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Combined periodontic-endodontic lesions may sometimes be abscesses, but these are considered in a separate category. A gingival abscess involves only the gingiva near the marginal gingiva or the interdental papilla. A periodontal abscess involves a greater dimension of the gum tissue, extending apically and adjacent to a periodontal pocket.
When gingival hyperplasia is confined to one area of the jaw, this is when it is termed an epulis fibrosa, caused by an increase in collagenous tissue with varying cellularity. [12] It may be sessile or pedunculated and is composed of fibrosed granulation tissue. Fibrous epulides are firm and rubbery, and pale pink in color.
In theory, gingival fibers are the protectors against periodontitis, as once they are breached, they cannot be regenerated.When destroyed, the gingival sulcus (labelled G in the diagram) increases in depth apically, allowing more debris and bacteria to remain in intimate contact with the delicate sulcular and junctional epithelia for longer times.
Perforating vessels originate from lamina dura and the vessels perforate the socket wall (cribriform plate). Gingival vessels are derived from the gingival tissue. Outer layers of blood supply in PDL may help in mechanical suspension and support of the tooth while inner layers of blood vessels supply surrounding PDL tissues. [11]
A peripheral ossifying fibroma, also known as ossifying fibrous epulis, is “a gingival nodule which is composed of a cellular fibroblastic connective tissue stroma which is associated with the formation of randomly dispersed foci of mineralised products, which consists of bone, cementum-like tissue, or a dystrophic calcification.
The tissues that sit above the alveolar bone crest are considered the free gingiva. In healthy periodontium, the gingival margin is the fibrous tissue that encompasses the cemento-enamel junction, a line around the
The tooth is attached to the surrounding gingival tissue and alveolar bone (C) by fibrous attachments. The gingival fibers (H) run from the cementum (B) into the gingiva immediately apical to the junctional epithelial attachment and the periodontal ligament fibers (I), (J) and (K) run from the cementum into the adjacent cortex of the alveolar bone.
The gingival tissue forms a crevice surrounding the tooth, similar to a miniature, fluid-filled moat, wherein food debris, endogenous and exogenous cells, and chemicals float. The depth of this crevice, known as a sulcus , is in a constant state of flux due to microbial invasion and subsequent immune response.