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7/29/2019 The Periodontal Pocket Dr Amam
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١٦واك،لو٢Dr amam amam
Dr. Amam Amam
The Periodontal Pocket CHAPTER 27
7/29/2019 The Periodontal Pocket Dr Amam
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١٦واك،لو٢Dr amam amam
The Periodontal Pocket
• Definition:
• Deepening of the gingival sulcus may
occur by coronal movement of the gingival
margin, apical displacement of the gingivalattachment, 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 c1assiflcd 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. Boneloss is vertical.
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• Pockets can involve one, two, or More tooth
surfaces and can be of different depths andtypes on different surfaces of the same toothand on approximating surfaces of the sameinterdental space.
• Pockets can also be spiral (i.e., originating onone tooth surface and twisting around the tooth
to involve one or more additional surfaces).These types of pockets are most common infurcation areas.
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١٦واك،لو٢Dr amam amam
Clinical Features
1. Gingival wall of pocket presents various degrees of
bluish red discoloration; flaccidity; a smooth, shinysurface; and pitting on pressure.
2. Less frequently, gingival wall may be pink andfirm.
3. Bleeding is presented by gently probing soft tissuewall of pocket.
4. When explored with a probe, inner aspect of pocket
is generally painful.5. In many cases, pus may be expressed by applyingdigital 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 mucin,
• 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 deadbacteria; 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 subcutaneouslyinto experimental animals.
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Root Surface Wall
The root surface wall of periodontal pockets
often undergoes changes that aresignificant because they may perpetuate
the periodontal infection, cause pain. and
complicate periodontal treatment.
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• Penetration and growth of
bacteria leads tofragmentation and
breakdown of the cementum
surface. and result in areas
of necrotic cementum,
separated from the tooth bymasses 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 byinjury to the outer surface of the gingiva, and notinvolving the supporting structures are calledGingival abscesses . Gingival abscesses may
occur in the presence or absence of aperiodontal pocket (see Chapter 23).
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1. Extension of infection from a periodontal pocketdeeply into the supporting periodontal tissues, andlocalization of the supportive inflammatory processalong the lateral aspect of the root.
2. Lateral extension of inflammation from the innersurface of a periodontal pocket into the connectivetissue of the pocket wall. Localization of the
abscess results when drainage into the pocket spaceis impaired.
Periodontal abscess formation may
occur in the following ways:
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3. Formation in a pocket with a tortuous course aroundthe root. A periodontal abscess may form in the cul-de-sac, the deep end of which is shut off from thesurface .
4. Incomplete removal of calculus during treatment of a
periodontal pocket. The gingival wall shrinks,occluding the pocket orifice, and a periodontalabscess 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 thesesituations, a periodontal abscess may occur in theabsence of periodontal disease.
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Periodontal abscesses are classified according tolocation as follows:
1. Abscess in the supporting periodontal tissuesalong the lateral aspect of the root. In this
condition, a sinus generally occurs in the bone
that extends laterally from the abscess to theexternal surface .
2. Abscess in the soft tissue wall of a deep
periodontal pocket.
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Any question?????