This document discusses periodontal pockets, including their classification, clinical features, pathogenesis, and treatment. Periodontal pockets are classified based on their morphology, relationship to crestal bone, number of tooth surfaces involved, nature of the soft tissue wall, and disease activity. Clinical features include enlarged gingiva and signs of inflammation. Pathogenesis involves changes in the soft tissue wall and pocket contents. Treatment depends on the type of pocket, and may include techniques to promote new attachment like non-graft or graft procedures.

1. Dr Jaffar Raza Syed Page 1
Periodontal Pockets
“Pocket can be defined as deepening of the gingival sulcus.”
Pseudo-pocket  Coronal migration of the marginal gingiva
True pocket Deepening due to apical migration of the junctional epithelium

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Classification Of Pockets
1. Depending upon its morphology
a. Gingival/false/relative pocket.
b. Periodontal/absolute/true pocket.
c. Combined pocket.
Classification Of Pockets
Depending upon its morphology
.
b. Periodontal/absolute/true pocket.
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3. Dr Jaffar Raza Syed
2. Depending upon its relationship to crestal bone
a. Suprabony/supracrestal/supra
b. Infrabony/intrabony/subcrestal/intra
ship to crestal bone
acrestal/supra-alveolar pocket.
abony/subcrestal/intra-alveolar pocket.
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4. Dr Jaffar Raza Syed
3. Depending upon the number of surfaces involved
a. Simple pocket—involving one
b. Compound pocket—involving two or more tooth
c. Complex pocket—where the base of the pocket is
with the gingival margin. It is also known as
Depending upon the number of surfaces involved:
involving one tooth surface.
involving two or more tooth surfaces.
where the base of the pocket is not in direct communication
margin. It is also known as spiral pocket.
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not in direct communication

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4. Depending upon the nature of the soft tissue wall of the pocket
a. Edematous pocket.
b. Fibrotic pocket.
5. Depending upon the disease activity
a. Active pocket.
b. Inactive pocket.

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CLINICAL FEATURES
Enlarged, bluish-red marginal gingiva with a ‘rolled’ edge
A break in the faciolingual continuity of the interdental gingiva.
Shiny, discolored and puffy gingiva associated with exposed root surfaces.
Gingival bleeding, purulent exudate from the gingival margin.
Mobility, extrusion and migration of teeth.
The development of diastema where none had existed previously.

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Symptoms
Localized pain or a sensation of pressure in the gingival after eating, which
gradually diminishes.
A foul taste in localized areas.
A tendency to suck material from the interproximal spaces.
Radiating pain “deep in the bone”.
A “gnawing’ feeling or feeling of itching in the gums.
The urge to dig a pointed instrument into the gums and
relief is obtained from the resultant bleeding.
Patient complains that food “sticks between the teeth”
or that the teeth “feel loose” or a preference to “eat on the other side.”
Sensitivity to heat and cold; toothache in the absence of caries.

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PATHOGENESIS
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Changes in the Soft Tissue Wall
blood vessels are engorged and dilated
connective tissue is edematous and densely infiltrated with
plasma cells (80%), lymphocytes and PMNL
epithelium along the lateral wall of the pocket presents striking proliferative
and degenerative changes
epithelial projection extends deep into the connective tissue and also extends
further apically than the junctional epithelium.

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The epithelium is infiltrated with leukocytes and other inflammatory cells.
Degeneration and necrosis of the epithelium leading to ulceration of the
epithelium and exposure of the underlying connective tissue.
Bacterial invasion along the lateral and apical areas of the pocket.
Some bacteria traverse the basement lamina and invade the subepithelial
connective tissue

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Pocket contents
Mainly debris consisting of
microorganisms and their products
(enzymes, endotoxins, and other metabolic products),
gingival fluid,
food remnants,
salivary mucin,
desquamated epithelial cells,
leukocytes.
Plaque-covered calculus projecting from tooth surface.
Purulent exudate consists of
living, degenerated, and necrotic leukocytes;
living and dead bacteria;
serum

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Zones In The Base Of A Periodontal PocketPeriodontal Pocket
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Relation of Loss of Attachment and Bone Loss to Pocket Depth
Pocket of same depth may be associated with different degree of attachment loss.
Pocket of different depth may be associated with same amount of attachment loss.
Area between the base of the pocket and the alveolar bone is always constant.
The radius of action of the plaque bacteria is 0.5 to 2.7 mm

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TREATMENT OF PERIODONTAL POCKE
I. Treatment of pocket depends on the type of pocket
REATMENT OF PERIODONTAL POCKET
Treatment of pocket depends on the type of pocket
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II. Treatment of suprabony and infrabony pocketTreatment of suprabony and infrabony pockets
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New attachment techniques:
It offers ideal result by reuniting the gingiva to the tooth at a position
Coronal to the base of pre-existing pocket.
Here all the structures of lost periodontium are restored.
Following are the techniques for new attachment:
Non-graft associated new attachment procedures.
Graft associated new attachment procedures.
Combined techniques.

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Removal of pocket wall by,
1. Retraction or shrinkage, e.g. scaling and root planing.
2. Surgical removal by gingivectomy or by means of an undisplaced flap.
3. Apical displacement of pocket wall by apically displaced flap.
Removal of the tooth side of the pocket,
by tooth extraction or partial tooth extraction such as
hemisection or root resection.
Bicuspidization