Lecture Notes: Gingiva and Assessment Techniques

Introduction to Gingiva

• Gingiva: Understanding the microscopic features is crucial for assessing the attachment levels in patients.
• Key Structures:
  • Gingival Matrix
  • Papilla: Capillary triangular area.
  • Attached Gingiva: Separated from marginal gingiva by a free gingival groove, though it can be difficult to appreciate in many patients.
  • Alveolar Mucosa: Highly vascular, elastic, and mobile.
  • Muco-gingival Junction: Boundary between alveolar mucosa and attached gingiva, important for assessment.

Measuring Attached Gingiva

• Attached Gingiva: Distance from the muco-gingival junction to the base of the sulcus or pocket.
• Keratinized Gingiva: Measured from marginal gingiva to the muco-gingival junction.
• Example Calculation:
  • Total keratinized gingiva = 5mm
  • Subtract sulcus depth (e.g., 1mm)
  • Result: 4mm width of attached gingiva

Techniques for Assessing Attached Gingiva

Tension Test

• Purpose: Determine if the gingival attachment is adequate.
• Procedure:
  • Move the patient's lower lip outward and forward.
  • Observe for movement in the gingival margin or papilla.
• Interpretation:
  • No movement: Adequate attached gingiva.
  • Movement: Inadequate attached gingiva, can lead to pocket formation, gingival recession, and inflammation.

Roll Technique

• Purpose: Confirm adequacy of attached gingiva.
• Procedure:
  • Use a periodontal probe, place it flat on the alveolar mucosa.
  • Roll the lip; see where the probe lands.
• Interpretation:
  • If the probe lands on the marginal gingiva: Inadequate attached gingiva.
  • If the probe does not move beyond the attached gingiva: Adequate attachment.

Conclusion

• Understanding and measuring the width of attached gingiva is critical for preventing potential gingival issues.
• Tension and roll techniques are practical methods for clinical assessment.