Periodontal pockets

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Periodontal pockets

  1. 1. OUTLINEDefinition.ClassificationPathogenesisClinical features andhistopathologyPocket ContentsMorphology of pocket boundariesMeasurement of periodontalpocketsTreatment.
  2. 2. pOCKETDEFINITION “Pathological deepening ofthe gingival sulcus”
  3. 3. CLassIFICaTIONGingival pocketPeriodontal pocketo suprabony pocketo infrabony pocket
  4. 4. sUprabONy INFrabONypOCKET pOCKET1.Base of pocket is is coronal to 1.Base of pocket is apical to crestthe level of alveolar bone. of alveolar bone.2.Horizontal pattern of bone 2.Vertical (angular) pattern ofdestruction. bone destruction.3.On facial and lingual surfaces 3.They follow angular pattern., pdl fibers beneath pocketfollow their norma;l obliquecourse.4.Transeptal fibers are arranged 4. Transeptal fibers are arrangedhorizontally. obliquely.
  5. 5. CLassIFICaTIONOF pOCKETs a/CTO INvOLvEDTOOTh sUrFaCEsSimple pocket Compound pocket Complex pocket
  6. 6. CLINICaL hIsTOpaThOLOFEaTUrEs GIC FEaTUrEs1.Varios degrees of bluish red 1.Circulatory stagnation.discoloration.Flaccidity. Destruction of gingival fibers.Smooth shiny surface. Atrophy of epithelium.Pitting on pressure. Edema and regeneration.2.Gingival wall may be pink and 2.Fibrotic changes .firm.3.Bleeding on probing. 3.Increased vascularity,thinning and degeneration of epithelium.4.On probing inner aspect of 4.Ulceration of inner aspect ofwall is generally painful. pocket wall.5.Pus may be expressed on 5.Suppuratiove inflammation ofapplying digital pressure. inner wall.
  7. 7. paThOGENEsIs
  8. 8. PATHOGENESIS
  9. 9. MICrOTOpOGraphyOF ThE GINGIvaLwaLL OF ThEpOCKET1-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.
  10. 10. pOCKETCONTENTs1.Debris consisting of microorganisms & theirproducts. 2.Gingival fluid, food remnants.3.Salivary mucin.4. Desquamated epithelial cells.5.leukocytes.6.plaque covered calculus.
  11. 11. rOOT sUrFaCEwaLLStructural changes in the cementum include:1-presence of pathologic granules. (Due to thedegeneration of the Sharpey’s fibers in the cementum).2-areas of increased mineralization. (Decrease thesensitivity).3-areas of demineralization (increase sensitivity, caries, &pulpitis may occur).
  12. 12. sUrFaCEMOrphOLOGy OF ThETOOTh waLL OF ThEpErIODONTaLpOCKETs1-cementum covered by calculus.2-attached plaque.3-the zone of unattached plaque.4-the zone where the junctionl epithelium is attached to thetooth.5-the zone of semi destroyed C.T. fibers.
  13. 13. rELaTION OF ThEaTTaChMENT LOss& bONE LOss TOThE pOCKET DEpThPeriodontal pocket measured from base of the pocket to thegingival margin.-Loss of attachment measured from base of pocket to theCEJ
  14. 14. HOW TO DETECTPERIODONTAL POCKET??????
  15. 15. CrITErIa FOrDETErMINING ThEpOCKETCLassIFICaTIONGingival pocket:T he probe should not penetrate apically beyondthe CEJ
  16. 16. Suprabony periodontal pocket:Penetrate beyond CEJbut not pass apical to thecrest of the alveolar bone.Infrabony pocketsProbe should penetratebeyond CEJ and passapical to the crest of theadjacent alveolar bone.
  17. 17. TrEaTMENTNon surgical treatment1.oral hygiene instructions and their follow through.2.Scaling.
  18. 18. 3.Root planning.Periodontal Medications Tetracycline Metranidazole
  19. 19. Surgical Treatment Pocket depth reduction through differentsurgical procedures :1.Gingival curettage.2.Gingivectomy.3.Periodontal flap procedures.4.osseous surgery5.Periodontal regenration preocedures.
  20. 20. GINGIVECTOMY

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