Perodontal Pocket-Formation,pathogenesis, treatment

Assalamu Alaikum. In this presentation, I have discussed in detail the formation, classification, pathogenesis, suprabony vs infrabony pockets, and treatment of periodontal pockets. I hope you find it beneficial.

1. Periodontal
Pocket

3. Previous SAQ in
professional
examination

4. 1.Define periodeontal pocket.
2.Classify periodontal pocket with illustration.
3.How redicular pocket is formed & how pocket is
formed?
4.What are the contents of a periodontal pocket?
5.What is clinical attachment level and how it is
determined?
6.What is the reliable method of measuring pocket
depth?
7.How do you diffentiate true pocket from false pocket?
8.Differentiate supra bony pocket from infrabony
pocket?
9.Write down methods of elimination of periodontal
pocket /treatment option of periodontal pocket.

5. Periodontal pocket can be defined as deepening of the gingival sulcus.


Classification of periodontal pocket with illustration -
1.Deepening upon it’s morphology :
●Gingival /False/Relative pocket
●Periodontal / absolute / true pocket
●Combined pocket

2.Deepening upon it’s relationship to crestal bone:
●Suprabony/supracrestal/supra-alveolar pocket
●Infrabony / Intrabony/Subcrestal /intra-alvolar pocket

6. 3.Deepening upon the number of surface involved :
●Simple pocket - involving one tooth surface.
●Compound pocket-involving two or more teeth surface
●Complex pocket - where base of the pocket is not direct
communication with the gingival margin.It is also known as spiral
pocket.

4.Depending upon the disease activity
●Active pocket
●Inactive pocket

5.Depending upon the nature of soft tissue wall of the pocket
●Edematous pocket
●Fibrotic pocket

7. Fig: A-Gingival Pocket B-Suprabony Pocket C-Infrabony Pocket

8. Formation of redicular pocket

Accumulation of micro-organism → Inflamatory changes
in the connective tissue →Degeneration of the
connective tissue → Destruction of collagen fiber & area
becomes occupied by the inflamatory cell→
Detachment of junctional epithelium → PMN nutrophil
invade the coronal end of junctional epithelium→ With
continued inflammation, the gingiva increases in bulk &
crest of the gingival margin extends coronally →
Junctional epithelium continues to migrate along the
root and separate from the root

9. Content of periodontal pocket
1.Microorganisms
a.Actinobacillus actinomycetemcomitans
b.Porphyromonas gingivalis
c.Prevotella intermedia
2.Products of microorganism
a.Enzymes
b.Endotoxins
c.Metabolic products
3.Gingival fluid
4.Food remnants
5.Salaivary mucin
6.Desquamated epithelial cells
7.Leukocytes
8.Presence of pus

N.B.-Desquamated epithelial cells and leucocytes are the main celluar
components of human saliva.

10. Clinical attachment level loss or CAL
Clinical attachment loss is defined as the extent of the periodontal
support that has been destroyed around a tooth.

Determination of CAL-

CAL is a more accurate indicator of the periodontal support around a
tooth than probing depth alone. CAL from a fixed point on the tooth that
does not change the CEJ.
To calculate CAL, two measurements are needed distance from the gingival
margin to the CEJ and probing depth. Then, we add these two numbers
together.

For example-

In case of Probing depth is 7 mm, recession is 2 mm. So, CAL is add probe
depth (7 mm) to (2 mm) = 9 mm

11. True pocket VS False pocket
True pocket False pocket
Also known as absolute or
periodontal pocket

Seen in periodontitis

Occurs with destruction of the
supporting periodontal tissues

Loosening and exfoliation of tooth
Also known as pseudo pocket or
relative pocket or gingival pocket

Seen in gingivitis

Formed by the gingival enlargement
without extraction of the underlying
periodontal tissues

The sulcus is deepened because of
increased bulk of gingiva

12. Determination of periodontal pocket/Reliable method of
measuring pocket depth -

1. Probing depth measurement

2. Clinical detection of attachment loss

3. Clinical detection of Suprabony and infrabony
pockets

13. Suprabony pocket

1. Also known as supracrestal or supra-alveolar
pocket

2. Base of pocket is coronal to level of alveolar
bone

3 Pattern of destruction of underlying bone is
horizontal

4. Lateral wall consist of the soft tissue alone

5. Interproximally, transseptal fibers that are
restored during progressive periodontal
disease are arranged horizontally in the space
between base of pocket and alveolar bone.

6. On facial and lingual surfaces, periodontal
ligament fibers beneath pockets follow their
normal horizontal-oblique course between the
tooth and bone
Infrabony pocket

1. Also known as subcrestal or intra-alveolar
pocket

2. Base of pocket is apical to crest of alveolar
bone so that the bone is adjacent to soft tissue
wall

3. Pattern of bone destruction is vertical
(angular)

4. Lateral wall consist of the soft tissue and
bone

5. Interproximally, trans-septal fibers are
oblique rather than horizontal. They extend
from cementum between base of pocket along
alveolar bone and over crest to cementum of
adjacent tooth

6. On facial and lingual surfaces, periodontal
ligament fibers follow angular pattern of
adjacent bone.

14. Treatment of periodontal pockets:
Treatment depends on the types of pocket-
●In case of Pseudo pocket/gingival pocket:

Scaling and root planing
↓
Re-evaluation and maitennance
↓[If pocket persists]
Gingivectomy and gingivoplasty
●In case of true/periodontal pocket:

Scaling and root planning
↓
Re-evaluation and maintenance
↓
Removal of pocket wall
↓
Removal of tooyh side of the pocket

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Zazakallah
khairon
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