Yasaman sherafatmand

Definition

Pathologically

deepened gingiva

sulcus

Deepening by

coronal movement

of gingiva margin,

apical displacement

of gingiva

attachment or

combination of both

Classification

1. Gingival pocket

2. Periodontal pocket suprabony

infrabony

a. Gingival

b. suprabony

c.infrabony

Gingiva pocket Periodontal pocket

Pseudo pocket

Seen in gingivitis

Formed by gingiva enlargment

without extraction of underlying

periodontal tissues

Deepend sulcus

Absolut or true pocket

Seen in periodontitis

Occurs with destruction of the

supporting periodontal tissues and

loosening of the teeth

Suprabony pocket Infrabony pocket

1.Base of pocket is coronal to the

level of alveolar bone.

2.Horizontal pattern of bone

destruction.

3.On facial and lingual surfaces ,

pdl fibers beneath pocket follow

their normal oblique course.

4.Transeptal fibers are arranged

horizontally.

1.Base of pocket is apical to crest

of alveolar bone.

2.Vertical (angular) pattern of

bone destruction.

3.They follow angular pattern.

4. Transeptal fibers are arranged

obliquely

Classification according to involved tooth

surfaces

A, Simple : one surface

B, Compound: more than one surface

C, Complex : originating on one tooth surface and

twisting around the tooth

Pathogenesis of pocket

formationBacterial plaque on tooth surface

Inflamation of marginal gingiva

Deepening of gingival sulcus

Gingiva pocket

Colonization of anerobicorganisms in subgingivalplaque ( spirochaetes and motile rods)

Mechanisms of collagen

loss

PMN fibroblast

Collagenase(matrix metalloproteinase)

Phagocytose collagen fibers (by extending cytoplasmic process to the lig. Cementum

interface)

Destruction of JE

And proliferation of epithelial cells along root surface apically

Detachment of coronal portion of JE

Migration of PMNs to coronal portion (more than

60%)

Seperation of epithelium cells from the tooth

Pocket formation

Difficulty in plaque removal

Growth of pathogenic organism

Further attachment loss

Horizontal bone loss

Clinical Features

Histopathologic FeaturesClinical Features Histopathologic Features

1.Bluish red discoloration of the

gingiva wall of pocket

flaccidity

shiny surface

Pitting on pressure

-circulatory stagnation

-destruction of gingiva fibers

-atrophy of the epithelium and edema

-Edema and degeneration

2.Pink or firm gingiva wall Fibrotic changes predominate over

exudation and degeneration

3.BOP Increse vascularity, degenaration of

epithelium, proximity of vessels to the

inner surface

4.Painful probing Ulceration of the inner aspect of

pocket wall

5.pus Suppurative inflamation

A. Soft tissue wall

1. Connective tissue

Oedematous

Infiltration of plasmacells, lymphocytes and PMNs

Decrease in JE

2. Epithelial tissue

Proliferative changes:proliferation of epithelial cells in connective tissue

Degenerative changes: ulcerative surface cells in latral wall of pocket

Microtopography of the gingival

wall of the pocket

1-Area of relative quiescence.

2-Area of bacterial accumulation.

3-Area of emergence of leukocytes.

4-Area of leukocyts-bactria interaction.

5-Area of intense epithelial desquamation.

6-Area of ulceration.

7-Area of hemorrhage.

Wall of pockets

1. Edematous : exodative or destructive

changes

2. Fibrotic : constructive changes

B.Pocket contents

1.Debris consisting of microorganisms & their products (endotoxin)

2. GCF

3.Salivary mucin.

4. Desquamated epithelial cells.

5.leukocytes.

6.plaque covered calculus

7.Pus : only a secondry sign and not an indication of the depth of pocket

C.Root surface wall

Due to exposure of root :

Chemical changes : absorbtion of Ca, Ph, Mg and resistance to caries

Cytotoxic changes :presence of bacteria on cementum

Structural changes :

1. areas of increased mineralization. (Decrease the sensitivity).

2. areas of demineralization (increase sensitivity, caries, & pulpitis may occur).

Surface morphology of the

tooth wall of the periodontal

pockets

1-cementum covered

by calculus.

2-attached plaque.

3-the zone of

unattached plaque.

4-the zone where the

junctionl epithelium is

attached to the tooth.

5-the zone of semi

destroyed C.T. fibers.

Gingival pocket:

T he probe should

not penetrate

apically beyond the

CEJ

Suprabony pocket:

Penetrate beyond

CEJ but not pass

apical to the crest of

the alveolar bone

Infrabony pockets

Probe should

penetrate beyond

CEJ and pass

apical to the crest of

the adjacent

alveolar bone.

Periodontal Disease

Activity1. Quiescence

reduced inflammatory response

little or no loss of bone

A buildup of unattached plaque

2. Exacerbation

bone and connective tissue attachment are lost

BOP

Increase in GCF

Site Specificity

Periodontal destruction does not occur

in all parts of the mouth at the same

time

Sites of periodontal destruction are often

found next to sites with little or no

destruction.

Relationship of Attachment

Loss and Bone Loss to

Pocket Depth degree of attachment loss depends on

the location of the base of the pocket on

the root surface, whereas pocket depth

is the distance between the base of the

pocket and the crest of the gingival

margin