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Periodontal Pockets

Pocket can be defined as deepening of the gingival sulcus.

Pseudo-pocket Coronal migration of the marginal gingiva

True pocket Deepening due to apical migration of the junctional epithelium

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Classification Of Pockets

1. Depending upon its morphology

a. Gingival/false/relative pocket..

b. Periodontal/absolute/true pocket.

c. Combined pocket.

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2. Depending upon its relationship
ship to crestal bone

a. Suprabony/supracrestal/supra
acrestal/supra-alveolar pocket.

b. Infrabony/intrabony/subcrestal/intra
abony/subcrestal/intra-alveolar pocket.

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3. Depending upon the number of surfaces involved
involved:

a. Simple pocketinvolving
involving one tooth surface.

b. Compound pocketinvolving
involving two or more tooth surfaces.

c. Complex pocketwhere
where the base of the pocket is not in direct communication
with the gingival margin. It is also known as spiral pocket.

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4. Depending upon the nature of the soft tissue wall of the pocket

a. Edematous pocket.

b. Fibrotic pocket.

5. Depending upon the disease activity

a. Active pocket.

b. Inactive pocket.

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CLINICAL FEATURES

Enlarged, bluish-red marginal gingiva with a rolled edge

A break in the faciolingual continuity of the interdental gingiva.

Shiny, discolored and puffy gingiva associated with exposed root surfaces.

Gingival bleeding, purulent exudate from the gingival margin.

Mobility, extrusion and migration of teeth.

The development of diastema where none had existed previously.

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Symptoms

Localized pain or a sensation of pressure in the gingival after eating, which


gradually diminishes.
A foul taste in localized areas.
A tendency to suck material from the interproximal spaces.
Radiating pain deep in the bone.
A gnawing feeling or feeling of itching in the gums.
The urge to dig a pointed instrument into the gums and
relief is obtained from the resultant bleeding.
Patient complains that food sticks between the teeth
or that the teeth feel loose or a preference to eat on the other side.
Sensitivity to heat and cold; toothache in the absence of caries.

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PATHOGENESIS

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Changes in the Soft Tissue Wall

blood vessels are engorged and dilated

connective tissue is edematous and densely infiltrated with


plasma cells (80%), lymphocytes and PMNL

epithelium along the lateral wall of the pocket presents striking proliferative
and degenerative changes

epithelial projection extends deep into the connective tissue and also extends
further apically than the junctional epithelium.

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The epithelium is infiltrated with leukocytes and other inflammatory cells.

Degeneration and necrosis of the epithelium leading to ulceration of the


epithelium and exposure of the underlying connective tissue.

Bacterial invasion along the lateral and apical areas of the pocket.
Some bacteria traverse the basement lamina and invade the subepithelial
connective tissue

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Pocket contents
Mainly debris consisting of
microorganisms and their products
(enzymes, endotoxins, and other metabolic products),
gingival fluid,
food remnants,
salivary mucin,
desquamated epithelial cells,
leukocytes.
Plaque-covered calculus projecting from tooth surface.
Purulent exudate consists of
living, degenerated, and necrotic leukocytes;
living and dead bacteria;
serum
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Zones In The Base Of A Periodontal Pocket

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Relation of Loss of Attachment and Bone Loss to Pocket Depth

Pocket of same depth may be associated with different degree of attachment loss.

Pocket of different depth may be associated with same amount of attachment loss.

Area between the base of the pocket and the alveolar bone is always constant.

The radius of action of the plaque bacteria is 0.5 to 2.7 mm

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TREATMENT
REATMENT OF PERIODONTAL POCKE
POCKET

I. Treatment of pocket depends on the type of pocket

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II. Treatment of suprabony and infrabony pocket
pockets

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New attachment techniques:

It offers ideal result by reuniting the gingiva to the tooth at a position


Coronal to the base of pre-existing pocket.

Here all the structures of lost periodontium are restored.

Following are the techniques for new attachment:

Non-graft associated new attachment procedures.

Graft associated new attachment procedures.

Combined techniques.

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Removal of pocket wall by,

1. Retraction or shrinkage, e.g. scaling and root planing.

2. Surgical removal by gingivectomy or by means of an undisplaced flap.

3. Apical displacement of pocket wall by apically displaced flap.

Removal of the tooth side of the pocket,

by tooth extraction or partial tooth extraction such as

hemisection or root resection.


Bicuspidization

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