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Dr. Amam Amam

The Periodontal Pocket CHAPTER 27 

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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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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?????