07 August 2012
PERIODONTAL POCKET | PERIODONTOLOGY
DEFINITION:“The periodontal pocket defined as a pathological deepened gingival sulcus.” There is also a loss of bone and disorganization of periodontal ligament.
Pocketing is the end result of inflammation and infection that causes the loss of tissue attachment to the teeth, one common consequence of periodontal disease.
IMAGES
GINGIVAL POCKET (False or Relative)
This is formed by gingival enlargement without destruction of the underlying periodontal tissue. The sulcus is deepened because of increased bulk of gingival.
PERIODONTAL POCKET (True)
This occurs with destruction of the supporting periodontal tissues. Progressive pocket depending leads to destruction of the supporting periodontal tissues and loosening and exfoliation of the teeth.
There are two types of periodontal pockets:
SUPRABONY (supracrestal or supraalveolar) in which the bottom of the pocket is coronal to underlying alveolar bone.
INFRABONY (intrabony, subcrestal or intraalveolar) in which the bottom of the pocket is apical to the level of the adjacent alveolar bone. Lateral pocket wall lies between the tooth surface and alveolar bone.
Pockets can involve one, two, or more tooth surfaces and can be different depths and types on different surfaces of the same tooth and on approximating surface of the same interdental space.
SIGNS AND SYMPTOMS
- bluish red
- thickened marginal gingival
- bluish red vertical zone from the gingival margin to alveolar mucosa.
- gingival bleeding and suppuration
- tooth mobility
- distema formation
Symptoms such as
-localized pain or pain deep in the bone
-pocket depths and extent is determine by careful probing of the gingival margin along each tooth surface.
Pathogenesis:
Periodontal pockets are caused by microorganisms and their products which produce pathologic tissue changes that lead to deepening of the gingival sulcus.
Bacterial invasion:
Bacterial invasion of the apical and lateral areas of the pocket wall.
Filaments,rods,coccoid organisms with predominant gram-negative cell walls have been found in interalveolar spaces of the epithelium.
Bacteria invade the intercellular space under exfoliating epithelial cells but they are also found between deeper epithelial cells and accumulating on the basement lamina and invade the sub epithelial connective tissue.
POCKET CONTENTS:
Periodontal pockets contain debris consisting periapically of microorganisms and their products (enzymes, endotoxins and other metabolic products)
Gingival fluid, food remnants, salivary mucin, desquamated epithelial cells and leukocytes plaque covered calculus usually projects from the tooth surface.
Purulent exudates if present consists of living, degenerated and necrotic leukocytes, living and dead bacteria, serum and scant amount of fibrin.
Extensive pus formation may occur in shallow pockets
Deep pockets may exhibit little or no pus.
Repair, resection, regeneration and extraction.
TREATMENT:
1.Maintain good oral hygiene
2.Scaling & Root planning
3.Laser deep pocket cleaning
4.Gingival curettage
5.Gingivectomy
6.periodontal flap surgery
a) Papilla preservation flap
b) Sulcular incision flap
c) Modified widman flap
d) Undisplaced flap
e) Apically displaced flap with bone contouring
7.Resective osseous surgery
8.Reconstructive osseous surgery
9.tooth extraction or partial tooth extraction
(hemisection or root resection)
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