This document discusses the classification, clinical features, and histopathology of periodontal pockets. It classifies pockets as gingival/pseudo pockets or true periodontal pockets. Periodontal pockets are further classified based on their location relative to the alveolar bone as supra bony or infra bony. The clinical features include signs like thickened gingiva and bleeding on probing. Histopathologically, the soft tissue wall shows increased blood vessels and plasma cells, while the root surface shows changes like pathologic granules and mineralization/demineralization. Treatment involves scaling and root planing, with surgery for persistent deep pockets.

2.  Pathologically deepened gingival
sulcus.

4. CLASSIFICATION

5. Pocket
Periodontal
True pocket
Suprobony
Supra crestal
supraalveolar
Intrabony
Infrabony
Subcrestal
Intraalveolar
Gingival
pseudopocket

6. 1. Gingival pockets { pseudo pockets/ relative
pockets }:
Is formed by gingival enlargement without
destruction of underlying periodontal tissue
2. Periodontal pocket { true pocket / absolute
pocket }:
is formed by destruction of underlying
periodontal tissues leading to loosening and
exfoliation of teeth

9. a. Supra bony { supra crestal/ supra alveolar }
in which bottom of the pocket is coronal to
underlying alveolar bone with horizontal
bone loss
b. Infra bony { sub crestal/ intra alveolar }
in which bottom of the pocket is apical to the
level of adjacent alveolar bone with vertical
bone loss.

12. • It can also be classified as
a. simple pocket:
involving one tooth surface.
b. Compound pocket:
involving 2 or more tooth surfaces
c. Complex / spiral pocket:
originating on one tooth surface and
twisting around the tooth to involve one or
more additional surfaces

14.  Signs:
a. thickened / ‘rolled edge’ marginal gingiva
b. Bluish red vertical zone from the marginal
gingiva to the alveolar mucosa.
c. Gingival bleeding ,suppuration or both
d. diastema formation

15.  Localized gnawing pain (dull and continuous)
 Radiating pain deep in the jaws.
 A sensation of pressure after eating gradually diminishes.
 foul taste in localized areas.
 tendency to suck material from the interproximal spaces.
 feeling of itchiness in the gums.

16.  urge to dig a pointed instrumentinto the gums
with relief obtained form the resultant
bleeding.
 Sensitivity to heat and cold, toothache in the
absence of caries.

18. CLINICAL FEATURES
HISTOPATHOLOGIC
FEATURES
Gingival wall of pocket presents
• Bluish red discoloration;
•Flaccidity;
• Smooth, shiny surface; & pitting on pressure
Discoloration  circulatory stagnation
flaccidity destruction of gingival fibers
Smooth shiny surface, pitting on pressure 
Edema atrophy of epithelium degeneration
Less frequently
Gingival wall may be pink and firm.
Fibrotic changes predominate over exudation
and degeneration (external wall)
Bleeding on probing Vascularity thinning , degeneration of
epithelium , proximity of engorged vessels to
inner surface.
When explored inner wall of pocket is painful Pain on tactile stimulation is caused by
ulceration of inner aspect of pocket wall
Pus may be expressed by applying digital
pressure
Suppurative inflammation of inner wall

19.  Only reliable method for locating periodontal
pocket is by careful probing of gingival margin

20.  On the basis of depth only it is difficult to
differentiate between deep normal sulcus and
shallow periodontal pocket.
 In such borderline case pathological changes in
gingiva distinguish the two conditions

22.  Initial lesion in the development of periodontitis
is the inflammation of gingiva in response to a
bacterial challenge.

33.  First event
inflammation { due to lying down of Gram
positive bacteria on supra gingival tooth surface }
changes in junctional epithelium
proliferates along root surface
coronal portion apical portion of junctional
detatches from the epithelium migrates
root

34. Due to bacterial enzymes replaced by pocket
And physical forces epithelium
Exerted by them.
 Second event:
aggressive growth and action of Gram negative
bacteria.
Emigration of neutrophils in large no.

35. Disruption of epithelial barrier causing open
communication.
loss of chemotactic gradient
Tissue destruction due to products released by
neutrophills as well as bacteria
resorption of alveolar bone
periodontal pocket is established

36. 1. Changes in the soft tissue wall
a. Blood vessels are increased in number , dilated and enlarged
b. Connective tissue is edematous and densely infiltrated with
plasma cells (80%) , lymphocytes , scattering of PMN’s .
c. JE becomes shorter
d. Degeneration and necrosis of the epithelium leading to
ulceration of the epithelium and exposure of the underlying
connective tissue.

38.  Proliferation of endothelial cells capillaries
fibroblast collagen fibers
 Bacterial invasion along the lateral and apical
areas of the pocket.

39.  Areas of quiescence
 Areas of bacterial accumulation
 Areas of emergence of leukocytes
 Areas of leukocyte-bacteria interaction
 Areas of intense epithelial desquamation
 Areas of ulceration
 Areas of hemorrhage

40.  Balance between Constructive and destructive
changes
 Edematous pocket wall
 Fibrotic pocket wall

41.  Microorganisms and their products
 Gingival fluid
 Food remnants
 Salivary mucin
 Desquamated epithelial cells
 Leukocytes
 Calculus
 Purulent exudate, serum, fibrin.

43. 2. Changes in the root surface wall
A. STRUCTURAL CHANGES:
a. Presence of pathologic granules
b. Areas of increased mineralization
c. Areas of demineralization
B. CHEMICAL CHANGES:
following minerals are increased
a. Calcium
b. Magnesium
c. Phosphate
d. Fluoride
e. others

44. C. Cytotoxic changes:
bacterial penetration into the cementum can be found as deep as
cemento-dentinal junction in addition bacterial products such as
endotoxins have also been detected
D. Zone seen:

45. Changes in the root surface wall
A.STRUCTURAL
CHANGES:
B.a. Pathologic
C. granules
b. Areas of
increased
mineralization
c. Areas of
demineralization
B.CHEMICAL
CHANGES:
C.following minerals
are increased
D.a. Calcium
b. Magnesium
c. Phosphate
d. Fluoride
e. others
C.CYTOTOXIC
CHANGES:
D.Bacterial
penetration as deep
as cemento-dentinal
junction
E.Endotoxins have
also been detected

47.  Slow but continuous
 Periods of exacerbation and quiescence

50.  Distance between apical end of JE and alveolar
bone is relatively constant
 Distance between apical end of calculus and
alveolar crest = 1.97 mm
 Distance between attached plaque to bone is
never less than 0.5mm and never more than
2.7mm

54.  Lateral periodontal cyst

57. • Detection of pocket : clinical examination and probing
are more efficient.
a. Radiographic method: pockets are not detected by
radiographic method alone
guttapercha points or calibrated silver points can be
used along with radiograph

59. Pseudogingival pockets true /periodontal pockets
Scaling and root planing scaling and root planing
Reevaluation and re evaluation and
maintenance maintenance
{ if pockets persists } removal of pocket wall
gingivectomy &gingivoplasty
removal of tooth side
of pocket

60. Suprabony
anterior teeth posterior teeth
Scaling and root planing scaling and root planing
And maintenance and maintenance
{persistent {persistent
Pockets} pockets +
inadequate
access
curettage
flap surgery
flap surgery utilizing crevicular
incision { if moderate to severe
pockets}

61. infrabony
new attachment procedures
1. Non graft associated
2. Graft associated
3. Combined technique