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

pocket

Gingival enlargement WITHOUT destruction of

underlying periodontal tissue

Apical displacement of epithelial attachment or true

pocket

Gingival enlargement WITH destruction of

supporting periodontal tissue

Classification of Periodontal

Pocket

According to morphology

1. Gingival, False, or Relative Pocket

2. Periodontal, True, or Absolute Pocket

3. Combined Pocket

Classification of Periodontal

Pocket

According to morphology

Classification of Periodontal

Pocket

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

Pocket

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