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The Periodontal Pocket

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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 gingival

attachment, 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 classified 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. Bone

loss is vertical.

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• Pockets can involve one, two, or More tooth surfaces and can be of different depths and types on different surfaces of the same tooth and on approximating surfaces of the same interdental space.

• Pockets can also be spiral (i.e., originating on one tooth surface and twisting around the tooth to involve one or more additional surfaces). These types of pockets are most common in furcation areas.

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Clinical Features

1. Gingival wall of pocket presents various degrees of bluish red discoloration; flaccidity; a smooth, shiny surface; and pitting on pressure.

2. Less frequently, gingival wall may be pink and firm.

3. Bleeding is presented by gently probing soft tissue wall of pocket.

4. When explored with a probe, inner aspect of pocket is generally painful.

5. In many cases, pus may be expressed by applying digital 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 mucine,

• 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 dead bacteria; 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 subcutaneously into experimental animals.

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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.

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• Penetration and growth of

bacteria leads to

fragmentation and

breakdown of the cementum

surface. and result in areas

of necrotic cementum,

separated from the tooth by

masses 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 by injury to the outer surface of the gingiva, and not involving the supporting structures are called Gingival abscesses . Gingival abscesses may occur in the presence or absence of a periodontal pocket (see Chapter 23).

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1. Extension of infection from a periodontal pocket deeply into the supporting periodontal tissues, and localization of the supportive inflammatory process along the lateral aspect of the root.

2. Lateral extension of inflammation from the inner surface of a periodontal pocket into the connective tissue of the pocket wall. Localization of the abscess results when drainage into the pocket space is impaired.

Periodontal abscess formation may

occur in the following ways:

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3. Formation in a pocket with a tortuous course around the root. A periodontal abscess may form in the culdesac, the deep end of which is shut off from the surface .

4. Incomplete removal of calculus during treatment of a periodontal pocket. The gingival wall shrinks, occluding the pocket orifice, and a periodontal abscess 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 these situations, a periodontal abscess may occur in the absence of periodontal disease.

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Periodontal abscesses are classified according to

location as follows:

1. Abscess in the supporting periodontal tissues

along the lateral aspect of the root. In this

condition, a sinus generally occurs in the bone

that extends laterally from the abscess to the

external surface .

2. Abscess in the soft tissue wall of a deep

periodontal pocket.

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