Histologic studies on the extension of the inflammatory infiltrate in human periodontitis

This study was undertaken to re-examine early and recent morphologic descriptions of gingival and periodontal inflammation based on a study of gingival biopsies and block sections of human jaws. A collection of 350 autopsy and surgically retrieved jaw sections containing multiple teeth and displaying various stages of periodontal inflammation were subjected to routine histologic preparation and analyzed with step serial sections. 105 gingival biopsies, serially sectioned, including 15 clinically normal specimens, were also studied. The results of these investigations suggest that the inflammatory lesion extends into the alveolar process and elicits a response, often before evidence of crestal resorption or connective tissue attachment loss has occurred. Similarly, deep penetrations of inflammatory cells into the alveolar bone, periodontal ligament and periapical tissues, along with fibrosis and enlargement of the marrow spaces, were common findings with advancing disease. More widespread distributions of inflammatory cells than previously described were found in clinically normal gingiva, while in more inflamed gingiva, the inflammatory cell types found and their pattern of distribution varied greatly from individual to individual. These observations cast doubt on the perception of human periodontitis as a localized and marginal disease and suggest that its effects may be much more pervasive than previously thought.