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Department of Periodontology.
.
PERIODONTAL POCKETS.
Presented by:
SAVAN UNNI IV th Year BDS C.D.C.R.I
Guided by: Dr.Saravana Kumar
TOPIC
• Define and classify pockets.Write in detail about the pathogenesis and histo-pathological changes that occur during pocket formation?
April 2001 Essay. October 1996 Essay.
DEFINITION
• The periodontal pocket is defined as a pathologically deepened gingival sulcus.
• A sulcus depth of 2-3mm is considered normal.
CLASSIFICATION
Based on its Morphology:
GINGIVAL POCKET
PERIODONTAL POCKET
COMBINED POCKET
CLASSIFICATION
• Based on its relationship to crestal bone:
Suprabony/Supracrestal/Supra alveolarpocket.
Infrabony/Intrabony/Subcrestal/Intra alveolar pocket.
CLASSIFICATION
• Based on number of surfaces involved:
Simple Pocket.
Compound Pocket.
Complex Pocket.
CLASSIFICATION
• Based on soft tissue wall of the pocket:
Edematous pocket
Fibrotic Pocket
CLASSIFICATION
• Based on the disease activity:
Active Pocket.
Inactive Pocket.
GINGIVAL POCKET
• Formed by gingival enlargement without destruction of underlying periodontal tissues.
• The sulcus is deepened because of the increased bulk of the gingiva.
PERIODONTAL POCKET
• It occurs due to destruction of the supporting periodontal tissues.
It can be of two types • Suprabony pocket• Infrabony pocket
SUPRABONY POCKET
• Also know as Supracrestal or Supra alveolar.
• The base of the pocket is coronal to the level of underlying bone.
• Bone loss is horizontal
INFRABONY POCKET
• Also known as Infrabony or subcrestal or intra alveolar pocket.
• The base of the pocket is apical to the level of adjacent bone
• Bone loss is vertical.
Classification based on involved tooth surfaces.
• SIMPLE POCKET:Involving one tooth surface.
• COMPOUND POCKET:Involving two or more tooth surfaces.
• COMPLEX POCKET/SPIRAL POCKET:Here the base of the pocket is not in direct communication with gingival margin.
PATHOGENESIS.
• Accumlation of micro organisms on the supragingival toothsurface and its extension into gingival sulcus.
• Inflammatory changes in the connective tissue wall of the gingival sulcus.
• Cellular & fluid inflammatory exudate causes degeneration of the connective tissue including the gingival fibers.
• Collagen fibers gets destroyed apical to the junctional epithelium and the area becomes occupied by inflammatory cells and edema.
• The coronal portion of the junctional epithelium detaches from the root as the apical portion migrates.
• Polymorphonuclear neutrophils invade the coronal end of the junctional epithelium in increasing numbers.
• With continued inflammation the gingiva increases in bulk and the crest of the gingival margin extends coronally.
• The junctional epithelium continues to migrate along the root and separate from the root.
Diagrammatic Illustration:
Mechanism Of Collagen Loss:• There are two mechanisms involved:
• FIRST MECHANISM:
Collagenases and other enzymes secreted by fibroblasts, polymorphonuclear leukocytes ,and macrophages.
These enzymes degrade the collagen and other matrix macromolecules into small peptides which are called as matrix metalloprotinases.
• SECOND MECHANISM :
Fibroblasts phagocytize collagen fibers by extending cytoplasmic processes to the ligament -cementum interface and degrade the inserted collagen fibrils and the fibrils of the cementum matrix.
HISTOPATHOLOGYEPITHELIAL CHANGES:• Epithelium becomes degenerated
and atrophied.
• Inner aspect of the pocket wall becomes ulcerated.
• Pus occurs in the pocket with suppurative inflammation of the inner wall.
HISTOPATHOLOGYCONNECTIVE TISSUE CHANGES:• The connective tissue is edematous
and densely infiltrated with plasma cells,lymphocytes,and pmn’s.
• Blood vessels are increased in number,dilated and engorged in subepithelial connective tissue layer.
• Single or multiple necrotic foci are present in the connective tissue.
• Proliferation of endothelial cells,with newly formed capillaries ,fibroblasts,and collagen fibers.
BIBLIOGRAPHY
• Carranza’s Clinical Periodontology Tenth Edition : “Chapter 27”
• Website : http://www.ncbi.nlm.nih.gov/pubmed
THANK YOU!