PERIODONTAL POCKET

Adei Ismail A. K., drg

Definisi
pathologically deepened gingival sulcus

Is one of the most important clinical features of periodontal disease

Characteristics
Onset - any age; most common in adults Plaque initiates condition Subgingival calculus common finding Slow-mod progression; periods of rapid progression possible Modified by local factors/systemic, factors /stress/ smoking

Classification
Coronal movement of gingival margin (poket gingiva ) Apical displacement of the gingival attachment (poket periodontal) combination

Clinical Sign

Deep red to bluish-red tissues Thickened marginal gingiva Blunted/cratered papilla Bleeding and/or suppuration Plaque/calculus deposits

Variable pocket depths Horizontal/vertical bone loss Tooth mobility

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Pocket Formation

Bacterial challenge initiates initial lesion of gingivitis With disease progression & change in microorganisms development of periodontitis
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Cellular & fluid inflammatory exudate degenerates CT Gingival fibers destroyed Collagen fibers apical to JE destroyed infiltration of inflammatory cells & edema Apical migration of junctional epithelium along root Coronal portion of JE detaches

Continued extension of JE requires healthy epithelial cells! Necrotic JE slows down pocket formation Pocket base degeneration less severe than lateral

Clinical & Histopathologic Features

1. 2. 3. Clinical : Pocket wall bluish-red Smooth, shiny surface Pitting on pressure Histopathology: 1. Vasodilation & vasostagnation 2. Epithelial proliferation, edema 3. Edema & degeneration of epithelium

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 Clinical: 1. Pocket wall may be pink & firm 2. Bleeding with probing 3. Pain with instrumentation

Histopathology: 1. Fibrotic changes dominate 2. blood flow, degenerated, thin epithelium 3. Ulceration of pocket epithelium

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 Clinical : 1. Exudate 2. Flaccid tissues

Histopathology: 1. Accumulation of inflammatory products 2. Destruction of gingival fibers

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Root Surface Wall

Periodontal disease affects root surface:
Perpetuates disease Decay, sensitivity Complicates treatment

Embedded collagen fibers degenerate cementum exposed to environment Bacteria penetrate unprotected root

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 Necrotic areas of cementum form; clinically soft Act as reservoir for bacteria Root planing may remove necrotic areas firmer surface
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Classification of Pockets
Gingival:
Coronal migration of gingival margin

Periodontal:
Apical migration of epithelial attachment Suprabony:
Base of pocket coronal to height of alveolar crest

Infrabony:
Base of pocket apical to height of alveolar crest Characterized by angular bony defects
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Different types of periodontal pockets. A, gingival pocket. B, suprabony pocket. C, intrabony pocket.

Suprabony & intrabony

Intrabony pocket