Good for a basic UG Class/ Introductory discussions for III years.

2. GLICKMAN-
Pathologically Deepened
Gingival Sulcus
GOLDMAN- A Diseased
Gingival Attachment
SHAFER- Pathologically
Altered Gingival Sulcus
AAP- A pathologic fissure between a tooth and the crevicular epithelium, and limited at
its apex by the junctional epithelium. It is an abnormal apical extension of the gingival
crevice caused by migration of the junctional epithelium along the root as the
periodontal ligament is detached by a disease process.

3. 1mm
1.50 mm

6. Signs
1. Bluish red margin
2. A reddish vertical zone
3. Break in facio-lingual continuity
of the interdental gingiva.
4. Shiny discoloured
5. Gingival bleeding
6. Purulent exudate of the gingival
margin
7. Looseness, extrusion and
migration of teeth
8. Development of diastema
Symptoms
1. Localised pain
2. Foul taste
3. Tendency to suck material
4. Radiating pain deep to
bone
5. Gnawing feeling or
itchiness
6.Urge to dig
7. Teeth feel loose and prefers
to eat from other side
8. Sensitivity to heat and cold
and pain in absence of caries

8. GINGIVAL POCKET
(pseudo pocket)
This type of pocket is formed by gingival enlargement without
destruction of the underlying periodontal tissues.
>1mm (CEJ to GM)
1.50 mm (BL to CEJ)

9. 1.SUPRABONY POCKET 2.INFRABONY POCKET

10. SIMPLE COMPOUND COMPLEX
Number of surfaces involved

11. Number of existing walls around a pocket

12. Pockets adjacent to
edentulous areas

13. “Two events”
PMN Migration
Loosens JE
Loss of Collagen
Enzymatic

14. JE split and Collagen Loss
Loss of collagen
JE proliferates to fill the gap
PMNs migrate through gaps in JE
Enzymatic
destruction

15. Histopathology
ROOT
SURFACE
WALL
LATERAL
WALL
BASE OF THE POCKET
UninvolvedInvolved

16. 10 Theories of Pocket Formation
1. Destruction of the gingival fibers is a prerequisite
2. Initial change in pocket formation occurs in cementum
3. Stimulation of JE rather than fiber destruction is important
4. Pathologic change due to destruction or trauma initiates
disease
5. Pocket is initiated by invasion of bacteria at the base of sulcus
6. Pocket formation is initiated in a defect in the sulcus wall
7. Proliferation of the epithelium in the lateral wall is the initial
change
8. “Two stage pocket formation”
9. Inflammation is the initial change in the formation of
periodontal pocket
10. Pathologic epithelial proliferation

17. Pockets are healing lesions
Pockets are chronic
inflammatory lesions
which constantly undergo
repair.
Constant destructive
and constructive
process.
Fibrotic pocket wall-
firm and pink

18. Root wall of the pocket
Remnants of Sharpey’s
fibers, Viable bacteria,
Altered and Necrotic
Cementum with
endotoxins are seen.
Pathologic granules (Dots)
representing areas of
collagen degeneration and
hypermineralized areas of
cementum may be seen.

19. Detection of Pocket
• Only method of
detecting and
measuring periodontal
pockets is careful
exploration with a
periodontal probe.
• Gutta percha points
or calibrated silver
points can be used
with the radiography
to assist in
determining the level
of attachment of
periodontal pocket in
relation to bone.

20. Supra vs Infrabony Pockets
No resistance Resistance
during lateral
movement

21. Types of probing