The gingiva serves as an effective barrier to insults to deeper periodontal tissue.
2
What is the difference between attached gingiva and interdental gingiva?
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Attached gingiva tightly adheres to the alveolar process, surrounding the roots, while interdental gingiva fills the area between teeth apical to their contact areas to prevent food impaction.
3
What are the most important tissues for dental professionals to know and understand?
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Gingival tissues
4
What is the purpose of periodontal treatment and homecare instructions?
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Creating a healthy environment for gingival tissue
What are the key characteristics of Attached Gingiva in terms of health?
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Pink with possible melanin (pigmentation), when dried, dull, firm, immobile with varying stippling
8
How is the width of Attached Gingiva measured on the facial side?
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By the distance between MGJ and external surface of gingival sulcus apex
9
What is the term for the tissue that fills the space between adjacent teeth?
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Interdental Gingiva
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What is another name for interdental gingiva?
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Interdental papilla
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What is the function of interdental gingiva?
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Prevents food impaction
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What is the definition of Marginal Gingiva (free gingiva)?
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Keratinized gingiva at the gingival margin
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What is the range of width for Marginal Gingiva from the free gingival crest to the attached gingiva?
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0.5-2.0 mm
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How does Marginal Gingiva differ from Attached Gingiva in terms of stippling?
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Lacks stippling
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What is the function of the free gingival groove?
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It separates the attached gingiva and marginal gingiva and corresponds with the depth of the sulcus.
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What is the significance of the gingival crest?
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It is the most superficial point of the marginal gingiva and is used as a landmark for probing.
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What is the location of the dentogingival junctional tissue?
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It faces the tooth surface.
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What is the free gingival groove?
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The free gingival groove is the space between the free gingival margin and the alveolar mucosa.
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What is the junctional epithelium?
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The junctional epithelium is a thin layer of epithelial cells that attaches the gingiva to the tooth.
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What is the gingival col and how is it formed?
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The gingival col is a concave shape between the facial and lingual gingival surfaces of the interdental area, formed apical to the contact area.
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What factors determine the depth and width of the gingival col?
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The depth and width of the gingival col depend on the expanse of the contacting tooth surfaces.
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What is the col in dental anatomy?
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A concave depression of tissue formed by the interdental gingiva apical to the contact area.
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What type of epithelium lines the col?
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Non-keratinized epithelium.
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Where is the col more prominent?
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In posterior teeth.
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What is the definition of attached gingiva?
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A thick layer of parakeratinized epithelium with extensive vascular supply.
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What distinguishes the attached gingiva from the free gingiva?
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The attached gingiva has tall, narrow papillae and is highly interdigitated between connective tissue and epithelium.
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How is the lamina propria of the attached gingiva related to the bone?
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The lamina propria is directly attached to the bone, making the attached gingiva firm and immobile.
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What is the difference between orthokeratinization and prakeratinization?
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Orthokeratinization is characterized by a surface layer without nuclei or organelles, filled with keratin. Prakeratinization involves keratin and shrunken nuclei in some cells, with no organelles in the surface layer.
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What are rete pegs/ridges and how do they contribute to the tissue's appearance?
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Rete pegs/ridges are epithelial extensions into the connective tissue, which give the tissue a stippling appearance.
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What is the marginal gingiva?
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An overlying surface layer of orthokeratinized stratified squamous epithelium.
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How does the marginal gingiva differ from the attached gingiva?
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The marginal gingiva is not attached to the underlying bony alveolar process, making it more mobile.
32
What is the biologic width and how is it measured?
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The biologic width is the combined heights of suprabony soft tissue attached to the tooth coronal to the alveolar bone crest. It is measured as about 2.04 mm, which is the sum of the epithelial attachment of the junctional epithelium and lamina propria measurements.
33
What is the importance of the position of restorative margins in relation to the biologic width?
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The position of restorative margins is crucial as placing them too inferiorly can violate the needed biologic width, leading to bone resorption, space for biologic width (BW), or gingival inflammation around the tooth.
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What is the histologic sulcus depth in millimeters?
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0.69 mm
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What is the biologic width in millimeters?
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2.04 mm
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What is the difference in thickness of facial gingiva between the maxilla and mandible?
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Thicker in the maxilla than in the mandible.
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Which teeth have the thinnest gingiva?
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Maxillary canines and mandibular first premolars.
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What is the significance of the cervical peak of the gingival contour in smile design?
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It is referred to as the gingival apex of the contour.
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What is the dentogingival junction?
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The junction between the tooth surface and gingival tissue
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What are the two epithelial components of the dentogingival junction?
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Sulcular epithelium and junctional epithelium
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What is the Sulcular Epithelium also known as?
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Crevicular Epithelium
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What is the depth of the healthy sulcus range?
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0.5-3 mm
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What is the deeper extension of the Sulcular Epithelium?
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Junctional Epithelium
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What is the volume of gingival/crevicular fluid produced per tooth per hour?
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1-2 microliters
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What is the significance of minimal flow in the healthy state of gingival/crevicular fluid?
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It indicates a normal state with no inflammation
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What are the immunological components found in gingival/crevicular fluid?
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IgG, IgM, IgA
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What is the Junctional Epithelium (JE)?
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A deeper extension of sulcular epithelium that lines the floor of the sulcus.
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How is the depth of the sulcus measured?
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By probing, which reaches the Epithelial attachment (EA) of the JE.
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What is the Epithelial attachment (EA) and where is it found?
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It is the attachment of the JE to the tooth surface, found on enamel, dentin, and cementum.
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What type of epithelium is the Sulcular Epithelium?
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Non-keratinized stratified squamous epithelium
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What is the interface of the Sulcular Epithelium?
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Smooth, not highly interdigitated
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What is the lamina propria?
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The lamina propria is the connective tissue layer beneath the epithelium.
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What distinguishes the sulcular epithelium from the marginal epithelium?
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The sulcular epithelium is nonkeratinized, while the marginal epithelium is keratinized.
54
What is the alveolar crest?
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The alveolar crest is the ridge of the alveolar bone proper.
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What is the characteristic of the junctional epithelium in terms of its interface?
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Smooth interface with no rete pegs or papillae
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How do the cells of the junctional epithelium differ in structure compared to other gingival tissues?
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Cells are loosely packed with fewer desmosomal junctions
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What is the permeability of the junctional epithelium compared to other gingival tissues?
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More permeable
58
What is the junctional epithelium (JE) and how does it differ from the sulcular epithelium?
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The junctional epithelium is a thin layer of epithelial cells that attaches the gingiva to the tooth. It is thinner than the sulcular epithelium and varies in thickness from 15-30 cells at the most coronal part to 3-4 cells at the apical portion.
59
What is the significance of the high metabolic activity in the junctional epithelium?
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The high metabolic activity in the junctional epithelium is due to the presence of many organelles, which indicates a high level of cellular activity and function.
60
What is the cementoenamel junction?
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The point where the cementum and enamel meet.
61
What is the cementum?
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A layer of bone-like tissue that covers the root of the tooth.
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What is the enamel space?
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The area between the enamel and the cementum.
63
What is the internal basal lamina and what does it consist of?
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The internal basal lamina is the most superficial portion of the junctional epithelium (JE) and consists of Lamina lucida and Lamina densa.
64
What is the function of the basal layer in the junctional epithelium?
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The basal layer is the deepest layer of the junctional epithelium and is characterized by constant and rapid cell division (mitosis) and coronal migration as cells die/shed in the sulcus.
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What is the function of the lamina densa in the junctional epithelium?
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The lamina densa is a dense layer of extracellular matrix that provides structural support and helps anchor the epithelial cells to the underlying connective tissue.
66
Identify the external basal lamina in the image.
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The external basal lamina is the layer of extracellular matrix that lies between the superficial epithelial cells and the underlying connective tissue.
67
What tissues fuse with ameloblasts to form the REE?
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OEE, stratum intermedium, and stellate reticulum
68
What is the acronym for the tissue formed by the fusion of ameloblasts with OEE, stratum intermedium, and stellate reticulum?
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REE
69
What happens during the fusion of REE and oral epithelium?
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Cells proliferate towards each other and intermingle
70
What is the reduced enamel epithelium (REE)?
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The reduced enamel epithelium is a layer of epithelial cells that is compressed to form the outermost layer of the enamel.
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What are the components of the reduced enamel epithelium?
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The components of the reduced enamel epithelium include the outer enamel epithelium, stellate reticulum, stratum intermedium, and ameloblasts.
72
What is the process called when the reduced enamel epithelium peels back off the crown during tooth eruption?
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Enamel Eruption
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What is the term for the space created between the tooth and the gingiva as the enamel epithelium peels back?
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Gingival Sulcus
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What is the term for the epithelial tissue that forms at the junction of the tooth and the gingiva?
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Junctional Epithelium
75
What is the role of ameloblasts in the development of the primary enamel apparatus (EA)?
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Ameloblasts secrete a basal lamina on the tooth surface that serves as a part of the primary EA.
76
How long does it take for the initial tissue to become the definitive junctional epithelium (JE) after tooth eruption?
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3-4 years
77
What is the JE turnover time in the oral cavity?
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4-6 days
78
How deep is the sulcus in a healthy gingiva?
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0.5 mm
79
What is the depth of the sulcus measured during periodontal probing?
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2-3 mm
80
What is the term for the junction between the tooth and the gum tissue?
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Cemento-enamel junction (CEJ)
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What is the term for the area where the tooth and gum meet?
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Gingival margin (GM)
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What is the term for the space between the tooth and the gum tissue in periodontal disease?
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Pocket
83
What is the definition of Gingival Recession?
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Apical migration of gingival margin from CEJ
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How is Gingival Recession measured?
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In millimeters using a probe
85
What is the formula for calculating Clinical Attachment Level (CAL)?
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CAL = PD + GR
86
What is the clinical attachment level (CAL)?
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CAL is a more accurate indicator of periodontal support than probing depth alone.
87
How is CAL measured?
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CAL is measured from a fixed point on a tooth, the CEJ.
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What is the formula to calculate CAL in the case of gingival enlargement or overgrowth?
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CAL = PD - GE (measurement of tissue over the CEJ).
89
What is the normal range for probing depth (PD) in health or gingivitis?
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2-4mm
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What does it mean for the gingival margin (GM) to be coronal to the cemento-enamel junction (CEJ) in health or gingivitis?
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The GM is positioned above the CEJ.
91
If the probing depth (PD) is 4mm and the tissue over the CEJ is 3mm, what is the clinical attachment level (CAL)?
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1mm
92
What is the effect of edema in the lamina propria during active disease?
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Edema in the lamina propria results in inflammation.
93
How does hyperemia cause the gingival tissue to become red?
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Hyperemia increases blood flow to the gingival tissue, making it appear red.
94
What happens to the interdigitation between epithelium and lamina propria due to edema?
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Edema reduces the interdigitation between epithelium and lamina propria, leading to the loss of stippling.
95
What is the term for the swelling of the marginal gingiva with its rolled margin?
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Edema
96
What is the term for the swelling of the attached gingiva with tissue enlargement?
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Edema
97
What is the cause of the clinical condition shown in the image?
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Acute inflammation with active periodontal disease of gingivitis
98
What is the increased permeability of JE and what does it allow?
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Increased permeability of JE allows WBC and microorganisms (including toxins) to enter the tissue area.
99
What are the initial signs of active disease?
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The initial signs of active disease are gingivitis.
100
What is GCF and what does it supply?
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GCF is gingival crevicular fluid that supplies minerals for subgingival calculus formation and a moist environment needed for dental biofilm growth.
101
What is the initial sign of gingivitis?
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Active periodontal disease (gingivitis)
102
What are the key signs of gingivitis?
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Acute or chronic inflammation with edema, increased number of WBCs, and epithelial ulceration with tissue thinning
103
What is the role of TLRs in gingivitis?
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Transmembrane proteins extending through gingival epithelial cell membrane, recognizing presence of bacterial endotoxins and mobilize inflammatory response
104
What is the term for the increased blood vessels in the deeper lamina propria that cause bleeding on probing in periodontal pockets?
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Increased blood vessels in the deeper lamina propria are called hyperplasia.
105
What is the cause of the increased blood vessels in the deeper lamina propria leading to bleeding on probing?
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The increased blood vessels are caused by ulceration of the junctional epithelium due to periodontal inflammation.
106
What is the histologic characteristic of PE?
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Presence of ulceration and gingival hyperplasia with rete ridges and connective tissue papillae formation at previously smooth tissue interface.
107
What is the clinical attachment level (CAL) and how is it measured?
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CAL is the distance from the gingival margin to the cementoenamel junction (CEJ). It is measured by the distance from the gingival margin to the CEJ.
108
What is the term for the lateral wall of the pocket epithelium that has true apical migration of the epithelial attachment?
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Lamina propria
109
What is the term for the newly formed pocket epithelium with migrated pocket epithelium giving it a long epithelial attachment?
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Rete ridges
110
What is the term for the connective tissue papillae at the interface between the dentogingival junctional tissue and the lamina propria?
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Collagen fibers
111
What is gingival hyperplasia?
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Overgrowth of interproximal gingiva due to medications like seizure control, antibiotics, or heart medications, accompanied by an increase in fibroblasts.
112
What causes gingival recession?
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Periodontal diseases, tooth position, abrasion from incorrect tooth brushing, abfraction from occlusal stresses, aging, tight frenal attachments, and thin/scalloped gingival biotype.
113
What distinguishes the superior tissue of a newly placed implant from that around natural teeth?
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The superior tissue of a newly placed implant originates only from oral mucosa epithelial cells, whereas the junctional epithelium (JE) around natural teeth originates from the root epithelial cells (REE).
114
What is the term used for the superior tissue of a newly placed implant?
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The term used is 'superior tissue'.
115
What is the mission of California Northstate University?
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To advance the science and art of health through education, service, scholarship, and social accountability.
116
What is the reference for the study on gummy smile?