THE PERIODONTAL POCKET DR.HOUNIDA IDIRIS

THE PERIODONTAL
POCKET
DR.HOUNIDA IDIRIS
DEFINITION


Pathologically deepened gingiva sulcus.
Deepening of gingival sulcus my occur by coronal
movement of the gingiva margin, apical
displacement of gingiva attachment or combination
of both.
Classification 1(Deepening of the gingival sulcus)

Pocket
gingival pocket
suprabony
pocket
periodontal pocket
infrabony
pocket
GINGIVAL POCKET
• also called pseudo pocket or
relative pocket or false pocket.
•Seen in the gingivitis.
•Formed by the gingiva
enlargement without destruction
of the underlying periodontal
tissue.
•The sulcus is deep because of
increased bulk of gingiva.
PERIODONTAL POCKET
•Also called absolute or true
pocket.
•Seen in periodontitis.
•Occurs with destruction of
supporting periodontal tissues
and loosing and exfoliation of
the teeth.
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.
 Infrabony pocket: The base of the pocket is
apical to the level of the adjacent bone. Bone loss is
vertical.

Supra bony pocket
Infra bony pocket
•Also called supra crestal or supra
alveolar pocket.
•Also known as subcrestal or intraalveolar
pocket.
•Bottom of the pocket is coronal to
underlying alveolar bone.
•Bottom of the pocket is apical to the crest
of the alveolar bone.
•Lateral wall consist of soft tissue alone.
•Lateral wall consist of tissue and bone.
•Pattern of destruction of bone is
horizontal.
•Pattern of destruction of bone is vertical.
•Interproximally, transeptal fibers
arranged horizontally ( between the base
of the pocket and the alveolar bone).
•Interproximally , transeptal fibers are
oblique ( extent from the cementum
beneath the base of the pocket along and
over the crest of the cementum of the
adjacent tooth).
•On the facial and lingual surfaces ,
periodontal ligaments fibers , follow the
horizontal-oblique course.
•On the facial and lingual surfaces ,
periodontal ligaments fibers follow the
angular pattern.
Classification 2

According to the involved tooth surface:
Pocket
Simple
Involved one surface
compound
involved more than
one surface
complex or
spiral
originate on
one surface
twisting around the
tooth to involve one
or more additional
surfaces but deep into
oral cavity on the surface of its origin
Pathogenesis of pocket fotmation






Presence of bacterial plaque on tooth surface.
Margin gingiva become inflamed.
Gingiva sulcus deepens due to edematous enlargement of
gingiva.
Gingiva pocket.
Anaerobic organisms tend to colonies the sub gingival plaque (
spirochetes and motile rods due to an aerobic environment
created in the pocket).
Large number of PMN , leukocytes and macrophages migrates
to the gingiva tissue in response to bacterial challenge.





Two mechanism of collagen loss :
I )lysosomal enzymes ( collegenase ) released by PMN ,
leukocytes destruction of collagen fibers in gingival C.T
II) fibroblast phagocytes collagen fibers by cytoplasmic
process to the ligaments cementum interface.
When the collagen fibers apical to junction epithelial get
destroyed , the epithelial cells proliferate along the root
surface in an apical direction until they become in contact with
healthy collagen fibers.
At the same time coronal portion of the junction epithelium get
detached from the tooth surface.






PMN cells migrate towards the coronal portion of junction
epithelium.
When volume of PMN leukocytes at the coronal portion of
junctional epithelium exceed 60% the epithelium cells separate
from the tooth surface.
Pocket information .
Plaque removal is difficult or impossible from deep pocket.
Favoring growth of pathogenic organism in that protected
environment.
Further attachment loss.


Horizontal bone loss.
If I.F.O present then vertical bone loss occurs (
angular bone loss).
The initial lesion in the development of periodontitis is
the inflammation of the gingiva in response to a
bacterial challenge.
Clinical Features
1.
2.
3.
4.
5.
6.
7.
Gingival pocket wall presents various degrees of bluish red
discoloration , a smooth shiny surface and pitting on pressure.
Less frequently , gingival wall may be pink and firm.
Bleeding is presenting by gently probing soft tissue wall of
pocket .
Painful during probing.
Pus may be present: It is not an indication of the depth of the
pocket or the severity of the destruction of the supporting
tissues. is a common feature of periodontal disease
loss of stippling.
Tooth mobility and diastema formation.
Pockets content
1.
2.
3.
4.
5.
6.
Debris of microorganism and their products.
Gingival fluid.
Salivary mucin.
Food remnants.
Desquamated epithelial cells.
Leukocytes.
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.
The root surface that gets expose to the oral
environment as a result of periodontal attachments
loss , undergoes following changes: structure,
chemical and cytotoxic.
Diagnosis and Detection
1.
2.
Careful exploration with a periodontal probe.
Radiographic: pocket are not detected by
radiographic examination because pocket is a soft
tissue change. Radiograph indicates area of bone
loss where pocket may be suspected they do not
show pocket presence or depth.
Note: Gutta Percha points or calibrated silver points
can be used with radiograph to assist in
determining the level of attachment of periodontal
pocket.