periodontal pocket activity
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Morteza Parmis
DDM
Periodontal Pocket Activity
Periodontal Pocket
Defined as a pathologically deepened gingival
sulcus due to apical migration of junctional
epithelium.
Periodontal Pocket
May occur due to:
Coronal movement of the gingival margin or pseudo
Gingival enlargement WITHOUT destruction of
underlying periodontal tissue
Apical displacement of epithelial attachment or true
Gingival enlargement WITH destruction of
supporting periodontal tissue
Classification of Periodontal
According to morphology
1. Gingival, False, or Relative Pocket
2. Periodontal, True, or Absolute Pocket
3. Combined Pocket
Classification of Periodontal
According to morphology
Classification of Periodontal
According to the relation between the base of the
pocket and crest of the remaining alveolar bone:
SUPRABONY
INFRABONY
Suprabony/Supracrestal/Supra
alveolar Base of the pocket is
coronal to the level of the alveolar bone.
Horizontal bone destruction
Transeptal fibers are arranged horizontally
On facial & lingual surfaces, the periodontal ligament fibers beneath the pocket follow their normal horizontal-oblique course between the tooth & the bone.
Plaque
Interdent
al space
Transep
tal
FibersAlveol
ar
Bone
Infrabony/Subcrestal/Infra
alveolar Base of the pocket is
apical the crest of the alveolar bone.
Vertical bone destruction
Transseptal fibers are oblique rather than horizontal
On the facial & lingual surfaces, the periodontal ligament fibers follow the angular pattern of the adjacent bone. They extend from the cementum beneath the base of the pocket along the bone & over the crest to join with the outer periosteum.
Plaque
Interdent
al space
Transeptal
Fibers
Alveola
r Bone
Classification of Periodontal
According to the number of surface involve
1. Simple Pocket
Only one tooth involve
2. Compound Pocket
Two or more tooth surfaces involve
3. Complex Pocket
A.k.a Spiral Pocket where the base of the pocket
is not in direct communicating with the gingival
margin
Formation of Periodontal Pocket
Depends on:
Host response
Anatomic Factors
1. Lingual groove
Local Factors
1. Plaque
2. Calculus
3. Anatomical position of the tooth
Formation of Periodontal Pocket
Deep pockets form over long period of time due
to continuous inflammatory reaction
Pocket develops, purulent exudates, food
remnants, serum or blood by-products, dead
bacteria, leukocytes and desquamated epithelial
cells.
Pocket Depth
It is a distance from the gingival margin to the
base of gingival pocket.
Pocket depth measurement is an essential part of
periodontal diagnosis
Loss of Attachment
Pathogenesis
Periodontal pockets are caused by
microorganisms (as spirochetes and motile rod).
Their products which produce pathologic tissue
changes that lead to deepening of the gingival
sulcus the cellular and fluid inflammatory
exudates causes degeneration of the surrounding
connective tissue including gingival fibers.
Clinical Features
bluish red, thickened marginal gingival.
bluish red vertical zone from the gingival margin
to the alveolar mucosa.
gingival bleeding suppuration.
tooth mobility and diastma formation.
localized pain or pain deep in the bone.
Histopathology
*It is a B-lymphocyte lesion while gingivitis is a T-
lymphocyte lesion.
Soft tissue wall
-C.T. is edematous, densely infiltrated with
plasma cell, lymphocyte & PMNs.
-B.V. are increased in no., dilated& engorged
particularly in the sub epithelial C.T.
-C.T. shows varying degree of degeneration.
-Multiple or single necrotic foci are occasionally
present.
Bacterial invasion
-Bacteria (filaments+rods) invade the intracellular
space under exfoliating epithelial cells& between
deeper epithelial cells accumulating on the
basment lamina & invade the sub epithelial C.T.,
also they found P.gingivalis, Provetella
Intermedia, & A.A.
Microtopography of the gingival
wall of the pocket: -By E.M.>> there are many areas either oval or
elongated and adjacent to each other.
1-Areas of relative quiesnce>>flat surface with minor depression.
2- Areas of bacterial accumulation.
3- Areas of emergence of leukocytes: for defense mechanism.
4- Areas of leukocyte-bacteria interaction.
5- Areas of intense epi. desquamation.
6- Areas of ulceration >>>cause pain (due to exposed connective tissue).
7- Areas of hemorrhage: due to numerous erythrocytes.
Periodontal Pocket
occurs:, if there are:
presence of the microorganisms.
colagenase to destroy C.T. fibers just apical to the
junctional epithelium.
vital junctional epithelial cells to migrate apically.
detachment of the coronal junctional epithelium.
invasion of the neutrophills to the coronal part of
the junctional epithelium making it heavy so more
detachment & apical migration.
Pocket Content
Debris consisting of microorganisms &their
products
Gingival fluid.
Food remenants
Salivary mucin.
Desquamated epithelial cell
Leukocytes.
Plaque covered calculus.
Periodontal Pocket
As a HEALING LESION
Periodontal pocket are chronic inflammatory lesion.
-The condition of the soft tissue wall & the
periodontal pocket results from the interplay of
destruction o& constructive tissue change.
Complete healing doesn’t occur because of
persistence of local irritant.
The balance between destructive & constructive
changes determines the clinical features
Periodontal Pocket Healing
Periodontal therapy
Provides a compatible surface for repair and
regeneration
New periodontal ligament fibers newly formed in
cementum
Root planning removes hypermineralized necrotic
cementum
Root planning produces smooth sterile fresh
surface for healing
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