OUTLINEDefinition.ClassificationPathogenesisClinical features and histopathologyPocket ContentsMorphology of pocket boundariesMeasurement of periodontal pocketsTreatment.

pOCKETDEFINITION

“Pathological deepening of the gingival sulcus”

Classification

Gingival pocket

Periodontal pocket

o suprabony pocketo infrabony pocket

Suprabony pocket

Infrabony pocket

1.Base of pocket is is coronal to the level of alveolar bone.

2.Horizontal pattern of bone destruction.

3.On facial and lingual surfaces , pdl fibers beneath pocket follow their norma;l oblique course.4.Transeptal fibers are arranged horizontally.

1.Base of pocket is apical to crest of alveolar bone.

2.Vertical (angular) pattern of bone destruction.

3.They follow angular pattern.

4. Transeptal fibers are arranged obliquely.

Classification of pockets A/c to involved tooth surfaces

Simple pocket Compound pocket Complex pocket

CLINICAL FEATURES

HISTOPATHOLOGIC FEATURES

1.Varios degrees of bluish red discoloration.Flaccidity.Smooth shiny surface.Pitting on pressure.

2.Gingival wall may be pink and firm.

3.Bleeding on probing.

4.On probing inner aspect of wall is generally painful.

5.Pus may be expressed on applying digital pressure.

1.Circulatory stagnation.

Destruction of gingival fibers.Atrophy of epithelium.Edema and regeneration.

2.Fibrotic changes .

3.Increased vascularity,thinning and degeneration of epithelium.4.Ulceration of inner aspect of pocket wall.

5.Suppuratiove inflammation of inner wall.

PATHOGENESIS

PATHOGENESISPATHOGENESIS

Microtopography of the gingival wall of the pocket

1-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.

Pocket contents

1.Debris consisting of microorganisms & their products. 2.Gingival fluid, food remnants.3.Salivary mucin.4. Desquamated epithelial cells.5.leukocytes.6.plaque covered calculus.

Root surface wallStructural changes in the cementum include:

1-presence of pathologic granules. (Due to the degeneration of the Sharpey’s fibers in the cementum).

2-areas of increased mineralization. (Decrease the sensitivity).

3-areas of demineralization (increase sensitivity, caries, & pulpitis may occur).

Surface morphology of the tooth wall of the periodontal pockets

1-cementum covered by calculus.2-attached plaque.3-the zone of unattached plaque.4-the zone where the junctionl epithelium is attached to the tooth.5-the zone of semi destroyed C.T. fibers.

Relation of the attachment loss & bone loss to the pocket depthPeriodontal pocket measured from base of the pocket to the gingival margin.

-Loss of attachment measured from base of pocket to the CEJ

HOW TO DETECT

PERIODONTAL POCKET??????

Criteria for determining the pocket classificationGingival pocket:T he probe should not penetrate apically beyond the CEJ

Suprabony periodontal pocket:Penetrate beyond CEJ but not pass apical to the crest of the alveolar bone.

Infrabony pocketsProbe should penetrate beyond CEJ and pass apical to the crest of the adjacent alveolar bone.

TREATMENTNon surgical treatment1.oral hygiene instructions and their follow through.

2.Scaling.

3.Root planning.

Periodontal Medications Tetracycline Metranidazole

Surgical Treatment

Pocket depth reduction through different surgical procedures :1.Gingival curettage.2.Gingivectomy.3.Periodontal flap procedures.4.osseous surgery5.Periodontal regenration preocedures.

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