soft tissue recession: A 5 year longitudinal study. J Clin Periodontol ; 2. Some periodontal tissue reactions to orthodontic tooth movement in monkeys. Journal of Clinical Periodontology ; —9.
Glossary of periodontal term - Attached gingiva is that portion of gingiva that extends from the base of gingival crevice to mucogingival junction. It is firm, resilient and tightly bound to underlying periosteum, tooth of alveolar bone through connective tissue. Orban - first to describe attached gingiva, he divided gingiva into free and attached gingiva demarcated by free gingival groove FGG. According to him, FGG is at appropriate level of the bottom of gingival sulcus. Ainamo J, Loe H: Anatomical characteristics of gingiva.
A Clinical and microscopic study of the free and attached Gingiva. J Periodontol ; Imaginary Horizontal Line 8. Facial aspects of attached gingiva extend to relatively loose and movable alveolar mucosa is demarcated by mucogingival junction.
On the lingual aspect of mandible, the attached gingiva terminates at the junction of lingual alveolar mucosa, which is continuous with mucous membrane lining the floor of the mouth. The palatal surface of gingiva in maxilla blends imperceptibly with firm and resilient palatal mucosa.
Histologically, the attached gingiva is better suited than non-keratinized mucosa to withstand mechanical irritations. The epithelium of attached gingiva is keratinized and has thin, prominent epithelial ridges. The connective tissue contains no elastic fibers. These characteristics are exactly the opposite of the histology of alveolar mucosa. Attached gingiva is lined by four layers: 1. Stratum Basale. Stratum spinosum. Stratum granulosm 4.
Stratum corneum. Connective tissue of gingiva, also known as lamina propria and it consists of: 1. Papillary layers subjacent to epithelium consisting of papillary projection between epithelial rete pegs. Reticular layers contiguous with periosteum of alveolar bone. Feature which are specific to attached gingiva are: Deep rete pegs. Thick lamina propria. Abundant collagen with no elastic fibers. Indistinct sub mucosa.
Thus attached gingiva can bear the compressive and shear forces. Chigao quintessence Elongated papilla provides good mechanical attachment and prevents epithelium being striped under shear forces. It is the distance between mucogingival junction and projection on external surface of bottom of sulcus. It is narrower in posterior tooth region: 1. Ainamo et al. The width of gingiva varies from mm, being greatest at the incisor region especially in the lateral incisor and smallest in the canine and first premolar region.
A study of the width of attached gingiva. Journal of Periodontology ,; The first and second molar demonstrated the greatest width 4. The free gingiva graft is still widely used today to augment the zone of attached gingiva in non-aesthetic areas and where root coverage is not planned Figures Raetzke Raetzke , and in a separate publication in the same year, Langer and Langer Langer and Langer described the free subepithelial connective tissue graft technique aiming at root coverage Figures Similarly to the free gingiva graft, a split thickness dissection is carried out to prepare a periosteal bed.
The donor connective tissue is harvested from the palate, with or without an epithelial collar depending in the harvesting technique used. Because this procedure is indicated primarily for root coverage, the exposed root must be scaled and root planed, followed by root conditioning, typically with tetracycline, in order to remove the smear layer and promote better attachment of the graft to the root surface.
The connective tissue is secured over the root by sutures. Since the root is avascular, it is important that the donor tissue extends laterally and apically to lay over the periosteal bed.
The mucosal flap is coronally positioned to either fully or partially cover the donor connective tissue. This ensures additional blood supply to the graft, which is particularly critical to the area of the donor tissue positioned over the exposed root. The flap should remain passive in its position, and is secured with sutures. As mentioned earlier, complete root coverage can be achieved in Miller I and II situations. Although seemingly the recession defect is covered and a band of keratinized tissue is restored, the buccal bone, periodontal ligament and cementum do not regenerate.
The donor tissue establishes connective tissue attachment to the exposed root at the coronal portions and long junctional epithelium attachment at the apical segment. Behavioral risk factors can be addressed through patient education.
Biological risk factors, such as minimally attached gingiva associated with gingival inflammation and hist ory of recession can be managed surgically through a free gingival graft procedure to augment the attached gingiva. Many procedures have been developed for correcting gingival recession. The Miller classification is of great help in establishing the predictability of root coverage.
Shelemay maintains a private practice in Ottawa limited to periodontics and implant surgery. Shelemay completed his MSc degree and specialty training in Periodontology at the University of Toronto in Shelemay can be reached at avishelemay me. Chmbrone et al.
Root-coverage procedures for the treatment of localized recession-type defects: A Cochrane systematic review. J Periodontol ; The relationship between the width of keratinized gingiva and gingival health. Longitudinal evaluation of free autogenous gingival grafts. Longitudinal evaluation of free gingival grafts.
A four-year re- port.
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