DENTOGINGIVAL UNIT

By- Dr Rohit Rai

Content
Junctional epithelium Gingival fiber Clinical importance of dentogingival unit

JUNCTIONAL EPITHELIUM

. In 1921, Gottlieb discovered that the epithelium of the gingiva

is in organic connection with the enamel surface and therefore only a shallow crevice exists at the free border of the gingiva. Gottlieb called the relation between epithelium and enamel, "Epithel Ansatz"epithelial attachment. The word "Ansatz" attachment was used to connote a relation similar to that existing between a muscle or tendon to a bone.

. Orban (1956) suggested that the attachment of the epithelium to the tooth should be considered as part of the dento-gingival junction. And term, "attached epithelial cuff" should be used instead of the term epithelial attachment.
(Journal of Periodontology 1956 Jul (167 - 180): The Epithelial Attachment (The Attached Epithelial Cuff) by Balint J. Orban)

 Attached epithelial cuff extends from the apical aspect of the gingival sulcus to the cemento-enamel junction. It is widest in its coronal portion (about 15-20 cell layers), but becomes thinner towards the cemento enamel junction (CEJ) Consists of a collar-like band of stratified squamous nonkeratinized epithelium. it is 3 to 4 layers thick in early life, but the number of layers increases with age to 10 or even 20; these cells can be grouped in two strata; basal and suprabasal

Length of the junctional epithelium ranges from 0.25 to 1.35mm

 Expresses K19 (which is absent from keratinized epithelia) and the stratification specific cytokeratins K5 and K14.

Morgan et al reported that reactions to demonstrate K4 or K13 reveal a sudden change between sulcular and junctional epithelium, with the junctional area being the only stratified non keratinized epithelium in the oral cavity that does not synthesize these specific polypeptides
Lack of expression of K6 and K16 (proliferation specific keratins), although the turnover of the cells is very high.

 Similar to sulcular epithelium, junctional epithelium exhibits less glycolytic enzyme activity than outer epithelium and lacks acid phosphatase activities.

 There are relatively few intercellular junctions and distensible intercellular spaces,and the adhesion between the epithelial cells thereby is reduced as compared with other gingival epithelia. The spaces enable diffusion of tissue fluids from the connective tissue through epithelium into the gingival sulcus.It also explains its susceptibility to tearing during probing. The unkeratinized surface,the orientation of cells with their long axis parallel to the tooth and the intercellular spaces permit the passage of bacterial products from the gingival sulcus to the connective tissue.

Cell layers which are not juxtaposed to the tooth exhibit numerous free ribosomes and prominent membrane-bound structures such as Golgi complexes and cytoplasmic vacuoles,presumably phagocytic. * Langerhans cells are present. * Lysosome-like bodies are also present . * Keratinosomes are absent. * Lacks acid phosphatase activity . * The borderline between the junctional epithelium and the underlying connective tissue doesnot present epithelial retepegs except when inflamed.

 Junctional epithelium attaches :to the 1.The tooth surface (epithelial attachment) by internal basal lamina 2.The gingival connective tissue by external basal lamina

Area of greater permeability and Numerous intercellular spaces

Area of greater attachment with Greater number of hemidesmosomes

Fewer hemidesmosomes & Cells with Germinative characteristics

Listgarten (1972) has calculated that the rate of cellular exfoliation from a unit surface of JE.it has been found that JE is 50-100 times faster than that of oral gingival epithelium.

Dento Gingival Junction

TOOTH ERUPTION AND FORMATION OF JUNCTIONAL EPITHELIUM

Functions of dentogingival unit : 1. Provide additional support for the teeth 2. Protect the underlying alveolar bone It has:- a cellular compartment

+
Extracellular compartment composed of fibers and ground substance.

Lamina propria consists of 2 layers :1) Papillary layer subjacent to the epithelium which consists of papillary projections between epithelial rete pegs. 2) Reticular layer contiguous with the periosteum of alveolar bone.

Connective tissue of gingiva

Collagen fibres (60%)

Fibroblasts (5%)

Vessels, nerves and matrix (35%)

 connective tissue is produced mainly by fibroblasts, although some constituents are produced by mast cells and other components are derived from blood. It facilitates cell movement and the diffusion of various biologically active substances including gases, minerals, nutrients, waste products,hormones,enzymes etc.

Glycoprotein

fibronectin laminin osteonectin tenascin elastin.

Proteoglycan

hyaluronic acid Chondroitin sulfate heparan sulfate dermatan sulfate Decorin Biglycan Versican Syndecan

* The name collagen comes from Greek meaning glue producer.When collagen is heated in water,it gradually breaks down to produce soluble derived protein i.e. gelatin or animal glue.

* Collagen type I forms the bulk of lamina propria and provides the tensile strength to gingival tissue.
Basic structure of type I collagen is a rod-like molecule approximately 300nm long and 1.5nm in diameter,composed of 3 polypeptide chains ( chains) wrapped together in a right-handed helix.

* Type IV collagen is found in basement membrane.

* Electron micrograph of collagen shows crossbanding with a periodicity of 700 between the individual dark bands.

* Type III collagen (argyrophilic reticulum fibers known so because they readily take up silver stain) branches between the collagen type I bundles and is continuous with fibers of the basement membrane and blood vessel walls.Molecular structure [1(III)]3.

Type V collagen has a parallel filamentous pattern and coats collagen type I and III fibers.

*Type VII collagen forms the anchoring fibrils,which are part of subepithelial basement membrane
collagen type VI is present as diffuse microfibrils around blood vessels and near epithelial basement membrane and nerves.

Functions of gingival fibers :1) To brace the marginal gingiva firmly against the tooth.

2) To provide the rigidity necessary to withstand the forces of mastication without being deflected away from the tooth surface.
3) To unite the free marginal gingiva with the cementum of the root and the adjacent attached gingiva.

STRUCTURE OF A COLLAGEN FIBER

TYPES OF GINGIVAL FIBERS

1) Circular fibers 3) Intercircular fibers 5) Transseptal fibers 7) Interpapillary fibers

2) Dentogingival fibers 4) Intergingival fibers 6) Transgingival fibers

ORIENTATION OF DIFFERENT GROUPS OF GINGIVAL FIBERS

Connective tissue fibers

Collagen

Reticulin

Fibres

Oxytalan

Elastic

* Tractional forces in the extracellular matrix produced by fibroblasts are believed to be the forces responsible for generating tension in the collagen.This keeps the teeth tightly bound to the alveolar bone.

Reticulin Fibers
Exhibit argyrophilic-staining properties Numerous in the tissue adjacent to the basement membrane. Also occur in large numbers in the loose connective tissue surrounding the blood vessels. Thus, reticulin fibers are present at the epitheliumconnective tissue and the endothelium-connective tissue interfaces.

Oxytalan fibers
Present in the gingiva and the periodontal ligament and seen to be composed of long thin fibrils with a diameter of approximately 150A0. Can be demonstrated light microscopically only after previous oxidation with peracetic acid. Function - yet unknown.

Elastic fibers (Elaunin & oxytalan)

Elaunin

represent another form of elastic tissue consisting of bundles of microfibrils embedded with in a small quantity of elastin

Oxytalan fibers
run more or less vertically form the cementum surface of the root apically, forming a three-dimensional branching meshwork that surrounds the root and terminates in the apical complex of arteries, veins and lymphatics also affiliated with neural elements. numerous and dense in the cervical region of the ligament, where they run parallel to the gingival group of collagen fibers function -not been fully determined, they are thought to regulate vascular flow in relation to tooth functions. Because they are elastic, they can expand in response to tensional variations, with such variations then registered on the walls of the vascular structure

1) Fibroblasts found between fiber bundles. - Constitute the preponderant cellular element in gingival connective tissue (65% of total cell population). - Mesenchymal in origin.
Functions :a) Synthesize collagen and elastic fibers. b) Synthesize glycoproteins and glycosaminoglycans of the amorphous intercellular substance. c) Regulate collagen degradation through phagocytosis and secretion of intercellular substance.

d) They exhibit contractility and motility. * In this manner,they play a major role in the development,maintenance and repair of gingival connective tissue.

* They are spindle-shaped or stellate cells with an oval-shaped nucleus.

* Cytoplasm contains well-developed RER,Golgi complex,mitochondria and many fine tonofilaments. * Adjacent to the cell membrane,all along the periphery of the cell,a large number of vesicles can be found.

* They reside in a network of connective tissue fibers.The intervening space is filled with matrix which constitutes the environment of the cell.
* Are the Architect builder and caretaker of connective tissue.

fibroblast

Ultrastructure of fibroblast

Mast cell
2) Mast cells are responsible for production of certain components of the matrix. - Also produce vasoactive substances which can affect the function of the microvascular system and control the flow of blood through the tissue.

- Cytoplasm is characterized by the presence of a large number of vesicles of varying size.These vesicles stain with certain basic dyes such as methylene blue and contain biologically active substances such as proteolytic enzymes, histamine and heparin.
(Oral Histology-Ten Cate)

- Heparin regulates rate of bone resorption.

- Well developed Golgi complex,scarce RER.

- They decrease in mild inflammation and increase in chronic inflammation.
(Periodontics-Grant,Listgarten)

- A large number of small cytoplasmic projections i.e. microvilli can be seen along the periphery of the cell.

Mast cell

3) Fixed macrophages and histiocytes are components of the mononuclear phagocyte system (reticulo-endothelial system). - Derived from circulating blood monocytes which migrate into the tissue. - Nucleus is characterized by numerous invaginations of varying size.A zone of electron-dense chromatin condensations can be seen along the periphery of the nucleus. - Well developed Golgi complex.

- Numerous vesicles of varying size present in the cytoplasm.

- Scarce RER but a certain number of free ribosomes are evenly distributed in the cytoplasm. - Remnants of phagocytosed material are often found in lysosomal vesiclesphagosomes. - A large number of microvilli of varying size can be seen in the periphery of the cell. - They are particularly numerous in inflamed tissue.

4) Inflammatory cells a) Neutrophils can be seen in relatively high number in both the gingival connective tissue and the sulcus. - Nucleus is lobulate. - Numerous lysosomes containing lysosomal enzymes are found in the cytoplasm.

b) Lymphocytes- are characterized by an oval to spherical nucleus containing localized areas of electrondense chromatin.

- Cytoplasm contains lysosomes,numerous free ribosomes,few mitochondria and in localized areas endoplasmic reticulum with fixed ribosomes.

- Lymphocytes are absent when gingival normalcy is judged by strict clinical criteria or under special experimental conditions;but they are practically constant in healthy normal gingiva,even before the complete tooth eruption. - Immunohistochemical studies using monoclonal antibodies have identified the different lymphocyte subpopulations:-

a) T lymphocytes (helper,cytotoxic,suppressor and natural killer) present in the infiltrate in the area below the junctional epithelium of healthy gingiva in newly erupted teeth in children. - thus interpreted as a normal lymphoid tissue involved in the early defense recognition system. b) B lymphocytes appear as time elapses.

c) Plasma cells contain an eccentrically located spherical nucleus with radially deployed electron-dense chromatin.

* Endoplasmic reticulum with numerous ribosomes is found randomly distributed in the cytoplasm. - Cytoplasm contains numerous mitochondria and a well developed Golgi complex. - Elaborate specific antibodies against already recognized antigens are always present in the sulcus of clinically normal gingiva.
plasma cell

5) Adipose cells and eosinophils may also be found in low number.

* The cellular activities in connective tissue are widely mediated by growth factors and cytokines released from the cells in the periodontal environment.Other mediating functions rely on extracellular matrix components.The cells may be triggered to release mediators,which results in either catabolic or anabolic processes.

The lamina propria of the gingiva has properties that distinguish it from the connective tissue of the PDL :-Fibroblasts lack alkaline phosphatase,have less contractile proteins and can release more prostaglandins in response to histamine. - Extracellular matrix has less ground substance,less type III collagen,is hyaluronan- rich and has a lower turnover rate. (Oral Histology-Berkovitz)

Clinical significance
Repair of gingival connective tissue :* Because of the high turnover rate,the connective tissue of the gingiva has remarkably good healing and regenerative capacity. * It is one of the best healing tissues in the body and generally shows little evidence of scarring after surgical procedures.This is caused by rapid reconstruction of the fibrous architecture of the tissues. * However,the reparative capacity of the gingival connective tissue is not as great as that of the PDL or the epithelial tissue.

* Dental procedures such as root planing, subgingival restorative procedures and crown and bridge gingival retraction techniques all damage both the epithelium and gingival connective tissue. * It is essential that dental procedures should be as atraumatic as possible so that sufficient volume of gingival collagen fibers are maintained to hold the healing gingiva close to the roots.This allows a new,intact epithelial lining of the gingival sulcus to be quickly reconstituted and thus heal without any loss of attachment.

Conclusion

References
Carranzas Clinical periodontology 10th edition Carranzas Clinical periodontology 9th edition