Periodontal pocket activity

1. Morteza Parmis
DDM
Periodontal Pocket Activity

3. Periodontal Pocket
 Defined as a pathologically deepened gingival
sulcus due to apical migration of junctional
epithelium.

4. 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

5. Classification of Periodontal
Pocket
 According to morphology
1. Gingival, False, or Relative Pocket
2. Periodontal, True, or Absolute Pocket
3. Combined Pocket

6. Classification of Periodontal
Pocket
 According to morphology

7. Classification of Periodontal
Pocket
 According to the relation between the base of the
pocket and crest of the remaining alveolar bone:
SUPRABONY
INFRABONY

8. 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
Fibers
Alveol
ar
Bone

9. 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

10. 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

12. 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

13. 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.

15. 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

16. Loss of Attachment

17. 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.

18. 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.

20. 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.

22.  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.

23. 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.

26. 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.

29. Pocket Content
 Debris consisting of microorganisms &their
products
 Gingival fluid.
 Food remenants
 Salivary mucin.
 Desquamated epithelial cell
 Leukocytes.
 Plaque covered calculus.

31. 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

33. 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