Dr Jamal NaimPhD in Orthodontics

Pre-clinical PeriodonticsPeriodontitis/

attachment loss

Periodontitis

Periodontitis is the inflammation of a periodontium

caused by specific microorganisms resulting in: attachment loss: progressive destruction of the PDL

and alveolar bone with pocket formation recession or both

Attachment loss

Pocket formation Bone loss Or both

The periodontal pocket

• In HEALTHY gingiva, the tip of the probe remains within the junctional epithelium.

• The dense network of collagen fibres under the epithelium gives resistance to probing.

• There is no BOP , the gingiva is pushed by side.

The periodontal pocketWhat makes the perio probe stop in healthy gingival tissues?

What makes the probe stop in gingivitis ?

• In gingivitis, the tip of the probe pushes through the junctional epithelium and penetrates the underlying inflamed connective tissue.

• The probe’s advance is stopped by the dense collagen fibres apical to the inflamed region.

• During & after probing, there is bleeding

The periodontal pocket

Periodontal attachment loss?Measured from CEJ to sulcus or base of the pocket.

Pocket depth? Measured from gingival crest (gingival margin) to base of the pocket

Attachment loss

False pockets (by gingival overgrowth) are not attachment loss.

Also called gingival pocket

Attachment loss versus pseudo pocket

bon e Periodontitis, deep pocket (10mm), periodontal attachment loss (10mm); destruction of gingival fibres, alveolar bone & periodontal ligament.

Attachment loss versus true pocket

Periodontal pocket

PD = 8mmPAL = 8mm

PD = 0mmPAL = 8mm

PD = 11mmPAL = 8mm

PD =8mmPAL=8mm

PD =0mmPAL=8mm

PD =11mmPAL=8mm

recession hyperplasia

Attachment loss versus pocket formation

Different pocket depths with the same amount of attachment loss.

The distance between the bottom of the sulcus (arrow) and the CEJ remains the same despite different pocket depths.

Attachment loss versus pocket formation

Same pocket depth with different amounts of attachment loss.

A: Gingival pocket with no recession.B: Periodontal pocket of similar

depth as in A, but with some degree of attachment loss

C: Pocket depth same as in A and B, but with still more attachment loss.

Attachment loss versus pocket formation

A: Gingival pocket: with no recession – pseudo pocket

B: Periodontal pocket: with some degree of attachment loss

Classification of pockets

Types of periodontal pockets

Types of periodontal pockets

Suprabony pocket = supracrestal = supralveolar pocket

Infrabony pocket =subcrestal = intraalveolar pocket

A: simple pocket: one surface is involved B: compound pocket: more than one surface is

involvedC: complex pocket: (also twisted P.):

originate on one surface and twist to involve another surface.

Classification of pockets

A B C

Clinical features of Pocket formation

Clinical features of Pocket formation

Clinical features of Pocket formation

Clinical features of Pocket formation