Attached Gingiva
Attached gingiva is the distance between mucogingival junction and projection on the external surface of the bottom of gingival sulcus or periodontal pocket. attached gingiva is continuous with marginal gingiva.
- Attached gingiva is the part of the gingiva which is tightly attached to the underlying periosteum of alveolar bone and cementum by connective tissue fibers.
- Attached gingiva is firm, resilient and hence immovable portion of the gingiva.
- Attached Gingiva is thus, firmly entrenched between two movable structures: the marginal gingiva coronally and the alveolar mucosa apically.
- Attached gingiva is different from keratinized gingiva and should not be confused with it.
- Width of the attached gingiva is measured as the distance between mucogingival junction and the projection on the external surface of the bottom of gingival sulcus/periodontal pocket. The dimensions of the attached gingiva vary from the anterior to the posterior teeth.
- Width of the attached gingiva is generally wider in the maxilla than in the mandible. The narrowest zone of the gingiva is found in the region of the maxillary and mandibular 1st premolars and usually in connection with frenum and muscle attachments. The pattern of variation is approximately the same in deciduous and permanent teeth.
- Width of the attached gingiva is wider in the supraerupted teeth. It also increases with age. This increase in dimension occurs as a result of an increase in the height of the alveolar process, which in turn, is the result of passive eruption.
- Width of attached gingiva is greater in incisor region that is 3.5 to 4.5 mm in maxilla and 3.3 to 3.9 mm in mandible and is less in posterior segments that is there is least width in premolar region which is 1.9 mm in maxilla and 1.8 mm in mandible.
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Significance of Attached Gingiva
- Attached Gingiva gives support to the marginal gingiva.
- Attached Gingiva provides attachment or a solid base for the movable alveolar mucosa for the action of lips, cheeks and tongue.
- Attached Gingiva can withstand frictional and functional stresses of mastication and toothbrushing. When the marginal tissue is the alveolar mucosa, it does not resist the functional stresses of toothbrush trauma imposed on it. Frequently, the result is apical shiftng of the marginal tissue and additional recession. attached gingiva is tightly attached to underlying periosteum and the alveolar bone with the densely organized connective tissue.
- Attached Gingiva acts as a barrier for passage of inflmmation. In the presence of microbial flra, tooth having alveolar mucosa at its margin shows more clinical signs of inflmmation than corresponding tooth that has a suffient band of the attached gingiva. Such marginal tissue appears to be more susceptible to the products of inflmmation that may result in pocket formation or apical migration of both attachment apparatus and marginal tissues.
- Attached Gingiva provides resistance to tensional stresses. Attached gingiva serves as a buffer between the mobile free gingival margin and mobile alveolar mucosa. There are skeletal muscle fibers within the alveolar mucosa that exert a force in an apical direction on the attached gingiva. This force is dissipated by bound down keratinized tissue.
Measurement of Attached Gingiva
There are four different methods used to measure width of attached gingiva.
- Measurement approach: In this method pocket depth or the sulcus depth is measured then the total width of gingiva is measured i.e. from gingival margin to mucogingival line. Thus by subtracting these two measurements width of attached gingiva is achieved. Total gingival width – Pocket depth = Width of attached gingiva.
- By using Schiller’s potassium iodide solution: after application of this solution total width of gingiva is measured i.e. from gingival margin to mucogingival line and later the sulcus depth or pocket depth is measured. Then by subtracting the total gingival width from pocket depth, we get the width of attached gingiva. Stained total gingival width – pocket depth = width of attached gingiva.
- Tension test: This is done by stretching the lip or cheek to demarcate the mucogingival line and to see for any movement of the free gingival margin. And if the free gingival margin moves during stretching of lips then the attached gingiva is considered to be inadequate.
- Roll test: It is done by pushing the adjacent mucosa coronally with a dull instrument. If the gingiva moves with the instrument then the width of attached gingiva is considered inadequate. In adequate width, the gingiva does not move because the attached gingiva is filmly attached to the underlying bone.
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