The document discusses periodontal pockets, which are deepening of the gingival sulcus caused by movement of the gingival margin or displacement of the gingival attachment. Pockets can be classified as gingival, suprabony, or intrabony depending on the level of underlying bone loss. Pockets contain debris, fluids, and microorganisms. Clinical features of pockets include discolored, flaccid gingiva and bleeding when probed. The root surface within pockets can undergo changes like cementum fragmentation. Periodontal abscesses are localized infections that can form through extension of infection from pockets or incomplete treatment leaving debris behind.

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The Periodontal Pocket

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The Periodontal Pocket
• Definition:
• Deepening of the gingival sulcus may
occur by coronal movement of the gingival
margin, apical displacement of the gingival
attachment, or a combination of the two
processes.

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CLASSIFICATION
Periodontal pocket. This type of pocket occurs with
destruction of the supporting periodontal tissues.
Progressive pocket deepening leads to destruction of
the supporting periodontal tissues and loosening and
exfoliation of the teeth.
Pockets can be classified as follows:
Gingival pocket (pseudo pocket): This type of pocket is
formed by gingival enlargement without destruction of the
underlying periodontal tissues. The sulcus is deepened
because of the increased bulk of the gingiva.

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types of periodontal pockets.
• Gingival pocket. There is no destruction of the
supporting periodontal tissues.
• Suprabony pocket. The base of the pocket is
coronal to the level of the underlying bone.
Bone loss is horizontal.
• Intrabony pocket. The base of the pocket is
apical to the level of the adjacent bone. Bone
loss is vertical.

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• Pockets can involve one, two, or More tooth
surfaces and can be of different depths and
types on different surfaces of the same tooth
and on approximating surfaces of the same
interdental space.
• Pockets can also be spiral (i.e., originating on
one tooth surface and twisting around the tooth
to involve one or more additional surfaces).
These types of pockets are most common in
furcation areas.

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Clinical Features
1. Gingival wall of pocket presents various degrees of
bluish red discoloration; flaccidity; a smooth,
shiny surface; and pitting on pressure.
2. Less frequently, gingival wall may be pink and
firm.
3. Bleeding is presented by gently probing soft tissue
wall of pocket.
4. When explored with a probe, inner aspect of pocket
is generally painful.
5. In many cases, pus may be expressed by applying
digital pressure.

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Pockets Content
• Contain: 1- debris of microorganisms and their products
(enzymes, endotoxins, and other metabolic products),
• 2- gingival fluid, 3- food remnants, 4- salivary mucine,
• 5- desquamated epithelial cells, and 6- leukocyte.
• Plaque-covered calculus usually projects from the tooth
surface (Figure 27-16). Purulent exudate, if present, consists of
living, degenerated, and necrotic leukocytes; living and dead
bacteria; serum; and a scant amount of fibrin. Tile contents of
periodontal pockets filtered free of organisms and debris have
been demonstrated to be toxic when injected subcutaneously
into experimental animals.

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Root Surface Wall
The root surface wall of periodontal pockets
often undergoes changes that are
significant because they may perpetuate
the periodontal infection, cause pain. and
complicate periodontal treatment.

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• Penetration and growth of
bacteria leads to
fragmentation and
breakdown of the cementum
surface. and result in areas
of necrotic cementum,
separated from the tooth by
masses of bacteria.

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Periodontal abscess
• A periodontal abscess is a localized purulent
inflammation in the periodontal tissues.
• It is also known as a lateral abscess or parietal
abscess.
• Abscesses localized in the gingiva, caused by
injury to the outer surface of the gingiva, and not
involving the supporting structures are called
Gingival abscesses . Gingival abscesses may
occur in the presence or absence of a
periodontal pocket (see Chapter 23).

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1. Extension of infection from a periodontal pocket
deeply into the supporting periodontal tissues, and
localization of the supportive inflammatory process
along the lateral aspect of the root.
2. Lateral extension of inflammation from the inner
surface of a periodontal pocket into the connective
tissue of the pocket wall. Localization of the
abscess results when drainage into the pocket space
is impaired.
Periodontal abscess formation may
occur in the following ways:

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3. Formation in a pocket with a tortuous course around
the root. A periodontal abscess may form in the
culdesac, the deep end of which is shut off from the
surface .
4. Incomplete removal of calculus during treatment of a
periodontal pocket. The gingival wall shrinks,
occluding the pocket orifice, and a periodontal
abscess occurs in the sealed-off portion of the pocket.
5. After trauma to the tooth, or with perforation of the
lateral wall of the root in endodontic therapy. In these
situations, a periodontal abscess may occur in the
absence of periodontal disease.

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Periodontal abscesses are classified according to
location as follows:
1. Abscess in the supporting periodontal tissues
along the lateral aspect of the root. In this
condition, a sinus generally occurs in the bone
that extends laterally from the abscess to the
external surface .
2. Abscess in the soft tissue wall of a deep
periodontal pocket.

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