GINGIVA

Presented by:
Dr. Namita Adhikari
2nd year PG Resident
Department of Periodontology and Oral
Implantology
 CONTENTS

Introduction
Macroscopic & microscopic features of gingiva
Structural & metabolic characteristics of different areas of
gingival epithelium
Gingival connective tissue
Blood supply, nerve supply and lymphatic drainage
Co-relation of clinical and microscopic features
Continuous tooth eruption
Conclusion
References
 PERIODONTIUM

The periodontium (peri = around, odontos = tooth)

comprises following tissues :
Soft tissues
Gingiva
Periodontal ligament
Hard tissues
Alveolar bone
Cementum
ORAL MUCOSA

4
 GINGIVA

The gingiva is the part of the oral mucosa that covers

the alveolar processes of the jaws and surrounds the
necks of the teeth.
– Carranza 13th edition

5
DEVELOPMENT

6
As the tooth erupts, the reduced
enamel epithelium grows gradually
shorter
A shallow groove, the gingival
sulcus, may develop between the
gingiva and the surface of the tooth
and extend around its circumference

7
 Macroscopic features
  (Schluger et al 1990)

8
 Marginal gingiva

• Terminal edge or border of the gingiva surrounding the teeth

in collar like fashion
• Demarcated by free gingival groove
• Forms soft tissue wall of the pocket
9
 Gingival Sulcus

 Ideal conditions – 0 mm{Pristine

Gingiva} (Gottlieb, Orban 1933)

 Clinically normal depth - 2 to 3 mm

 Histologic depth -1.8 mm with

variations from 0 to 6 mm

10
 INTERDENTAL
GINGIVA
• Occupies the gingival
embrasure, which is the
interproximal space beneath
the area of tooth contact
• Pyramidal or have a "col"
shape
• PYRAMIDAL SHAPE- Tip
of the papilla is located
immediately beneath the
contact point

11
 COL SHAPE

• It is valley like depression that

connects the facial and lingual
papilla and conforms to the
shape of interproximal contact

• Thin, non keratinized, stratified

squamous epithelium
• Has many features in common
with junctional epithelium

12
Formed by
• Lateral border and tip : Marginal gingiva
• Central interevening portion : Attached gingiva

Shape
• Pyramidal : anteriors
• Col shape : posteriors

Diastema : Firmly bound over the interdental bone to form

a smooth, rounded surface without interdental papillae
 ATTACHED GINGIVA

• Firm, resilient and tightly bound to the

underlying periosteum of alveolar bone

• Facial aspect of the attached gingiva

extends to the relatively loose and
movable alveolar mucosa

• Demarcated by the mucogingival

junction

14
Methods of measuring width of attached gingiva

Visual Method after using Schiller’s potassium

iodine solution

Tension test- Done by stretching the lip or cheek to

demarcate the muco-gingival line and to see for any
movement of the gingival margin

Roll test or tiggling test : Done by pushing the adjacent

mucosa coronally with a dull instrument. The loose
alveolar mucosa moves whereas attached gingiva being
attached to underlying periosteum does not move
15
 Measurement Method

Greatest in the incisor region :

3.5-4.5 mm in maxilla
3.3-3.9 mm in mandible (Ainamo and Loe 1966)

Narrower in the posterior segments:

1.9 mm in maxillary first premolar
1.8 mm in mandibular first premolars

16
• The increase with age of the width of attached gingiva J.
Ainamo A. Talari 1976

• Width of attached gingiva increases with age due to

the supra eruption of teeth to compensate for the
occlusal wear

• As the width of the attached gingiva is measured from

the mucogingival junction which is a constant landmark
throughout life, so there is slight increase in the width of
attached gingiva with age Ainamo J,1976

17
Functions and clinical importance

 Dissipates functional and masticatory stresses

 Provides a resistant barrier to plaque induced
inflammation
 Prevents Recession
 Deepens vestibule to provide better access for
tooth
Improves esthetics, patient comfort and ease
of hygiene

18
How much zone of keratinized gingiva is necessary to
maintain the health of periodontium?

Lang & Loe (1972) : First controlled Clinical Trial

When the>2mm
Surfaces tooth of
surfaces keptSurfaces
free of clinically
< 2mm of
detectable
keratinized gingiva= plaque. keratinized
Healthy gingiva=Inflammed

Which means 2 mm or less than 2mm of attached

gingiva remain inflamed
Lang & Loe strongly suggested that 2mm width
of keratinized gingiva is important for maintaining
the health
19
How much zone of keratinized gingiva is necessary to
maintain the health of periodontium?
How much zone of keratinized gingiva is necessary to
maintain the health of periodontium?
 • Facilitate subgingival plaque
formation because of improper
Inadequate pocket closure resulting from the
zone of movability of the marginal tissue
Friedman 1962
attached
gingiva • Favors attachment loss and soft
tissue recession because of less
tissue

• Accumulation of food particles

during mastication

• Impede proper oral hygiene

measures
Gottsegen 1954, Rosenberg 1960, Corn 1962,
Carranza & Carraro 1970
24
 Microscopic anatomy

Histologically gingiva is composedStratified

of : Squamous
Epithelium
- Cellular
1. Gingival epithelium
Central core of connective
tissue
- Collagen fibres and ground
2. Epithelial connective tissue interface
substance

(Listgarten 1972;Mackenzie 1988)

3. Connective tissue

25
 Gingival epithelium
 Oral epithelium
 Oral sulcular epithelium
 Junctional epithelium

Cell type of gingival epithelium

Principle cell: Keratinocyte
Other cell: Clear cells or non keratinocyte
Langerhans cells
Merkel cells
Melanocytes
Lymphocyte

26
FUNCTIONS OF GINGIVAL EPITHELIUM

To protect the deeper structure

Allow selective interchange with oral environment
(Achieved by proliferation & differentiation of
keratinocytes)
Physical barrier to infection
 Play an active role in innate defense by responding to
bacteria in an interactive manner
(Dale BA, Periodontal 2000 30:70, 2002 )
As important initiator,regulator and host immune
response against periodontal pathogens

27
 EPITHELIAL PROLIFERATION
• Takes place by mitosis in the basal layer and less frequently in
the suprabasal layers

a)Progenitor cells- Divide & provide new cells

b)Maturing cells- Differentiate & mature to

form a protective surface layer
Differentiation
(1) Progressive flattening of the cell with an increasing
prevalence
• Process of tonofilament
of keratinization
• Progressions of biochemical and morphologic events that
(2)occur
Intercellular
in the celljunctions coupledfrom
as they migrate to thethe
production of
basal layer
keratiohyline granules

(3) Disappearance of the nucleus 28

Cells of various layers by electron microscope

29
 STRATUM BASALE (ST. GERMINATIVUM)

• Cells are cylindrical or

Cuboidal

• Synthesize DNA and can

undergo mitosis thus providing
new cells

• Most of the new cells are

generated in the basal layer

30
 STRATUM SPINOSUM

• They frequently shrink away from

each other, remaining in contact
only at points known as intercellular
bridges Spiny or prickly like
profile

• Spinous cells are the most active in

protein synthesis

31
 STRATUM GRANULOSUM

• Cells are larger and flatter

• Cells show increase in maturation

• Nuclei shows signs of degeneration and

pyknosis

• Cytoplasm is predominantly occupied

by the tonofilaments & tonofibrils

• Cells contain large no of small granules

– keratohyaline granules
32
 STRATUM CORNEUM

CORNEOCYTES
 Made of keratinized,larger and flatter
 Most cells than granular
differentiated cells cell
epithelial

 Formed bylack
 Cells bundles
nucleiof keratin
and other organelles
tonofilaments embedded in
amorphous matrix of filagrin
 Lack keratohylin granules &
surrounded by resistant envelop
made up of keratolinin &
 Ultrastructurally comprises of
involucrin
densely packed tonofilaments in
matrix proteins
 Inter Connected through
desmosomes
 Layer is acidophic
33
 Keratinocyte
 Low molecular wt-40kDa e.g. Glandular,
simple epithelium
 Intermediate M.wt. e.g. Stratified
epithelium
 High M.wt.-67kDa e.g. Keratinizing
stratified epithelium
Basal cell: LMW keratin, K19 & express other HMW
keratin as they migrate to the surface.

St. corneum : K1 keratin (68kD)

Stratified oral epithelium : Possess keratin 5,14,15

Keratinized oral epithelium : Possess keratin 1, 6, 10, 16

Nonkeratinized : keratin 4 and 13 and 19 34

 • Complete keratinization process leads to the
production of an orthokeratinized epithelium
Orthkeratinized Parakeratinized

 similar to that of the  Intermediate stage of

skin keratinization
 No nuclei in the stratum  stratum corneum retains
corneum and a well- pyknotic nuclei
defined stratum  keratohyalin granules
granulosum are dispersed, not giving
rise to stratum
granulosum

 Non keratinized epithelium has neither granulosum nor

corneum strata where as superficial cells have viable nuclei36
 Epithelial connective tissue interface
DESMOSOMES (Macula adherens)

keratinocytes are interconnected by structure

on the cell periphery called Desmosomes

Consist of 2 dense attachment plaque into

which tonofibrils insert

Intermediate electron dense line in

extracellular compartment

Tonofibrils radiate in brush like fashion from

attachment plaque into cytoplasm of the cells

37
 MELANOCYTES

• Embryologically derived from the neural

crest ectoderm

• Enter the epithelium at about 11 weeks of

gestation

• Present in basal & suprabasal layer The ratio of melanocytes to

the keratin-producing
epithelial cells is relatively
• Possess long dendritic processes constant at 1:36 cells

• Synthesizes melanin in the organelles

called premelanosomes or melanosomes 38
 Langerhans cells

 Dendritic cell

 Suprabasal layer

 Belongs to Mononuclear
phagocytic system

 Marked ATPase activity

39
 Antigen presenting for lymphocytes

 Contain g-specific granules (Birbeck’s granules)

 Immunologic function, recognizing and processing

antigenic material that enters the epithelium from the
external environment and presenting it to T
lymphocytes.

 Found in oral epi. of normal gingiva & in sulcular

epithelium

 Absent from the junctional epithelium

40
Merkel cells:
• Located in deeper layers
• Harbors nerve endings and connected
to adj cells via desmosomes
• Tactile perceptors / specialized neural
pressure-sensitive cells

Lymphocytes:
• Seen in nucleated cell layer
• No desmosomes or tonofilament
• Associated with inflammatory response

41
Basal lamina

30-60 nm
Glycoproteins &
laminin

30-50 nm
Type IV collagen 300-400 A°
thick.

42
 Oral or outer epithelium
0.2-0.3 mm
Covers crest and outer surface of marginal
gingiva and surface of attached gingiva

Keratinized or parakeratinized , prevalent

surface is parakeratinized

K1,K2,K10,K12 specific to epidermal type

differentiation

K6,K16 highly proliferative epithelium

43
 SULCULAR EPITHELIUM

Lines gingival sulcus

Thin, nonkeratinized, stratified squamous

epithelium without rete pegs (Contain K4,
K13, K19)

Extends from coronal limit of JE to crest of

gingival margin

Acts as semipermeable membrane through

which injurious bacterial products pass into
gingiva and tissue fluid from gingiva seeps
into sulcus
44
Oral sulcular epithelium lacks merkel
cells

Though nonkeratinized have potential to

keratinize
1. If reflected and exposed to oral
enviroment and
2. Bacterial flora of sulcus is totally
eliminated

45
JUNCTIONAL EPITHELIUM

• Junctional epithelium is the non keratinised stratified

squamous epithelium which attaches and form a collar
around the cervical portion of the tooth that follows
CEJ Carranza’s clinical periodontology

• Attached to the tooth surface (epithelial attachment)

by an internal basal lamina (lamina densa and lamina
Lucida)
• Attached to the gingival connective tissue by an
external basal lamina

46
 Gottlieb (1921) was the first to describe the junctional
epithelium. He termed it as epithelial attachment.

WAERHAUG -1952 Based on his animal experiments(in dogs) he

postulated that the cells of the epithelial attachment adhere weakly
to the tooth surface and it forms the lining of the physiologic
pocket

Orban’s concept (1953) stated that the separation of the epithelial

attachment cells from the tooth surface involved preparatory
degenerative changes in the epithelium.

47
Waerhaug’s concept (1960) Epithelial cuff
Based on insertion of thin blades between the surface of tooth and the
gingiva. Blades could be easily passed apically to the connective
tissue attachment at CEJ without resistance.
It was concluded that gingival tissue and tooth are closely adapted but
not organically united

Max Listgarten- 1966-67 Based on transmission electron microscopic

studies he proved the existence of a hemidesmosome basement
lamina attachment between the tooth and the cells of the so called
cells of epithelial attachment

48
 Schroeder and Listgarten concept (1971)

• Primary epithelial attachment refers to the epithelial

attachment lamina released by the REE

• It lies in direct contact with enamel and epithelial cells

attached to it by hemi-desmosomes

• When REE cells transform into JE cells the primary epithelial

attachment becomes secondary epithelial attachment

• It is made of epithelial attachment between basal lamina and

hemi-desmosomes.

49
 ANATOMICAL FEATURES

Thickness: Early life: 3-4 layers

With age: 10-20 layers

Width: Coronal aspect: 10-29 cells wide

Apical aspect: 1-2 cells wide

Length: 0.25mm-1.35 mm

• Interproximally JE of adjacent teeth fuse to form

the lining of the col area

• Epithelial connective tissue interface is smooth (no

rete pegs)

50
 Zones of JE
Apical zone: Germinative characteristics

Middle zone: Higher density of hemidesmosomes

Role in adhesion

Coronal zone: Numerous intercellular space

Increased permeability

51
 MICROSCOPIC FEATURES
• 15-30 cell layers coronally and 1-3 layers
at apical termination

• It has two strata- stratum basale and

stratum suprabasale

• The innermost suprabasal cells(facing the

tooth surface) also called DAT cells
(Salonen et al 1994) form and maintain the
epithelial attachment apparatus

52
 FUNCTIONS OF JE
JE is firmly attached to the tooth and thus forms an
epithelial barrier against the plaque bacteria.

It allows the access of GCF, inflammatory cells and

components of the immunological host defense to the
gingival margin.

JE cells exhibit rapid turnover, which contributes to the

host parasite equilibrium and rapid repair of damaged
tissue
Genco RJ et al AAP 1996

53
RENEWAL OF GINGIVAL EPITHELIUM

Turnover times for different areas

of the oral epithelium :
Palateactivity
Mitotic and cheek : 5 to
exhibits 6 days periodicity, with the
a 24-hour
highest in the morning and lowest rates occurring in
Gingiva : 10 to 12 days,
evening

Junctional
Mitotic epithelium
rate is higher : 1 to 6
in nonkeratinized areas and is
days in gingivitis
increased

54
GINGIVAL CONECTIVE TISSUE

Collagen fibres (60%)

Fibroblasts (5%)

Vessels

Nerves

Matrix (about 35%)

55
 Connective tissue
(Lamina propria)

Papillary layer
Adjacent to epithelium and Reticular layer
consists of papillary Contiguous with
projections between the periosteum, collagen
epithelial rete pegs fibers arranged in thick
Collagen fibers are loosely bundles
arranged, thin & many
capillary loops are present
Extra-cellular
Cellular compartment compartment
56
 Ground substance
Fills space between fibres and cells, is amorphous
and has high content of water

Proteoglycans: glycosaminoglycan (mainly

hyaluronic acid and chondroitin sulfate)
Glycoprotein: fibronectin and osteonectin
(predominant is protein )
Glycoprotein as carbohydrate unit of proteoglycan
contains polysaccharide as macromolecules that is
important for resilency of gingiva

57
 FIBRES OF CONNECTIVE TISSUE

• Fibers are produced by fibroblast

Collagen:
1. Collagen fibres  Primarily type I & III
2. Reticulin fibres in lamina propria
3. Oxytalan fibres  Provide tensile strength
4. Elastic fibres to the gingival tissue
 Type IV & VII in basal
lamina
 Type V may be in
inflamed tissue

58
 GINGIVAL FIBERS

Connective tissue of the marginal gingiva is

densely collagenous and contains a prominent
system of collagen fiber bundles called
gingival fibers
Functions
 To brace the marginal gingiva firmly against
the tooth
 To provide the rigidity necessary to
withstand the forces of mastication without
being deflected away from tooth surface
 To unite the marginal gingiva with the
cementum of the root and adjucent attached
gingiva
59
 Supragingival fiber
Principal groups
Name of fiber Origin and orientation Supposed
group function
Dentogingival From cementum, Provide
splay laterally into gingival
lamina propria support

Alveologingival From periosteum of Attach gingiva

the alveolar crest, to bone
splay coronally into
lamina propria
Dentoperiosteal From cementum near Anchor tooth
the cementoenamel to bone;
junction, into protect
periosteum of the periodontal
alveolar crest ligament
60
Name of fiber group Origin and orientation Supposed function
Circular Within free marginal and Maintain contour
attached gingiva coronal and position of
to alveolar crest, free marginal
encircle each tooth gingiva
(“purse string”)
Transeptal From interproximal Maintain
cementum coronal to relationships of
alveolar crest, course adjacent teeth;
mesially and distally in protect
interdental area into interproximal bone
cementum

61
 Secondary group fibers
Periosteogingival From periosteum of Attach gingiva
the lateral aspect of to bone
alveolar process,
splay into attached
gingiva
Interpapillary Within interdental Provide
gingiva (gingival support for
papilla), orofacial interdental
course gingiva

Transgingival Within attached Secure

gingiva, alignment of
intertwining along teeth in arch
the dental arch
between and around
the teeth
62
 Secondary group fibers

Intercircular From cementum on distal Stabilize teeth in

surface of a tooth, splaying arch
buccally and lingually around
adjacent tooth and inserting on
mesial cementum of next tooth
Intergingival Within attached gingiva, Provide support
immediately subjacent to and contour of
epithelial basement membrane, attached gingiva
course mesiodistally
Semicircular From cementum on mesial None intuitively
surface of tooth, course distally, obvious
insert on cementum of distal
surface
63
 FIBROBLAST
Principle cell, Mesenchymal in origin
Functions:

Primarily responsible for synthesis of
extracellular matrix

Maintenance of tissue homeostasis, via
phagocytosis & collagenase production

Contract & participates in wound
contraction

MAST CELLS:
 Contain granules that composed
of histamine & heparin

 Derived from blood monocytes

64
Macrophages:
• Ingest damaged tissue & foreign
material
• Stimulation of the fibroblast
proliferation

Inflammatory cells: Plasma cells,

lymphocytes

65
REPAIR OF GINGIVAL CONNECTIVE TISSUE

Because of high turn over rate, the connective tissue

of gingiva has high regenerative capacity and good
healing

Shows little evidence of scarring after surgical

procedures because of rapid reconstruction of the
fibrous architecture of the tissues
Melcher AH

66
BLOOD SUPPLY

67
NERVE SUPPLY

68
LYMPHATIC DRAINAGE

69
 Clinical correlation

COLOUR OF GINGIVA
Coral pink(attached and marginal
gingiva)
ALVEOLAR MUCOSA-
1. vascular supply
2. Thickness
Red ,smooth ,shiny
of the and
epithelium
 Stippled,
3. Degree of keratinization
Thinner, non keratinized,
4. Presence of pigment-containing
No rete pegs, more vascular, cells
loosely arranged connective
tissue

70
 CONTOUR
Scalloped outline on facial & lingual
surfaces
Varies and depends on;
1. Shape of teeth and their alignment
in arch
2. Location and size of area of
proximal contact
3. Dimensions of the facial and lingual
gingival embrasures

71
• Teeth with relative flat surfaces : straight
line
• Teeth with pronounced M-D concavity of
labio version :Normal Contour is
accentuated
• Teeth in lingual version : Horizontal &
thickened contours
• In Inflamed conditions : Stillman’s
cleft& McCall’s Festoons.
• ANUG : Reverse contour

72
 CONSISTENCY

The gingiva is firm & resilient with exception of the

movable free margin, tightly bound to underlying bone

The collagenous nature of lamina propria & its contiguity

with mucoperiosteum of alveolar bone determines the
firmness of attached gingiva

Resiliency is due to gingival fibers

Gingival fibers contribute to the firmness of gingival
margin

73
 SHAPE
Triangular and knife- edge in the anterior regions due to
point sized contacts of the teeth

Broader and more square shaped tissue in the posterior

sextants due to the teeth having broad contact areas

74
 SIZE OF THE GINGIVA

Sum total of the bulk of cellular and

intercellular elements and their
vascular supply

Alteration in size is a common feature

of gingival disease

75
 POSITION OF THE GINGIVA

• The level at which the gingival margin

is attached to the tooth
• It is 0-3 mm coronal to CEJ
• Position continues to change with age
as eruption continues throughout life
(Gottlieb & Orban)

76
SURFACE TEXTURE OF GINGIVA

• Similar to an orange peel

• Viewed by drying the gingiva
• Attached gingiva and central portion of
the interdental papillae is usually
stippled

 Absent in Infancy
 Appears at about 5 yrs of age
 Increases until adulthood
 Frequently disappear in old age

77
King in 1945, stipples were the result of attachment of the gum
to the alveolar bone by connective tissue fibers, which exerted
a localized tension to depress areas of the tissue

In 1948, Orban observed that the 'stippling' is caused primarily

by reticular elevations rather than depressions.

78
Active Eruption- Movement of teeth in the direction of occlusal
plane

Passive Eruption- Exposure of teeth by apical migration of gingiva

Anatomic crown – Portion of the tooth covered by enamel

Anatomic root – Portion of the tooth covered with cementum

Clinical crown – Part of the tooth that has been denuded of its
gingiva and projects into the oral cavity

Clinical root – Portion of the tooth covered by periodontal tissues

79
 PASSIVE ERUPTION

• Gottlieb and Orban believed that active and

passive eruption proceed together
• Passive eruption is divided into the four stages

Stage 1: The teeth reach the line of occlusion. The junctional epithelium
and the base of the gingival sulcus are on the enamel.
Stage 2: The junctional epithelium proliferates so that part is on the
cementum and part is on the enamel. The base of the sulcus is still on the
enamel.
Stage 3: The entire junctional epithelium is on the cementum, and the
base of the sulcus is at the cementoenamel junction.
Stage 4: The junctional epithelium has proliferated farther on the
80
cementum.
• When the teeth reach their functional antagonists, the
gingival sulcus and JE are still on the enamel, and the
clinical crown is approximately 2/3 of the anatomic
crown (Gottlieb and Orban in 1933).

• The distance between the apical end of the JE and the

crest of alveolus remains constant throughout
continuous tooth eruption (1.07mm)

• Exposure of the tooth by the apical migration of gingiva

is called gingival recession/atrophy

81
• Physiologic recession – According to the concept of
continuous eruption, gingival sulcus may be located on
crown, CEJ or root depending on age of the patient and stage
of eruption. Therefore, some root exposure with age is
normal

• Pathologic recession – is a result of cumulative effect of

minor pathologic involvement and repeated minor direct
trauma to the gingiva

82
 • Term “Periodontal biotype” introduced by Seibert and
Lindhe categorized the gingiva into ‘‘thick-flat’’ and ‘‘thin
scalloped’’ biotypes
Thick Biotype Thin Biotye
1. Broad zone of the 1. Thin band of the keratinized
keratinized tissue tissue,
2. Flat gingival contour 2. Scalloped gingival contour
3. Thick bony architecture 3. Thin bony architecture
4. More resistant to 4. More sensitive to
inflammation and trauma inflammation and trauma

83
• Predict the outcome of root coverage procedures and
restorative treatments

• Gingival or periodontal diseases are more likely to

occur in patients with a thin biotype

• Thick biotypes show greater dimensional stability

during remodeling compared to thin biotypes

84
 Age changes of gingiva

Stippling usually disappears with age.

Width of the attached gingiva increases with
age. Gingival connective tissue:
• Increased rate of conversion of soluble to
insoluble collagen
Gingival
• Increased epithelium:
mechanical strength of collagen
 Thinningdenaturing
• Increased and decreased keratinization
temperature of collagen
• Decreased
 Rete rate of synthesis of collagen
pegs flatten
 Migration • Greater collagen
of junctional content. apically
epithelium
Reduced oxygen consumption.

85
 CONCLUSION

Gingiva is an important part of periodontium that

plays a significant role in maintaining tooth
integrity.

So, a clinician needs to have sound knowledge

regarding its normal anatomical and
ultrastructural characteristics and function for
making clinical decision that will maintain the
gingival health.

86
 REFERENCES
Carranza’s Clinical periodontology 13th edition
Clinical Periodontology and Implant Dentistry , Jan
Lindhe, 5th edition
Ten Cate’s Oral Histology, 8th ed.
Schroeder, listgarten, The gingival tissues: the
architecture of periodontal protection, Periodontology
2000, Vol. 13, 1997, 91-120
Ainamo J & Tallari A: The increase with age of width
of attached gingiva, J Periodontal Res;11:82, 1976
Tissues and cells of the periodontium Periodontology
2000, Thomas M. Hassell,vol 3,9-38

87