Department of Periodontology.

.
PERIODONTAL POCKETS.
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 alveolar
pocket.

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.

HISTOPATHOLOGY
EPITHELIAL 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.


HISTOPATHOLOGY
CONNECTIVE TISSUE CHANGES:
The connective tissue is edematous
and densely infiltrated with plasma
cells,lymphocytes,and pmns.
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
Carranzas Clinical Periodontology
Tenth Edition : Chapter 27

Website :
http://www.ncbi.nlm.nih.gov/pubmed


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