Periodontal Pockets: Definition, Classification, Treatment Strategies

Management Of Periodontal Pockets: Definition, Classification, Clinical Features, Pathogenesis, And Treatment Strategies

Contents of Periodontal Pockets

• Debris consist of:
  • Microorganisms and their products (enzymes, endotoxins and metabolites).
  • Dental plaque.
  • Gingival fluid.
  • Food remmants.
  • Salivary mucin.
  • Desquamated epithelial cells.
  • Leucocytes.
• If purulent exudates is in amount:
  • Degenerative and necrotic leukocytes.
  • Dead and living bacteria.
  • Serum and scanty amount of firm.

Treatment of Periodontal Pocket

Treatment Depending on the Type of Pocket

 

Treatment of Supra Bony and Infra Bony Pockets

 

Treatment of pockets classified under three main headings

• New attachment technique: Gingiva is reunited to the tooth at a position coronal to base of pre-existing pocket. Techniques are non-graft associated, graft associated and combined techniques.
• Removal of pocket wall:
  This is done by:
  • Scaling and root planning which leads to retraction and shrinkage.
  • Gingivectomy or undisplaced flap
  • Apical displacement of pocket wall by apically displaced flap
• Tooth extraction or partial tooth extraction, i.e. hemisection or root resection can cause removal of tooth side of pocket.

Diagnosis And Classification Of Periodontal Disease

Periodontal Disease Activity

• As per this concept periodontal pockets undergo multiple periods of exacerbation and quiescence due to episodic bursts of activity which is followed by period of remission.
• Period of quiescence shows reduced inflammatory response and very litte or no loss of bone as well as connective tissue attachment.
• Bunch of unattached plaque with gram-negative, motile and anaerobic bacteria starts period of exacerbation which is characterized by loss of bone and connective tissue attachments and deepening of pocket.
• Period of exacerbation may last for several days, certain weeks or months and is followed by a period of remission or quiescence in which gram-positive bacteria proliferate and stable condition is achieved.
• Bone loss in untreated periodontal disease occurs in episodic manner. These periods of quiescence and exacerbation are called as periods of inactivity and periods of activity.
• Clinically active periods represent bleeding either spontaneously or on probing and presence of greater amounts of gingival exudates.