Periodontal Pocket
Periodontal Pocket
Periodontal Pocket
A. Gingival Pocket
B. Suprabony
C. Intrabony Pocket
II
III
[B] Depending upon the nature of the soft tissue wall of the
pocket:
(1) Edematous Pocket.
(2) Fibrotic Pocket.
SIGNS :
1)
2)
3)
4)
5)
6)
7)
8)
SYMPTOMS
1)
2)
3)
4)
5)
6)
7)
8)
9)
CLINICAL FEATURES
HISTOPATHOLOGIC FEATURES
1. Circulatory strangulation
Vertical
Oblique
II
Collagenases
&
other
enzymes
secreted
by
various
cells
such
as
fibroblasts,
PMNs,
leukocyte & macrophages,
becomes extracellular and
destroy collagen; these
enzymes
that
degrade
collagen and other matrix
macro
molecules
into
small peptides are called
matrix metalloproteinases.
Fibroblasts
phagocytize
collagen
fibers
by
extending
cytoplasmic
process to the ligamentcementum interface and
degrade
the
inserted
collagen fibrils and the
fibrils of the cementum
matrix.
Bacterial Invasion
Occurs along the lateral & apical areas of the pocket in cases of
chronic periodontitis.
Filaments, Rods & coccoid organisms with predominent gramnegative cell walls have been found in intercellular spaces of
epithelium.
(a)
Area of relative quiescence: Shows
relatively flat surface with minor depressions &
mounds and occasional shedding of cells.
(b)
Area of bacterial accumulation: which
appear as depression on the epithelial surface with
abundant debris and bacterial clumps penetrating into
the enlarged intercellular spaces. These Bacteria are
mailnly Rod, cocci, filamentous & a few spirochetes.
(c)
Areas of emergence of leukocyte: leucocyte
appear in the pocket wall through holes located in the
intercellular spaces.
(d)Areas of Leukocyte-bacteria
interaction:
Numerous leukocytes are
present & covered with bacteria
in an apparent process of
phagocytosis.
Bacterial plaque associated with
the epithelium is seen either as
an organised matrix covered by
a fibrin like material in contact
with the surface of cells or as
bacteria penetrating into the
intercellular spaces.
(e)Areas of intense epithelial
desquamation: consist of
semi-attached & folded
epithelial squames, sometimes
partially covered with bacteria.
(f)Areas of ulcerations with
exposed connective tissue.
(g)Areas of haemorrhage with
numerous erythrocytes.
Leukocyte-bacteria interaction
POCKET CONTENT
Periodontal pocket contains
Debris (consisting of microorganism &
their products mainly enzymes,
endotoxins and other metabolic
product)
Gingival fluid
Food remnants
Salivary mucin
Desquamated epithelial cells &
Leukocytes
Plaque covered calculus projects from
tooth surface.
If purulent exudate present:consists
of
Living, degenerated and necrotic
leukocytes,
Living and dead bacteria
Serum
A scant amount of fibrin.
Inactive
SITE SPECIFICITY
Periodontal destruction does not occur in all
parts of the mouth at the same time but rather
on a few teeth at a time or even only some
aspects of some teeth at any given time. This is
referred to as the site specificity of the
periodontal disease.